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 should have worked toward that cert when I was in the ER..I worked 10 hour shifts from 5 p to 3:30 a so I almost always got to do the rape kits..everyone else went home at 11:00 and since they were always so time consuming and many times I was the only female RN on..I was the chosen one. I actually didn't mind them too much. I have done them on very young to very old..So do you work exclusively for one ER or do you contract out to others??
In the program where I was trained, we worked exclusively for one ER. We were the regional facility for sexual assaults so they came to us.
In the program we are establishing we will be servicing the entire county, including 3 hospitals. We will be on call to whatever facility needs us. (they are pretty close together)
Its never too late to go back and get your certification, Erin. We have lots of non-ER RN's interested and when we seat the first class I imagine it will be kind of half and half....
Where did you do your training? I know Kaplan has a Forensics program that may?? include SANE training. I am doing their life care planning class right now..then I have to obtain my CCM since I am currently doing work comp case management. I also review incidents and claims against hospitals for a large ins co. ..my plate is pretty full but the Forensic nurse has always intrigued me..who knows? I "remake" myself every 5-6 years..what the heck, that is the great thing about having that RN behind my name..:) Erin
I received my training through Via Christie Medical Center in Wichita Kansas. I was living in Kansas at that time, and a new program was being started in our area.
Our program here in PA will be taught by instructors from the Centre County Sexual Assault Response team in Altoona PA.
If you go to this link, you can find programs in your area:
I have often thought of doing the Case management thing although I dont think we have anything like that in my area of PA. we all need a break from ER nursing eventually. My goal is to be the clinical coordinator for my SANE program and in the spring I will be on a 6 mo+ sabbatical from the ED to assist in writing and training a new ED program for our current computer system... I can hardly wait!
Absolutely. They are excited, eager, and often put me to shame with their energy (and I'm pretty energetic). I have more difficulty with staff transferring in to the ER from other units, because they've not got the "fear" in them.
Face it, the "fear" is what makes ER go...what's coming in? what is this patient not telling me? and for new grads, even the most mundane will inspire fear. Plus, they're so damned NICE! It's refreshing for this old er worker to have NICE people around.
I read an article once that statd that it takes 5-7 years for a nurse to feel comfortable in a critical care unit. I try to tell this to our staff every time they c/o "that one's slow". Our job as seasoned er workers is to help them become better er nurses, not debate whether they can do it. I had a HORRENDOUS orientation in a PICU as a new grad, these folks set me up for failure daily. It was attitude, not the work.
I agree, alot is personality, and work ethic. I would trade about 1/2 the staff that is senior who ***** and moan, for the kids who are running around anytime! Always ask, always learn,
Absolutely. They are excited, eager, and often put me to shame with their energy (and I'm pretty energetic). I have more difficulty with staff transferring in to the ER from other units, because they've not got the "fear" in them.
Face it, the "fear" is what makes ER go...what's coming in? what is this patient not telling me? and for new grads, even the most mundane will inspire fear. Plus, they're so damned NICE! It's refreshing for this old er worker to have NICE people around.
I read an article once that statd that it takes 5-7 years for a nurse to feel comfortable in a critical care unit. I try to tell this to our staff every time they c/o "that one's slow". Our job as seasoned er workers is to help them become better er nurses, not debate whether they can do it. I had a HORRENDOUS orientation in a PICU as a new grad, these folks set me up for failure daily. It was attitude, not the work.
I agree, alot is personality, and work ethic. I would trade about 1/2 the staff that is senior who ***** and moan, for the kids who are running around anytime! Always ask, always learn,
ABSOLUTELY!!!! I am a 30 yr nurse who still loves what I do and agree completely with erjulie! Give me a young, enthusiastic new grad any day, who challenges my thinking and keeps me on my toes! There's a lot to be said for training them the way you want them....and not trying to re-train or break bad habits. I don't think that a new grad increases your chance of getting a poor ED nurse any more than a "bad" transfer. Some of my biggest nightmares, over the years, have been "experienced" nurses.
You sure have the fear thing right. Hanging your tail out over the edge and pushing that outer envelope is exhilarating. You gotta have the fear, the urgency factor. But, when I did it I always knew I had to have the clearest focus. When I was doing it and I was with a particular patient I'd say. "Now this is the only case right now. This is the case. There is no other case." and bfore each shift I'd pray: "God, please don't let me screw up." I didn't work with new grads and didn't trust them. I had been doing heavy Med/Surg and Neuro Acute and they, too, were scary. In fact, in the back of my mind, no matter how I practice, the fear is still there and I think it is one of my best friends. I see other specialites where new grads have that fear and I think it is good for them.
I appreciate from you that my perspective is not the only one. I think I've altered my opinion somewhat. (come to think of it, when I've been a ER patient, I never once asked "How long you been doing this?" The nurses treating me knew I was one of them and were tough on me and made me focus on cooperation with treatment. Pain and confusion when I'm very ill in the ER is always a tough nut and I've somehow learned to help my caregivers out and be thankful. And, I'm glad they didn't blab my condition to others in the hospital so it wouldn't get me in trouble with admin or my colleagues- I have hyperhydrosis and diabetes incipidis and can get into trouble really fast and not (can't) know it.
