Not properly trained for ER?????

medicrn16 · Sep 20, 2009

IMHO, you will work better where your heart's desire is. I can tell you that most of the students in my class had NO desire to do critical care or ED. BUT, all the medics in my class did. As medics in our profession, we have already treated (albeit in the back of a truck for a max time of say 20-30 minutes), MIs, stroke, resp failure, done CPAP, major trauma, DKA, hypoglycemic coma, worked numerous codes (at best with 3 people), etc.

That being said, I completely understand that caring for a pt for 12 hours (our shifts at the level-1) is MUCH different than treating for 30 minutes. But, the clinical thinking that goes behind assessing a pt in their home with sometimes limited or NO information available, reacting QUICKLY, having CONFIDENCE, in what you are doing or are about to do, ADVOCATING for your pt are all similar actions performed in the ED. I completely agree with previous poster who stated that your team is the biggest contributing factor to the success of ANYONE in the ED...regardless if you have experience on med-surg or are a grad RN. If you are where you WANT TO BE...I don't believe anything can stop you from accomplishing your goal. I also agree with the poster that said as a grad RN, you are never truly prepared to work anywhere...how can you be?

Editorial Team / Moderator · Sep 22, 2009

Everyone is different. Some are more prepared for the ED than others. With my experience as an ED tech and as a paramedic, I was well suited to transitioning as an RN in my ED -- I have fabulous and supportive coworkers, had a great preceptor, and did an ED nursing fellowship at our hospital's Level 1 with a bunch of other new grads -- some so green they'd never even seen the ED before (yikes ... I wouldn't WANT that stress!!). I had a great orientation period, too. But even with all that support/help/knowledge/experience, it still took me time to transition into my new role as an ED RN. It was stressful. It still is!

But comparing being an EMT (even an EMT-P, in many regards) to being an ED RN? Apples and oranges, and I can say that from both sides of the fence. Yeah, they're both fruit, and that is the overlap, but they're very different roles.

alicia9178 · Sep 25, 2009

Well...I TOTALLY disagree. If you are wanting to be an ER RN then do that. I would probably not go for the Level One Trauma Center, but honestly ER is its own world and being on the floor is not going to help. I went to ER 3 months after getting my RN license and cannot imagine being anywhere else. Now...it was and still is VERY hard, but it is all about your level of dedication. YOU CAN DO IT!!!

ALicia

gifted87 · Sep 30, 2009

Wow that is the most inaccurate and discouraging advice i have heard in a long time. ASN grads probably have twice as much clinical experience than a BSN grad. I am not taking anything away from the BSN grads but that is a fact just about anywhere here in the state of MD. Furthermore, I am a proud grad of an ASN program and was hired directly into the ER with NO previous hospital or healthcare experience. Don't believe the hype because that is truly BS!

EmergencyNrse · Sep 30, 2009

Everyone coming to do emergency medicine for the 1st time isn't properly trained. There isn't a nursing program out there that can prepare you for what goes on in the ER. It's just experienced and learned.

So much of what we all do as nurses comes from O.J.T.

Now I wouldn't go looking for level 1 right out of the gate but no facility is going to throw you to the wolves. You will get an orientation period. You get to work quick care and lower acuity patients. You advance to patients of higher and higher acuity. You will know what it is to use critical thinking and assessment skills. Triage and priority! There will be a preceptor that will nurture you, help you grow and possibly shatter your desire to ever do nursing again.:chuckle

Just kidding.

It's dynamic and rewarding. You will see people for diaper rash and splinters as well as Heart Attack, Stroke, Gunshot Wounds... There are people that fall off of roofs, hit by cars, hit other cars. (GOD I love it!)

There will be patients that hear for the 1st time diagnoses of Cancer, Diabetes, and other terminal illnesses. You will help people that are absolutely going through the worst and miserable times of their lives.

They're hurt, scared, and feel horrible both physically & mentally.

Nurses are there to help them. To be there to comfort them both sick & injured...

Somebody HAS to do it. Accidents and disease will continue to happen. You can BE that nurse!

You will love it or you will hate it. But don't turn your back because someone placed doubt in your mind.

Best of luck.

foreverLaur · Sep 30, 2009

ASN grads probably have twice as much clinical experience than a BSN grad.

?????

Editorial Team / Moderator · Sep 30, 2009

They're hurt, scared, and feel horrible both physically & mentally.
Nurses are there to help them. To be there to comfort them both sick & injured...
Somebody HAS to do it. Accidents and disease will continue to happen. You can BE that nurse!

