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.
The only stupid question is the one that's not asked.
The only time I would see nurses getting irritated with people asking questions is if the one asking was asking something that even a student nurse should know, or asking a question about something they have already been told several times before.
I coordinate the graduate nurse program in our facility and my personal philosophy is that all new grads should first work med-surg in order to develop assessment skills. HOWEVER, I also strongly feel that individuals vary in ability, knowledge, personality, etc. We allow new grads to choose (according to what is available). I watch the ones in critical care areas and get them transferred if it looks like they are overwhelmed. They can always go back later, but I don't want them losing confidence so early in their career. So, it depends on YOU! I would put you in ED and give you the chance to succeed.
Specializes in ER - trauma/cardiac/burns. IV start spec.
I graduated nursing school at 40 and went straight to the ER I knew from the very beginning that the ER was the only place for me. I thick that there are 2 kinds of nurses that do NOT belong in the ER, those who think they want to try and those that think they are going to "save a life" everyday.
There is no glory to be had in the ER. At best you can stabilize and admit, rescus. patients and admit or medicate and turf.
I spent 10 years in ER. The only reason I am not there now is due to a latex allergy I developed.
If you have a deep seated desire to
1. Put up with the drug seekers.
2. Treat STD's
3. Apply splints and teach crutch walking
4. Tell screaming irate mothers that their 13 yo girl is preg.
5. Deliever Full term high risk babies because Mom did not arrive soon enough to get to L&D.
6. Treat CHF patients that decided to stop their meds so they could eat all the high sodium foods over the holidays.
7. Treat chest pains.
a. r/t cocaine use
b. overdosed on meds by accident
OK course all the above s*** is made bearable by the
8 Chest pain that you work up despite the fact that the MD was going to send home (protocals can help) because she was Female and he had seen her the day before. You and your teammate present him with Cardiac enz. through the roof - she goes to cath lab from ER.
9. The CHFer that the residents want to send home and you refuse until the ER Md agrees and suddenly the patient codes.
10. Deliever twins by emergenct c-section, save the babies but lose the mother.
11. Bust your butt on burn pt. just to lose her 1 hour later.
12. Crack the chest of 12 year old that had heart problems (also he looks just like your own son) massage heart by hand to lose him anyway and then be accused of not trying because his family was hindu.
Get my drift. To all who say go to floor first - No Way. Every thing you learn there you have to forget. I have precepted many floor nurses to the ER and not ONE could handle the work.
We who are ER nurses have a certain autonomy. We have things that we do without MD first giving order. I would nave gotten fired if I had been sent to floor. I won't wait to draw labs on crashing patient, apply O2 or ordering respiratory Tx for asthma pt.
We had many nurses, veteran nurses that could not start a cardizem drip. In fact our nurse educator taught drip wrong!!!! She had to be corrected.
If you really want it go for it. If it is in your "blood" you will make it.
Specializes in ER - trauma/cardiac/burns. IV start spec.
I graduated nursing school at 40 and went straight to the ER I knew from the very beginning that the ER was the only place for me. I thick that there are 2 kinds of nurses that do NOT belong in the ER, those who think they want to try and those that think they are going to "save a life" everyday.
There is no glory to be had in the ER. At best you can stabilize and admit, rescus. patients and admit or medicate and turf.
I spent 10 years in ER. The only reason I am not there now is due to a latex allergy I developed.
If you have a deep seated desire to
1. Put up with the drug seekers.
2. Treat STD's
3. Apply splints and teach crutch walking
4. Tell screaming irate mothers that their 13 yo girl is preg.
5. Deliever Full term high risk babies because Mom did not arrive soon enough to get to L&D.
6. Treat CHF patients that decided to stop their meds so they could eat all the high sodium foods over the holidays.
7. Treat chest pains.
a. r/t cocaine use
b. overdosed on meds by accident
OK course all the above s*** is made bearable by the
8 Chest pain that you work up despite the fact that the MD was going to send home (protocals can help) because she was Female and he had seen her the day before. You and your teammate present him with Cardiac enz. through the roof - she goes to cath lab from ER.
9. The CHFer that the residents want to send home and you refuse until the ER Md agrees and suddenly the patient codes.
10. Deliever twins by emergenct c-section, save the babies but lose the mother.
11. Bust your butt on burn pt. just to lose her 1 hour later.
12. Crack the chest of 12 year old that had heart problems (also he looks just like your own son) massage heart by hand to lose him anyway and then be accused of not trying because his family was hindu.
Get my drift. To all who say go to floor first - No Way. Every thing you learn there you have to forget. I have precepted many floor nurses to the ER and not ONE could handle the work.
