Should a new grad try ED or not?

[MegRyanGirl]

Hi everyone,

I just finished nursing school and studying for NCLEX while looking for a job at the same time. I interviewed at a hospital that has the largest number of ER patient intake in New Jersey. I was interested in the job first, but the manager of the deparment really scared me off with a realistic picture. He told me that sometimes they have 11-12 patients per nurse and they don't cap the patient load because you just can't turn them down. The orientation is 13 weeks which is great, but he told me that one new grad quit after 2 days, and another one quit after a few weeks. I have no experience in the ED but I have worked as an extern on an ICU unit for a month at a small community hospital. I also worked as a medical assistant at a doctor's office that has 150 patients a day..which is a lot for a doctor's office, but of course it's nothing like ED. I tend to work well in a high pressure, fast paced work environment and get bored easy if there is nothing to do. Originally I turned down the offer, but I am rethinking about it. I don't want to be one of those people that quits after a few weeks. It doesn't look good on the resume either if I leave after a few weeks. Any suggestions would be appreciated!

Thanks

:monkeydance:

[traumaRUs, MSN, APRN]

I think the manager is just trying to be realistic - it costs much $$ for orientation and then to not have a return on your money...

13 weeks doesn't seem like too little amount at all. In fact 12-16 weeks is the norm in the ER where I worked. If you go into this realistically and realize that you aren't going to be comfortable for about a year and not totally cool for two years - I say go for it.

The ENA (https://www.ena.org/) is a great resource. Get all the extra training that you can. You might just find that you love the adrenaline rush. That is what brought me back year after year (10 years total). I have been gone two months and still miss it very much...just gotta have the adrenaline rush!

Ask the manager what do they use for orientation? The ENA has modules that are very comprehensive and interesting. Ideally, orientation should be both didactic and clinical time. You should have a limited number of preceptors too. You probably want about three to get an idea of how different people organize the workload. I will say that 11-12 patients per RN is ridiculous and the manager really needs to look at national guidelines. The ENA for instance, lists 4:1 as the ideal. In the level one trauma center (65,000 visits per year) we typically had 4:1 but could slide to 6:1 depending on their acuity.

Good luck - but ask questions. I would say go for it.

[jojotoo, RN]

Even though I think that the ER is the best place in the hospital to work, this ER is not for you. You may like a fast paced setting, but you are talking about a potential assignment that most seasoned nurses wouldn't accept. 10-12 patients with no cap? Is this the ER or an urgent care?

You would be better off getting a year of med/surg experience under your belt. That would greatly help your organizational and assessment skills.

But if you just can't wait that long to get to the ER, Choose one that is smaller with a more reasonable patient load. Don't be fooled by a 13 week orientation - that's not enough for a new grad, no matter how smart you are.

Good Luck.

[fgoff]

MegRyanGirl,

I agree with TraumaRUS. It is possible to so straight to ER. I did it when it was my turn! I too had "some" prior exprience but I still stuggled... it took all of the orientation ( I don't remember the length after all these yrs) to find my footing then and more to be comfortable with all that was going on around. But it happened & I loved ER. (still do!)

Be up front with yourself & your nurse manager about the skill set you will be brining in to the ER & where you willl need the most assist.

Please use the ENA for information/resouses. Be sure to ask about what types of certification are required & what is time allowed for you to achieve them.

Best of Luck!

[West_Coast_Ken, BSN, RN]

Hi everyone,

...the manager of the deparment really scared me off with a realistic picture. He told me that sometimes they have 11-12 patients per nurse and they don't cap the patient load because you just can't turn them down.

Wow, what a guy. Endangering the safety of 11 people just to take another. I'm still a student but this place sounds plain nuts and dangerous to the pts and the staff.

Btw, I'm thinking of the ED for my direction following graduation, too. Good luck to you whatever you decide.

