Question for the experienced ER RNs

Specialties Emergency

Published

I was suppose to graduate from an ADN program last May, but didn't pass by 4 points. At the time, I had a job lined up in two different ER's, and had to turn them both down. In the last year, I got my LPN license and have been working on the cardiac unit at my hospital (where I was a float PCP/CNA prior). I enjoy the floor, the type of pts, my coworkers, my unit manager and everything for the most part.

Now I am ready to graduate (AND PASS) this May with my ADN. I am doing much better in school this year. Again, I have an offer to work in the ER and of course stay on my cardiac floor.

A part of me says to stay on the cardiac floor, get more experience, and later move to the ER. But I LOVE the ER, which I have since I floated in there as a cna/tech. I am up on arms on which way to go. I ask local RNs, and some say go to the ER, others say get the experience on the floor. The only con I can think of for the cardiac floor, is that sometimes they are short nurses, which each nurse takes 15 pts. Normally, it's 10 pts, and they are trying to get to primary care with 5-6 pts for each RN. I don't really want 10 pts much less 15, ya know!

Cons for the ER? Not sure, I really enjoy it all, puke, poop, crazies, drunks and all!

Any advice from my wiser peers?

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If you want the ER, go to the ER. The floor experience you've had is invaluable but it's always the risks and opportunities you don't take that drag on you later.

What if you turn down ER and later have trouble getting in? Or then they want eperienced people first.

If you're in ER, it's usually easier to go back to the floor and you'll know more of what to expect, plus you'll have the perspective of both positions.

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I agree about going to the ER if that is what you want to do.... I am planning on going to the ER also (as soon as a spot comes open, I had to wait because I hadn't finished a class yet)but I love the variety and the change every hour just about and then the people they never cease to amaze me.:lol2:

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Specializes in ED, ICU, PACU.

I would say go to the ER if they are going to train you with a preceptor (treat you as a new grad). Since this was your original goal, you might find yourself resenting things on the floor if you stay just because of the familiarity there. If you love puke, poop and drunks, there is no better place for you than the ER :clown:

Personally, I think the best thing about it is the ability to leave at the end of the shift (most of the time) and not have to stay to catch up on paperwork. It is about the only place I have seen where 24/7 care really is understood; and, you can just hand off your unfinished work to the nurse that relieves you because you picked up the previous nurse's infinished work.

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Thanks all! One of the things that makes me want to stay is the pressure from my friends/coworkers on the floor. But you know what they say about peer pressure! I think I will persue that ER spot! And yes, I'll be with a preceptor for 3-4 months. :)

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Sounds like you have made up your mind....... GO For it!!!! The fact that yu stated you may have 10-15 patients on the other unit would make me run the other way... Doesn't seem very safe at all!!! Take care and keep us posted:nurse::redbeathe:nurse:

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Specializes in 1 PACU,11 ICU, 9 ER.

Good luck, you will love the ER. I transferred there after doing ICU for 14 yrs and like the mix of both. As long as you have a good sense of humour and are a little crazy you will love the ER!:nuke:

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Specializes in PCCU, ER.

If you really want the ER then go there. You don't want to waste time hating the Med/Surg floor and be miserable while you wait to transfer.

However, in MY OPINION, I don't think new grads should start in the ER. I believe that the ER is not the place to teach new grads how to be a nurse. It's just too busy! As an ER nurse you need to be able to look at a patient and instantly have an idea of what's really wrong and the severity. For example, an experience nurse knows (in general) what a true heart attack patient looks like and how treat. I think that being in the ER is just too overwhelming for a new grad. In my ER we hire new grads but by experience I noticed that very few last. They usually transfer to the tele floors because "this is just too much". In fact, we hired four new grads and only 1 stayed. The turnover for new grads in the ER is very high so be prepared....

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If you really want the ER then go there. You don't want to waste time hating the Med/Surg floor and be miserable while you wait to transfer.

