New Grads in the ED (?)

athomas91 · Dec 31, 2003

i started as a new grad in the ed - have been there since - i have worked w/ those that are great right out of school and those that cannot hack i t- but if you are ready and willing to work hard and learn alot - then go for it..... and nobody kills your chances - go to that interview - show them your enthusiasm - and promise them to be a hard worker - and they'll give you a chance.

Trauma Tom · Dec 31, 2003

Do not let this experience change your mind. There are so many opportunities for new graduate nurses look around and find the opportunity that suits you. I too heard nurses say that you should go to med/surg on a floor before going to the ED or to the ICU. My feelings are these are from nurses who may have had to do so years back when there were no shortages. I finished nursing school when I was 48 and did not want to wait two years before going to the ICU as I want to go to CRNA school and did not feel I could afford to wait too long. I worked as a nurse extern in Grady in Atlanta which is a level one trauma center. After finishing six months in the ED I went to the SICU as a nurse extern. I then passed my boards and began my orientation. We have plenty of new grads and so does the ED. My feeling is you can either be trained to work in the ED or ICU or not. It may be beneficial for some nurses to go to the floor first, however, not everyone has to. A lot depends on you. I was told by one ICU nurse that she would rather have a new grad and train her to be and ICU nurse as opposed to getting a nurse after two years because they would have to be retrained to get rid of their bad habits. I do not pay a lot of attention to what most have said. If you think you can hack it in the ED, go for it. At the worst you may have to go somewhere else if you cannot hack it in the ED, but what have you lost in the meantime. Good luck.

veetach · Dec 31, 2003

I will try to stay off of my soapbox, but I dont know if I can do it. LOL

I do not think new grads belong in any specialty area. I have only been out of school for 10 years but I dont think they are teaching any differently now than they were then. We were NOT ready to take on a specialty unit in any form. There is a certain amount of learning a new nurse has to do outside of the classroom. That teaching is always left to the seasoned experience nurses that the new grad works with, and I think a new grad is best precepted in a med surg environment.

I worked med surg for 2 1/2 years after I graduated from nursing school, my experience there was priceless. To this day, I have nurses who have been out of school 2-3 years coming to me and asking how to do standard med surg procedures that they did not learn. Things like maintaining central lines, decub care, peritoneal dialysis, runningTPN, working with G-tubes or J-tubes, etc.

These are all things we did on a routine basis in med surg, and we dont see that often in the ED.

I believe there should be a certain period of learning HOW to be an RN, and gaining some confidence in ones self and ability to perform tasks and learn to think quickly, hence perfecting that critical thinking we were all taught. In most cases, they dont know what they dont know.... no offense intended.

Hospitals nowadays will hire new grads in the specialty units without blinking an eye. they are cheap, and as far as the hospital is concerned, the other RN's will pick up the slack.

I will put the soapbox away now.

:) :) :)

LilgirlRN, ADN, RN · Dec 31, 2003

It can be frustrating working with a new grad in the ED. most things in the ed aren't real emergencies but when they do occur you need to know what to do and how to do it. it's not the new grads fault, its not fair to them to expect them to know how to do things they've never done. it's also unfair to the patients, they deserve experienced emergency care when they need it. i've worked with new grads that i considered naturals in the ed, but they are unexperienced and make mistakes. had a new grad giving an insulin drip at twice the prescribed rate because she made a math mistake and it didnt sound funny to her that the pt was getting 20 units an hour because oh her inexperience. experience is something that needs to be had before working in a busy ed. as long as you have rn behind your name, you are just another body to management, they will try to put you wherever a body is needed. the ed i work in now isnt part of nursing service, which is great, they cant pull from us, nor can they send someone who doesnt know how to work the ed.

veetach · Dec 31, 2003

Lilgirl, I cant agree more. In the last year I have had a new grad RN start a Cardizem drip on a patient at 60 mg/hr, (he miscalculated the drip rate) and another new grad giving Cardizem had a patient brady down into a 3rd degree block and nearly go into cardiac arrest. (She didnt know you have to watch the rate, bp and rhythm when giving Cardizem)

Both of these individuals were off of orientation and functioning independantly in the ED. It is impossible to follow them around and monitor every thing they do. It can be a dangerous situation.

We also had a new grad add Potassium to an IV bag on a chf patient..... 40 meq in 1 liter of NS!!!! :rolleyes:

gaulkari · Dec 31, 2003

I have to agree. It's not that I don't think a new grad couldn't learn its just as a new grad myself I am well aware of the fact that there is a lot I don't know. I think about things like missing a S/S that a experienced nurse would never miss. In a ED, ICU etc the patients can't afford to be someone's first learning experiences. A small misunderstanding or error could mean a life.

