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.
First, I have loved reading everyone's thoughts. I am glad to see that it evoked some strong feelings, because this is a very emotional issue for me right now. When I started this post I struggled with the fact that I did not want to sound like Med/Surg is less challenging than the ER. In fact, I thought my Med/Surg clinicals were 5 times harder than my ER experience.
In the ER, I never had to support someone to the bathroom scared they would pass out on me. I never had to change an occupied bed (although in gero. I did it plenty and got rather good at it). I never had to care for a de-hisced wound while explaining to a (horrified) patient that it would be all right (eventually). To me, the physical demands and the psych/soc are harder in Med/Surg.
I am much more scared of Med/Surg than the ER. There seems to be a lot more support from other staff in the ER, and other nurses and your physicians are right there for questions. In Med Surg, even as a student, I felt like the Lone Ranger. When you are in a patient's room, no one knows what you are going through, plus you have no idea what is happening to your other patients.
So my motivation to be in the ER was not because I thought it was "cool" or because I am some kind of cowboy(girl). I do have confidence that I could learn the meds, critical thinking, etc. everyone has mentioned. But there does seems to be a common theme that most people who did well starting in the ER had some kind of prior tech/LPN/EMT experience, which I do not have. Everything I see in the hospital is a "first-time" for me. So I do a lot of "looking stupid" (loss of ego in nursing school is food for another posting!)
I am staying within the hospital system affiliated with my university because they will reimburse our loan amounts. So if they restrict me to Med/Surg, that's that for now. I am trying to build up my courage and confidence. Meanwhile, I took the NCLEX on Monday and I'm waiting to see if I passed. It shut down at 75 questions, so it's either good or bad.
Thanks again for all the food for thought. I feel more confident now that I see many people think start in Med/Surg is mandatory, and hardly anyone thinks it is a bad thing, even if I want to go to the ER later.
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.
That's a good point...I live in Phoenix where it's easy to be "just one of the crowd"
I am proud of being a nurse as well:cool:
No offense taken.
I just never understood nurses who blurt out the fact that they are a nurse before giving the chief complaint. And I wasn't implying that you do that, your post just struck a familiar ring, that's all.
Great post. (Though something tells me Veetach won't think so :roll)
I also agree w/ your comment about LTC.
I did ER for 8 years (right out of school) and used to think most, if not all (it was my experience) LTC nurses were terrible. Now I'm the house sup for a LTC/SNF, and we have to decide who goes to the ER, and who we can keep here...
I think what you are saying is that one can handle any kind of nursing, if you put your mind to it, and work hard to ALWAYS learn...
Good post, and thanks for being forward thinking.
sean
By the way, I used to hate LTC nurses because at all the ERs where I worked, I rarely got paperwork on the patient, and even LESS rarely got a phone patch...LAME
I ALWAYS send ALL the paperwork I can come up with, AND call report before the patient has left my building!
You see, what slows things down is the arcaine nature of many LTC facilities which make you do a full set of pages before we send. I at least try to get the Page 2 done right away and copy off the MARs, RXs and any new orders. I also grab another person to help me. When the EMTs come, we are near ready.
Then, I call ER. I always make sure I call ER and tell them what and who they're going to get. I think they appreciate it. Its worked so far. And, if they have a DNR order, I send that, too, and I always send the face page. Its a lot of scrambling, but its gotta be done.
ER folks: Tell me how we could make things even better for the patient- and you.
When I started ER 20 yrs. ago I did not have a preceptor. I did have big sisters though, and I was surrounded by other experienced co workers to use as role models. Yes, ER people are very supportive of new grads. But after a couple of years I began to sometimes wonder if their help outweighed its cost. It seems that every time somebody helped with my patients, I got the sense that they were helping me because I was so inadequate. I know that the feedback that they gave other people about me had some that cr*p. The last day I worked ER I would have been hard pressed to find a Nurse who would help my patients without acting like they are doing ME a personal favor. Physicians techs, EMTs, and everybody else was better at helping OUR patients. Anyone in the health care business should consider any sick person as one of OUR patients.
Hogan,
I respect you more than any other nurse that I have spoken to. I am about to enter a new specialty, but LTC?
The world needs to be disbused of thier perception of LTC nurses. You stated that when you were ER, the LTC nurses were terrible. I do not beleive anybody in the sick people business could be terrible. What I think you should have said is that the LTC patients you got received terrible care. I applaud your efforts at improving it.
