New grad: ER or Med-surg?

[Studentnurse418]

Hello all.

I'm sort of in a predicament. I am not sure on which position to choose after I graduate next month.

I was offered a position in the Emergency Department at a trauma level I hospital, but it is in a city that I do not want to live in for 2 years. The pros for having this job is that it is my dream job and fits my professional goals. The location of this hospital is a 45 minute drive from my house so one consideration is to commute.

I am also in the process of hearing back from another Magnet hospital who interviewed me for a med-surg/trauma unit. This hospital is only about 20 minutes away from where i live. I want to be closer to home so the location of this hospital is the best. If i get offered this position I am not sure if I should commute from home and work in the Emergency Department or take the med/surg unit and possibly do an internal transfer in a few years.

Can anyone here offer some advice as to what a new grad should do?

[NickiLaughs, ADN, BSN, RN]

Good Call on the ER. If that's what you want, there's no reason to start in another unit for skills. The New Grad programs of today are designed for new nurses who want to work in that particular area. I went into ICU as a new grad (I did have a few years of LVN experience). Don't regret it at all, and some of the new nurses could hack it and some couldn't. It depends on the person, although I think they've gotten better at identifying who will succeed and who won't in the interview process.

I think with your current experience, your drive and your goals you will do excellent! And congrats on scoring a job in this crappy economy.

PS. I've noticed many med surg/tele nurses have had trouble transferring departments where I have worked the last few years. My latest is very open to it, but I've noticed a downward trend on cross training. I think with this economic climate it's best to go with your ultimate goal.

[~Mi Vida Loca~RN, ASN, RN]

Pretty personal choice but if it were me I would do the ED hands down. A 45 min. commute is nothing. Especially if it's 3 days a week.

[~Mi Vida Loca~RN, ASN, RN]

I don't understand why people say to do a year of med-surg first. If the ED offers a good sized orientation, the new graduate can learn how to prioritize patient care in the emergency setting that way. If someone were to start in med-surg and then transition, they'll have to learn everything all over again because ED and med-surg are different beasts. As someone who would rather start in the ED or ICU than in med-surg, why should I take the time to learn one way of learning to do things, and then throw it out the window when I transfer to the ED or ICU.

Anyway, congratulations. I can only hope and pray that I am as fortunate as you when I graduate. Best of luck with orientation.

Our ED here doesn't really care if you have have med/surg first because they say the ED is such a specialized unit that everyone will need to have orientation anyway. Our ED here even uses different IV's then the Floor nurses, they do straight caths and the floor nurses are usually doing Foley's, they have a different charting system, different med access, different policy and procedures for everything. So someone can have 20 years med/surg and it will still be a completely different experience.

I am hoping I have a good orientation, they don't have a set amount of time, it's catered to your areas of strengths and weaknesses that are constantly reassessed.

[Anna Flaxis, BSN, RN]

I don't understand why people say to do a year of med-surg first. If the ED offers a good sized orientation, the new graduate can learn how to prioritize patient care in the emergency setting that way. If someone were to start in med-surg and then transition, they'll have to learn everything all over again because ED and med-surg are different beasts. As someone who would rather start in the ED or ICU than in med-surg, why should I take the time to learn one way of learning to do things, and then throw it out the window when I transfer to the ED or ICU.

I see it a little differently.

The assessment and time management skills you gain in med/surg will transfer well to the ED setting.

You will have the benefit of working mostly (I say mostly, because there are always exceptions, and if I don't mention that now, someone else will) with patients healthy enough to undergo surgery. You will have the benefit of knowing your patients' medical history as well as the diagnosis that brought them to the hospital.

Med/surg will give you a foundation for assessment and time management that you can take with you into any setting.

In the ED, you will work with everyone from neonate to centenarian. They walk through the door or come in by ambulance with an unknown diagnosis. The infant could be septic or have a simple case of croup. The little old lady could be having a stroke or a UTI.

I'm sure that there are many who have gone into the ED straight from nursing school and have done well. I would simply caution you not to undervalue the benefits of having a little experience under your belt prior to taking a job in the emergency setting.