We who are ER nurses have a certain autonomy. We have things that we do without MD first giving order. I would nave gotten fired if I had been sent to floor. I won't wait to draw labs on crashing patient, apply O2 or ordering respiratory Tx for asthma pt.
We had many nurses, veteran nurses that could not start a cardizem drip. In fact our nurse educator taught drip wrong!!!! She had to be corrected.
If you really want it go for it. If it is in your "blood" you will make it.
>>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.
Nope, dont agree with this mindset at all. If "an ER is an ER" then you could easily take an RN with experience in a small rural medicl center and drop them in the middle of a Level I trauma center and there would be no additional orientation necessary. That wont happen.
For those of you who are ready to jump right into the ED fresh out of school, just remember, you have RN behind your name just like everyone else. You will be required to identify a pt having an MI just by their presenting appearance, you will need to be confident in your ability to identify respiratory distress in an infant and know what to do when the mom brings them in to you, you will be required to maintain Cardizem drips, Nipride drips, Nitroglycerin drips, Dopamine drips, Aggrastat drips, along with administering Retavase and running a cardiac arrest call, often times in the same afternoon. In our ED it is not at all uncommon to have 4 unstable patients assigned to the same RN. You have to know side effects of overdose of all of the above drips and no instinctively how to handle it.
Are you ready? There may be no one available to help you. The docs will expect you to know what you are doing.
I am amused at those new grad nurses who think they are ready for a specialty unit fresh out of school. Often times they are so sure of themselves until they get in over their head, and then they come running for help. Even those who have apprenticed in the specialty area need extensive orientation. Of course this is just my opinion.
i couldn't disagree more w/ the posts that i have read about new grads in the ed....first and foremost - if you have a good ed manager - then you have a good ed preception rotation - you aren't just thrown to the wolves.....and let me tell ya - i would take an eager new grad anyday compared to a floor nurse of 10 years....no offense meant, however there are learned habits that floor nurses develop that are nearly impossible to break and that absolutely do not work in an ed....
now , are there those who can and can't cut it - YES...... but you will know if that is what you are meant for - let's face it - you can teach a monkey to put a foley in - you cannot teach someone to be a hard worker, you cannot teach critical thinking skills and you cannot teach insight and reaction to critical situations.....
i have worked w/ NP's who (for some strange unknown reason) decided to come work in the ED as a staff nurse..... it was SCARY.... worse than any new grad i have ever seen.....
to be honest - i have never seen a new grad do badly in the ed...during rotations in school - you get a feel if you can hack it or not - and new grads are ususally more cognizant that seasoned nurses as far as looking up meds, double checking doses and asking questions when appropriate......
floor nurses are hard workers - and you couldn't pay me 100$/hr to do the things they have to do - but i strongly feel that each nurse has a predisposition - either you are a critical care nurse (er, icu, etc...) or you are not - all are valuable - however if i had been forced to do m/s prior to going to the ed - i would have quit nursing....
While I am personally quite conservative in this area believing that every graduate have a firm background in Med/Surg Nursing for at least a year, (its like an internship. I wouldn't trust a nurse who didn't have that experience.), I wonder about the instructor.
A few years ago I wanted to change from the years of doing ward nursing, got my ACLS and did some telemetry and ICU. There were no openings in ER, so I got an agent and applied to different places. Good references, preparation, experience, you name it. Everyone rejected me and I couldn't figure out why.
I'm over fifty and good. But, when I asked my agent what the problem was, he was very frank: "They won't hire you because you are too old." What could I do? Sue? Confront? Complain?
So, I went to a friend, retired, who said, "Dear, if you're over 35, they won't even look at you no matter your degrees or qualifications. They want young stuff."
Here's one way to get in, but I haven't tried it: Apply to a place that is so desperate, a place in the middle of East Cowpud, Nowhere, that they can't refuse you. They will pay very low and you will be overworked like crazy taking care of farmers, Amerindians, recluses, cowboys and truckers, but you will get your foot in good. You will be an ER nurse.
Another is to go be an EMT for awhile and get to know the ER nurses. I haven't tried that, either. Worth a shot, I guess. Do parttime EMT and parttime RN work. Gotta get that EMT certificate you can get probably at any community college or with the American Heart Association. Ask an EMT outfit. Or become a volunteer firefighter. The more "good calls" you get in on the better.
I guess every form of change has its sacrifices and not all of us can be dipped in gold out of the gate. But, it sure as hell beats getting slammed and shut out.
