FERNtastic

Prior to joining the profession and pursuing a career in nursing, I had my own stereotypical mindset to breakdown. For years, I had been advised from those in the field that I should consider nursing and that I would be great in the profession. At the time, I had little to no experience in the medical field and frankly gave nursing little consideration dismissing the idea, as I didn't see myself as a relatively manly male in a female dominated profession. I guess it had more to do with ignorance than anything. I set my sights on what I considered a more masculine pursuit, the fire department. On that career path I became an EMT working on an ambulance and saw firsthand all that goes on in the ER. It was through that experience that I underwent a paradigm shift, breaking the hold of ignorance and allowing me to see the realities of the profession. In that role I saw a much higher percentage of male RNs and thought, "hey, I could that", opening up the idea of nursing as a career possibility. Fast forward several years, I am now an RN in a level I trauma center and wouldn't have it any other way. As for being discriminated against, in some cases I would say it was just the opposite, as I sometimes wondered if I was getting preferential treatment because I was a male. I was well respected and often ushered into more of a leadership role during nursing school. I excelled in all aspects of care during clinicals and felt very welcomed, even during my OB rotation. In my current position, I have never been asked to have a female perform a procedure. In extremely few cases, patients have expressed surprise that I went into a career requiring such tasks as toileting and cleaning patients. I have replied those tasks are such a small percentage of what I do as to be negligible, usually less than 5 percent of my time. I truly enjoy what I do and am grateful I was able to open my eyes to nursing as a male profession.

I myself am a recent new grad who started in the ED straight out of nursing school with relatively no clinical experience (EMT-Basic for 6 months, ED-preceptorship for 1 month in nursing school). I am in my early 30's, so I wasn't exactly a doe-eyed new grad starting my first job ever though. From the start, it was quite the transition. I needed help for everything, IV-start success rate of maybe 50%, more than half the time had difficulty pulling labs from an existing line, couldn't read "physician-scratch", had to ask about various meds I had never given before and maybe a few times after that, couldn't anticipate labs, uncomfortable with vented patients, drips, etc. Just learning hospital protocol, the charting system, the multitude of forms and when to use them was a daunting task. However, I was a quick learner. Within a few short months, things finally clicked and I was no longer just tasking, having a greater sense of what was going on and enabling me to anticipate and prioritize more effectively. In time, I learned many tricks of the trade for our everyday tasks and gained confidence as an ED nurse. I became more competent and independent as time progressed, allowing my preceptor to do their own thing and me not having to ask for assistance every 10 minutes. I've been on my own for a few months now and that in itself was another huge transition, as I encountered many scenarios I had no experience with, yet worked through these with the help of a supportive staff. My advice is to be patient. The biggest thing is patient safety; perhaps the new grad may be slow and require assistance, but as long as they know the difference of what can and can not harm the patient, and know when to ask for help, working in the ED should all click at some point, transitioning your newly precepted nurse from a bright-eyed new grad into a competent and proud ED nurse. I am thankful for my experience that I worked with wonderfully patient preceptors who worked with me and took the time to answer my multitude of questions without judgement and help me in the transition from school to practice. Best of luck with your new grad.

I disagree about the mentality that you need to "pay your dues" before getting into the ER. This is the mindset of a lot of people, to go do some time in med-surg or another area before you're prepped to make it in the ER. I was hired and participated in about 5 months of orientation with a small group of new grads as well as a few experienced experienced nurses who had between 1-4 years of med-surg experience before making the transition. In my opinion, we all encountered similar challenges as we entered the ED and in many ways, the new grads excelled as we weren't as rigid in how we worked. The challenges faced by those coming from med-surg were different and often seemed to be focused on the autonomy and independence experienced by the ER nurse, whereas in med-surg you couldn't do anything without a doctors order, in the ER you have to think for yourself and have the ability to take action if your assessment warranted. As new grads, these limitations hadn't been ingrained yet, and so perhaps it was easier to follow the example of our preceptors. Granted, the time spent in med-surg likely helped develop familiarity with various medications, conditions, as well as hospital policy (they were interdepartment transfers), the difference between those with med-surg experience and new grads wasn't as clear as night and day as some would imagine. All-in-all, the ER is certainly not suitable for every new grad, but if your heart is set on it and the opportunity presents itself, by all means go for it. Things to look for would be a culture supportive of new grads and a well developed and thorough orientation ideally 4-6 months in duration. Best of luck!

I am a new grad and was fortunate to start my nursing career in the ED at a large, urban, county hospital. I have been there 5 months now and love it. It did, however, take about 4 months after I was licensed and looking for a job full-time to get in. 300 people applied, 30 were interviewed, and 4 were hired, so yes, I was very lucky. The market right now for new grads is not great, with stories of new grads taking over a year to find their first nursing job. Ideally, you'll land straight into the department of your choice (the ED), but I wouldn't hold out for that in this market or you may be waiting for an extended period of time. My advice would be to take what you can get but with a plan. I was preparing to enact my plan C to go into an LTC facilty halfway across the country before my boat came in. First off, if you can get into a facility with an ED where you'd want to work, take it, doesn't matter which department (med-surg, OB, peds, whatever) as long as it's acute care and you can do the job in a professional capacity. Likely, after some time and experience you can transfer into the ED through an interdepartmental transfer. Alternatively, if you can't get the transfer approved, you'll have gained the magical one-year of acute care experience opening up opportunities elsewhere. The experience working will likely build on your nursing foundation developed in school and make the transition into the ED easier. Best of luck to you!

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I work at a level 1 trauma facility in a large, urban, county-run teaching hospital. I'm on the medical side and as a new grad had about 20 weeks of orientation. Was also put through a critical care class (based on the ENA orientation program). We have a ratio of 3-1, though sometimes 4-1. Really doesn't make a difference whether they are all ICU or med/surg level patients, unless you're doing tPA in which case it's 1:1. It's my first week going solo, and I'm amazed at all the "firsts" I've encountered this week despite my generous orientation.