Thank you for your insight and thank you all for your great care. You have what we used to call in the USAF "The Right Stuff".
...The nurses treating me knew I was one of them and were tough on me and made me focus on cooperation with treatment...
No offense, but why can't nurses keep the fact that they are nurses to themselves when they are patients...It has NO bearing on being a patient (Unless the nurse is cracking your chest:eek: , then bring it up...)
Otherwise it means nothing to me. As a patient, I have told the ER staff that I am self employed, a web page designer, and a landscaper...
I have been an ER nurse for over 20yrs, most of it as CEN, (year I've had all those other girl scout badges too). I have worked contract in over a dozen ERs, large small, urban, suburban, rural, teaching and non-teaching. Most of my full time experience was in level 1 truama centers, but I was usually in the busiest place in town, 90-150,000 pts/yr.
Many of you seem to feel that the right preceptor makes all the differerence.
What a bunch of crap! Any preceptor that I ever had was nothing more than just some other politician, just like most nurse educators or most other nurse bureaucrats. Although I'm sure there must be some good ones, the only good preceptor that I ever had was me. BTW I helped to develop a preceptor program and helped orient 6 nurses, and helped in continuing education while some politician got paid to do it.
When I got out of school, I was bound and determined to work ER. I went to County General. The DON had me go through the whole rigamarole of applying before she told me, "Of course you understand you will be going to med-surg for two years." Check please! So, I went down town. I talked my way into the ER, since the "acting" director was very psych oriented and I had 5 yrs as a ward attendant. In those days it was unheard of for anyone to work any specialty area without 2 yrs M/S.
My two week "orientation" consisted of buddying me up with a seasoned RN and just hanging around, watching, and doing everything I hadn't learned in school. I got really good with IVs and blood draws, and continued to take on any hard stick that everybody else had tried (as I do to this day).
My first shift (with my 6-week old license) we went on trauma rounds. I had an LPN and a tech. We took report from the PM nurse on 40 truama cases. By the time I got report on number 2, I'd forgotten everything I'd been told about number 1. By the time I'd gotten report on all 40, my scrubs were filled with number 2. The LPN and the tech just rolled up their sleeves and went to work, while I figured out to find the one who was dying, and work my way down.
What I learned was to have, not a preceptor, but RESOURCE people. I learned to utilize my resource folks any way that I could. I still utilize anybody who can help OUR patients and I mean ANYBODY! Students, EMTs, techs, ward clerks, lab techs, housekeepers, security, chaplains, housekeepers and visitors. Many years ago my chemistry professor said, "You know, if you have a enough people in a room, you have almost everthing known to mankind in that room." Please do not assume that the stupidest person you meet does not know something that you do not. You'd be surprised how much I have learned from winos, junkies, and psychotic patients.
Med students and nursing students and residents have taught me more (about the latest stuff) than a PhD in a university. This knowledge may be miniscule compared to what I have learned from LPNs and techs. Some of these folks are sharper than I am, particularly in LTCs. In many instances they are the leading edge in critical care, because they are the first one to find the sick patient. They have to spot the dying grandma, and they had better be right! Imagine how angry the DON at the nursing home gets when she has to make her budget with a bed unoccupied!
The first code I attended was a CP arrest. The pharmacist kept handing me syringes, "Push this." Ok I did, but after the code was over I said, "In school I learned to never give a med unless I knew what it was." 20 min later the pharmacist handed me copies of the drug abstracts for the stuff we had given. 2 months later I was ACLS.
To this day I will not give a drug without knowing indications, contraindications, dosage, mechanism of action, peak, duration, and side effects. Sometimes I extract the information from somebody else's brain while I am drawing it up. I have had medical residents volunteer to give IV digitalis, but I have no problem pushing it myself if I know the serum level and I agree that it is indicated.
What bothers me in the post is the belief that med surg is just a dumping ground. Do you really look at nurses on the floor as people who are just not bright enough to work ER? How would you feel if you loved med-surg and all of your colleagues were new grads who were too stupid to work critical care? Medical Surgical Nurses are no less specialists than any of us. Any good Med-surg nurse can get CERTIFIED in their specialty. How can you send your patients, who are sick enough to be admitted, to a dumping ground?
I would like to see a few good med-surg nurses check in on this string. Too bad all we're gonna hear from is some more arrogant ER nurses.
Where I live its a bit tough to do. Everyone here already knows I'm a RN, so I can't very well hide it. some of them I work with. Some of them I graduated with. Besides, the local hospitals are the best ones around.
And, I don't really see any reason to keep something I'm very proud of a secret- and I'd never tell them I'm something I'm not. Its just not the thing to do in an emergency situation, especially if they ask what my job is or where I am employed. I can't find any sense in it.
Sorry you were offended. None meant.
Please re-read my letter and you might see what the exact import of my letter is
(I was responding to New Grads In The ER).
Its OK with me whatever you want to do. More power to you.
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 should have worked toward that cert when I was in the ER..I worked 10 hour shifts from 5 p to 3:30 a so I almost always got to do the rape kits..everyone else went home at 11:00 and since they were always so time consuming and many times I was the only female RN on..I was the chosen one. I actually didn't mind them too much. I have done them on very young to very old..So do you work exclusively for one ER or do you contract out to others??