As a licensed new grad in the NYC area my biggest fear right now is of course, not getting a job. A clinical instructor I am close with offered to help me get a position in a local ED (ED IS MY DREAM!!) where her husband is attending MD. When I did some research, I found that this hospital has less than satisfactory ratings by patients and national standards. One nurse I know who works at a different hospital nearby told me she has heard that there is some unsafe practice going on - she did not provide details.
I've already contacted the head of department who is supposed to call me this week to set up an interview.
How do I approach the possibility of remaining unemployed (I can see that student debt in my peripheral vision...) vs. working in a less-than-desired and possibly unsafe environment? I am especially concerned being that it's a first job and therefore will probably influence the way I practice forever, not to mention that I really really do not want to risk losing my license!
I am a new graduate, and I started in the ER (it was my dream). It was very unsafe, and a horrible environment. I threw up everyday before work, and lost 12 pounds the last two months I worked there. I couldn't sleep, couldn't eat, and my confidence became nonexistant. I was terrified that if I continued to work in that environment I would end up losing my license. At the same time i was told that people who brought issues up to managment were fired, or forced to quit and group 1ed. They were black balled and couldn't find work. I was afraid if I quit that working less than a year would make it impossible to find another job. It was a rock, a hard place, and hell. Anyway, I finally found another job, gave my two weeks notice, and feel much better. I feel lucky I was able to get out of that mess alive. I have gained 6 pounds back, and I love my new job. Everything is done it a patient centered, ethical way. Everyone is positive. I am actually learning skills, and everyone is so positive. I get up excited to go to work. I thought all hospitals were like the horrible one, and I almost quit nursing all together. You don't want to get involved in a bad situation like that. Its not worth anything they could possibly pay you.
I believe your practice is only as unsafe as you allow it to be. Keep in mind, your priority is to advocate for the patient. If you feel something is unsafe, then speak up. Take the job. It will improve your confidence as a nurse. Also, look at location. Sometimes an area can make the hospital look unsatisfactory when really the hospital may be in a high crime area.
You could also approach this situation as an opportunity to be part of a change! You will have a voice as an RN and you can be a patient advocate for these patients. Think of the lives you could touch! I am a new grad RN myself. I have almost completed the 6 month internship. Have I seen some things I don't agree with, sure. But I take it as a lesson and learn from it myself. Good luck! The ER is an amazing place to be!
You are truly between the rock and the hard place. ER is daunting for nurse with 30 years of experience, never mind new grads. And as much as people say "go for it , you can make a difference"; if the climate is true to your friends experience; you will be miserable, frustrated and posssibly railroaded out in your first 6 months. Trust me, NO ONE will take a new grad seriously in the ER in those conditions. If these problems are institutional, your fight will be even harder. I would advise you to go into the situation with eyes wide open; DO NOT BACK DOWN when you are sure you are right,, but prepare yourself for the consequences if right thinking people are seen as troublemakers in this institution. We NEED great nurses like you, but we don't want to see you burn out in a no-win situation, either.
I would ask two questions: (1) What sort of orientation program do you offer new graduates, and how long is it? (2) What quality standards is the ER currently working on?
If they answer, "Well, orientation is very individualized," that might well mean, "We put you with a preceptor for a while, until it becomes inconvenient for us to tie up a staff member with your orientation needs." Quality of orientation can mean the difference between success and failure. Make sure they aren't skimping on it.
An ER (in fact, any nursing unit) that is concerned with quality of care will have certain goals that they're working on at a given time. Past goals of my ER have been things like "door to balloon time" in MI patients (how long it takes from the time the patient arrives at the ER until reperfusion is occurring in the cath lab), and door-to-antibiotic time in patients diagnosed with pneumonia. If they can tell you specifically what quality issues they're working on, that's a good sign. If they can't, it could be that they're not as focused on improving quality as they need to be.
You do make a good point, that your first job will set the tone for your career. I started out with a job that provided a great orientation, but poor staffing and management support. It was terribly hard work, but I got the basics down and then moved on to a better job, with better staffing.
One more thing: make sure that this emergency department has enough experienced nurses to serve as resource people. Recently, a very well qualified and experienced ER nurse interviewed for my department. When asked why she was leaving her current position, she said, "The staffing of my unit has changed over the past couple of years, to the point that we now have about 80% new graduates. It's not uncommon for me to be the only experienced RN on duty. Not only am I expected to precept all these new nurses when they're doing something new, but I also end up with a full load, often including the critical and trauma patients that they're not ready for. It's too much responsibility, and I need to protect my license."