Good for you and to cadeusus for doing something to improve the care of LTC. When you call report on a patient how long are you on hold before you can give report? Do you really think the nurse who takes your report really listens? Do you think they write down what you say on the leg of their scrubs and relay the info? Good for you in sending as much of the MR for everyone you send. I hope you are including the EMTs in your reporting. I have found their asessments much better than anybody elses. Do you think the MR you send gets looked at by the nurse or intern who are always "too busy" to read a 6-page MAR? Do you fax the MR also? Sometimes this helps our patients by tipping off admitting who can expidite their paperwork, AND to retrieve a copy of the dictation from their last visit.
What I have learned about LTC is not that it is some third-rate specialty or the last stop in a nursing career. LTC people are, all too often, the leading edge of the health care system. After all, I rely on you folks to be the first person to spot a sick person who needs to go to the hospital. I hope you are always right! Imagine how your NH will make its budget with another empty bed.:kiss
I've been complimented by paramedics and nurses for the thoroughness of my reports. I treat report like I always did in the ER. I am concise, succinct, and quick, oftentimes writing little crib notes to help me along. And you make a good point about the perception of LTC nurses. It's not as easy as I once thought it must be.
When sending a patient ANYWHERE, one should always call report ahead. And the EMTs and medics deserve a good report as well.
It's ALL connected guys. From the occ med clinic to the CVICU. Our patients have been to them all.
I will try to stay off of my soapbox, but I dont know if I can do it. LOL
I do not think new grads belong in any specialty area. I have only been out of school for 10 years but I dont think they are teaching any differently now than they were then. We were NOT ready to take on a specialty unit in any form. There is a certain amount of learning a new nurse has to do outside of the classroom. That teaching is always left to the seasoned experience nurses that the new grad works with, and I think a new grad is best precepted in a med surg environment.
I worked med surg for 2 1/2 years after I graduated from nursing school, my experience there was priceless. To this day, I have nurses who have been out of school 2-3 years coming to me and asking how to do standard med surg procedures that they did not learn. Things like maintaining central lines, decub care, peritoneal dialysis, runningTPN, working with G-tubes or J-tubes, etc.
These are all things we did on a routine basis in med surg, and we dont see that often in the ED.
I believe there should be a certain period of learning HOW to be an RN, and gaining some confidence in ones self and ability to perform tasks and learn to think quickly, hence perfecting that critical thinking we were all taught. In most cases, they dont know what they dont know.... no offense intended.
Hospitals nowadays will hire new grads in the specialty units without blinking an eye. they are cheap, and as far as the hospital is concerned, the other RN's will pick up the slack.
I will put the soapbox away now.
:) :) :)
I couldn't disagree more...why work in MedSurg if a specialty area is your preference? I was hired as a new grad in L&D, and don't believe anyone ever picked up my slack. I had orientation, and di just fine. Some things need to be learned on the job, and MedSurg would not have done much for me in my area. But then again, I am not an 18 year old with no life experience, and I knew what I wanted out of nursing. Each person must decide what is right for them. Who wants to work in MedSurg, always short, being frustrated? That's all I have heard from past classmates. Life is too short to be miserable.
What in the HELL could you possibly mean by specialty field?
Are you saying is that medical-surgical nursing is NOT a specialty? Tell that to all your colleagues who are certified in their specialty. Aren't they specialists? You mean I CAN'T go back to college and get a MSN in M.S. and then be a specialist. Suppose when you were working a floor, you fell in love with your specialty. How many years could you stand working your floor as a dumping ground for new grads who were too stupid to work a "specialty."
I think what truly torques my testes is the sweeping statement from impudent, snobbish, critical care types. "NO NEW GRADS IN ER, PERIOD!" It took you 2 1/2 years, fine, but please do not generalize that because it took you that long, everyone else needs that long.
When I went to ER right out of nursing school I had never set foot in one before. Back in those days it was virtually unheard of for any new grad to go anywhere BUT med-surg. I had to do some high-grade finagling to get straight into ER.
I would never recommend it to any new grad, considering how I struggled, but I did it. I was ACLS, without being forced, within 6 months of becoming an RN. I was CEN before 2 years had elapsed. I have been ER for over 20yrs, most of it in the highest volume level 1 in the state.
I agree with you if your comments are confined to advice. I would never recommend that a new grad start their career in ER if they had been advised not to do so.
