Evelyn2003

This is not about new grads in the ED, but just about my story coming in to nursing. Now that everyone thinks I am an idiot. I am not thinking I am Superman out to save anything. Nursing school to me was leave my ego and my self-esteem at door. Everything I ever knew is now useless. Whatever I was good at, forget it doesn't matter anymore. Superman ate his cape a long time ago. Accountants are not known for their hearts, so you probably don't think I have one, but I know I have one, and that includes not wanting to offend anybody, so I apologize if I did. "don't want to bother with" was WRONG. I have said enough, and besides it is hard to talk with a mouth full of foot, knee, ...

No way am I saying that ER nurses don't provide the best care and that I am going to be any better than anybody else. In fact, I know that I will never be as good as people with so much more experience. I have been astounded at the amount of knowledge and responsibility that nurses have and the stamina that it takes to do all that they do. I am TRYING to say that I understand that it is not all glamour. But I have heard the very attitudes I wrote about and I won't pretend I haven't, but it may just be the few people I have worked with. I don't believe in criticizing other nurses because I know until you walk in those shoes, you don't know what you are talking about. BEFORE I went to school, what I heard from nurses was, we need extra hands, and if I can handle some of the load that maybe isn't the most glamourous, then LET ME. I am glad we finally got out in the open though, an attitude that breaks my heart and does make me question why I left my whole life behind because the cry went out "we need more nurses" and I wanted to make a difference with the rest of my life. Instead, when I get here, I get "who do you think you are?" I did not expect the "we won't accept you until you have paid your dues" attitude. I makes me sad, but it won't make me quit before I am even started.

I knew as soon as I hit "submit" that my posting made it sound like I was just trying to avoid those tasks. That is not at all the case. I just can't stand feeling like the Lone Ranger, like I have always felt in Med.Surg. I WANT to work in the ER so I can care for the Hispanic mom that brings her kid in because they have no place else to go. I want to care for the middle-aged guy with the toothache who doesn't have insurance because he was laid off. Get this, I want to care for someone's mom/grandma while the other ER nurses are groaning "not another nursing home dump". And for the migraine patient that everyone accuses of med-seeking because I understand they have no reg. doc or their fancy specialist really doesn't want to treat them when they are actually in pain. I even want to care for the boarder patients, explaining for the 20th time why they don't have a room yet, even though they are admits to r/o an MI, which means it is our job to prevent them from coding while they are waiting. And I know there is not a lot of time to do this, but I really want to see if it is possible to get some of the "frequent flyers" connected with the right resources so the are not coming to the ER when they should be somewhere else. In some ways, I think I want to be in the ER to care for the patients that other people don't want to be bothered with.

First, I have loved reading everyone's thoughts. I am glad to see that it evoked some strong feelings, because this is a very emotional issue for me right now. When I started this post I struggled with the fact that I did not want to sound like Med/Surg is less challenging than the ER. In fact, I thought my Med/Surg clinicals were 5 times harder than my ER experience. In the ER, I never had to support someone to the bathroom scared they would pass out on me. I never had to change an occupied bed (although in gero. I did it plenty and got rather good at it). I never had to care for a de-hisced wound while explaining to a (horrified) patient that it would be all right (eventually). To me, the physical demands and the psych/soc are harder in Med/Surg. I am much more scared of Med/Surg than the ER. There seems to be a lot more support from other staff in the ER, and other nurses and your physicians are right there for questions. In Med Surg, even as a student, I felt like the Lone Ranger. When you are in a patient's room, no one knows what you are going through, plus you have no idea what is happening to your other patients. So my motivation to be in the ER was not because I thought it was "cool" or because I am some kind of cowboy(girl). I do have confidence that I could learn the meds, critical thinking, etc. everyone has mentioned. But there does seems to be a common theme that most people who did well starting in the ER had some kind of prior tech/LPN/EMT experience, which I do not have. Everything I see in the hospital is a "first-time" for me. So I do a lot of "looking stupid" (loss of ego in nursing school is food for another posting!) I am staying within the hospital system affiliated with my university because they will reimburse our loan amounts. So if they restrict me to Med/Surg, that's that for now. I am trying to build up my courage and confidence. Meanwhile, I took the NCLEX on Monday and I'm waiting to see if I passed. It shut down at 75 questions, so it's either good or bad. Thanks again for all the food for thought. I feel more confident now that I see many people think start in Med/Surg is mandatory, and hardly anyone thinks it is a bad thing, even if I want to go to the ER later.

Thanks to all for all your thoughtful answers. I agree, new grads don't know what they don't know. And I want to be sure that once I am off orientation, wherever I go, I can carry my own responsibilities and provide safe care. I have worried that in Med/Surg you are actually more responsiblity, sooner, than in other areas. It is not politically correct to talk about, but age is a two-edged sword. On the one hand, even doctors think you know more than you do. On the other hand, people are more frustrated with you when you don't know everything. And, yes, there are times in the ER when you have to act -- now -- from experience. For now I am going to start in Med-Surg. I think this way I will have more knowledge and confidence when I do go to the Emergency Dept. (and I will, eventually). Please, if anyone else has anymore thoughts, I would love to hear them.

I would like to hear what you think of new grads starting out in the Emergency Department. I just finished an accelerated BSN program. Some of my classmates are starting in the ER. My clinical instructor and my preceptor killed my chances by giving weak references and using the "everyone needs to start in Med/Surg". But I loved my clinical preceptorship in the ER and another (more experienced than my preceptor) nurse even said I should apply to work in the ED. I am a 46-yo, ex-accountant, no medical background, but I did have straight-A's in our program. Disappointed and confused.