Not Hiring New Grads in ER's

FloatRN19 · May 18, 2015

If you love the ED might as well go the smaller route than to try and go from a floor nurse to an ED nurse. I know when I interviewed in an ED that if I had had any ED experience they would have hired me. If you decide to just apply for a bigger hospital and wait to transfer to their ED, I'd suggest A float pool/resource team job. I know two of the three hospitals I have worked at(aide and RN) they let both float pools orient to the ER after six months.

dishes, BSN, RN · May 18, 2015

Ask the ER managers at the large urban hospitals if they prefer to hire internal experienced floor nurses or external experienced ER nurses. It sounds like you anticipate multiple job offers after graduation, you're lucky, most areas are saturated with new grads and many are finding it difficult to receive a single job offer.

cel589 · May 18, 2015

Thank you both for the help! I really appreciate it.

@dishes- I definitely know how difficult it is for new grad RN's getting jobs and I'm just as nervous for myself. I did get very lucky and got my dream externship at a really great hospital who usually hires most of their externs after graduation. However, they don't hire new grads into the ER so I don't know if it's worth it to try to get an ER job at a smaller hospital when I'm lucky enough to have the opportunity to most likely get a job at an amazing hospital right out of school. I will definitely take your advice and try to talk to the nurse managers during my externship and get their advice on the topic! Thank you!

concordance · May 18, 2015

Ooh friend I'd take that externship. It'll give you a little more support out of school and a little more "graceful" transition into being a nurse.

I work in the ED now and we hire new grads but it can be brutal to watch them...I started on a stepdown unit and though I hated the job I appreciate the skills it afforded me--time management, pt education, maneuvering the really large patients, talking to doctors, all that stuff. I think it was easier to start on a unit than it would have been in the ED...this from a girl who loves the ED.

ERGirl83 · May 19, 2015

If you end up with options, I'd take the ED job. And be careful about turning up your nose at a smaller facility. Having worked in Level I, and II trauma centers, and in a smaller community facility, I actually think a small facility can be a great place to gain experience, and personally, I prefer it. Because there are less additional resources (techs, phlebs, etc), you really learn to manage your patients more independently, and you really get a chance to put together the whole picture. There's also a better opportunity to really develop a relationship with your docs who will teach you a ton. Additionally, at many larger facilities, newer nurses must wait a long time to have a crack at the higher acuity patients. But, in a smaller facility, when a full arrest, or otherwise critical patient arrives, it becomes an all hands on deck situation, and you'll gain experience much faster that way.

in our department, we prefer to hire previous ER Nurses, or new grads who did an ED Capstone. So many skills from the floor just don't transfer over. I find that I spend more time breaking down the ED way of thinking with an experienced floor nurse than with a new grad. Im sure that varies but it's definitely the preference where I work.

Plus, if you start in an ED, you will already have obtained your certifications like ACLS, PALS, TNCC, and ENPC, which will make you more marketable should you want to move to a larger ED.

Dranger · May 19, 2015

I have hadnew grads in the ED transfer patients to the ICU without having a clue. It can be downright scary. I would go floor/stepdown to ED.

thenightnurse456 · May 19, 2015

I'm a firm believer that new grads shouldn't start in critical care areas. I know there are some fantastic nurse residency programs, but invaluable skills, experiences and lessons can be gained from working in floor units.

I've taken report from a grad in ICU and it was a mess, despite completing an amazing residency program they were only focussed on tasks (like most grads). This is not acceptable in critical care when you really do need to understand the big picture. Miss something in a critical environment and things go south very quickly.

I know this post will anger some people, but this is my opinion. Flame away.

FloatRN19 · May 19, 2015

I'm a firm believer that new grads shouldn't start in critical care areas. I know there are some fantastic nurse residency programs, but invaluable skills, experiences and lessons can be gained from working in floor units.
I've taken report from a grad in ICU and it was a mess, despite completing an amazing residency program they were only focussed on tasks (like most grads). This is not acceptable in critical care when you really do need to understand the big picture. Miss something in a critical environment and things go south very quickly.
I know this post will anger some people, but this is my opinion. Flame away.

I wouldn't say you're completely wrong, a lot of new grads do need to start in the more General care areas. But there is a percentage that are built for critical areas, just off the top of my head maybe 1/8-1/10 something like that. I know of a couple icu's that like to hire new grads just so that they are able to train them exactly how they want and mitigates any bad habits they'll get from working medsurg. I often hear the time management line get thrown around, you'll learn time management there etc, etc. Honestly I felt like I learned better time management in the ICU so when I floated back to ms everything slowed down and was easier to manage.

Also, did you tell the new grad this? Something I've always had an issue with was staff complaining about other stuff. I'd always ask, "did you tell them that?" More often than not they hadn't told them that. How are they supposed to get better if you don't tell them they are deficient.

thenightnurse456 · May 19, 2015

I wouldn't say you're completely wrong, a lot of new grads do need to start in the more General care areas. But there is a percentage that are built for critical areas, just off the top of my head maybe 1/8-1/10 something like that. I know of a couple icu's that like to hire new grads just so that they are able to train them exactly how they want and mitigates any bad habits they'll get from working medsurg. I often hear the time management line get thrown around, you'll learn time management there etc, etc. Honestly I felt like I learned better time management in the ICU so when I floated back to ms everything slowed down and was easier to manage.
Also, did you tell the new grad this? Something I've always had an issue with was staff complaining about other stuff. I'd always ask, "did you tell them that?" More often than not they hadn't told them that. How are they supposed to get better if you don't tell them they are deficient.

I do see your point. And yes the new grad was spoken to and received more preceptor time and general education.

Some new grads will thrive in a critical care area, but in general I believe they will gain more from working in general areas first.

Julius Seizure · May 20, 2015

I'm a firm believer that new grads shouldn't start in critical care areas.
I know this post will anger some people, but this is my opinion. Flame away.

I dont intend to "flame" you at all, first of all! No one will ever, ever agree on this, of course. But different opinions make life more interesting, right?

Personally, I have two very strong opinions on this subject:

#1: There are pros and cons to starting in ICU. And on the floor. And in the OR. And the ER. And....well you get the idea

#2: No path is right for EVERYONE.

All I can really speak to is my own personal experience. I doubt I would have stayed in nursing if I had done two years in adult med surg. I have spent my entire career in pediatric critical care and if I could do it over again, I would do it the same way. I got a solid foundation in PICU, then specialized in cardiac surgical ICU, then peds critical care float pool (I function just fine on the floors when I float there, by the way - as long as its a pediatric floor! No adults for me, thanks!). If I were in the OPs shoes, I would choose the smaller hospital ER job if I could.

What I would say, OP, is this.....whichever path you choose, make the most of it. I believe you can build a solid career either way. Be open to every opportunity that you are offered, and if you get more than one, great! There is not really a wrong decision.....its just which path you want to walk down.

cel589 · May 21, 2015

Thank you all for your help! I really appreciate everyone's advice. I've applied for ER as my senior capstone but it's not guaranteed you get your first choice. I agree with above posters and truly believe there is a place for every nurse! I'm definitely willing to start in a smaller ER or on a different floor if it leads to me to my end goal and as a more prepared and experienced nurse. Thank you everyone!