Need advice: should I start out in ER or tele/med-surg?

[secondfiddle]

Here's my situation: I'm an ADN student graduating in May. I'm 29 years old and currently work as an extern (pretty much a CNA) on the tele floor of a community hospital. I plan to stay at this hospital when I graduate. I have always been interested in ER nursing, but we only get 1 day in the ER to observe as students so it's been hard to make a judgement call based on this limited time. This is a "second career" for me, so I am still learning basic patient care from scratch, but I do consider my critical thinking skills to be strong. I'm trying to decide whether to do my preceptorship in the ER and try to get hired there upon graduation, or do my preceptorship in ICU or general tele and get hired on the floor where I currently work.

The monkey wrench in this situation is that my husband and I want to have a baby (our first) this year. I know, sounds crazy trying to do this as a first-year nurse, but many factors have weighed into our decision and we feel that now is the right time. I am wondering which choice might be easier on me considering our plans. I have more familiarity with the tele floor, but it is certainly not an easy place to work either. Regarding the ER, it is a community hospital as I said, so serious traumas get flown out. Although I ultimately see myself in the ER, I wonder if given my situation it might be best to get the general med-surg experience while I deal with a pregnancy and then head to ER when I have more experience.

I am trying to find a balance for what is best for my family, nursing career, and mental health :chuckle, which makes for a tough decision. But any advice and input would be much appreciated. Thanks in advance. :)

[JRapha'sRN]

I would find out what kind of orientation is offered by the ED. When we hire a new grad they are put in ICU for several weeks (up to three months) as well as on a tele floor for the same amount of time and then come down to the ED and work with a preceptor for 3-6 months. If your ER can do this for you, it is ideal. If not, and they will throw you right in, then I would agree with most of the other posters and say start on your med/surg/tele floor.

[Maverick80]

i have a friend who just became an L&D nurse last june. She is pregnant and due with her first child in april. She is doing just fine!! she is working and couldn't be happier with her choice to go straight into L&D!!

I say do what you really want to do. If being on a tele or med-surg floor is going to make you miserable then don't do it, go for the ER.

Everyone i've talked to say it's better to just do what area you want, you will adapt, doing a year as a miserable med-surg nurse will not be good for you or your baby. Be a ER nurse and have a baby, don't worry about what others say!!

[nitenurse911]

PLS, PLS- do yourself and your future co-workers a huge favor and spend a year in a Med-Surg/ Tele setting. Getting a good foundation is critical, no pun intended. For all the reasons sited above, your first year you will learn more than all the time you spent in school and then some not to mention building your confidence and intuition. All houses need a strong foundation; it's hard on you and your peers when you can't cope and expect them to shoulder part of your load and theirs when you are floundering and it is uncomfortable to work with staff that you question in terms of their skills/ reliabilty to pick up on cues or plan ahead. I believe in teamwork but you get tired of constantly carrying the heaviest load because you can.

Personally, I am battle -weary from the "Barbie's" who are more interested in working on their "M.R.S's" and landing themselves a Resident on their way to life on "Pill Hill" - for those of us who have chosen NOT to have a family, I resent working short when management doesn't cover the shifts vacated by maternity leaves; I have no viable excuse to take the same time off with pay which I find is an inequity that sits unaddressed

[TouchstoneRN]

I have been a nurse for five years. My first four years were spent in med/surg, tele/pcu, did some psych and NH/Rehab parttime. I am so glad I did that prior to specializing in the ER. I have such a well rounded background and can perform under pressure without losing it because I have lot's to draw from. I will tell you like I have told other new nurses do a year to two in Med/surg/tele. You will be glad you did

[nolongeridealistic]

Stay for a year on the telemetry floor. The things you learn on the floor can be used any where you chose to go later. It will provide the foundation for your practice and help fill in the gaps from your previous clinical experiences.

[nsFAMU]

Well I guess I have to disagree with everyone else. I graduated 12/2005 and went directly into the ER as did 5 other new grads at the time. If ER is what YOU want to do then do it. I actually want to work in the NICU but didn't and I really regret that decision. As a student my friends and I went to a recruitment and asked a DON if she thought we should get a year of M/S and she said "No, do what your passion is or you'll make yourself and me miserable". Besides, my 2 best friends went into M/S and it's surely not easier than other areas of nursing, they all have their pros and cons.

Non of us new grads had trouble in the ER and I had never even drawn blood before I started working! I remember being so nervous the first time I was in a code but when the nurses that had been there for years couldnt open the crash cart I had to show them how! If u start in Med-Surg and then go into ER you'll have to readjust to the fast pace and skills needed for the ER.

I'm actually on my first ER travel assignment after working just 1 year in the ER and that is also going great as well. I am an excellent nurse and my patients tell me so all the time! Maybe a year of M/S would make me super excellent? I don't know but I am happy with where I am and the progress I have made.

I think you'll be less likely to get burned out if you're doing what you love especially when you'll have a baby to go home to. Good luck and congrats!

[TwinkieBee]

I'm not a new grad any more... I've been out of school for 15 months and I'm currently working in a med/surg unit because I thought that would be a great way to get good experience. I'm DYING to work in the ED and actually interviewed recently for an internship in the ED. I got absolutely no respect from the panel of 6 people who interviewed me for being a floor nurse. I did not get the job.

I know I'm getting great experience by doing med/surg first, but now I'm afraid I'll be pigeonholed as a floor nurse forever. It doesn't help that the only way people can get off my floor is by quitting, as the manager will not give good references to interviewers.

I would really like to know what interviewers are looking for in an potential ED nurse. I'm older (in my 40's), yet I can work circles around my younger workmates.

Any comments or advice would be most welcome.... Thanks

[honeylet_1710, BSN, RN]

I can proudly say that if you had an experience specially in acute medical unit you can easily adjust to any other unit i worked for two years in medical unit then worked as an ER nurse for another 2 years i actually enjoyed both and i havent had any dificullty in adjusting . And now at present i am an Oncology, hematology nurse and without my foundation in Med surg it will be very difficult for me to cope

[HM2VikingRN, RN]

I think that it is important to follow your muse.

I don't think that there is a one size fits all rule. What works for individuals varies with their developmental stage and age. A 24 yo new grad has different needs for professional development than a 40 something second career RN. The first may need to take time to just grow up while the second may have extensive experience dealing with high stress work environments.