New Grad hired in the ER, question.

Alexx_xox · Jan 15, 2018

This is an interesting post. I am still a nursing student but I have interest to work in critical care but was told I would have to work in med-surg first. I have nothing against med-surg and am willing to work in almost any unit for that first job but if the opportunity comes to work in critical care right after graduation I am pretty sure I am doing it!

If you know you want to do critical care, then I say go for it. While working as a nurse apprentice I knew I was meant to be in the ER and thats where I am staying. I also have nothing against any other unit and respect the work done amongst all team members in a hospital, but I know what my heart desires. Don't let people's negative comments make you question what you love and what you want. Regardless of people's responses in this post, I am still going to continue on with my new grad position in the ER, I was just interested in other people's opinions. The opinion's of others would NEVER change my mind, but it is nice to see what others think. I also do feel like people who started in straight med surg vs critical care have this complex where they feel EVERYONE should do their time because THEY did their time. I dont fully agree with this myself. Do what you love ALWAYS!

Alexx_xox · Jan 15, 2018

I know two nurses who started in ER as new grads, and it was a perfect fit for them. :) They both had EMT experience. Best wishes to you!

Thank you so much!

Alexx_xox · Jan 15, 2018

I'm a ED nurse that started in the ED as a new grad. I couldn't imagine doing anything else. It's tough but possible, especially if you have a good team!

AGREED! I love my team so much in the ER, we all rely on one another. Night/mid shift always seems to have team work down very well.

Alexx_xox · Jan 15, 2018

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!

I have very thick skin, Im not afraid of people and their comments LOL!! I have an Italian mother and I was raised in Chicago, it takes a lot to hurt my feelings.

Also, I am a very hard worker and know that I can put in the time necessary to learn what I need to learn. I am humble enough to know I am not perfect and that, with time, I will be a great nurse and future teacher to other new grads.

Alexx_xox · Jan 15, 2018

I'm a long term ER Nurse who worked about a year in a step down unit before I applied to the ER. Did that experience help me? Not much to be honest. Every job has its own discrete qualities and duties. I've worked with bad ER crews and good ones and there is something to be learned for both of them. The ER lives on teamwork. When I was on the floor I watched nurses let new nurses "drown" with the excuse that this would teach them something. Any decent ER nurse will not allow this to happen. Always help your colleagues and in turn they will help you. Experienced ER Nurses who have not become jaded will know that it is their job to help develop a new member of the team who will be called on the future to help with patients and develop yet new members. Be humble and helpful and pay attention. Hold on it should be a fun ride. Good luck!!!

Thank you so much for your advice. xoxo

turtlesRcool · Jan 15, 2018

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 were, pardon my bluntness, idiots.

I vehemently disagree with anyone who thinks med-surg is only worthy to be a stepping stone.

Med-surg is a great place to get a general overview, which is why it's so often recommended to new nurses. It CAN be used as a "stepping stone" to other areas, but I think that's because a busy med-surg unit will give exposure to a variety of different disease processes, and require both critical thinking and time management.

Additionally, with patient populations getting sicker, and resources getting cut, there are few med-surg nurses who don't get their share of patients who honestly need a higher level of care.

When ED doctors do a sloppy job admitting patients, or a patient takes a turn for the worse, guess who spends the next shift assessing the patient and advocating for him/her? That's right - the med-surg nurse. Several times, I've had patients who were REALLY sick and inappropriately placed on my floor, and it's taken basically the whole day to get them transferred to stepdown or ICU. And when the patient finally leaves (usually after my shift or at the very end), I've spent 8 or 9 hours caring for someone who should have been a 1:2, but I've done it while also being responsible for 4 or 5 other patients. I promise it's not a lack of critical thinking, but a lack of time and/or equipment that hinders my ability to give these patients (and the rest of my load) the care they need.

Now, I've only been doing this for a few years, so maybe I'll change my tune somewhere down the road, but I feel like one could spend a whole career in med-surg, and still be learning new things. My med-surge colleagues with 20, 30, or even 40 years at the bedside have not wasted their career or their intellect. I'd wager most of them have a wealth of knowledge that far surpasses new grads in the ER.

Tacomaboy3 · Jan 15, 2018

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.

As long as the unit has an excellent training program with excellent preceptors, and the preceptee is a quick study, has tenacity and solid newbie clinical skills, then have at it!

I would argue specializing in emergency nursing, though, isn't necessarily the same as critical care nursing. Sure, you'll take care of critically ill patients, but that likely won't be the norm.

