New Grad hired in the ER, question.

[Alexx_xox]

Hey guys,

So I want to bring up a hot topic here that I hear often. As I have stated before, I am a new grad, about to take my NCLEX and I was hired in the ER prior to graduation. I was only one of 2 new grads offered a position in the ER at my local hospital.

I often here MANY seasoned nurses say that new grads should NOT be hired in critical care positions. I feel I have an advantage over other new grads since I have worked as a nurse apprentice in the ER prior to graduating.

I know a lot of students do not feel they belong in med/surg or any "stepping stone" unit, so I am here to ask you guys your opinion. Whether you're a nurse for 2 years or 25, what is YOUR opinion on a new grad starting in the ER?

In case anyone is wondering my opinion, I am a firm believer that some people are meant to go into critical care- BOTTOM LINE. I don't really believe new grads NEED to start on a med/surg floor to gain their experience and time management. I truly believe some just do better than others in critical care right off the bat.

I am a mother to 2 sons, as well as a hairstylist and managed to work full time throughout the entire RN program, so I do not feel like I am lacking in time management.

I know I still have soooo much to learn and I absolutely LOVE being given the opportunity to learn in a critical and fast paced environment.

Let me know what YOU guys think. Im also going to add a poll in case some of you guys do not have the time to write out your answer, but if you do, please take the time to respond because I truly am curious.

Thanks so much,

XO, Alex

[StrwbryblndRN]

I agree with you. Not everyone is cut out for critical care. And some should not start in critical care.

Everyone is different. If you worked as an apprentice prior to graduation then you have an idea of how the ER can

be and whoever hired you felt you could do it.

Congratulations on your new job.

[JKL33]

I know a lot of students do not feel they belong in med/surg or any "stepping stone" unit, so I am here to ask you guys your opinion. Whether you're a nurse for 2 years or 25, what is YOUR opinion on a new grad starting in the ER?

In case anyone is wondering my opinion, I am a firm believer that some people are meant to go into critical care- BOTTOM LINE. I don't really believe new grads NEED to start on a med/surg floor to gain their experience and time management. I truly believe some just do better than others in critical care right off the bat.

I personally think it depends on the person, and depends upon a proper (read: lengthy and organized) orientation with an assigned preceptor who enjoys working with new RNs. This is always my advice - when seeking a new grad ED position one should look for a department that isn't chaos due to cultural problems or staff turnover and that there is a decent assurrance that the unit is committed to providing a proper orientation. Actually all of this is true for any new nurse on any unit - success in a new position depends so much on what you make of it and the supports in place.

You may know a lot of people who don't believe they belong on a "stepping-stone" unit; I would say the fact that inexperienced or soon-to-be nurses might call med-surg a "stepping stone" is a reflection of the limited scope of their own perceptions and to some extent indicates that they see it more as an obligatory putting in of time rather than an excellent opportunity to lay down a foundation for an entire career.

TBH, my experience is that people who excel as new grads in the ED are the ones who are excited but appropriately nervous about it...usually (but not always) they aren't the ones declaring where they do and don't belong as absolute novice nurses. $.02

You can visit the ED forum and will be able to read various commentary related to this topic. Here is one such thread.

[RotorRunner]

I started in the ED as a new grad. I did my practicum there and was offered a job before graduation. Years down the road as I moved on to leadership roles I oriented a couple of new grads in the ER. Most did very well. There's no reason why a new grad RN can't be oriented to the emergency department with proper guidance and training.

Obviously, you won't be working in triage for some time. That's a particular position that requires a couple years of experience assessing patients.

Congrats on the job and starting out your nursing career! Best of luck.

[Alexx_xox]

Yes, I thrive in that setting. I know it intimidates most new grads, but for me, its where I feel I belong.

[Alexx_xox]

I agree with you on the triage. Working as a nurse apprentice we always had the nurse with the most experience in triage. I would love to eventually be able to triage patients, but I do believe this is a skill that takes a lot of experience and knowledge. I am super excited for my future in the ED. Thank you for your response.

[Alexx_xox]

I use the term "stepping stone" because that is what it is often referred to by instructors in my program. In fact, many of them advocated for students not to stay in a med-surg unit as it hindered their abilities to think on a more critical level. I am not speaking for myself, but what instructors have told us. I have no history on a med-surg unit I have just worked in the ER for a year and a half.

