New grads in the ER

Scavenger'sWife, RN · May 5, 2003

Read the posting by dsczephyr. It is very well said and IMHO, very true.

Very generally speaking, I feel few new grads are ready for ED. They lack too many basic skills. I do not care where you went to school, it truly does not prepare you for the "real world". You may, for example, be very able to take a BP...but how able are you to take one on a patient who is bleeding out from a GI bleed? You may have great luck starting your IVs in school, but how many 85 year old patients with spider veins and paper skin did you have? or babies? (I have worked with new grads who NEVER had started an IV independently! :eek: )

The list can go on & on. So I really think it is a good idea to get experience, polish your skills, learn telemetry, get ACLS and PALS, get your organizational skills honed, and obtain some experience with the scarey stuff like bleeders, the dying, the psychotic, the drunk & disorderlies, etc.....Med-Surg will get you most of this. And learn about patho-phys and disease process.

Also, I would ask one or more of your instructors in nursing school where they thought you belonged. These nurses have seen you in action and may have helpful advice.

flaerman · May 13, 2003

Jim, Yes new grads can be precepted into great ER nurses', not all but I am a preceptor and have precepted a few myself. You need good assessment skills and a good knowledge base. I find that paramedics who have gone to nursing school do well. If you were good in school it helps or even if you had worked as a tech in an ER. The last 3 we precepted in our dept wound up with one leaving to go to med/surg for more experience, the other 2 did okay but one moved away and one went agency after gaining a year of experience to make better money. I am also in charge of our dept's orientation of new staff and we just some supposedly experienced nurse who are far from what we expected. One is gone and another will probably go as he is just lacks good critcal thinking skills and lacks a good knowledge base. Excellent critcal thinking skiils are what make the difference between a good ER nurse and an average one. Good luck--Paul

Sarah, RNBScN · May 14, 2003

Get your floor experience first. Learning to look after a pt. load of 8 - 10 pts. Prioritize and organize your skills that you've worked on for the last 3 yrs. or 2 yrs. depending on the length of your program. Your the RN - meds, IV, tx. and procedures that the RPN may not be allowed to do.

The learning has just begun...when you spread your own wings.

jetsetter · Jun 4, 2003

I was a new grad last may and went straight to ER, it was horribly hard, and I loved every minute!!!!!!!!!!

dont let anyone talk you out of doing what you want to do. If its not right for you , it will take you one shift to know.

follow your heart, not your checkbook or someone else's opinion, and you'll do just fine.

HARN · Jun 4, 2003

I think a new grad should go to an area that interests them. If that be med-surg, ER, or a unit...whatever gets them motivated. All of us need to start somewhere, where that my be is up to that person...More power to you whom have started in high stress, busy areas....We need nurses EVERYWHERE....

happystudent, RN · Jun 5, 2003

Originally posted by jetsetter
I was a new grad last may and went straight to ER, it was horribly hard, and I loved every minute!!!!!!!!!!

dont let anyone talk you out of doing what you want to do. If its not right for you , it will take you one shift to know.

follow your heart, not your checkbook or someone else's opinion, and you'll do just fine.

I totally agree with you, sista!!

I just started today as a critical care tech in one of the busiest trauma centers in the state... I Frikken love it!!!!

I knew that I wanted to work in the ed right out of rn school (grad may 04) so I applied as a tech to make sure this is what I wanted to do......

Let me tell you, I say my first deceased 3month old:o but I cant wait to go back tomorrow..

There is so much to learn, even as a tech... but I am so hungry to get as much experience as possible that I cant get enough!!

There is no way that I could go to med surg, Ive been there done that... Med surg is okay, but there is just something about the alarms that go off when the emts are on their way with a code.....

Hey I say if you can do it go for it and dont look back!! Thats what Im doin'

Happy:D

atownsendrn · Jun 5, 2003

I started as a new grad in the ER. I had been in the same ER as a tech for 3 years (worked fulltime while in school). Wouldn't have wanted to do it any other way.