Only my opinion however!

Y2KRN · Dec 31, 2003

Hello,

I can tell you that I went to the ED after working the floor for only a year. I went to the floor because that is what I was encouraged to do. I hated the floor, and I love the ED.

I must tell you going to the ED was a big learning curve, I still have much to learn and you do learn every time you work. You have to know a little about everything. I have seen new grads make it and others that wanted to go to the floor.

As advice the others have given you. Depending on your geographical area look for a really good orientation program. I have had to move a lot when my husband was in the military. I got a good start but, had a terrible orientation at my next ED. However, I stayed there two years and just now got a new job in the Ed. I really think part of success in the ER as a new grad comes from the orientation program. I just left a fifty bed ED because there was a mass exodus of seasoned wonderful resource, experienced nurses. I am thankful that I got a job where most of them went. I found it difficult to work in an enviroment where I was senior. There were many issues but, I have to say the one positive thing that came out of it was I found that I could hold my own and tread water when all of the resource people were gone. But, there has to be a very good blend of newbies and nurses that have been doing ER nursing for a while.

I welcome the new grads but, you need the experience in the ER as well!!! Ask those kind of questions, when you interview. It is a great time to be a nurse and you do what is in you heart!!! Follow that lead and you will do just fine.

Good-luck and Congrats on graduating.

Y2KRN

New CCU RN · Dec 31, 2003

So I guess that a med surg unit where you get a brief orientation, care for anywhere from 6-10 patients with often a very high acuity, are often put in charge much sooner than an ER or an ICU is a better environment.

I think the issues that we see are the realities are nursing education these days as well as healthcare's state and are blamed on the new grad. It isn't the inexperience that someone didnt find an Insulin gtt or a Cardizem gtt at such alarming rates to be dangerous...that fault in my humble opinion lies on the educators NOT the new grad.

Just my opinion.

veetach · Dec 31, 2003

>>I think the issues that we see are the realities are nursing education these days as well as healthcare's state and are blamed on the new grad. It isn't the inexperience that someone didnt find an Insulin gtt or a Cardizem gtt at such alarming rates to be dangerous...that fault in my humble opinion lies on the educators NOT the new grad.

AND those educators are no where to be found after graduation. The new grad is a licensed nurse, just like everyone else. The job of watching these new grads ends up in the lap of the experienced nurses in the dept....

Another problem lies in the fact that a new grad does not know, what they dont know. They are excited, exuberant and ready to go! Critical patients in the ED or ICU/CCU are not who these nurses need to be learning on.

BTW if your med surg unit has a ratio of 6 patients to one RN you should jump at the opportunity!! When I left med surg nursing in 1997 we had 12-14 patients per RN.

LilRedRN1973 · Dec 31, 2003

What are your thoughts about a nursing student who is working in the ICU for a year and a half BEFORE they graduate nursing school? Do you think that student would be able to start working in the ICU as a new grad? I ask this because I just started working as a Nurse Apprentice and although as of right now, I can't do much in the way of patient care, I'm being exposed to all the different lines, drips, monitors, etc. that occur in the ICU. I want to remain here all through school so that when I do graduate school in May 2005, I will be able to do my job as an ICU nurse without having the more experienced nurses take up my slack. That being said, I know that there is a LOT I will have to learn and a LOT I will have to experience for myself. But I wanted to get your opinions on a student who works in the ICU while in school before being released on her own after graduation. :rolleyes:

LilgirlRN, ADN, RN · Dec 31, 2003

ya'll excuse me, i have a broken arm, hard to type, so no caps. i think its wonderful that you work in an icu and they are teaching you things. yes, i think you will be able to work there, not only are you learning there, you are forging bonds. having friends that you work with helps you to learn by their example.

now to the other post that questioned taking care of 5-6 med surg pts vs working in the ed as a new grad. any pt can go bad, but most on med surg are stable and for the most part you know what is wrong with them. you never know what is comiing thru the door in the ed. i routinely take care of a pt with cardiac chest pain, a pt with copd and sats in the low 80's who is not a dnr, a woman with pid, and a child with a temp of 104.5 all at the same time. i am acls and pals certified, a new grad isn't. i have nothing against new grads, in fact i love to teach. the fact, thats what new grads do, they learn, nursing school is like high school and your first few years out of school is akin to college. nursing school gives you an idea of how to be a nurse, working as one makes you a nurse. consider it on-the-job training. they call er nursing a specialty for a reason. even doctors have to become doctors before they can become specialized.