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 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. "
Noooo the fault is that of the nurse whether new or old. Whether or not she or he was taught that in school has no bearing. Once you have that license you had better know what you are hanging, side effects precautions etc... I think that the point some of the others are trying to make is that in a busy ER, it is difficult to find time to learn basics. I did ER after 6 yrs of floating.. consistantly working with pts with heart failure, Diabetes and Resp disease that are "stable" prepares you much better when faced with a slew of them that are crashing and acute..you are familiar with the meds etc etc..I worked with new grads in the ER and with the exception of one, it was hard. The Docs were pretty hard on them as well ..they expected the nurses to really know the basics. They were more than willing to teach ER specialty stuff but Insulin drips and Cardizem drips..most would have come unglued...not a pretty site nor a pleasant situation for the new grad.
As an addendum to my last post... Melanie was asking about if she teched in the ICU prior to grad would she be ready..absolutely!! I was only thinking about those new grads that I worked with in the ED that had only had 1-2 shifts in there during school. We had several LPNs, ED Techs and even volunteers that went through RN school while working in the ED..they were awesome when they graduated and were able to "hit the ground running" since they knew where things were, they knew the staff and Docs and they knew the flow of the ER...ER basics are quite different from the floor so coming in with no exp in basic nursing coupled with no experience with paperwork, hospital policy etc etc can make it difficult.
I have read all the posts with interest and I still say go for it. After working in the ICU and the ER I have seen many nurses who did not belong in either place, both seasoned nurses and new grads. The key in my opinion is to ask when in doubt. I have been in the ICU for a year as an RN and I asked questions when I started and still do. It is not like you are all alone and can not ask for help from other members of your unit or from other nurses in the ED. You are part of a team and I have not worked in any ER or ICU where people would not offer to help out any nurse who needed a little assitance. I think personality has a lot to do with where nurses end up in their careers. You will find your niche and I am sure you will prosper. Good luck.
I agree, new grads don't know what they don't know. And I want to be sure that once I am off orientation, wherever I go, I can carry my own responsibilities and provide safe care. I have worried that in Med/Surg you are actually more responsiblity, sooner, than in other areas.
It is not politically correct to talk about, but age is a two-edged sword. On the one hand, even doctors think you know more than you do. On the other hand, people are more frustrated with you when you don't know everything. And, yes, there are times in the ER when you have to act -- now -- from experience.
For now I am going to start in Med-Surg. I think this way I will have more knowledge and confidence when I do go to the Emergency Dept. (and I will, eventually).
Please, if anyone else has anymore thoughts, I would love to hear them.
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.
I just wanted to say...to those who posted stories about new grads who hung incorrectly calculated drips. Well, granted I am not even a new grad yet BUT... during my PEDS ED rotation, I actually caught a mistake in the dosage ordered by the doc that even the SEASONED RN overlooked.
I think that anyone can start in any area if they are cut out for it and if they have the proper orientation and training .
I got the same old speach 6 months ago when i graduated... "do med surg..."
I cant stand med surg... caring for 5-6 non critical patients with a million different diagnosis and a million different docs... If i had been on med surg i would have left nursing long ago.
Anyone can be an awsome nurse if they love what they do.. everyone has a knack somewhere.... you just gotta find it..
and orientation it a huge part of new grads becoming what they are... If you properly train a new grad from the start they can be a good nurse in any area.. no matter how specialized or critical...
as far as those mistakes go (with gtts).. of course human error is always a factor... but i think anyone should know that when you are hanging gtts like cardizem, amio, or giving a cardiac med or a anything IV you always have someone check yoiur calculations and your rate no matter how experienced you are ....just my opinion
I started out in the ER fresh out of school, however, I had been a paramedic for nearly 10 years, and had worked as a tech on and off at that same ER for about three years before finishing school so I can't say it was hard for me to adjust to being an RN in the ER.
That said, I will say that I asked and STILL ask questions. If I am hanging a drip that I haven't hung in awhile then I always have another nurse double check me. I'd rather look stupid than make a mistake and harm my patient. I always have another nurse double check my math on any peds meds I have to mix myself; again, I'd rather look stupid asking a question than make a mistake that will harm a patient.
I feel like though that ER is as natural to me as breathing, not easy mind you, but natural. The only other place I might like to try someday is ICU. I love the everchanging pace of the ER and even though I get frustrated at times by some of the dumb things we see, right now I wouldn't want to work anywhere else.
We have several new grads in our ER and most of them have done ok. We have some "old timers" that the new grads could run circles around. I had a "seasoned vet" WALK a patient back from triage with a complaint of rapid heart rate. The HR she got on the dynamap was within normal limits, so she thought nothing of it; yet when I actually took a MANUAL pulse, I found his heart rate to be *GASP* RAPID! She didn't even have the basic instinct to reach down and grab his wrist! I might add that she had worked in the ER as a tech for YEARS prior to getting her RN.
I had another "seasoned vet" let a chest pain patient walk back to the room with one of the registrars and the triage notes not filled out simply because she was backed up in triage! She called back and told me that she was sending a patient with chest pain and history of heart surgery back to my quad. When I questioned the YOUNG woman about her surgery, it turned out that she had had aorta repair due to an MVA several months earlier. This kind of triage from an RN that has been in the ER for years
I could go on and on and I'm sure that others have similar stories. I guess my point is, I think that you are either cut out for a specialty area or you're not and no amount of experience in "med/surg" is going to change that. It might give you experience with basic skills but going into a specialized area should feel like putting on a new shirt in your favorite style and color, it has to be worn a little to be really comfortable, but you know you're going to love it cause it's just your style!