Alexx_xox · Jan 15, 2018

Your instructors were, pardon my bluntness, idiots.
I vehemently disagree with anyone who thinks med-surg is only worthy to be a stepping stone.
Med-surg is a great place to get a general overview, which is why it's so often recommended to new nurses. It CAN be used as a "stepping stone" to other areas, but I think that's because a busy med-surg unit will give exposure to a variety of different disease processes, and require both critical thinking and time management.
Additionally, with patient populations getting sicker, and resources getting cut, there are few med-surg nurses who don't get their share of patients who honestly need a higher level of care.
When ED doctors do a sloppy job admitting patients, or a patient takes a turn for the worse, guess who spends the next shift assessing the patient and advocating for him/her? That's right - the med-surg nurse. Several times, I've had patients who were REALLY sick and inappropriately placed on my floor, and it's taken basically the whole day to get them transferred to stepdown or ICU. And when the patient finally leaves (usually after my shift or at the very end), I've spent 8 or 9 hours caring for someone who should have been a 1:2, but I've done it while also being responsible for 4 or 5 other patients. I promise it's not a lack of critical thinking, but a lack of time and/or equipment that hinders my ability to give these patients (and the rest of my load) the care they need.
Now, I've only been doing this for a few years, so maybe I'll change my tune somewhere down the road, but I feel like one could spend a whole career in med-surg, and still be learning new things. My med-surge colleagues with 20, 30, or even 40 years at the bedside have not wasted their career or their intellect. I'd wager most of them have a wealth of knowledge that far surpasses new grads in the ER.

I honestly applaud you for all the hard work that I know you are doing! Here where I live we do not have nurse to patient ratios, so sometimes our med surg nurses can have up to 9 patients and I know that takes a special type of someone to be able to handle that amount of work.

Im sorry if you didn't like the term stepping stone but as I stated, thats often what is was referred to as in my program. We only know as much as we hear/learn as a new grad.

AnnieOaklyRN, BSN, RN, EMT-P · Jan 15, 2018

This isn't a yes or no question. It all depends on the new grad and there personality and experience.

Annie

ayysolapsu09 · Jan 15, 2018

I have been a nurse for a grand total of 7 months, and have been working as an EMT for 4 years while going to RN school. Most of my instructors thought I would end up in the ED because of my pre-hospital experience. I personally thought differently, and opted to work on a med-surg floor. My intangible goal was to be as well-rounded as possible, with a more concrete goal being able to handle a full run of 5 patients for 12 hours. I'm still working on that, but I am certainly doing much better now than I was when I started. Due to some unforeseen circumstances, I am moving to North Carolina to work in a small ER in the Asheville area.

Right now I am extremely excited about the move, but I definitely wish I was still working more Med-Surg. While working EMS, I realized that I would be dealing with the same patient population in the ER as I would be if I was in the field. I also realized that my understanding of longer term patient care would be limited by the shorter interactions presented in the ER. I am further conflicted by my possible master's routes (NP vs NA) which I need to examine on a much closer level. I knew that I would be moving at some point during RN school, so I decided that the best course of action for me was to help my resume and get some general med-surg experience, advance onto critical care experience once I had a handle on the basics, and advance onto whatever choices made the most sense for me when the time to make those choices arrived.

I can safely say that I lacked no shortage of critical thinking in the med-surg department; many times orders were put in that I had to think about the orders and the safe and proper implementation of the orders in regards to the patient presentation. What's more is that there were some clinical decisions about contacting the physician that had to be made; I didn't have the luxury of an MD at my hip, as they usually are in the ED. When I asked my doctor a question, it had to be important, and I had to make sure I covered my end as completely as possible before contacting them (nothing sucks more than calling a doctor with half the information on hand, I feel like a jackass when I do that, esp. at nights when there is only one hospitalist for the entire hospital). I also have to rule out what I can rule out on my own before contacting an MD (ex. blood sugar for stroke mimics).

I don't think I lack the critical thinking experience; it is certainly not as deep as an ICU experience, but it is challenging in its own right. I wanted to run as a PHRN in PA, so that meant that I could do whatever I wanted and still satisfy my pre-hospital itch (no more I think, that doesn't exist in NC unfortunately). Would I have gained as much out of a 6-month stint in a CC unit? Maybe. But I know I milked out as much as I could in my own department. In that regard, I think new nurses can work wherever they want, but what matters is that they want to work there; I don't want to work with a nurse who doesn't want to be there. I knew a few of those, and it's depressing and demoralizing. Enjoy what you do, or find something you like. Anyone who doesn't like it can pound sand.

Alexx_xox · Jan 15, 2018

Totally agree with you, do what you love, ALWAYS! That is definitely my motto.

llg, PhD, RN · Jan 15, 2018

I think it depends not only on the new grad ... but also on the particular ED or ICU. Some ED's/ICU's have been hiring new grads regularly for a period of several years and have orientation programs appropriate for new grads AND support systems in place for new grads. Those units are prepared for new grads. Other units don't have those support systems in place -- and may even have unrealistic expectations for any new grads they hire.

Avoid the units that do not have the appropriate supports in place. But if the unit does offer the appropriate support, I see nothing wrong it.

llg (started as new grad in NICU many, many years ago with no experience and no problems)

New Grad hired in the ER, question.

Should new grads be able to start in a critical care position?