New grad in the ER, yes or no?

Dixielee, BSN, RN · Jun 2, 2012

It depends on the ED and the length and quality of your new grad orientation. ED nurses do need to work independently and quickly. I don't think most new grads have the intuition or experience needed to safely function in a busy ED like you describe. There is so much trust that must be developed to make the team work, and that trust is earned, now simply awarded.

I'm tired after a long shift, so I won't elaborate but there are many threads on this forum that debate and discuss this situation ad nauseam.

As far as the adrenaline rush....yes, that is a part of ED, but unless you work exclusively in a trauma ED, there are many shifts where you only deal with very routine patients. They may be sick, but no real adrenaline rush. You flame out quickly in an environment of constant stress. Most days you will deal with people with kidney stones, abdominal pain and vomiting, broken skin and bones, chest pain that is not a STEMI, suicide attempts, drug seekers, headaches that are not big head bleeds, changes in LOC that is not life changing like a stroke, or some kid who took someone elses meds.

You deal with drunks who lie in their own vomit, endless people from car crashes who come to "be checked out" because their insurance agent told them to, women with pelvic pain and STD's, kids and adults with sore throats and coughs and a lot of people who just do dumb stuff that gets them hurt!

That said.....ALL of my good stories come from the ED! After 38 years, you would think I would have seen it all, but the endless stupidity of human beings always give me pause and make me shake my head in wonder at just how we have survived as a species this long.

Yes, you get the adrenaline rush when you hear the announcement, "we need two on the pad in 5 minutes" because the chopper is bringing in the guy from the high speed chase who arrested en route, the kid who nearly drowned, the head bleed from a rural hospital, the teenagers who wrapped their car around a telephone pole, the 41 year old stroke, the GSW, the guy who was stabbed in the chest during a robbery, or the small child who was victimized by a parent. Many times you will be exhilarated, but you will just as often be left with a sense of sadness at the cruelty of one human being to another.

ED is not for everyone, but neither is OB, psych or dialysis. We all must find our niche. Many times it takes a few false starts to find yours and it may change several times over the course of your career. Whatever you decide to do, just decide to be the very best at it you possibly can.

FORTHELOVEOF!!!! · Jun 2, 2012

Thank you! It is a trauma 1, but the night I worked we didn't have any because our ICU's were full, it was still great! To be honest, I have been on med/surg, neuro, CVICU, OB, psych, and LTC either in clinical or work and the ER is the only place that I get excited about going back to. I will probably get my start in a med/surg/neuro floor as that is where I intern most of the time and as long as they like me, the RN job is mine after graduation. I like it but I don't see myself doing it for long, it's so physically taxing! I will set my sites on the ED after I get some experience under my belt but my love is hospice, I wish I could do both and still get full time benefits. Thanks again for taking the time to reply!

brainkandy87 · Jun 2, 2012

I think a new grad can thrive in the ER just as easily as a young nurse that's moving to ER from the floor, as long as that new grad is quick to adapt, knows when to ask questions, and knows how to properly manage their time.

shoegalRN, RN · Jun 2, 2012

I work in a Level I Trauma Center and it's not always an aderaline rush, but I do look forward to going to work.

There are two new grads in our ED that completed our Nurse Residency Program and will be graduating in a couple of weeks. I can see why some people say it's good to have a year of floor experience under your belt prior to trying the ED.

I believe they are both very good nurses, but I think the nursing judgement and time management will come with experience. Also, I worked with one of the new grads and he just did not want to ask for help, although he was sinking and the docs were starting to get annoyed. A pt was diagnosed with pnuemonia and the docs ordered blood cultures X 2 prior to antibotics being administed. There is a 4 hour window where we have to have antibotics administed from time of arrival to the ED. The patient was past the four hour window and blood cultures had not been drawn, nor antibotics were given. The docs questioned the new nurse and he was busy dealing with a chronic pain patient who was a frequent flyer who had an ER level of being a 4, which is pretty low on the acuity scale. I asked this nurse over and over again did he need help and he said "no, I got it". He never once told me he havent drawn the blood cultures or given the meds. He ended up getting a good talking to by the attending about time management and asking for help when needed. The docs then came to me and asked me to draw the blood cultures and give the meds.

