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 just graduated in June of 03 and had my job in the Emergency Department before I graduated contingent on me passing boards. My manager told me that she loves to hire new grads based on the fact that we get trained for the ED not trained for a Med Surg Unit. We also get 6 months of orientation. We don't take ACLS, PALS, or TNCC until the end of our orientation or for up to 6 months after we are off of orientation. I know I am new not only to this forum but to nursing but some of the replys were harsh on this subject. I don't start any drip or give any IV medication without double and triple checking myself and most of the time I have another nurse check it also. I work in a small ED. We only have 16 beds and our other hospital ED has 15 but they are considered Level III trauma where as our hospital is not. New grads if they are willing to learn and want to learn are great in the ED. Granted alot of new grads need a year or so of med surg experience before going to ED but not everyone.
You have said what I have been telling not only people that I graduated with but other nursing classes. I have to agree with what you have said 100%. Go after your dreams. Don't go somewhere where you won't be happy.
Originally posted by Scis
ER's are ER's. No amount of med/surg. prep will prepare one to be proficient in the emergency room, anymore than thinking that OB/GYN floor experience is necessary due to the amount of "outside" deliveries that happen in the ER. It is a specialty area that requires much expertise, however, I do not agree that
there is no place for eager, willing new graduates. Let's face it,
"tasks" like mentioned in one of the posts are just that, "tasks".
With training, ANYONE can perform those tasks. You don't have
to be an experienced RN to do them. What is necessary in an
ER, especially a busy one such as the Level I, Level II trauma
centers are nurses that are eager to learn and are not afraid to
ask questions of seasoned ER veterans. The attitudes posted
don't seem like new grads would be comfortable with asking for
assistance from them. The new nurses must be aware that they
can ask for help with anything, and those managing the nurses
need to know their capabilities at the present time and what they
need for the future. Don't "eat the young", help them mature
into the specialty they feel fits them.
I started in a Level I urban trauma center right after I graduated
from nursing school as a GN, before I even sat for the state boards. I was hired because I told them that was the only area
I wanted to work in the best hospital in the area. I learned all
I could to specialize right from the start, ACLS certified by one
year, PALS by two, along with Trauma Nurse Cert., then sat
for the Emergency Nurses exam two years after being in ER
Nursing. I knew it was what I wanted, I went for it, I had
excellent mentors who I felt comfortable asking anything I
needed to ensure patient safety, and succeeded. I wouldn't
want to see anyone discouraged from what they feel they want
to do. I've been at it for ten years now, just accepted a
Clinical Coordinator position in a slightly less busy ER, but I
could not envision working in any other specialty area.
There is one crucial area that I have learned in ER in the last 1.5 that I didnt know after graduating..GET SOME GOOD SHOES! YOUR FEET WILL apreciate them!
You watch too much tv...and although you obviously have a big heart, I think you are a little naive. The Hispanic mom that brings her kid in? Come on...
LOLOLOL MishlB, true true true....:chuckle time does have a way of opening our eyes, doesnt it?
Hi! Have had computer problems and haven't been able to post for a while. I'm so happy to be able to participate again!
I just wanted to add my testimonial to the group of real life "new grads" that started in the ER. I graduated from nursing school in 2002, at age 40, and started in the ER. Its not what I pictured myself doing when I decided to start a career in nursing, but I have been successful. Its the absolute best "job fit" I have ever had in my life - and I have been continuously employed in various types of business/managment/sales situations since I graduated from college in 1984 with my BA. BUT, I didn't just fall into it right after graduation....I did alot of "field research" first. Before going to nursing school, I quit my well paying job and took a job as a nurses aide on a med/surg floor. Also worked as a "tech" on a Cardiac/tele floor. One day I was "forced" to float to the ER as a nurses aide....and thats when I discovered that it fit.
I am one of the first to say that not all new grads belong in a specialty care area. You have to have alot of initiative, maturity, and people skills. Most of all, you have alot of learning to do and that requires alot of hard work above and beyond what may be expected of new grads in some other areas. My hard work started before graduating, as used my employment positions to learn, watch, and acquire as many skills as I could before I hit the floor as an RN. I did not do anything that would be unacceptable for an unlicensed person, but what I couldn't do I watched, questioned, read about, and assisted with whenever possible. After passing my boards and accepting a job in the ER inwhich I had served as a tech, I continued to do my homework and study
as if I had not graduated from school. I gained ACLS, ENPC, and TNCC certification within my first year. Next month I will sit for the CEN exam. It takes a special combination of academic preparation (or home study), practical work experience, critical thinking, and humble discipline to succeed in this specialty - in my opinion. Most importantly, "no man is an island unto himself" and you need the support of your team and mentors.
