Not properly trained for ER?????

Editorial Team / Moderator · May 19, 2010

Woo hoo! Congrats. I'm sure you'll make the most of your time. :)

murphyle, BSN, RN · May 19, 2010

I'm a recent grad who started straight in the EC (we're a Level 2 center - we don't see a lot of trauma, but we do get tons of major medicals), and also a graduate of an Accelerated BSN program. According to the conventional wisdom, I should have burst into flames as soon as I walked through the unit doors. "New grads can't hack it in the ER!" "BSNs don't have any clinical training compared to ADNs!" "ASD-BSNs aren't real nurses at all!"

And yet I've received nothing but positive reviews from my preceptors, managers and colleagues, and people are absolutely shocked to hear that I'm a newbie. The average "How long did you think I had been a nurse, before you asked me?" response is three to five years.

I firmly believe that any given graduate's suitability for any unit is dependent upon his or her motivation and dedication to learning what is required to be a good nurse on that unit, and much less dependent upon how many years of experience he or she has in other units. If you know you want to work in Emergency or anyplace else, and you have the guts to get in there and learn it, I see no reason why you can't succeed. In my case, I study for work: I read journals and textbooks (both medical and nursing), follow emergency care Websites (ACEP, ENA, etc), and ask the personnel around me for their experiences and "clinical pearls." I read instruction manuals for equipment. I know that there will always be something I don't know, but I strive to build a broad enough knowledge base so that even if I don't know that specific answer, I know where to look or how to figure it out.

In the modern healthcare environment, doing a year of med-surg trains you to be a med-surg nurse. Any other unit you go to will have completely different procedures, protocols, patient mixes, and so forth. In the EC, on the other hand, you see everything. My colleagues and I can go from titrating pressor drips and troubleshooting a Vigileo to reading fetal heart tones and assisting a pelvic exam on any given night. Med-surg does not prepare you for that, and I've also heard that stated from the nurses on my unit who went that "traditional" route. (It's also been my experience that the contingent nurses we occasionally get from the med-surg floors tend to have a difficult time coping in the EC. Your mileage may vary.) Perhaps instead of telling every new grad to work med-surg for a year before going to specialty care units, we should tell them to start in their chosen specialty at a smaller hospital and work up to a large institution.

:twocents:

Footballnut · May 19, 2010

Congratulations and enjoy your experience!

In answer to your earlier question there are some new grads that do well in the ED setting but most benefit from having some time to develop as an RN in another setting. I have even had some long term paramedics have difficulty entering the ED as an RN. Others have done fabulously. The new grads that are more likely to do well in our department have generally worked in the department for a while as a tech or CNA. Even some of them still need time somewhere else before they can tackle the job. A very few students come through that are obviously a fit too. A lot has to do with your critical thinking skills and ability to adapt and work quickly.

And, yes, you will see everything and get the opportunity to make a difference.

PS, this is my favorite book of the week:

Critical Thinking in the Emergency Department: Skills to Assess, Analyze, and Act

Shelley Cohen, RN, BS, CEN

bassadict69 · May 3, 2011

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.

Here it is two semesters later, and I have seen a lot during my time as a tech in the ED! Tonight is my graduation from my nursing school and May 23 I start as an RN App in the same ER...Thanks to everyone for the encouraging posts!

shoegalRN, RN · May 4, 2011

Here's a saying that I've heard in the ER:

They will have to beat the (insert RN specialty here) nurse OUT of you to get to the ER nurse IN you.

ZippyGBR, BSN, RN · May 4, 2011

No pre-registration programme be it USAmerican / European / Antipodean/ Martian or what ever will prepare you for ANY speciality at all - regardless of it's academic level or the quality and quantity of placements ( although obviously a EU directive compliant type course with thousands of hours of varied high quality clinical placements will provide a better experience than a course with a few hundred hours of placements in limited areas of clinical practice.

Some People will be able to take on the challenges and steeper learning curve of starting work in an environment other than 'ordinary' hospital inpatient /LTC as a first job.

