How Hard is it to Start in the ER?

Footballnut · Nov 17, 2013

We have residency programs for new grads in our ED and they are very competitive, but not impossible, to get into. So, yes you can get into an ED as a new grad. We have had some great new grads over the years. That being said, every bit of experience before you come to an ED will apply to what comes up in the ED in some way.

Even though ED is a separate specialty your judgment and what you bring to the team is even better with more experience and information. I had a background in postpartum, ICU, PACU, med-surg, administration and IV therapy before I came to ED. Other people bring other backgrounds. Med-surg is helpful since you often have to sort out so many medical problems. Depending on your patient population pediatric experience could be very helpful. A background on a cardiac-type unit is also helpful. One nurse I worked with in the past was an oncology nurse before coming to the ED. It was great checking in with her when the need arose.

Anna Flaxis, BSN, RN · Nov 17, 2013

Is it difficult to land an emergency job right out of school?

In my neck of the woods, yes it is difficult to get into the ED as a new grad. At my old workplace, they never hired new grads right into the ED. They only hired transfers from other units within the hospital, or if from outside, RNs with prior ED experience.

At my current place of employment, it's much the same. They would rather fill holes in the schedule with agency nurses than hire inexperienced nurses into the ED. That's because there are times when there is only one RN present.

I don't know what it's like where you are.

Monah86 · Nov 21, 2013

Speaking as a new grad who just accepted an ED Residency position I think you never know unless you try really, however I do think its a great idea to apply to internships/residency programs as they are specifically open to new grads since you'll get some good training and its a great way to break into a specialty so i've been told. Good luck in your endeavors hun whatever field you start in i'm sure your gonna ROCK IT! Congrats on your spring graduation as well!

Fire Bird · Nov 21, 2013

I graduated in May and started a nurse residency program at a hospital in july, eventually leading to the ED. If you really want to start in the ED when you graduate, maybe try applying for residency programs in-state/out of state? or apply to local EDs? Some helpful hints: get medical work experience, medical volunteer experience, leadership experience, network at hospitals you are applying to.

Guests · Nov 21, 2013

Our department does not hire new grads even though the hospital has a residency program. It's just too busy, too chaotic, and too uncontrolled for new grads.

We don't even precept students for the same reason - though I think that's misguided.

I recently had an 'almost-new-grad' say to me, "Geez, they'll take last-semester students in the ICUs but not in the ED? How does *that* make any sense?"

I then pointed out a shift will often see me deal with an out-of-control tweaker while simultaneously getting a trauma into another room just as it turns out that we need to cardiovert my third patient as I'm basically ignoring my 4th patient. The ICUs are very controlled environments while the ED is very uncontrolled... there's very little bandwidth free to accommodate a newbie and our wash-out rate, even with experienced nurses, is significant. We're chronically understaffed and need everybody to pull their own weight very quickly.

maverickemt · Dec 2, 2013

Hi...I don't know when I will leave the air force but I would like to start in the ER without previous ER experience. I am a RN for 5 years and have done regular med/surg, intermediate care with telemetry. I have been looking on the internet for formal ER internships and I have called the recruiters. They have told me to just apply for ED given my 5 years experience (since I have more than one year of med/surg experience)....I am partly scared to start without any formal training. I would love to start in the ED with an internship. Any suggestions?

Editorial Team / Moderator · Dec 2, 2013

They have told me to just apply for ED given my 5 years experience (since I have more than one year of med/surg experience)....I am partly scared to start without any formal training. I would love to start in the ED with an internship. Any suggestions?

Internships are generally reserved for new nurses. You shouldn't need the same amount of orientation, really. In the EDs where I've worked, any nurse I've known who has come from another area (Tele, Ortho, ICU, etc.) has received a few weeks of orientation, but that is usually all it took to shift from wherever-else-RN to ED RN. I agree with the advice you've been given -- just apply!

turnforthenurse, MSN, NP · Dec 2, 2013

It's pretty difficult to land an ER position out of school. Is it impossible? No. Look for places that do internships, imo that is your best bet.

I started out as a floor nurse in PCU and worked there for 2 years before I transferred to the ER. I floated a lot to my hospital's ER and networked - and in turn they could see my work ethic - and that gave me opportunity to transfer to that department. Now I belong to the ER permanently lol.

Guests · Dec 3, 2013

The smaller the hospital, generally, the easier it is to "push" your way into the ED... which is what I did...

I'd go down whenever I could... at lunch, when things were dialed in on the floor, to get supplies... whatever...

I considered myself to be on a continual ED interview from the moment I started on m/s and looked for every opportunity to make a good impression.

In my case, they offered me some occasional orientation shifts, mostly because they wanted me to vacate my regular m/s shifts for another person who wasn't playing well with her regular shift-mates; there were no openings but I snapped up the opportunity and inconvenienced myself by splitting my work-week and changing my days.

One day, out of the blue, the DON cruised through the m/s floor and said, "___ just gave her notice... would you like to move to the ED?" I wasn't ready (and didn't have time for a proper training period) but leaped at it, despite the possibility of flaming out with no room for me to return to the floor. It was a gamble but it paid off; I made it through the rough spots, got a 2nd ED per-diem job, and finally landed in the big-time (which for me was/is trauma 1)

ED out of the gate is a challenge, to be sure, but it's by no means an insurmountable one.

utadahikaru · Jan 23, 2014

Hard. Very Hard. But it can be done. I started in the ED right out of school. Don't let anyone tell you what you can't do.

agrooters4 · Jan 23, 2014

I graduated a year ago from an ADN program in California. It took about 6 months, but I got a new grad position in an ER, in North Carolina. It's certainly challenging starting in the ER, but it's right where I want to be. I also work with great nurses who help me out. It's not a trauma center, but it is a busy hospital. There are several nurses I work with who also started out as new grads in this ER, and they say it takes a year or two to get settled in. Some days I feel good about my nursing performance, and other days I feel overwhelmed (especially with higher acuity pts). But it's a great experience!!

OlivetheRN, ADN, BSN, RN · Jan 24, 2014

I graduated a year ago from an ADN program in California. It took about 6 months but I got a new grad position in an ER, in North Carolina. It's certainly challenging starting in the ER, but it's right where I want to be. I also work with great nurses who help me out. It's not a trauma center, but it is a busy hospital. There are several nurses I work with who also started out as new grads in this ER, and they say it takes a year or two to get settled in. Some days I feel good about my nursing performance, and other days I feel overwhelmed (especially with higher acuity pts). But it's a great experience!![/quote']
Hi fellow NCer! :) I started as an ADN new grad in the ER as well. Just graduated this past May