And the minute you realize that you ARE that nurse ... well, you won't ever forget it. :)

nursepotter05, RN · Oct 1, 2009

I did a level 1 pediatric er straight out of school. I did go through a residency program. I have a bachelor's degree, but as far a nursing training, I don't see that a new grad with a bachelor's degree would be any more prepared for the er/icu than an associates. I think that your emt experience will help you get a job in an er because you do have experience in emergency situations. Go for the er, I think you can do it. The instructors in my nursing school always advised not to do er or icu as new grads, however i have seen plenty of new grads not only do it, but be successful at it. Check out the level one trauma center and see if they have a residency/new grad program because many of them do. Get a job as a tech, that is useful to gain experience and get your foot in the door, as well. Good luck!

Maikafer-RN · Oct 1, 2009

I am a new grad 6 months into my first job in a level 1 trauma ER, 2 months off orientation. I've survived so far.. I do look at some of the more experienced nurses and wish I had their experience under my belt, but so far I like it and although it's fast paced I feel like I can handle it. The pace doesn't bother me - I was a waitress for 6 years and I am used to the juggling and prioritizing. I'm just looking for some feedback - what is the main reason everyone says that new grads should not work in the ER? Is it the pace? Or the lack of experience that hinders critical thinking skills? I know it is difficult to learn in a fast paced environment, but is doing homework at the end of the day good enough? Is it because the danger of making a mistake and killing someone and/or losing your license is higher in new grads? I'm just curious because I think about this a lot, and wonder if I am just lucky that I have not had a difficult time so far. I wonder if something bad will happen in the future, or if this really is the right place for me. (It feels like the right place..) Do you think that working in the ER as a new grad makes you a better nurse, or a worse nurse? Input?

We must have started at the same time as new grads in the ER and I feel the same. I'm 3 months off a 4 month orientation and I just had a review/eval with the director and she is very impressed with where I'm at as a new grad. I didn't think I would be doing as well as I am but I feel very confident with most situations that come through the doors. Of course there are those full arrests that come in and we some how get them back and they are unstable and ICU isn't ready to receive them for a few hours so we end up holding them and coding them repeatedly and I need help from the other experienced RNs but generally I feel pretty good.

I oriented on days and since I've been on nights on my own I get a lot of the RNs asking me where I worked before and when I tell them no where I'm a new grad that had practically zero ER experience they are shocked. A lot of people tell me they would have never guessed I'm a new grad. I think I work with a good team of nurses and they are always open to questions I have. I would say our ER is fairly busy, I've been told we are one of the busiest in the county (no trauma though) and I'm generally able to hold my own with little to no help from others.

I think about the same things as you...why does this job feel so right for me (I actually ended up in ER on accident, they had filled all the ICU positions and offered ER instead - I NEVER thought of being an ER nurse but I accepted and LOVE it and can't imagine working any other unit!)

I think I'm making not necessarily a better nurse but I'm becoming a very competent nurse. I feel like if I wanted to I could go work any other unit from ER since we see it all. We see many procedures in the ER, we are used to emergencies/codes, we get an insane amount of practice with skills (IVs, foleys, NGs etc) so I feel like working ER as a new grad was an excellent choice!

motivated2nurse · Oct 2, 2009

Im a new grad in the ER.......I'm learning a lot and I wish that I could hurry along to this time next year..........Last night I felt as though my preceptor did not want to be bothered, and it's was very stressful.........This makes it hard and awkward......She tells me that she work in Med/surg 10 years before coming to the ER and she feels that no new grad should start in the ER.......I mean that's her opinion and I did work as a tech before this and did an ER externship the year before.......I ve seen new grads succeed and fail in the ER, but I can say the preceptor makes the difference......I feel that I can suceed with help, Im frustrated, not by my inexperience but by the personality conflict of the experience nurses who make me feel as though Im being hassed in a sorority............I love nursing and the ER but nurses are some baggage carrying, psychoes, that I just have to adjust too................Urrgghhh!!!!!!!!!!!!

whatdayoftheweekisit · Oct 6, 2009

Clinically, there would be no less preparation for the ER coming out of an Associate program than say a Bachelor's program. A new grad in the ER is a new grad...doesn't really matter what alphabet soup is behind their name. I have seen some new grads do ok in the ER and some that get a couple weeks of orientation and then shipped off to med-surg as it becomes abundantly apparent that the ER is not where they should start. It sounds like you have emergency experience as an EMT...I think that definitely helps. No matter what, you should be given a lengthy orientation if you are in fact hired in an ER as a new grad. And no matter how long that orientation is, you should not expect to be running three or four trauma rooms on your first day of orientation. The vast majority of RNs in practice have Associate degrees. The number of BSNs is rising but clinically there is no difference.

bassadict69 · May 19, 2010

A little update...

I just completed second level clinicals & today I got hired as an ED Tech at one of our local hospitals...I am stoked! I go through a 3 week orientation starting June 1st.