ZippyGBR, BSN, RN · May 4, 2011

Here's a saying that I've heard in the ER:
They will have to beat the (insert RN specialty here) nurse OUT of you to get to the ER nurse IN you.

you can take the Nurse out of the ER , but you can't take the ER out of the Nurse ...

algebra_demystified · May 5, 2011

Hey Emergency dept. new grads,
I am not biased against new grads working in the ER, but I have a question about how you feel prepared. Of course an excellent orientation goes a long way, but there is soooo much to know. In a specialty, although you want to know how to treat the WHOLE PERSON, you still have a limited number of diagnosis to greatly familiarize yourself with. In the emergency department, you never know what you will get, so I would feel the need to familiarize myself with EVERYTHING about everything lol. Like someone above said, you don't know what you don't know...nothing personal, but how does a new grad know everything that I would think (as an outsider) would need in emergency nursing? So my question is just how do you feel prepared. Do you just remember everything from nursing school, or have you been through an amazing orientation? Kudos to all of you new grads who are getting through in the emergency dept. I would just like to know how you are doing, as I am somewhat considering an urgent care center (not quite, ED, but....) Thanks, I can't wait to hear from some of the ED grads!

You go to war with the army you have, not the one you wish you had.

I graduated about two and a half years ago, did a short stint in a Medicare convalescent home, and then two years in criminal psych. Without the criminal psych background, I don't think I would have a thick enough skin to do it.

I think a lot of the new grad nurses who want to work the ED get off on watching people die. That's just one man's opinion, but I think there's something to it. I'd rather figure out what's causing this particular patient's abdominal pain and help put family members at ease, but I guess my adrenal glands have been squeezed dry by the criminal psych stuff I dealt with for the last couple of years. I don't have an intense drive to get on the rapid response team and work trauma... I've seen enough suffering to last me a lifetime. Suicides, cutters, blah blah blah.

I think the part I enjoy about the ED is the sociocultural stuff. The Saudi Arabian family, the Somalians, the male/female family roles, the lack of respect for females, the need to make decisions by the eldest son, that kind of thing interests me a lot.

Granted, I haven't had to deal with a lot of death yet, but Yalom's Existential Psychotherapy was immensely helpful in helping me put death in a context for people at all stages of the lifespan. I think you can get the bulk of it through Wikipedia, if anyone's interested.

As far as preparation for the ED role goes, I've been lucky enough to be precepted by the the Employee of the Year for a very large hospital system who has 20+ years on the floor as an ED nurse. He's wrong about the patient's diagnosis REGULARLY, so I'm not so worried about my preparation. I can take care of my responsibilities, ask for help when it's time to do so, and pitch in when another nurse is drowning in tasks. We all have our place in the hierarchy, we all have our strengths and weaknesses, and with a good attitude we can work as a team to serve our patients to the best of our collective ability.

Learn one, do one, teach one.

hiddencatRN, BSN, RN · May 6, 2011

I think a lot of the new grad nurses who want to work the ED get off on watching people die.

.....what?

emtb2rn, BSN, RN, EMT-B · May 6, 2011

.....what?

Yeah, I had the same thought.

algebra_demystified · May 10, 2011

Yeah, I had the same thought.

The discussions I've had with my training cohort have led me to that conclusion. They're excited to see a cardioversion, a vtach, get off on the suffering of the family, etc. "Wow, I got to do a code today, you should have seen the wife's face!"

Assessing abdominal pain just isn't as exciting.

Maybe it's just the new grads.

I personally don't get off on watching people die. I've cut enough nooses and been involved in enough psych emergencies that I'm not interested in it anymore. I'd rather problem solve and direct the pt to the next treatment facility once the immediately life threatening emergency is resolved.

I'm more interested in the pharmakinetics and assessment in the acute setting than I am in the drama.

Deescalate, resolve problems, move the pt to the next level of care, etc. That's why I like the ED.

hiddencatRN, BSN, RN · May 10, 2011

The discussions I've had with my training cohort have led me to that conclusion. They're excited to see a cardioversion, a vtach, get off on the suffering of the family, etc. "Wow, I got to do a code today, you should have seen the wife's face!"
Assessing abdominal pain just isn't as exciting.
Maybe it's just the new grads.

I feel like this should be obvious, especially to someone who professes to like to think critically so much, but the fact that the new grads you know are like that (assuming you are correctly interpreting their motives) doesn't mean that we're all or even mostly like that. Small, nonrandomized samples don't generalize well.