We have had nurses come down from the floors and just not cut it because they didn't have the "think while you're running" mentality. They were used to doing one task at a time, one patient at a time and you just can't do that in the ER. While you are doing one thing, you have to have another part of your brain focused on the next ten tasks that need to be done.
Maybe I sound cheesy but that's the way I feel and it's the easiest way I know how to explain it.
Anyway, that's my two cents and just my humble opinion. Godd luck in what ever you decide to do.
I don't believe an ER nurse can ever "look stupid" by asking a question, especially when patient care and safety are at stake.
Let's face it, sometimes our actions can "make or break" a situation (or life or death, literally). What does "look stupid" are mistakes done when they could have been avoided.
I think in the ER, one should never be seduced into thinking they "know it all". Just when you get to that point, BAM! something will catch you off guard! Trick is to stay current,
keep knowledgeable, and double-check your actions if necessary.
In the words of ol' Flo Nightingale:
"A woman (or man nowadays) who thinks of herself, "Now I am
a full nurse, a skilled nurse. I have learnt all there is to be learned", take my word for it, she does not know what a nurse is, and she will never know: she has gone back already."
I read some of the responses in reference to new grads working in the E.R., and I just wanted to make a few comments. Yes, the E.R. or ICU units are very difficult areas to work in. My belief is that if a new nurse has a good orientation for an adequate length of time, and the preceptor is really a good educator, a new nurse can learn these areas. I've been working in E.R. now for 5 years, and I always feel that I'm learning something new all the time. My feeling is that it all depends on the preceptor as well as how many experienced nurses are available to be resourceful when they are needed. This is something that definitely should be researched prior to accepting employment in this area. I worked full-time in one E.R. for 5 years while working per diem for a nursing registry to pick up extra shifts. All E.R.'s are not alike. My primary job had some awesome nurses with an abundance of experience, and they were all so resourceful. Through the registries, I've worked at different hospitals where a lot of the E.R. was staffed with a high ratio of new graduates (once you've been doing this for a while, you can pick-up on who is experienced and who is not) and most recently I had one of those nurses relieve me for lunch and when I returned I found that my patient had worsened. She was standing over the patient attempting to put a Foley catheter in him instead of alerting the doctor about his deteriorating condition. So, my advice is to make sure you get adequate training if you choose to begin your career in a critical care area .
I started out in the ER fresh out of school, however, I had been a paramedic for nearly 10 years, and had worked as a tech on and off at that same ER for about three years before finishing school so I can't say it was hard for me to adjust to being an RN in the ER.
That said, I will say that I asked and STILL ask questions. If I am hanging a drip that I haven't hung in awhile then I always have another nurse double check me. I'd rather look stupid than make a mistake and harm my patient. I always have another nurse double check my math on any peds meds I have to mix myself; again, I'd rather look stupid asking a question than make a mistake that will harm a patient.
I feel like though that ER is as natural to me as breathing, not easy mind you, but natural. The only other place I might like to try someday is ICU. I love the everchanging pace of the ER and even though I get frustrated at times by some of the dumb things we see, right now I wouldn't want to work anywhere else.
We have several new grads in our ER and most of them have done ok. We have some "old timers" that the new grads could run circles around. I had a "seasoned vet" WALK a patient back from triage with a complaint of rapid heart rate. The HR she got on the dynamap was within normal limits, so she thought nothing of it; yet when I actually took a MANUAL pulse, I found his heart rate to be *GASP* RAPID! She didn't even have the basic instinct to reach down and grab his wrist! I might add that she had worked in the ER as a tech for YEARS prior to getting her RN.
I had another "seasoned vet" let a chest pain patient walk back to the room with one of the registrars and the triage notes not filled out simply because she was backed up in triage! She called back and told me that she was sending a patient with chest pain and history of heart surgery back to my quad. When I questioned the YOUNG woman about her surgery, it turned out that she had had aorta repair due to an MVA several months earlier. This kind of triage from an RN that has been in the ER for years
I could go on and on and I'm sure that others have similar stories. I guess my point is, I think that you are either cut out for a specialty area or you're not and no amount of experience in "med/surg" is going to change that. It might give you experience with basic skills but going into a specialized area should feel like putting on a new shirt in your favorite style and color, it has to be worn a little to be really comfortable, but you know you're going to love it cause it's just your style!
We have had nurses come down from the floors and just not cut it because they didn't have the "think while you're running" mentality. They were used to doing one task at a time, one patient at a time and you just can't do that in the ER. While you are doing one thing, you have to have another part of your brain focused on the next ten tasks that need to be done.
Maybe I sound cheesy but that's the way I feel and it's the easiest way I know how to explain it.
Anyway, that's my two cents and just my humble opinion. Godd luck in what ever you decide to do.
Pam;)
Thank you! My only fear is that I tend to ask a too many questions, which irritates people, I fear.
I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an 
Erin RN
396 Posts
"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. "
Noooo the fault is that of the nurse whether new or old. Whether or not she or he was taught that in school has no bearing. Once you have that license you had better know what you are hanging, side effects precautions etc... I think that the point some of the others are trying to make is that in a busy ER, it is difficult to find time to learn basics. I did ER after 6 yrs of floating.. consistantly working with pts with heart failure, Diabetes and Resp disease that are "stable" prepares you much better when faced with a slew of them that are crashing and acute..you are familiar with the meds etc etc..I worked with new grads in the ER and with the exception of one, it was hard. The Docs were pretty hard on them as well ..they expected the nurses to really know the basics. They were more than willing to teach ER specialty stuff but Insulin drips and Cardizem drips..most would have come unglued...not a pretty site nor a pleasant situation for the new grad.