To the new grad,
Work wherever you and your advisors think you can, (and I sure as HELL do not cosider any kind of administrators ADVISORS). Do not go to Med-surg unless you want to. See if you can figure out your second choice after ER. Try to go to work there. Maybe ICU has the kind of controlled chaos that some people like. The reason I couldn't do it is because I think I would soon get tired of falling in love with my patients and then watching them die. In ER I see people die every day, but the hours that they spend with me are not enough for me to learn to love them.
Once you feel comfortable in your unit, see if you can float to ER, or at least visit when you can. Once ER people see you are interested they will be glad to help you learn and transistion to another specialty. :kiss
Great post. (Though something tells me Veetach won't think so :roll)
I also agree w/ your comment about LTC.
I did ER for 8 years (right out of school) and used to think most, if not all (it was my experience) LTC nurses were terrible. Now I'm the house sup for a LTC/SNF, and we have to decide who goes to the ER, and who we can keep here...
I think what you are saying is that one can handle any kind of nursing, if you put your mind to it, and work hard to ALWAYS learn...
Good post, and thanks for being forward thinking.
sean
i just have to give you kudos..I did a 3 yr stint in LTC as a charge nurse and then unit manager and IMO, LTC is one of the most challenging areas to work..With many of these people , the staff is everything to them..ie: nurse, cargiver, family....Even though it is not as technical as the ER or other critical care areas, it still requires a great deal of knowledge and critical thinking esp since most of the time the nurse is it and many times you have to fight to get anyones attention. I had to leave it just because I got so attached to the pts..the little old men really got to me...I was a manager in a pretty high flutin place and actually took care of a man that was from germany that helped design the first hydrogen bomb..also had a little lady that defected from Austria that had been royalty..no one came to see either of them or most of the others for that matter...It really broke my heart!! I also had a hard time with the apathy I saw in a lot of the staff..they were like robots passing pills many of them could care less..made my job really hard!! Erin
Do the old grad nurses really think that knowing how to run a TPN, treating decubitis ulcers or having med surg experience will really make a difference on how any ER (new or old) nurse will respond to an emergent situation and how many central lines do you have to even bother with in a ED setting. I was a new grad and I can tell you that there are veteran ED nurses out there who cant even put on simple volar splint or give proper crutch training. Its all about repitition, the more you do it the better you get. Another case in point, during my orientation we had a pt who needed a chest tube, the most veteran nurse there
(10yrs experience including paramedic, cardiac nurse) forgot how to set one up, but the cool thing about her is that she wasnt afraid to admit it. From my experience as a new grad, nurses who think they are high and mighty, are more critical and are not willing to teach.....I have to question their skills. If your new grads are making these mistakes, you better check your orientation program. Just remember that old grad nurses make bone head mistakes too.
I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an 
Evelyn2003
7 Posts
First, I have loved reading everyone's thoughts. I am glad to see that it evoked some strong feelings, because this is a very emotional issue for me right now. When I started this post I struggled with the fact that I did not want to sound like Med/Surg is less challenging than the ER. In fact, I thought my Med/Surg clinicals were 5 times harder than my ER experience.
In the ER, I never had to support someone to the bathroom scared they would pass out on me. I never had to change an occupied bed (although in gero. I did it plenty and got rather good at it). I never had to care for a de-hisced wound while explaining to a (horrified) patient that it would be all right (eventually). To me, the physical demands and the psych/soc are harder in Med/Surg.
I am much more scared of Med/Surg than the ER. There seems to be a lot more support from other staff in the ER, and other nurses and your physicians are right there for questions. In Med Surg, even as a student, I felt like the Lone Ranger. When you are in a patient's room, no one knows what you are going through, plus you have no idea what is happening to your other patients.
So my motivation to be in the ER was not because I thought it was "cool" or because I am some kind of cowboy(girl). I do have confidence that I could learn the meds, critical thinking, etc. everyone has mentioned. But there does seems to be a common theme that most people who did well starting in the ER had some kind of prior tech/LPN/EMT experience, which I do not have. Everything I see in the hospital is a "first-time" for me. So I do a lot of "looking stupid" (loss of ego in nursing school is food for another posting!)
I am staying within the hospital system affiliated with my university because they will reimburse our loan amounts. So if they restrict me to Med/Surg, that's that for now. I am trying to build up my courage and confidence. Meanwhile, I took the NCLEX on Monday and I'm waiting to see if I passed. It shut down at 75 questions, so it's either good or bad.
Thanks again for all the food for thought. I feel more confident now that I see many people think start in Med/Surg is mandatory, and hardly anyone thinks it is a bad thing, even if I want to go to the ER later.