Med-Surg good preparation for ER?

[Joe NightingMale, MSN, RN]

I'm thinking of doing ER at some point in the near future. I'm presently almost a year into my first RN job, on a heavy med-surg floor. I am likely to become an NP at some point in the future, and I've heard that ER is a good preparation, lots of diversity and plenty of opportunities to practice prioritization and assessment.

I've heard various responses as to what type of preparation is good for ER. Some people say new grads can handle it. Others say a year or two of acute care. Still others say a year or two of intensive care.

At my present position, I've gotten a fair amount of experience with blood draws, IV starts, IV meds, wound care, pain management, G-tubes, feeding pumps, blood transfusions, trachs, and restraints. Also had some experience with PCA, TPN, and heparin drips. However, I haven't had experience with vents or vasoactive drips, which aren't allowed on our floor.

[Faeriewand, ASN, RN]

I would like to know also. I've been in med/surg for 18 months though as an LVN-finishing up my RN now and wondering where to go from here if I don't want to stay med/surg. :)

[farmerRN]

I am of the school that any experience you bring to the ER, the better you will be successful! I have been an ER nurse now for 5 years. I worked for 4 years on a big and busy medical/telemetry/oncology unit. I did medical/surgical travel for a year before I got burned out doing floor nursing. Going to the ER will be a different mindset. It will take a little time to adjust to the pace. But even after a year, you have a basic practice that you have learned. You should at this point have your assessment skills down and things like vents are usually managed by the RTs in ER and vasopressor meds...will take time to learn. I have worked with new grads in the ER...success rate is pretty low unless they have an EMS backround. I certainly enjoy ER nursing...except on the weekend night shifts!!!!!

[sandnnw, BSN, MSN, EMT-B, APRN]

You're ready. One good year of med-surg and you can handle almost anything. Don't need ICU experience for most ERs.

You will gradually "build" into a smidge of ICU in the ER, e.g. Levo/Dopamine drip, trauma arrests (involving a team) of which within six months to a year you will learn to RUN yourself, overdoses, births (again, you should have a consulting OB RN to tell you EXACTLY what to do, yikes!) and in about a year or two, you'll be the charge RN.

In my ER, only a few of us have what I would call "real" ICU experience (>3-5 years) and in reality, if you don't use it...you lose it anyway, day to day the information changes and fades from the old brain. Depending upon what type of ER you work in (intercity, trauma, academic, VA, Peds, rural, etc) your situation may be different. For example, intercity ERs may have a code an hour where ICU/trauma experience is absolutely required (think TV drama here) or like in my VA situation, we have one a week (usually a non-ACLS fall). We take a new grad a year, some ERs may never take a new grad, although, they may take their nursing extern students who have worked over the summers/semesters and are "seasoned" to their ER. It all depends.

I worked Med-Surg for 10 years (loved it). MCCU for 5, now ER for 5 and am a NP part-time for the past year. The ICU was not for me, but it did give me a new appreciation for that kind of work and I cherish the valuable experience I learned. I have found my home in the ER. My goal is to be an APN in the ER and to retire from there. Its only taken 20 years to discover that. Good luck,

jimbo

[Lunah, MSN, RN]

Joe, I've only ever worked in the ED, so take what I have to say with a grain of salt -- but it seems that when a nurse experienced elsewhere first gets to the ED, he/she feels like a green new grad all over again. I've heard that from a few RNs that have transitioned to our ED from other areas, but because we have great preceptors and supportive staff, and those new-to-the-ED RNs had solid nursing experience, they were all successful in the transition. :)

So if you switch to the ED, don't be surprised if you feel out of your element and brand new all over at the beginning! But with your m/s experience, I'm sure you'd succeed. Good luck!!

[ernrs2b]

I started as a new grad in the ER and I dont suggest it. I wish I had had some ICU experience prior. It took a few years to feel truely comfortably with those patients and I now feel I'm a "jack of all trades and master of none" I'm now a supervisor in the ER and we look/prefer to hire nurses with floor experience, because of their time management skills amongst other qualities. good luck with your decision!