Just being honest here. When I first got out of RN school, I went straight to ICU, and was able to function. But now, 7 yrs later, now working in ER, i realize that I didn't know half enough of what I needed to. If something had went wrong, all it takes is a split second and a wrong decision to kill someone. It's too late to take it back and say, "I thought I was ready". I know that working as an EMT has probably given you exposure, but let me tell you, wait until you have walked a mile in a nurse's shoes. If you are so confident that ER would be no problem for you, then a year on Med/Surg should be no problem for you.