After that day, I noticed he is quick to ask for help when he is drowning. I told him we ALL ask for help, nobody is able to do everything on their own, no matter how long you've been a nurse. I also explained it's ok to ask for help because we are a team in the ER and it's best to be ahead of the game so whenever that trauma comes in, you can drop everything and go.

I think it would be good to start on a floor where you can get the time management and the need to change priorities down to a science prior to coming to the ED.

Altra, BSN, RN · Jun 2, 2012

My answer is a qualified yes -- for the right new grad who is prepared for the reality of ER nursing AND who is in an ED with a well-planned orientation program that fosters the development of skills and independent judgement.

FORTHELOVEOF!!!! · Jun 2, 2012

Thank you all for your responses. I believe I will take the job on my current floor because it is waiting for me and use that time to better my skills. I think after a year I should be able to shake off some of the insecurities that go along with being a new nurse and have at least some experience to help me excel in the ED. I appreciate all of the positive feedback about new nurses in the ED but I really don't want to take a chance and not make it because I was in too big of a hurry to get in there.

Thanks again!

hiddencatRN, BSN, RN · Jun 2, 2012

Try a board search as well. This topic comes up a lot (it's this board's "what nursing shortage" discussion).There are a ton of posts on the various pros and cons here.

SunSurfRN · Jun 4, 2012

Generalizations of "new grad" vs "experienced are subjective. If you look at the objective new grad with a BSN and maybe they were a paramedic or ER Tech in past life, or did their internship in ER....they know what they are getting into. I've seen some experienced nurses who come to ER from other parts of the hospital and hate it.

srobb11 · Jun 5, 2012

As a new grad in the ER getting to the end of orientation, I'll tell you it's hard. Time management is my biggest obstacle at this point, which I know will come with time. Everyone keeps telling me I'm doing a great job, but there are days that I just don't see it. Great job compared to what? lol.

Anyway, I love it and wouldn't want to be anywhere else, but there have been a few days that I just want to run out screaming, there are nights (last night actually) where I can't sleep thinking of everything I did and wondering what I could have done differently, hoping I didn't miss anything, pray I don't get called into the director's office for something I did or didn't do. The scariest part is not knowing what you don't know, if that makes any sense. But no matter how bad the day is though, I'm still excited to go to work.

I would say it just really depends on the ER, the training and if the team is supportive. You definitely cannot be afraid to ask for help or ask questions. I know that no matter what I need, there's someone willing to take the time to answer a question or help. This is where a supportive team, or lack thereof, will make or break a new grad.

ETA: I should probably add that I worked as a tech in the same ER during my last semester of school, so that has helped tremendously with the transition.

swansonmail · Jun 6, 2012

I started as an ER nurse right after my preceptorship as a nursing student over two years ago.

I had clinical experience as a medical assistant but none as a nurse. What helped me the most was that I am a natural "prioritizer" because I have four children of my own...Time management is of essence and you must develop that skill quickly if you do not already have it. Otherwise you will be frowned upon by all your ER team. Keep in mind that patients will frown at you regardless: their opinion does not count: in their mind their runny nose is the ONLY priority you should have.

Some tips that worked for me: use note pads if you are a visual learner, when you take report, write it down, there is no shame in being thorough, as some jaded oder nurses might want you to believe.

As the other responses indicate, do not hesitate to ask for help, but do so in an organized fashion: after your 1-2-3 priorities are clear in your mind. This will show whoever you ask for help, that you can critically think. Develop a thick skin: you will need it in that highly demanding environment: people and families will test your boundaries and you will be running around getting every visitor coffee if you do not make those boundaries clear!

Good luck, emergency medicine is such an awesome field!