You don't want to end up in a job that requires you to care for a critical patient that you're not ready for...especially if there's no one there who can take the time to guide you through it, answer questions, or help you with difficult procedures.
Every hospital has horror stories; you don't have to nose around the internet very far to find flagship hospitals that have transplanted hearts into incompatible recipients, cut off the wrong limb, sent people home who later died, etc. When you work at a hospital, you get to see "the man behind the curtain" ala Wizard of Oz. It's enough to scare a new nurse to death. But having been at several facilities, you can learn from each -- sometimes, you learn about the nurse you DON'T want to be.
Know the policies and procedures, but also know that real world nursing is nothing like nursing school. At least with us, we didn't pull 7 patients as students, or have pts who were trying to code one minute and bust into the med room the next. Know the right way to do the basics -- foleys, IVs, know the critical care meds, and be super sharp on your history taking skills. Good luck out there, we need you!
Listen, you have unfortunately graduated from nursing school at a bad time for NYC. 2 hospitals have just closed down and close to 1000 RN's are out of work. These are all union workers and most NYC hospitals have implemented a hiring freeze until the dust settles and the displaced workers either retire or find new positions.
You take this job, pay attention, learn what you can, get you ACLS, PALS, stay for 8 to 9 months or maybe a year and then jump ship to a better hospital.
It will be much easier to get a job with experience under your belt.
I would DEFINITELY interview for the job. New grad jobs in the ED are hard to find.
I started as a new grad in a community ED 9 mos ago. I am thriving. I would ignore the advice that says you should do med-surg for a year before ED. You can start in the ED, if you don't like it, you'll know right away and you can find another job. Some are made to do ED, others are not.
Questions to ask in your interview, as a preliminary screening for safe practice/policy:
1) what is the nurse to patient ratio? ENA recommends 1:4
2) what happens if there are call-ins? what is the acceptable maximum nurse to patient ratio? at what point to you get nurses from other floors to help?
3) are there "task/float" nurses available? are there paramedics assigned to certain nurses or teams of nurses? what is tech staffing like?
4) is there central monitoring for patients who need to be cardiac monitored? is there someone to watch the monitors?
5) what is the policy and procedure for psych patients? do they have sitters available?
6) what is the policy for rooming patients from triage? is the nurse notified immediately? are patients placed in a gown and put on the monitor by the transporting tech?
and, just a few pointers.....
The key to surviving as a new grad in the ED
1) Study, study, study: I subscribe to medscape and do continuing education all the time- they have case studies on there that pertain to the ED. I bought a book that I would highly recommend called In a Page: Emergency Medicine by Caterino & Kahan. I reference my old NCLEX study guide for how to do certain procedures. If I take care of a patient with a certain diagnosis that I am not familiar with, I go home and look it up. I do research on nursing interventions for a patient that I wish i could have taken care of better.
2) Identify and cozy up to a mentor QUICKLY. Find someone who is willing to help you learn how to place NG tubes, tricks on starting lines, etc If they reference the policy and procedure for the hospital, or better yet: evidence-based practice, you know you have a winner! If you take care of a patient with a GI bleed (for example) for the first time, say, "hey, so-and-so, am I missing anything here?"
3) if your hospital has protocols, become familiar with them quickly. It will help you anticipate your orders. If you don't know why a certain med/imaging/lab is called for, look it up.
4) help others whenever you can. Buddy up to the RN who is the best at placing lines and help her with her grunt work. Then she'll start those hard sticks for you. Its politics yes, but its also teamwork!!!
coolpeach
1,051 Posts
I am a new graduate, and I started in the ER (it was my dream). It was very unsafe, and a horrible environment. I threw up everyday before work, and lost 12 pounds the last two months I worked there. I couldn't sleep, couldn't eat, and my confidence became nonexistant. I was terrified that if I continued to work in that environment I would end up losing my license. At the same time i was told that people who brought issues up to managment were fired, or forced to quit and group 1ed. They were black balled and couldn't find work. I was afraid if I quit that working less than a year would make it impossible to find another job. It was a rock, a hard place, and hell. Anyway, I finally found another job, gave my two weeks notice, and feel much better. I feel lucky I was able to get out of that mess alive. I have gained 6 pounds back, and I love my new job. Everything is done it a patient centered, ethical way. Everyone is positive. I am actually learning skills, and everyone is so positive. I get up excited to go to work. I thought all hospitals were like the horrible one, and I almost quit nursing all together. You don't want to get involved in a bad situation like that. Its not worth anything they could possibly pay you.