new graduate: ER OR MED-SURG?

neneRN, BSN, RN · Apr 5, 2005

Depends on your personality and learning style. I went straight from school to ER and did very well. We commonly hire new grads, most do okay and find their way after several months, some do great right away, and then there are some who would've been better off somewhere else.

If I had to pinpoint what differentiates the most successful ones, I'd say that they are not afraid to jump into any situation asking what they can do to help. They participate when a code comes in, or come and watch procedures they've never done before. They want the learning oportunities even if they're scared to death. You need to be able to calm your own fears in order to learn.

You also have to be able to ask for help- this is maybe the most important quality. If you're not sure, ASK SOMEONE; your fear of looking stupid or silly could cost someone their life. I would rather have someone ask me a hundred questions than just assume something. This includes questioning doctor's orders and requesting orders that the doc may have overlooked.

You have to be motivated and able to critically think-- in the ER, you don't wait for the doctor's orders- you anticipate the orders and do it while you're waiting for the doc to see the pt.

Your assessment skills need to be strong- it is the nurses that determine which pts get seen and treated in what order. You have to be able to quickly recognize which pts are most acute and prioritize what needs done for them now.

Last but not least- a sense of humor/thick skin. In emergent situations, people get snippy, docs get loud, and if something gets overlooked or not done quickly enough- it falls onto you as the nurse. Psych pts like to swing at you. Drunks like to yell at you. Visitors like to complain about you. You can't take any of this personally and you definitely can't take it home with you. ER nurses have the most warped sense of humor, but that's what usually gets you through the day.

You'll either love it or you'll hate it. I wouldn't do anything else.

Aneroo, LPN · Apr 5, 2005

I'll be a new grad in May also, and I am starting out in a level-1 trauma center. I was told :confused: that I wouldn't be put in triage or in the trauma room for at least a year. They're not going to throw you in there as a new grad. I am looking forward to it so much. From the expereinces I've had with RN's down there, they're awesome. They searched me down to show me stuff and let me try things. Granted, I am incredibly nervous, but would so much rather be here than med-surg. I actually think I'd get burned out faster on med-surg just because I wouldn't want to be there. And if you do get burned out of the ER a few years down the road...you can go almost anywhere! -Andrea

ER-RN · Apr 5, 2005

hi i am a new graduate and new RN!
i was wondering if you suggest that i work in the ER or med-surg unit?
people told me to gain my experience from med-surg. wait until 1-2 before going into the ER. and then i have some who told me go straight to the ER because i will learn.

Pick ER

I went straight to the ER after graduating and never regretted it. However, I did have lots of ER exp. prior (unit clerk, EMT, ER Tech. and then Nurse Extern) There were three of us (new grads) and we were all hired at the same time. We were a great support group for each other. Do what ever you can to prepare ahead of time for example EKG classes or purchase books with Heart strips. Your school book store should have them. If you can begin studying for ACLS. Don't panic it will all make sense once you start living it and you will love it. You might meet a few nurses who don't appreciate new grads, so just stay away from them. (They probably like working short staffed and they deserve it.) Buddy up with good nurses who like to teach, they are the most helpful. I suggest smaller ERs for learning purposes, but if you find a Level 1 Trauma center with a great nurse educator and supportive staff GO FOR IT!!! If you don't like the ER then do med-surg. There's lots of great nursing opportunities out there you just have to find your niche. What worked for one nurse doesn't also work for another.

P.S. I know for a fact med-surg nursing doesn't make you any smarter - by ALL THE STUPID QUESTIONS med-surg nurses ask you when calling report. (I am sincerely sorry to all the competent med-surg nurse for this comment)

Good luck in what ever you choose!!!!

ERNURSE4MS · Apr 5, 2005

I think it depends on what size ER you are planning to go to. I had 5 years MED-SUR, CCU/ICU,PEDS experience it gave me essential assessment skills and time management skills. Now I work in a small level4 ER with a high pt flow for our area. We have a staffing ratio of 3RNS on days and 2 RNs on nights with 9 ER beds. We had a new grad start off on nights in our ER and he is still having a very difficult time adapting to the speed in which we have to work. On the other hand a guy I went to nursing school with went directly to this ER and flourished on days, the key difference was my friend had EMS experience. I just want to caution you to think your decision through and if you can, go to that ER and check out the dynamics of the nurses there. Speak with the Nurse manager and see how long you will be on orientation, the longer the better. Also check out the requirements( acls,tncc,pals,catn,ekg analysis) and get them first.

Hrtnurse14 · Apr 7, 2005

I would have to say that if you go anywhere besides ER you should go at the very least to a unit that has heart monitors. This would give you a good basis for learning your heart facts, drips, and hone your assessment skills. I never cared much for bedside nursing but felt ER was too critical for me right out of school. I have done a few years on Tele and I am transitioning easily into ER. I do love the variety of patients and the pace. Tele was nice to learn on because even though it was busy there was also variety but a more controlled environment. I am currently orienting with a new grad. He had no prior experience and he is having a difficult time because EVERYTHING is new to him. I think that as with another posting said if you have strong skills and you are willing to jump in and learn and learn quickly then your o.k. If not do a little time on tele to get your feet wet (you'll be surprised at how fast it will go by) and then transition. Also, with tele you will see many aspects of the hospital that may also intrest you. Good luck.