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.
Our ER does not accept new RN grads unless they already have been working in the ER as LPN's. Otherwise they have to have a year of Med/Surg or ICU experience. ( Having worked critical care most of my career, I'm not a big fan of new grads in the ICU's either, but my hospital has an excellent orientation program.) Our ER is high volume, high acuity and we have a lot of nurse autonomy to initiate standing orders and start treatments. This requires organizational skills, and nursing judgement that most new grads do not have. There's just no way around experience. Thats not to say I haven't seen student nurses who would probably do fine in the ER, but we aren't set up to offer the type of structure and orientation they need as new RN's.
:) again, i must say that all most everything depends on the individual. like i said in my previous post, i have seen ccu rn's (just an example, not pointing fingers) come to the er and then after a few shifts run for the hills and "run home to momma".
let's face it. anyone can do anything if they are in the right place at the right time. that's why nursing is so cool. if one department does not work, ther are many more departments to try.
for all those with no patience, relax and enjoy the ride. you never know, you might be helping to culture one he@# of a nurse!
and for those grads who are in limbo, stick with your convictions. the er is one he@# of a ride! enjoy!
i agree that it is completely individual dependent....
i do not know a hospital in the tristate area i live in that doesn't take new grads in the er........they would have had to lock me in a padded room before i would work on a floor (those of you who do that i applaud) - however I COULD NEVER work on a floor...
and for those who think just because you are a new grad you aren't up to par - i ran circles around experienced nurses at my first job.....they asked me questions - i could read ekg's when they couldn't...so let's give people a chance to do what they were meant to do and not discriminate - as far as i am concerned this is just another evidence that nurses are still trying to eat their young and hold others back.....
>>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
this is exactly what I am talking about. There is not a new grad on this earth who does NOT need orientation to the ED. 'nuf said.
ithey would have had to lock me in a padded room before i would work on a floor (those of you who do that i applaud) - however I COULD NEVER work on a floor...
and for those who think just because you are a new grad you aren't up to par - i ran circles around experienced nurses at my first job.....they asked me questions - i could read ekg's when they couldn't...so let's give people a chance to do what they were meant to do and not discriminate - as far as i am concerned this is just another evidence that nurses are still trying to eat their young and hold others back.....
Athomas, it sounds to me like you are quite the prodigy. Running circles around experienced nurses, being the resource person and as a new grad even!! I would love to hear what those experienced nurses would have to say....
Oh BTW never say never, it will come back and kick you in the ass some day.
I was the regular RP (resource person, charge nurse) after 4 months out of school. That sure as heck pissed some nurses off - They got over it...I was good, and my gut was better (Thank you to my DON that put me in triage 2 days/week for a year as an ER tech )
They offered me as much orientation as I wanted, I stopped it after a week...
Am I cocky? Maybe...
But I backed it up professionally. They knew I would ask if I had any questions...They also knew I wouldn't sink because they wouldn't let me...
Athomas isn't declaring himself a prodigy, just better than average, right out of the gates...
His ER likely trained him quite well before graduating, and I'll bet he has a previous career, and was 30+ when he started nursing...
Being a psych tech in an urban psychiatric treatment center, doing "takedowns" for 9 years, made me a good (as most) ER nurse immediately. Those I worked with TOLD me so...
Are we the exception? Probably. But don't turn every new grad away!
interesting discussion; i'm sure institutions weigh the need vs. experience issue all the time with specialty areas, but having worked in an ED recently for a couple of years, and it being the first yr. management decided to do new grad internships, i can tell you it was, for the most part, a disaster. one nurse out of the six thrived, the rest were phenomenally dangerous.
They offered me as much orientation as I wanted, I stopped it after a week...
Am I cocky? Maybe...
But I backed it up professionally. They knew I would ask if I had any questions...They also knew I wouldn't sink because they wouldn't let me...
this is exactly my argument... They knew you wouldnt sink because they wouldnt let you.... It becomes the responsibility of the established nurses to "not let you sink". This means they have to watch you along with their own patients. It puts a strain on everyone involved. We could debate this topic all day, and we are all entitled to our own opinions. I am sure you are all safre practitioners, even if you knew it all when you graduated from school. Please give some credit to those RN's who bailed you out when you got in trouble.