If you really want it, go for it! Be prepared that you will never learn all that there is to know, and that you will never be immune to making mistakes. Atleast, thats the way its been for me.
By the way, I am moving from a busy level 3 trauma center and starting a new job in a level 1 trauma center this week. So here goes a "new grad" into another level of challenge....facing new unknowns, new fears, new learning, and probably new mistakes.
I can only hope it goes as well as my first year has gone.
As a new grad hired in the ED 8 years ago I am glad that my director wasn't as closed minded as some of you. You can't make judgements across the board, it all depends on the individual nurse and the orientation program set up in the ED. I worked my butt off and my ED put me through TNCC,ENPC,ACLS and a 10 week Critical Care class. I was the first new grad they ever hired and with alot of dedication on my part and a great preceptor I am now an important part of my ED. I have seen new grads hired since and some have made it, some haven't but it depends on the individual. As far as central lines, and all that- do you forget that most of the patients the floors get come through the ER!!! We see it before you!! THere are things that are seen in the ED that med/surg will NEVER see. We deal with all ages, all problems, and ALL areas of nursing combined- you can't get that experience on a Med/surg floor!! Procedures are task oriented- you can be taught that in the ED . THere are actually more oppurtunities to learn in the ED! Do you think we don't do dressing changes? Alot of stuff we do and send home before it even gets to you! As far as mistakes, seasoned nurses do it to- I have a pt the other night that had a 14 year ED nurse give 3 times the max dose of Dopamine to- don't make a blanket statement- treat every nurse as an individual- because they are! So if you are a new grad and are willing to put in 110% into learning than I say go for it- I am glad I did and my director is too!
As far as central lines, and all that- do you forget that most of the patients the floors get come through the ER!!! We see it before you!! THere are things that are seen in the ED that med/surg will NEVER see. We deal with all ages, all problems, and ALL areas of nursing combined- you can't get that experience on a Med/surg floor!! Procedures are task oriented- you can be taught that in the ED . THere are actually more oppurtunities to learn in the ED! Do you think we don't do dressing changes? Alot of stuff we do and send home before it even gets to you! As far as mistakes, seasoned nurses do it to- I have a pt the other night that had a 14 year ED nurse give 3 times the max dose of Dopamine to- don't make a blanket statement- treat every nurse as an individual- because they are! So if you are a new grad and are willing to put in 110% into learning than I say go for it- I am glad I did and my director is too!
Now I will get off my soapbox!
Tiggergirl, we KNOW what we do in the ER, we all work there! We all have opinons based on our past experiences. I am glad yours were good, Congrats!!! :)
In my opionion, the Bottom line is, new grads need training, is it better to do it in a controlled environment on basically stable patients or in a chaotic ER with unstable patients....???? Before we get into this again, this is just my opinon and We are all allowed to our own opinions.
In the ER yes, procedures are tasks and can be taught but there is also a huge amt of critical thinking one needs to be able to do on ones feet and this is usually while performing tasks. Think about it, when you are in on a trauma 1/2 of your brain is concentrating on what you are doing the other is thinking what you will be doing next
I stay with VT on this one and I am not making a blanket statement over all new grads only over those I have seen in the ER..I literally saw one do well..I saw a few let go, I saw a few transfer to a different area and a few quit altogether. I also saw so many of them with the "deer in the headlight" look. Hey!! It is just my feeling that being a new grad and new to the ER is a huge pair of shoes to fill and like the original poster most have no real clue what the ED is really like..It is not "trauma in the ER" every min of every day and it is not "ER".
Think I will just agree to disagree..we all have our own opinion on this and these opinions are based on our experiences..If I saw many a grad jump right in and get the job done I would be debating it from the other side but I didn't.
I can think of no greater philosophers of our times than the various musicians we all listened to. In our generation when "the music mattered" (well, the words, anyway), so, after skipping a generation, again, the music again matters., about life, our perceptions of it, the lessons learned, the emotions, the seriousness of it all, gives me great happiness. I, again have some kinship with the younger generations. My quotes have some meaning.
If I ran a Nursing School, two of the courses I would implement would be "Songs In The Key Of Life" and "Lyrical Philosophy". I'd want my students to be able to connect with humanity and how it works and how certain artists interpreted it, from James Brown, Dave Matthews, Steeley Dan, Supertamp, Stevie, Wonder, Frank Zappa (a course in itself), The Beatles, Smashing Pumpkins, Blues Travellers, The Levellers, Billy Bragg ( and we want to add even more).
In literature, I would definitely include as much of Emily Dickenson, D.H. Lawrence, Maya Angelou, Robert Burns, Patti Smith (her music, too), Voltairine DeCleyre, Simone Weil (and others you choose).
