I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an Accelerated BSN program. Some of my classmates are starting in the ER.
My clinical instructor and my preceptor killed my chances by giving weak references and using the "everyone needs to start in Med/Surg". But I loved my clinical preceptorship in the ER and another (more experienced than my preceptor) nurse even said I should apply to work in the ED.
I am a 46-yo, ex-accountant, no medical background, but I did have straight-A's in our program.
I started out fresh out of college directly into a Level II Trauma Center ER with three helicopters parked on the roof, but I had a huge amount of experience and felt comfortable doing so. I have to agree with many of those who say the ER or the ICU's aren't the best place to start out in with absolutely no experience, but it can be done. We all know that nursing school doesn't teach you anything about being a nurse. Nursing school begins during the first day of hospital orientation. I don't think you need a great deal of experience before you start, but I think you need some. The first day you work with a name badge with the following initials after your name RN you're afraid you're tying your shoes wrong! You need to be a little settled in before you play with the big boys. Many of the decisions you make in the ER/ICU's will need to be made instantly. Right or wrong you'll need to be able to go with them, and live with them. You'll need a little back before you go there! You're only going to be a new nurse once. Learn how to be a nurse. Please don't break yourself into being a nurse. There's no hurry. There's no rush. Take your time. It's not fair to make others work harder because every time is the first time for you. It will happen no matter what area you start in but it's better suited for a slower environment. Good luck to you in whatever challenge you take up, and I'm sure your decision will be the right one. Remember everyone has to start out new somewhere.
First, I have loved reading everyone's thoughts. I am glad to see that it evoked some strong feelings, because this is a very emotional issue for me right now. When I started this post I struggled with the fact that I did not want to sound like Med/Surg is less challenging than the ER. In fact, I thought my Med/Surg clinicals were 5 times harder than my ER experience.
In the ER, I never had to support someone to the bathroom scared they would pass out on me. I never had to change an occupied bed (although in gero. I did it plenty and got rather good at it). I never had to care for a de-hisced wound while explaining to a (horrified) patient that it would be all right (eventually). To me, the physical demands and the psych/soc are harder in Med/Surg.
I
Not sure where you work, but all the ER's I worked in I assist patients to the BR all the time (and wait outside the door praying they dont' fall or kill themselves or shoot up etc.. I'm not going to wait in the room w/ them)
I change beds all the time, ER stretchers and even hospital beds..where do you think the admitted patients go when there are no more floor beds??? They stay in the ER!!! I've taken care of the same patient in the ER for 3 days in a row on a few occasions!!! A few years back we had 61 "boarders" in the ER I worked at.
It sounds like you want to work in the ER b/c you don't want to do tasks that are associated with M/S nursing, and that is a falacy. Heck you may even have to give a bed bath and feed a patient too in the ER. Perhaps you should reevaluate your nursing career if this is the case (don't mean to sound too harsh)
I knew as soon as I hit "submit" that my posting made it sound like I was just trying to avoid those tasks. That is not at all the case. I just can't stand feeling like the Lone Ranger, like I have always felt in Med.Surg.
I WANT to work in the ER so I can care for the Hispanic mom that brings her kid in because they have no place else to go. I want to care for the middle-aged guy with the toothache who doesn't have insurance because he was laid off.
Get this, I want to care for someone's mom/grandma while the other ER nurses are groaning "not another nursing home dump".
And for the migraine patient that everyone accuses of med-seeking because I understand they have no reg. doc or their fancy specialist really doesn't want to treat them when they are actually in pain.
I even want to care for the boarder patients, explaining for the 20th time why they don't have a room yet, even though they are admits to r/o an MI, which means it is our job to prevent them from coding while they are waiting.
And I know there is not a lot of time to do this, but I really want to see if it is possible to get some of the "frequent flyers" connected with the right resources so the are not coming to the ER when they should be somewhere else.
In some ways, I think I want to be in the ER to care for the patients that other people don't want to be bothered with.
I knew as soon as I hit "submit" that my posting made it sound like I was just trying to avoid those tasks. That is not at all the case. I just can't stand feeling like the Lone Ranger, like I have always felt in Med.Surg.
I WANT to work in the ER so I can care for the Hispanic mom that brings her kid in because they have no place else to go. I want to care for the middle-aged guy with the toothache who doesn't have insurance because he was laid off.
Get this, I want to care for someone's mom/grandma while the other ER nurses are groaning "not another nursing home dump".
And for the migraine patient that everyone accuses of med-seeking because I understand they have no reg. doc or their fancy specialist really doesn't want to treat them when they are actually in pain.
I even want to care for the boarder patients, explaining for the 20th time why they don't have a room yet, even though they are admits to r/o an MI, which means it is our job to prevent them from coding while they are waiting.
And I know there is not a lot of time to do this, but I really want to see if it is possible to get some of the "frequent flyers" connected with the right resources so the are not coming to the ER when they should be somewhere else.
In some ways, I think I want to be in the ER to care for the patients that other people don't want to be bothered with.