[JKL33]

I use the term "stepping stone" because that is what it is often referred to by instructors in my program. In fact, many of them advocated for students not to stay in a med-surg unit as it hindered their abilities to think on a more critical level. I am not speaking for myself, but what instructors have told us. I have no history on a med-surg unit I have just worked in the ER for a year and a half.

Well your instructors' comments are unfortunate. No one is hindered from critical thinking if they have the mental capacity for it and the desire to do so. On the other hand, it's hard to think critically without a knowledge base - - now I'm not saying that new grads who go to critical care areas don't develop that - of course they do/can. I'm saying that the unit in which one starts out is not the determining factor as far as [lack of] ability to think critically and that the overall goal should be to form a solid knowledge base wherever one is.

[Wuzzie]

I use the term "stepping stone" because that is what it is often referred to by instructors in my program. In fact, many of them advocated for students not to stay in a med-surg unit as it hindered their abilities to think on a more critical level. I am not speaking for myself, but what instructors have told us. I have no history on a med-surg unit I have just worked in the ER for a year and a half.

Your instructors are idiots. Feel free to show them this post. I'd be interested to know how many of them had long illustrious careers as ICU nurses.

FTR: I never once practiced as a med-surg nurse. I went straight into critical care as a new grad so this isn't sour grapes.

[Wuzzie]

I agree with you on the triage. Working as a nurse apprentice we always had the nurse with the most experience in triage. I would love to eventually be able to triage patients, but I do believe this is a skill that takes a lot of experience and knowledge. I am super excited for my future in the ED. Thank you for your response.

Just so you know triage is often referred to as the "penalty box" (we also called it b*^%h-in-a-box) You'll figure out what that means once you do it.

Also please use the quote feature when responding. It makes it easier to follow your responses.

[Wuzzie]

Whether you're a nurse for 2 years or 25, what is YOUR opinion on a new grad starting in the ER?

And now to the actual question.

It entirely depends on the new grad. I went straight into the NICU (this was long before the concept of new grad residencies) and did just fine. To be clear, I had worked as a nurse tech in the unit for a year prior to graduating so I had a head start in time management and other non-tangibles. I did face some hazing and some down-right bullying from a nurse, let's call her Beulah, who did not think new grads belonged in "her" unit. But from a nursing standpoint I excelled and went on to be trained as a transport nurse after I had been there a year which, at the time, was considered an honor. I also did a stint in the ED later in my career. Frankly I don't think ED nurses will care much that you are a new grad (ICU nurses are waaaay more anal and I was one so I can say that) As long as you learn reasonably fast, move fast and work really hard that's really all they care about. Slow nurses are the bane of ED nurses existence. That being said, don't rush your learning. By that I mean if you don't know the answer, the process, the procedure for the love of God open your mouth and ask!!! You may get a short answer but generally that is a reflection of lack of time for long-winded educational sessions not exasperation that you are asking in the first place.

There really is no one "right" place for a new grad to start. There are so many factors that play into it. The new grad, the type of unit, the hospital, the personalities of all involved, the training, the preceptor situation. Really a new grad could succeed or fail in ANY unit for a multitude of reasons. Personally I think med-surg is a fine place to start and an equally fine place to stay and it gets old hearing people, like your instructors, dogging it. If a med-surg nurse can't critically think that's on that particular nurse not the type of nursing they are practicing. All areas of nursing require critical thinking otherwise patients would be dying in much larger numbers and for stupid reasons. Congratulations on your achievement and don't worry about whether you should be here or not because it really doesn't matter. You go be awesome!!!

And Beulah...you can suck it you miserable cow!

God I wish I could have said that to her face back then!!!

[LucyLou88, MSN, RN, NP]

You will hear "seasoned" nurses say a lot of things. They want new nurses to live their personal hell. Nothing you do in a floor will make you a better ED nurse. Learn now..right now, to let everything you hear just roll right off our back. Work hard, learn everything you can, put the patient first, make allies of the providers, be professional and polite to everyone. They will still be saying the same old things when you are the nurse manager of the ED!