New Grad thinking to start career in the ER

EDGRADNURSE · Jun 22, 2006

Hi,

I started in a small, community hospital's ED (40,000-50,000 visits per year) as a new grad. Had a great orientation (ENA modules plus 3 months w/preceptor).

Personally, I found it overwhelming to learn basic nursing skills in an ED. Per my choice, I decided to switch to telemetry. I'm just as busy and it can be just as overwhelming. However, I DO have more time to hone my organizational skills and learn more pathophys, cardiac rhythms, etc.

I don't regret my decision but I miss the ED and hope to go back one day. When I do, I will feel more comfortable performing skills quickly.

But just because I felt this way, does not mean that you will. A fellow new grad with little experience absolutely thrived in the ED. She loves it and does not want to do any other type of nursing.

Go for it. The worst thing that can happen is that you decide it isn't right for you at this time and move into another area (for keeps or to go back at some future date). You have nothing to lose and may end up really liking it.

I graduated in 12/05 and several of my fellow classmates have already switched jobs in order to find their "niche". Not failure--just making different choices.

LeesieBug · Jun 22, 2006

Well, I'll let you know how it goes for me. I start the first week of July:uhoh3:

I am a LITTLE wary because I didn't really choose ER, it chose me:mad: I chose my first workplace based soley on the facility...I wanted to be somewhere that was a positive environment. During school I learned that I can handle any type of nursing, if I am working with a welcoming, supportive group of professionals. SOOOO, they wanted me in ER and felt I would do well, fit in well there...so off I go.

Good luck in starting your career!

JMBM · Jun 22, 2006

It depends, it depends, it depends. I also went right from school into an ED, albeit after a long time as a medic. I cannot count the number of sleepless nights (or days) I had, hauling out the textbooks and trying to catch up with what I'd discovered that day I didn't know. One of the co-workers who did the same thing relates how she stopped on the way to work every day to throw up. There is no doubt that there is a very, very steep learning curve right out of school regardless of what department you join and, in an ED, there is not alot of time to learn. Now, that all being said, if your facility has a good internship program that includes several months of preceptorship, that will make all the difference. Try to talk to some "grads" of the program to see how they are doing. If it looks good, go for it. A good program will make sure you have your legs under you before they set you loose. ....just be ready for a few sleepless nights.

gonzo1, ASN, RN · Jun 22, 2006

If you are a person who doesn't take criticism personally, are able to roll with the punches, and have a very thick skin then try the ER. Make sure they have a very good orientation in place. My ER does not have orientation really, you just hang with a preceptor for maybe three weeks. If there is any unit that eats their young ER is right up there at the top. That said I did not go there as a new grad but heard many nurses tell the new grads "you don't belong here" If you are a person who needs to work in a warm fuzzy environment don't start in ER go there after you have a chance to hone your skills on med/surg. PS: I love the ER and am always nice to the new grads.

vampireslayer · Jun 23, 2006

I went right into the ER after graduating, but my hospital had a pretty good, long internship. I wouldn't do it without a really good internship, with a hospital that is used to accepting new grads into the ER.

Yes you will have people you work with stating that new grads don't belong there. Oh well. Get over it.

And yes you will feel overwhelmed, and underprepared. There are so many little things to learn, in addition to the big things. Things that were difficult for me were silly things like what patients should I go to the docs with, and which ones should I just leave in their rooms for the docs to get there when they get there. Some are obvious of course, but others...I just didn't want to "bother" the docs.

We also are supposed to begin the process of ordering labs...the docs add to what we've started, but we are supposed to know or have an idea of where the particular symptoms are pointing...should I draw blood or just a chest xray for the asthma patient? What if it's not just asthma though? Should I do a CBC & a CMP for the person with the fever, or is this one that the doc will say "flu" and not want anything done? I didn't want to look "foolish" by over-ordering, or by doing nothing! Get over the fear of "looking foolish", it eats up way too much energy!

I used to cry in the car on the way home, because of the way my preceptor yelled at me, pushed me HARD, told me how many things I'd done wrong, expected so much of me. Sometimes even now, almost a year after I started, I get that teary eyed feeling after work because I'm TIRED of feeling stupid and new!

If you don't mind feeling stupid & inadequate, and you're willing to put yourself through about 6 months of hell, emotionally that is, and another 6 months of ego-bruising loss of self-confidence...then go for it. It's tough, and a HUGE learning curve because you have so much other stuff to learn in addition to ER protocols...but if you go in with the attitude of "I can put up with anything for 6 months" you'll be okay.

Good luck!

VS

Trauma Columnist · Jun 23, 2006

I just quit the ER after 10 years and I already miss it terribly. I worked in a very busy (65000plus visits/year) level one trauma center. I went there with two years RN experience. It is a place that is very autonomous, fast-paced and chaotic. With a solid orientation (12-16 weeks) plus a mentoring program for an entire year you can do it. Just don't short-change yourself. You will not know everything in a year...you will then know what you don't know! lol However, with a sense of humor, lots of extra work studying and the willingness to ask for help, you can do it.

Good luck...