Evelyn2003,
You did it again! You flushed the toilet on yourself. You're circling the drain. How dare you imply that ER nurses give anything less than the best possible care they possible can for each and every patient we see. Day in day out we refer these chronic patients to the clinics, free services, veteran's...We can't force these people to do something they can't or don't wish to do! Most can't afford to do the simplest of things such as getting across town to that Vet's Clinic. How dare you sit on your thrown and suggest that your friends, coworkers, and people you don't even know are sitting on their butts goofing off and not taking care of their pt's because they don't wish to be bothered. What scares me is you honestly believe you're going to come downstairs and save the day with your Superman Cape by doing something we all haven't tried to do day after day year after year. Honestly, I hope to god you have the solution to fix this wrong, but you should have the answer in your hand before you come bouncing through the ER doors shouting how worthless we all have become.
Yeah, you pretty much got your leg in your mouth right up to the knee at this point. It all well and good to want to do all the things you say you want to do...bully for you....but, when you have been in the ER for awhile, and you have seen that same 24 year old hispanic mom comes in with 7 kids for the 7th time all with sniffles, and the meth addict come in for the 10th time with tooth ache from meth use tooth rot, and an LTC facility sends in a patient whose demise is imminent because the family has decided they just can't lose grandma so do everything you can to save her shriveled body! Come back then and gush with your "I want to save the world" attitude.
ER nurses don't have a "I don't want to be bothered" attitude, for the most part. Anyone that comes to ER only wanting the "good" stuff needs to go somewhere else, cause the reality is that sometimes you get the minor stuff. And anyone that comes to ER thinking that THEY are going to be the ones that change things in the ER, better come down off that cloud nine and back down to the real world.
Some people can't and won't be educated as to proper ER use. Some people have no other choice but to come to ER because they can't afford to go to a regular doctor, so they come to ER because they don't have to pay upfront.
I don't mean to sound mean evelyn, it's all well and good to have wishful thinking, but listen closely to what others are telling you.
No way am I saying that ER nurses don't provide the best care and that I am going to be any better than anybody else. In fact, I know that I will never be as good as people with so much more experience. I have been astounded at the amount of knowledge and responsibility that nurses have and the stamina that it takes to do all that they do.
I am TRYING to say that I understand that it is not all glamour. But I have heard the very attitudes I wrote about and I won't pretend I haven't, but it may just be the few people I have worked with. I don't believe in criticizing other nurses because I know until you walk in those shoes, you don't know what you are talking about.
BEFORE I went to school, what I heard from nurses was, we need extra hands, and if I can handle some of the load that maybe isn't the most glamourous, then LET ME.
I am glad we finally got out in the open though, an attitude that breaks my heart and does make me question why I left my whole life behind because the cry went out "we need more nurses" and I wanted to make a difference with the rest of my life.
Instead, when I get here, I get "who do you think you are?" I did not expect the "we won't accept you until you have paid your dues" attitude. I makes me sad, but it won't make me quit before I am even started.
I used to be an ER "snob" I thought we were "the most important" kinds of nurses (I'm not projecting here, just talking about me:rolleyes: )
I went to LTC because of a weekend double "Baylor" program. I'd have to say after 6 months, it's just as hard as ER nursing, AND I don't have a doc to back me up (in the facility) In the ER, I could bring a patient back to a room right away, and a doc takes it from there (as far as the kind of workup, and which direction(s) we will take with the patient). My liability essentially ends there. I return to triage, and fight the masses!
In LTC, I and the LPNs (w/ much CNA help also) make the decisions. Sure, we can call a doc, but if we don't play super advocate (or salesman) to sell what WE think is going on w/ the patient, we are the fall guys!
When in doubt, send. And to the ER nurses that curse me when they get my LTC patient, (you know who you are, I was one of them - I was the king of calling LTCs and chastising a nurse for any number of things when I was in the ER) (Though if you don't call report and send paperwork, then the ER nurse should be angry, and should give feedback to the LTC nurse, as not calling report is RUDE, period!) kiss my patooty
Anyway, last week, I had to hang TPN for the first time EVER. I called two good friends who were working that night, in 2 separate ERs about any advice they could give me. Neither had ever hung it before. I was ON MY OWN. At least when I hung Nipride for the first time as a new grad, I had MANY resources from which to choose, and all were glad to help! (no veetach, contrary to your belief, this does not "bring the ER down" as I would later help them with an IV that she/he may have missed, or do a discharge, you know, teamwork:roll )
From this perspective, I'd say that a new grad RN or LPN doesn't belong in LTC right out of school. 1 year ago I'd have laughed at that statement, but now...
Maybe a CNA that was at the same LTC facility in which she/he wanted to then work after graduation, and then if, and only if, she'd have gotten some intense training as a CNA (helping w/ dressing changes, etc.) could do it right out of school.
As a new grad in the ER, I had at most, 6 patients (minor ones), but usually 2 or 3. In LTC, an LPN could have as many as 25 patients!
You do the math!
Keep it humble guys, we are ALL important nurses, no matter where we practice.