However, in MY OPINION, I don't think new grads should start in the ER. I believe that the ER is not the place to teach new grads how to be a nurse. It's just too busy! As an ER nurse you need to be able to look at a patient and instantly have an idea of what's really wrong and the severity. For example, an experience nurse knows (in general) what a true heart attack patient looks like and how treat. I think that being in the ER is just too overwhelming for a new grad. In my ER we hire new grads but by experience I noticed that very few last. They usually transfer to the tele floors because "this is just too much". In fact, we hired four new grads and only 1 stayed. The turnover for new grads in the ER is very high so be prepared....

I disagree. A busy tele unit can be just as bad if not worse. In many ways the ER is actually a better place IMHO. MAR's, chart checks, etc. I dump my patient off on the tele foor and say "thak God I don't worke here" to myself on most days. It is simply a matter of what area of nursing works for you. For example, I currently work as a flight RN. It would be a joke watching me take on 9 tele patients. In spite of all of my ER, transport, and flight experience, it would be an absolute joke. Again, this is only my opinion.

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If you really want the ER then go there. You don't want to waste time hating the Med/Surg floor and be miserable while you wait to transfer.

However, in MY OPINION, I don't think new grads should start in the ER. I believe that the ER is not the place to teach new grads how to be a nurse. It's just too busy! As an ER nurse you need to be able to look at a patient and instantly have an idea of what's really wrong and the severity. For example, an experience nurse knows (in general) what a true heart attack patient looks like and how treat. I think that being in the ER is just too overwhelming for a new grad. In my ER we hire new grads but by experience I noticed that very few last. They usually transfer to the tele floors because "this is just too much". In fact, we hired four new grads and only 1 stayed. The turnover for new grads in the ER is very high so be prepared....

I also disagree about new grads in the ER. Personally i prefer to work with ER nurses who have ICU and M/S experience because they are able to handle a busy load (Med Surg) and handle a critical unstable patient (ICU).

my home ED has now been hiring new Grads for 6 years. it is a Huuuge 60 bed level one trauma center. our new grads have all stayed except for 2 who went to traveling. I think if there is such high turnover in your new grad population, you might want to look at your orientation.

For the original poster (OP)

As far as having to take a lot of patients, this will happen in the ER too. If ther eis a nasty trauma or some guy needing to go to the cath lab, that nurse is going to be completely tied up, meaning that suddenly their 5-6 other patients are going to be someone elses responsibility, which you will pretty much have to assume without getting some sort of detailed report. So I wouldnt count on not having a lot of patient load in the ER, the acuity of those inherited patients can also be pretty high.

Still, I recommend the ER if its what you want to do. if you hate it, you know you will have a place on the tele floor....:wink2:

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Specializes in ED staff.

MOst nurses would tell you to stay on your floor and gather experience that can be used in the ER, however, if you want ER go there. With the nursing shortage as it is you can always go back to the floor you're working now or really anywhere you'd like to go. You can gain experience anywhere, my thought is this.... if you enjoy ER more then you will learn more readily there. The ER is like no other place, you have to know some of everything that means you will be fit to go anywhere you want to if you decide you're tired of the ER. Work the ER, if you want more cardiac experience then work up there a day or two or three a month. The only draw back I see for the ER for a new nurse is that it makes you cynical and distrustful of what patients are telling you.... we see a lot of drug seekers and the ER has made me think that everyone is guilty of it until proven innocent by reason of kidney stone or MI or fib/tib fracture. Plus if you do ER long enough you think everything should run on ER time.... I hate going to my doctor and waiting a few days for labs to come back, but its especially true if I have a loved one in the hospital. I want everyone to take care of "my" patient the way it would be done in the ER. STAT!!!!

Go where your heart leads you, it's usually the wisest choice. Good luck :)

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Thanks all! After much stressing out over this, I am going to the float pool! I was approached by the float pool manager and was asked to join them. After a year or two on the float pool, I can join the 'specialty float' that floats between the ER and ICU. For now, I'll just float from floor to floor. Oh, and it pays $5 more an hour. :)

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