Jennifer, RN · Jun 25, 2006

I worked 5 years on a tele floor, and when I transferred to the ER, I felt like I was a new grad. I felt like even the simple things like inserting a foley, which I had done many, many times was foreign. I felt so out of place for the first 6 months, but at least I was ACLS certified and had some solid RN critical thinking experience behind me. I can not imagine how hard it must be for a new grad to start in the ER. You are taking care of very ACUTELY sick pts and need to have the experience to differientiate between sick and REALLY sick. Sometimes it is not so easy. You will need to know how to interpret labs. You will need to be able to pick through the pts that are truely in pain and the pain med seekers (this was hard for me at first). You will need to have a thick skin, because the doctors and PAs are not always nice, but you have to work with them daily. You have to be able to leave your job at work, do not take it home with you. Find some good resources and use them!! Good luck!!!

tramalady45 · Jul 1, 2006

I'm a 46 yo male, new grad, thinking of starting my career in nursing in a very busy ER. I have no experience accept for clinicle through school and a summer extern program. I ran a very busy business for 20 years so I know what hard work and long days are like. I would like to hear from any past new grads that started right away in the ER and if its the right move. I'm worried that I dont know enough, and do not want to fail in my first assignment.I'm hoping to hear some positive encouragement or not. Any insight will be greatly appreciated.
Thanks,George

I say go for it. I started fresh out of school with zero experience in hospitals at all other than our required clinicals. I work in a level 1 trauma center, we see 100,000 + patients per year and we are constantly running. I hated the ER in school and actually said that I would NEVER work in the ER and I got called for an interview and decided to try it out and I would never want to work anywhere else now. I absolutely love it. try to have a good sense of humor. Don't forget to laugh, don't take things to personally, really make an effort to find out who your strongest players are and utilize their knowledge, don't be afraid to admit that you don't always have the answer, don't be afraid to cry over a patient in front of their family,they will remember you for it and appreciate you for being human and truly caring for thier loved one, or don't be afraid to hold a patients hand while they are dying, don't be afraid to try new things, don't fear starting IV's in a really weird place ( my weirdest was a lady's nipple....) and remember the patient assumes that you have lots of experience so just relax and breath and be confident and they will never know the difference. Don't hide from the hairy scary stuff like a traumatic full arrest or peds codes because you need the exposure and the knowledge and it will thicken your skin, and above all, never forget how hard you worked for this and why you are doing it. There will be days you regret it, days that make you question your faith and days that make you truly believe in a higher power. Savor them all as they are all a part of what makes our job so beautiful. Good luck!

PammyRN,CEN · Jul 1, 2006

Hi Just wanted to share my story with you. I started my career out in the er,, they had a skeleton crew so I was thrown to the wolves after 5 weeks of preceptorship. one week of that was classroom time, so for 4 weeks I got 3 12 hr shifts of training and that was it. I felt overwhelmed, scared, incompetent(even though I knew that wasn't true). I felt as if everyone knew the drill except for me. Felt much like a fish out of water, it was really uncomfortable, having the trauma rooms assigned to me used to scare the crap out of me.. I felt like quitting, but encouraged myself to hang in there, and so I did. I Love emergency nursing.....sometimes things come in that still make me almost go into SVT but I just take a second and remind myself that all I have to do is call out that I need some help and they always come...that is the glory in working in the er if ya need a DR. you can just call out that you need a Dr in here and there they are.

Anyway I might add you need acls, pals, some offer internships with classes in critical care..all of that stuff helps.. I have been in the er since graduating in 2004 and I love it and can't imagine ever doing anything else. I have taken the CEN exam and CCRN exam and probably have stupid stamped on my forehead as I took the charge nurse position in our ER.

Good Luck to you .. and just try to hang in there if you experience any of the things that I talked about...."this to shall pass".

Pam

Martibear · Jul 2, 2006

Hi! I graduated from nursing school in May 2004, went straight to the ED, worked as a GN for 7 months, had a baby, passed boards, now I'm still in the ED. I couldn't see myself anyplace else. ( well maybe the other night I wish I wasn't and ED nurse) Check with the hospital, maybe they will let you shadow a RN for a day or 2 to get a feel for it. I love it, don't regret a thing! GO FOR IT. If you hate it you can always do floor nursing, OR, MD office, so many options! Best of luck to you!

Granted Fal · Jul 3, 2006

I was/am a new grad in an ER in Colorado that often sees upto 350 pt's per night, the thing you want to realize is that the ER is also an urgent care center for people that don't have insurance and that the really sick people are probably about 3-5% of the incoming. You won't get shoved into traumas like they shows on t.v. as a newbie and if you do, you'll probably being doing tech scut like IV's foley's etc, which the experienced RN's do anyway. It's basically alot of IV's and IV med pushing, so knowing your meds is crutial. I had a really rocky start with a moody pregnant preceptor that wasn't reliably there, as a result I got shuffled around and got to see many approaches. The thing to focus on, depending on your ER is what is their goal? PT satisfaction? Throughput? etc. All I really care about is pt care so I try to provide the best I can, if a Dr. reams you for spacing out on labs needing to be done or you find yourself drowning because you have three ambulances coming in at the same time and you call for a float and no one comes and your tech abandons you or gets pissy with you etc...... then you just realize that all the other RNs are getting screwed the same way... so relax! Prioritize, and if your pts aren't dying, you're doing the right thing....

Seriously though, we have a chest pain center and I do still feel underqualified to be in there with many of the drips we hang, and when the code begins, you'd really like to feel solid, but this comes with experience. I suggest to study your butt off till you feel confident in getting up to speed with the things that come through your station time and time again. I ask and you should ask tons of questions, usually the docs in the ED are really cool, unlike some on the floor I've heard, and they'll tell you where they are going with their tx plan. Some don't, but oh well.... I like best the autonomy and the fast pace. So if that scares you, it should..... hope that helps.