I am thrilled that you guys think you are so good that you dont need orientation but the bottom line is.... EVERY new grad needs extensive orientation in the specialty units and even then many do not make it.
Hospitals put new grad nurses in specialty depts because they are cheap. I make $8 per hour more than a new grad nurse and that money adds up. Sad but true...
you were "charge" 4 months after graduation??? uh huh.....
Every ED has different requirements for charge nurses. Just because some hospitals allow inexperienced new grads to be charge nurses doesnt mean that the nurse is qualified.
Sorry to get on your last nerve, and make you so defensive. I do not know how big your ED is, or how busy. In my ED the only nurses allowed to be charge nurse are those with the most experience, and even some of them dont want it. It is not a glamorous job.
I have worked in an ER that didnt even need a charge nurse, because they were so small. I have also worked in an ED that required a clinical manager AND a charge nurse to keep everything under control. It is all relative.
All I am saying is, IMHO there isnt a new grad on earth who doesnt need orientation, and who is qualified to be a resource person for their coworkers.
As for "teamwork" when it applies to keeping an eye on new grads on your team, it becomes the responsibility of the experienced nurses to make sure the newbies dont get in over their head. It has to be done, more out of necessity than out of desire. Its called CYA.
Reread a previous post of mine...Our ED saw 50,000 patients/year, urban hospital in Phoenix...
I worked night shift, had 28 beds in the ED, 200 beds in the hospital, 7 RNs, 1 LPN and 2 ER techs for a 7p-7a shift...
We were frequently on "diversion" or "saturation" due to HIGH ambo traffic (oftentimes 8-10 per hour)...150 patients/day...
Yes, I was indeed charge of the (are you sitting down:roll) WHOLE ER (were you one of the 2-3 nurses talking smack behind my back the 2 years that I did regular, scheduled, charge??:chuckle )
I literally got bored w/ my orientation a week in. I had gastric lavaged over 50 patients, ON MY OWN, as an ER tech (we were frequently short nurses, and they trusted me, and were willing to sign off on the chart)
I had done everything but pass/hang meds as an ER tech...
including:
I triaged
I lavaged
I NG'd
I defibbed
I started IVs
I splinted
I taught splinting
Helped w/ pelvics
Set up IV pumps
Spiked IV fluids
I actually took an assignement one night as we were 2 nurses down, but did not pass meds
Look, I've quite clearly outlined my extensive "pre-grad RN training" in this thread...You seem quite arrogant yourself.
Your attitude is all too common. You think You're at, or near the top of the nursing food chain, quite willing to eat his young, as is all too common in nursing nationwide...I'll wager you are rude and bossy to the ER techs, unit secretaries, and registration staff, and likely don't even speak to the housekeeping staff (other than to order them around)
I encountered a couple of ER nurses like you on my way to and after graduation...
I was a part of the "dedicated triage team" AS A TECH...
I was the "official RN/LPN trainer/orienter" of new staff 6 months after graduation...
I did all of the QCs and yearly staff training for the accu check machines...
I had ACLS and PALS pre graduation...I defibrillated DAILY as an ACLS trained ER TECH
I could go on.
How dare you brush me off as working at some 5 bed ER where everyone is in charge, just because I was a new grad. You and nurses like you are the problem...
I pity your "old school" attitude and you for that matter. You are missing out on working w/ new grads (albeit 1 in 4 that actually can hang) and their "fresh" attitudes.
I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an 
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Deaconess
32 Posts
Our ER does not accept new RN grads unless they already have been working in the ER as LPN's. Otherwise they have to have a year of Med/Surg or ICU experience. ( Having worked critical care most of my career, I'm not a big fan of new grads in the ICU's either, but my hospital has an excellent orientation program.) Our ER is high volume, high acuity and we have a lot of nurse autonomy to initiate standing orders and start treatments. This requires organizational skills, and nursing judgement that most new grads do not have. There's just no way around experience. Thats not to say I haven't seen student nurses who would probably do fine in the ER, but we aren't set up to offer the type of structure and orientation they need as new RN's.