Sometime in the 1970s certain medical schools realized that mathematics, engineering and science backgrounds were insufficient to the upcoming and necessary Humanistic (patient inclusive) approach. They had been training physicians with immense technical knowledge, but with little connection to the emotional and spiritual needs of the patient. The leaders of this movement were not the physisicans, but the Nurse Philosophers.
I was part of that movement and taught at U. Mass. Medical School under this new model. What exciting times.
We gathered around us the most brilliant minds of the era: John C. Lilly, Richard Alpert, Robert Gass, Melvin Krant, Dame Cicely Saunders, teachers at the Naropa Institute and Esalan, The Hudson Institute, Jon Kabbat-Zinn, Saki Santorelli and a slue of others. We did have our detractors.
I am happy to mention that this model became (or was already in use by Nursing) absorbed by the medical community- in some areas- and in others not so much; ER and OR missed much. they determined it did not, by and large, fit their medical milieus. I think it will be particularly hard for them to do so unless those who are now entering these specialties, bring it and practice it in the clinical situation.
I see the greatest sabateur to this Humanistic "patient centered" model is increased clinical patient loading and the increased clinical stress of overwork and understaffing. (In the ideal "primary care" model for Humanistic Medicine, the patient load was a maximum of 5:1 Today we are seeing mininums of 8:1 and maximums of 12 and 15:1, not only unsafe and unrealistic, but anti-humanistic. The patient is turned into an instrument of commodity and production for profit.
I urge everyone who can to read the new book: "Code Green".
Anyone who is a fan of Frank Zappa (actually anyone who can actually remember him) is a friend of mine. There aren't too many of us in the world, veetach!
the term "Code Green" is used when a care provider is in immenent danger from a patient or the clinical environment. In mental health facilities it used to be called a "Mayday".
The book, "Code Green: Money-Driven Hospitals and the Dismantling of Nursing" by Dana Beth weinberg (ISBN 0-80143-9809), 5/2003, $24.95 is about our current crisis. Call it the "Octopus" for our generation. It applies both to the term and the conditions outlined in the book.
Far from being a conspiracy, this is an open and ongoing project by the 'for profit' health care industry to take over all aspects, including drugs, hospitals, clinics, insurance, native employment, "green card" employment, hospital supplies and even the Fair Wage and Labor Act, consolidate and maximize profits and destroy worker organization. Its aim is the implementing the extremes of the Objectivism. I think even Ayn Rand would have objected, equating its nemisis as the totalitarian structure in "We The Living", because that is where it is headed. I doubt that Congress will have the guts to apply itself to stop this "Trust" before it is too late. The "Health Care Trust" may be our greatest enemy.
We cannot turn our heads away from the fact that the very head of the Federal Reserve is none other than the head of Rand's famous "Collective", Dr. Alan Greenspan. Others involved in this effort include Sen. Trist, MD, of Tennessee- whose family owns, for the most part, the hospital gargantua, HCA, in lockstep with Kaiser Permanente and Tenet.
The whole thing is quite a tangled web of ownership, consolidations, partnerships, interconnected demand and supply backed-up by both the increasing need of the public for health care services and the expoding medical-pharmaceutical industry.
For the Service portion of the industry: Nurses, techs, pharmacists, food service, custodial, management, transport, engineering, science and research, they are presently hard-put to keep up with the demand.
Ergo, immigration and the new relaxaions on immigration are hoped by both government and industry to help solve this problem. somew countries have become so alarmed by the drain on their own medical professional pools that they have shut down emigration of both nurses and physicians (The Phillipines is an example. Ireland will soon follow.) Entering our system, they will make less and cost less, and have no power. The "Green Card" rules. (And these are excellent fully qualified professionals).
With the new "amnesty", Mexico sends its workers to the US.
Already, its GNP base is "Green Card"ers sending monies back to Mexico and Americans seeking cheaper drugs and services. Brazil has already followed. Others are Ghana, Haiti, Nigeria and Kenya.
They have qualified workers willing and able. Many, though, are illegal. I have no doubt an immigrant worker "amnesty" will be forthcoming for them.
I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an 
mercRN
26 Posts
I just graduated in June of 03 and had my job in the Emergency Department before I graduated contingent on me passing boards. My manager told me that she loves to hire new grads based on the fact that we get trained for the ED not trained for a Med Surg Unit. We also get 6 months of orientation. We don't take ACLS, PALS, or TNCC until the end of our orientation or for up to 6 months after we are off of orientation. I know I am new not only to this forum but to nursing but some of the replys were harsh on this subject. I don't start any drip or give any IV medication without double and triple checking myself and most of the time I have another nurse check it also. I work in a small ED. We only have 16 beds and our other hospital ED has 15 but they are considered Level III trauma where as our hospital is not. New grads if they are willing to learn and want to learn are great in the ED. Granted alot of new grads need a year or so of med surg experience before going to ED but not everyone.