Scis · Jun 13, 2003

I started nursing school as a second career and figured most people my age had 10 years under their belts by the time I graduated. The only place I aspired to work all through nursing school was the large Level I trauma center of NJ's major teaching hospital. All the best (ie worst) trauma cases were always brought there and the accidents were always reported in the local newspaper. The helicopter would fly patients in from all over the state, how exciting! Well, at every turn, my nursing instructors, seasoned nurses I knew, everyone, told me that I would NEVER get accepted to this institution without experience at a "smaller" ER. No way I would accept this notion, I applied the February before I graduated from nursing school, I was accepted and started barely a month out of school. All new nurses to this ER regardless of background were enrolled in the department orientation. The learning consisted of 3 months of classroom/lab work, along with testing on the material along the way. You were informed that within 1 year of employment, you had to satisfy the necessary ACLS and PALS requirements and keep your certifications current. By choice I had my CEN and TNCCP status within 2 years of employment. I have never regretted the extra effort I had to put in post graduation to get and retain my position in this ER. Bottom line, if ER is in you, you'll do whatever is required to practice there. The ER is also located in a very poor, urban area, so a myriad of patients and clinical presentations roll through the doors daily (or nightly in my case). You really get to use all the skills you acquire. That's what ER is, and that's why those of us who do it love it!

I say if it's right for you, jump right into it. I don't condone the theory of working on med/surg etc. first--the floors are nothing like the ER. It's like telling a college-level prepared teacher to teach kindergarten first before pursuing a career as a college professor, no comparison.

I have been doing this for 10 years and have never regretted the effort. By keeping myself educated and informed, I can best serve my patients, the core of nursing care.

Sounds sappy, I know, but it's true! Patty

4XNURSE · Jun 13, 2003

Originally posted by HARN
I think a new grad should go to an area that interests them. If that be med-surg, ER, or a unit...whatever gets them motivated. All of us need to start somewhere, where that my be is up to that person...More power to you whom have started in high stress, busy areas....We need nurses EVERYWHERE....

I couldn't agree more.

Telling someone what they can't do, or where they can't go, won't help anything. A lot of nurses burn out putting in their time in areas they never wanted to be, in the first place.

Be prepared to work hard, study hard, and put up with a lot of sh**.

Just my $ 0.02.

ken :devil:

ernurse1234 · Sep 9, 2003

I agree with the fact that it truly depends on the RN. If he/she has the personality to be in the ER is the key. There are many new grads that may be "book smart", get a big head in school, think they can handle anything and they are typically the ones who can do the poorest as a new grad in the ER. I have been a preceptor for many years and also been actively involved with education/orientation processes for new grads. We were keeping our new grads in orientation for 6 months, and at the end of the 5th month I sent them to ACLS. Usually by the 3rd or 4th month I could tell if they were going to make it or not clinically. Personality wise I could almost always tell the FIRST day that I met them. It is key they have a strong preceptor and a organization that supports learning. I don't think there are any hard and fast rules to "getting someone oriented", but I think there are definite "red flags" that I have seen throughout my career that have been the kiss of death for a new grad in the ER. Usually that "Know it All" attitude is what gets most ER nurses' pissed off and not willing to teach the new person. But again, it varies on the experience of the institution and the willingness of the individual to learn and experience new things and not be afraid to ask questions. :kiss

portland_guy · Sep 9, 2003

I'm wondering what type of personality of a person best fits in an ER? What are some of the qualities that are required? Organizational skills? Flexibility?

Reason is I am thinking of a career change to nursing. I think ER sounds like a very fast past environment where you get to see a lot of variety. The day must certainly fly by, but I am wondering if it would be a good fit for me.

fab4fan · Sep 9, 2003

Agree with ernurse 1234; I worked in the ED until I was injured, and that used to really piss me off (new grad know it alls, that is). My attitude, when I went to ED (after 16y exp in other areas) was: Ask questions, keep your eyes open, and for heaven's sake, think twice before you think you know it all...you don't.

And comparing ED nurses: med-surg nurses to college profs.: kindergarten teachers...that's really poor. Thank your stars there are nurses who like M/S. ED nurses are no better, no smarter, no more challeneged than M/S.

Someone who hasn't even worked one day as a licensed nurse simply cannot say that she/he has "been there, done that" with M/S nursing. No, you haven't. In addition, being a tech, EMT, parmedic is simply not the same, and good paramedics will be the first ones to set you straight on that. There are similar skills, but there are big differences, too.