New Grad Completed Practicum in ED seeking career path advice

amzyRN · Jul 22, 2017

I'm not a veteran ED nurse but I'd thought I'd try to answer your questions regardless of my short time in the specialty. I think it's important to consider that in the ED you won't always be taking care of trauma patients or working codes. That might be a fraction of what you do but the majority of the time you'll be working with run of the mill ED patients, some of whom should have seen their primary care doctor but for whatever reason use the ED for primary care. You'll deal with aggressive people, drug seekers, homeless people with lice and scabies who smell so bad that you might need to barf when you leave the room. That part is sad and can wear a nurse down. Also, you'll realize, if you've worked in more than one ED that EDs can vary a lot in work conditions and you need to interview wisely so you can detect a xxxx hole and stay away from it.

Some EDs have unsafe staffing, favoritism in assignments so that some of the staff always get the sickest and most work intensive assignments. Not all ED doctors are cool with nursing staff and some of them are just as degrading to nurses as they would be on general medical floors.

If you enjoy seeing a variety of patient populations and medical scenarios some of which are life threatening then the ED might be for you. If you like a fast paced enviornment where you are constantly shifting your attention and re prioritizing then you'll probably enjoy it.

Recognizing a sick patient comes with experience, you'll have to see patients to get that clinical gut of who's about to die. Your basics you learned in nursing school will guide you to spot sick patients. Skin signs will tell you a lot about how sick a patient is. Cool, pale, diaphoretic patient should grab your attention. If a patient is worried about them self, if they think they are about to die, you should not dismiss their concern.

I've only been in the ER for a little over a year and the thing that keeps me coming back is the patients, seeing so many different people and sometimes making a profound difference in their lives. What might be the end for me is the workload and unsafe and short staffing that I have found in the last 2 EDs I've worked in.

ACLS, PALS, are requirements for most EDs, sometimes they require TNCC. Getting the CEN in my opinion before a solid 2 years of experience won't really add much to your resume and income, so I'd forgo it until you had solid skills and knowledge in the specialty. That's just my opinion about the CEN though.

Good luck!

DayDreamin ER CRNP · Jul 22, 2017

Hello Everyone,
ACLS, PALS
TNCC, ENPC, CEN
Question #1: For all the veteran ED nurses out there, what advice can you give to a New Grad who's interested in pursuing a career in an ED?
Question #2: Additional certifications or courses that would be beneficial for this career?
Question #3: Tips to help increase awareness/recognition of when a patient is about to bottom out/decline in status?

#1. Do a search here. Some of these questions have been answered quite a bit around here.

#2. I have my ACLS, PALS, TNCC, and CEN. while these are great certs, they don't make me a better ER nurse. My experience and co-workers make me a better nurse.

#3. Experience. Learn to trust your gut.

nrslife824 · Aug 11, 2017

Hello and congratulations!!

The ED is a unique and gratifying place to work. HOWEVER (you saw that comin', right?), it's not always about the codes and the trauma's. ER is chaos. But in the chaos, you find you have the peer group to weather any storm. It's a camaraderie like nothing else.

I've been doing this gig since 1999. *sigh* My feet hurt, I get mentally exhausted, but cannot imagine working in any other area. To be a good ER nurse, you have to be good at anticipating needs , know what the next step is, and be able to the nitty-gritty of what is going on with the patient in the first place. And never lose your "nice".

I will say that over the years, I have seen the expectations placed on ED nurses increase. We carry heavy loads. People are sicker, hospitals are full, and ER physicians rely on us to order the correct protocols to get the ball rolling. ED throughput and Medication Reconcilliation are big buzzwords these days, and have been for almost 10years now. Seems like we have to do more work for the floors too.

For a new grad, it can be overwhelming, and perhaps not the best place to start. But it sounds like you went through a decent program. Expect that there will be horrible days, awesome days, and apocolyptic days. It's the ED, anything can happen..... and it usually does.

Guest374845 · Aug 23, 2017

I knocked all of those out in the same year. Are they all offered at or by your facility?