New Grad in the ED


Hi everyone,

I'm a new grad nurse with my BSN (fresh out of nursing school! Yipee!), and I recently got a job in an Emergency Department in a large city hospital. I was never a PCA or nursing assistant, so my only clinical experience is from rotations in nursing school (none of them were in an ICU or ED). The orientation period is pretty extensive (16 weeks), but I'm worried that I still won't be ready in time since this is my first experience in the ED. I've been orienting for 2 weeks, and I absolutely love it so far. I enjoy all of the challenges, variety, and really using my critical thinking skills. I was hoping that I could get advice on how to become a competent ED nurse so I could start using it before I have to be on my own on the floor. I know other people have posted about this topic before, but they all seemed to be from years prior. I'd appreciate any advice, tips, and tricks that anyone thinks would be helpful to a new grad nurse in the ED. Thanks in advance!

Specializes in Emergency. Has 21 years experience.

Welcome to the darkside. Check out the stickies at the top of the forum. There's a lot of good basic info posted on starting out in the er.

zmansc, ASN, RN

867 Posts

Specializes in Emergency.

First, congratulation on getting through RN school, passing your exam and getting your license. Enjoy that!

Second, more congrats on getting a new grad ER job. Someone told me, now that you have your RN license, the learning begins. It doesn't matter where you go to work, you will be learning alot. Try to apply the information you learned in school to what is going on in the ED. Ask questions, you are still expected to be learning, and growing, and even when the orientation is over, you will still be a new nurse, who should be growing and learning (stop me if you catch a theme)....

Your orientation is not to make you so confident that you don't need anyone else, it's to get you strong enough to where you won't hurt anyone, and will know when to call for help. The ED is a team sport, play nice with your teammates now, you will need them in the future, oh, and they can help you learn much faster!

I always suggest to folks new to the ED, figure out a way to study something every shift. It could be you take a chart home and study up on it every night, or you jot some notes down and go study the subject, or you do the research while at work during your lunch break (if you happen to work at a facility that has such a thing). It really doesn't matter how you do it, but almost every shift presents something where you can learn, take advantage of that. Grow, gain more knowledge, ask others why pt x was treated different than pt y when they both had dx z?

Make nice with the providers. Most provider's I have met LOVE to teach. They absolutely love sharing their knowledge. Now when they are slammed, they don't want to be interrupted, but if you can find the right time, when they are not slammed, they will answer all kinds of questions for a nurse that is trying to learn more and get better at treating their patients.

Finally, there will be rough shifts. You will walk away feeling like a complete idiot who is never going to be able to hack it. It happens to all of us at sometime. Figure out how to let that go, you will have a better day the next day. Don't let something shake your confidence in yourself. Even the best sprinter had to learn to walk at some point in their life, you are learning to walk as an ED nurse... You will be running soon enough.

Good Luck and enjoy the ride!


13 Posts

Hello and congratulations! I started almost 2 years ago as a new grad RN in the ED. It is a steep learning curve. Don't be afraid to ask questions, even when you are off orientation. I agree with the above poster that said orientation is to make you safe, there will still be PLENTY to learn and experience off orientation. Soak it all in while you're on orientation. Watch what your peers do. If you don't know, ask. You will slowly learn to trust yourself more and more as time progresses, but don't become complacent. Almost 2 years into this, I still learn something new each day I go to work. Also, don't be too hard on yourself. There will be days that you feel defeated and worthless; don't let them get to you. Everything is a learning opportunity. Learn your policies and procedures for your area of employment, and know what is and is not within your scope of practice for your state. Just because you see a peer do something, doesn't mean it's right. That being said, you will learn a TON from your peers. The ED can be exhausting and brutal. Some days are rougher than others. However, (most of the time), I love what I do! It can be very gratifying and exciting. Good luck and best wishes! :)

Specializes in Emergency Department. Has 4 years experience.

#1. Ask LOTS of questions. All of the docs I work with love to educate and teach. Sometimes, our co-workers are too busy to explain everything, but Docs seem always willing to take the time.

#2. Be enthusiastic and willing. You may not be the fastest or the best, but you WILL get faster and better. But the one thing Docs and nurses hate is slackers. So get off your arse and hustle!

#3. Be a team player. Always be willing to help out. Don't ever say, "That's not my patient!".

#4. Ask to do things you suck at. Do you suck at infant caths or IVs? Ask to be the first to try it. As long as it's not emergent, most nurses will let you have the first poke or two, or the first try.


2 Posts

Great advise! I am in the same boat. New grad in May, starting orientation in the beginning of November. I'm a little nervous that it has been so long since graduation. Any additional advise for getting into a good groove with such a large gap of formal learning? Nursing school was so intense and it seems crazy that it ended abruptly and now its showtime!

zmansc, ASN, RN

867 Posts

Specializes in Emergency.
Great advise! I am in the same boat. New grad in May, starting orientation in the beginning of November. I'm a little nervous that it has been so long since graduation. Any additional advise for getting into a good groove with such a large gap of formal learning? Nursing school was so intense and it seems crazy that it ended abruptly and now its showtime!

Follow the advice above. Be humble about what you do know and always try to take some new knowledge out of every situation you are involved in. Don't sit back and let it come to you, put yourself out there and ask, jump in. It's a fine line, you don't want to get in the way, and you don't want to push a med when you don't know what it does, but at the same time, you need to gain experience.

Finally, when you do make a mistake, own up to it, learn from it, and figure out how to not make it again. Your human, we all make mistakes.


74 Posts

Specializes in Emergency room, Neurosurgery ICU. Has 10 years experience.

EDNurse0310, 10 years ago, I was you. Hired into ER as a new grad. Here's my advice, take all the advice listed above! Expanding on that, there will be a couple of "older" (more experienced) nurses that you will work with whom you will click" with; these will be your mentors, they will be the ones you feel most comfortable going to with patient care issues, questions about procedures, they will be the ones you ask for advice because you feel most comfortable with them. Yes, ER is a team, and everyone works together to save lives, but as in any job, there is always one person whom you work best with. Embrace that,use these people as resources, glean all the knowledge and years of experience from them. They have vast quantities of it to share! Never pass up the opportunity to assist in a difficult case or rarely seen condition.

I still remember fondly the nurse who became my mentor, I cried when she retired. (she wasn't chosen by management to mentor me, we kind of just fell into that relationship) ER is not only a team, but very much your "work family", in every sense of the word family.

Congratulaions! Enjoy the experience. Grow! Learn!