And, don't worry. Then young 'uns will soon find the world is gonna have a long party kickin' the snot nose outa 'em. Most of 'em won't last in ER. They'll be loster than a jackrabbit in a Montana snowstorm, quite Nursing and run home to Momma.
i don't know what kinda nurses you all have worked w/ - but i pity your experience if you have not seen successful new grads
- our nursing program required acls, ability to read ekg's etc....and the last semester of my school was an internship in a cvicu - and from day 1 - i went straight to the ed - they stopped my orientation after it was realized i didn't really need one - and i have been going strong since......there are thousands of new grads just like that - and we are encouraging them NOT to do what they dream of?!?!?! that is ludicrous - during orientation it will be shown who will make it and who won't - i have seen very few fail - and have worked in multiple ed's in the state in which i live...
as for being lost.....i was never lost - and it was abudantly clear from day 1 - so let's stop discouraging new grads - and encourage them to be the best they can be (which is of course in the ed....)
you were very lucky to have had such a well rounded nursing school experience! i agree with what you are saying. here is my experience.
i went to an adn program. the instructors never smiled and were harsh, like they needed to get some.... some life. they were condicending and not encouraging in the least. hopefully, as the times have changed, so did the philosophy of adn schools.
on the last day of class, everyone had to say what field of nursing they wanted to go into. i said that i wanted to go into the er. my instructor told me not to because i would drown.
well, i did it anyway. i worked 8 months on a tele floor and then went to the er. it was hell. i had a horrible preceptor and the nurse manager told me that she would give me 2 weeks with another one. she also said that if i wasn't up to par after that, i was out. i did fine!
well, i am here, an er nurse with acls, pals, tncc , charge nurse etc... 12 years later! i almost wish that i could see her now. i know what i would say to the condicending such and such.
i am good at my job. to make a long story somewhat shorter, i don't think all nurse grads can be put in the same class. adn, bsn msn etc. i think it depends on several things:
the individual
the preceptor
and the orientation program
this is just my opinion. i lived it and i do fine. everyone should be given a chance. i have worked with alot of nurses with many years experience who have transfered in. transfered from places like icu, medsurg, pacu and ect. some could cut it and some could not. again, i think the previously mentioned factors should be taken into account.
And, don't worry. Then young 'uns will soon find the world is gonna have a long party kickin' the snot nose outa 'em. Most of 'em won't last in ER. They'll be loster than a jackrabbit in a Montana snowstorm, quite Nursing and run home to Momma.
First I want to say how lowsy it is that you have been discriminated against. On the other hand, I don't see why you have to diss on the young nurses like that for retribution- they're not the ones who've acted injustly.
i don't know what kinda nurses you all have worked w/ - but i pity your experience if you have not seen successful new grads
- our nursing program required acls, ability to read ekg's etc....and the last semester of my school was an internship in a cvicu - and from day 1 - i went straight to the ed - they stopped my orientation after it was realized i didn't really need one - and i have been going strong since......there are thousands of new grads just like that - and we are encouraging them NOT to do what they dream of?!?!?! that is ludicrous - during orientation it will be shown who will make it and who won't - i have seen very few fail - and have worked in multiple ed's in the state in which i live...
as for being lost.....i was never lost - and it was abudantly clear from day 1 - so let's stop discouraging new grads - and encourage them to be the best they can be (which is of course in the ed....)
Genius post my friend...
I graduated 8 years ago...I was hired as an ER tech/extern one year before graduation...I'd been a psych tech for 9 years...I'd never set foot in an ER prior...I convinced a manager to hire me, and was the hardest working ER tech...They put me in triage for at least 2 shifts/week. I started helping the nurse, then soon became a triage TECH (RN cosigned)
When I was in the main ER, I was allowed to do certain things, while doing my ER tech duties...This went on for a year, 32 hours/week. I graduated, kept working as a tech. I took my boards, passed and was oriented for a week...I was as good as most anyone there RIGHT OUT OF SCHOOL!!! (I was doing charge 4 months out...AN urban ED in Phoenix, 50,000 patients per year!!)
I also learned humility as a tech...Don't think I hung Nipride by myself the first time. I asked for help (though I was completely on my own, and could have likely done okay alone, I asked!!!)
What's the moral?
There are SOME new grads that will flourish in the ER right out of school...Others will fail...Do your homework, TRAIN THEM WHILE THEY ARE IN SCHOOL...It's FREE orientation people!!!!!
I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an 
MrsWampthang, BSN, RN
511 Posts
Don't ever worry about asking too many questions.
The only stupid question is the one that's not asked.
The only time I would see nurses getting irritated with people asking questions is if the one asking was asking something that even a student nurse should know, or asking a question about something they have already been told several times before.
Good luck and God bless!
Happy New Year everyone!
Pam