I'd likely run screaming from a maternity ward, and I used to be "super nurse:roll "
This is not about new grads in the ED, but just about my story coming in to nursing. Now that everyone thinks I am an idiot.
I am not thinking I am Superman out to save anything. Nursing school to me was leave my ego and my self-esteem at door. Everything I ever knew is now useless. Whatever I was good at, forget it doesn't matter anymore. Superman ate his cape a long time ago.
Accountants are not known for their hearts, so you probably don't think I have one, but I know I have one, and that includes not wanting to offend anybody, so I apologize if I did. "don't want to bother with" was WRONG.
I have said enough, and besides it is hard to talk with a mouth full of foot, knee, ...
it is rather obvious that EVERY type of nursing requires its own strengths!! i don't think anyone here has stated otherwise.....but the one thing that the ER does provide that many (but not all) other areas of nursing do not is a HUGE SICK DOSE OF REALITY - we see more s#%& than anyone from death to drug abuse to very sick elderly to you name it... it does make us a little more harsh, a little more forthright, but it doesn't mean we don't care - or that we aren't providing the best care possible....different situations just call for different measures..
This is not about new grads in the ED, but just about my story coming in to nursing. Now that everyone thinks I am an idiot.
I am not thinking I am Superman out to save anything. Nursing school to me was leave my ego and my self-esteem at door. Everything I ever knew is now useless. Whatever I was good at, forget it doesn't matter anymore. Superman ate his cape a long time ago.
Accountants are not known for their hearts, so you probably don't think I have one, but I know I have one, and that includes not wanting to offend anybody, so I apologize if I did. "don't want to bother with" was WRONG.
I have said enough, and besides it is hard to talk with a mouth full of foot, knee, ...
it is rather obvious that EVERY type of nursing requires its own strengths!! i don't think anyone here has stated otherwise.....but the one thing that the ER does provide that many (but not all) other areas of nursing do not is a HUGE SICK DOSE OF REALITY - we see more s#%& than anyone from death to drug abuse to very sick elderly to you name it... it does make us a little more harsh, a little more forthright, but it doesn't mean we don't care - or that we aren't providing the best care possible....different situations just call for different measures..
Your absolutely correct athomas91, every area of nursing has its difficulties. It's hard to take any nurse out of their specialty and put them into a new one without them having some degree of hardship. It's tough for an ICU nurse to enter med/Surg, and it's equally difficult to put a Tele nurse onto an Ortho floor. There is no superior breed of nurse. ER nurses know a little bit about a great number of things. Med/Surg knows a lot about Med/Surg, and Tele knows a huge amount about circulation. There is no superior breed of nurse.
This thead was one of the best. If nothing else I hope we have dispelled some myths that are most popular among the elite class that most ER people think we are.
I have been an ER nurse for over 20 years. I have worked in urban, suburban, teaching and non-teaching hospitals in over a dozen ERs. Most of my career was spent in one of the ten best trauma centers in the world.
One of the comments that disturbs me is, "We see more of it than anybody else." What a bunch of horse shit. Don't you think whoever brought you those cases SAW them? Don't you think whoever you send your cases to SEES them?
I am about to enter a new specialty. I would like to think that I have made a difference. It was a rare day that I took off my scrubs without the feeling that I had done the best I could under some pretty miserable circumstances. Even in my last week of ER practice I was seeing new things. Whenever I thought I had seen it all, something new would hit the door. God has a pretty good way of teaching humility. I sometimes wonder if I have any more significance than that dirty dressing that I find on my shoe in the locker room.
Evelyn,
Please do not delude yourself that everything you know is useless. I thought so too, when I first started. The longer I practice, the more I am able to use and appreciate the tools that I got in school. What I learned in school was not so much how to do anything but to FIGURE OUT how to do everything. After you are in practice for a few years you will be able to go back to the tool kit you have tucked away in your mind, and apply them to your practice.
Hogan,
If I ever get near Pheonix (we drove through there in October) I will buy you a beer.
I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an 
Speculating
343 Posts
I started out fresh out of college directly into a Level II Trauma Center ER with three helicopters parked on the roof, but I had a huge amount of experience and felt comfortable doing so. I have to agree with many of those who say the ER or the ICU's aren't the best place to start out in with absolutely no experience, but it can be done. We all know that nursing school doesn't teach you anything about being a nurse. Nursing school begins during the first day of hospital orientation. I don't think you need a great deal of experience before you start, but I think you need some. The first day you work with a name badge with the following initials after your name RN you're afraid you're tying your shoes wrong! You need to be a little settled in before you play with the big boys. Many of the decisions you make in the ER/ICU's will need to be made instantly. Right or wrong you'll need to be able to go with them, and live with them. You'll need a little back before you go there! You're only going to be a new nurse once. Learn how to be a nurse. Please don't break yourself into being a nurse. There's no hurry. There's no rush. Take your time. It's not fair to make others work harder because every time is the first time for you. It will happen no matter what area you start in but it's better suited for a slower environment. Good luck to you in whatever challenge you take up, and I'm sure your decision will be the right one.
Remember everyone has to start out new somewhere.