Regards,

Ken

[prenurse]

Only you know yourself and what you can handle. Working in the ED will test your strongest self limits. :uhoh21: I have been a RN in a ED for one year, I have been a RN for one year - I had to do 3 months of med-surg which at first I hated but realized it was very helpful when I finally got to the ED. I LOVE THE ED, everyday, I love it, BUT it is a very stressful and demanding job. I already have pain in my left foot.

We are a small ED - 15 beds total, 4-5 nurses on from 7p-11p but then we go to 3 at night from 11p-7a - one nurse does triage, so that leaves 2 nurses to divide 15 rooms - its tough, we are small but we serve 8 counties, we are at least 1 hour from all other hospitals. We have serious trauma's and we have toothaches - we see it all. GETTING INTO A ER RIGHT AWAY IS GREAT - SOME PEOPLE HAVE TO WAIT A LONG TIME - that in itself is a plus for you - AND YOU MAY NOT KNOW WHAT YOU WANT UNTIL YOU TRY IT. Many nurses change units all the time.

 I feel that experience in the ER is going to be the best. Everyday I feel a little bit better about my knowledge, but I am learning something new everyday Just keep your eyes open and your ears open and you will learn a lot just by watching others - also you will get a feel along the way which way is best and right for you. Mentors are great - however you have to do it your way.

I read "Nursing 06" (magazine), I joined ENA (emergency nurses association), I also take as many classes as I can - I have taken TNCC (trauma nursing core curriculum), ACLS, ABLS (Advanced burn Life Support), Disaster training, EKG class, Triage class, etc.....

You can listen to everyone and take it into consideration, but you have to do what's right for you and you will find out yourself - Good Luck with your decision!!

[neneRN, BSN, RN]

I used to be all for hiring new grads into the ER, but now that I've been there awhile...I'm not so sure. I started there right out of school and still love it 5 years later. I've seen new grads come in and the majority take a good year to get proficient, a few do amazingly well right off the bat, and many leave before their first year is up.

I think the difference in their success really goes along with personality. My observations, for whatever they're worth...

The new grads that do the best...

...are the ones who are always ready to jump in, even with critical pts, despite the fact that they may be terrified; they understand that knowledge and experience will get them past those fears and make them a better nurse.

...are the ones who aren't afraid to look stupid and will ask questions/use their resources, but can also work through situations with critical thinking

...are the ones who are confident enough to trust their assessment skills/question docs/not take things personally

Most of these things come with time and experience, so of course they're not the norm for a new nurse. Just be aware that in the ER, you may be managing the pt's care for up to several hours before they're even seen by a doc...there are protocols to follow in most ERs, but not everything is covered. Our ER has very few protocols, so much of what the nurse does before the pt sees the doc (IV, labs, EKG, Xrays, O2 concentration, cultures, foley, whatever) is based on what you ANTICIPATE the doctor will want. Our docs expect this, and some get upset if things aren't done before they see the pt. When a pt starts to go bad, you need to be able to recognize that. When you do a 12 lead, you need to be able to look at it and be able to tell if your pts having an MI. When a diabetic pt comes in with belly pain and N/V, you need to know to worry about DKA. When your pt slips into an arrythymmia, you need to be able to anticipate what's needed to fix it. These are just a few scenerios, but they happen every day. Of course you're going to have help and resources, but 13 weeks can't teach you everything...you have to be aware that you will see things that you may not be able to handle as a new grad fairly frequently.

I'm not trying to discourage the OP, just some food for thought.

I would ask to shadow an ER nurse for a shift or two before making a decision.

[nuangel1, BSN, RN]

i think the er is great .i do believe new grads can do it but it takes a very good orientation ,good preceptorship,and lots support form boss and staff .that said i don't know it that is the correct er for you .only you know that ,however that caeload is ridiculous i don't care how sick or minor those pts .no nurse should be responsible for 10-12 pts .

[EDValerieRN, ASN, RN]

A seasoned nurse wouldn't accept that assignment, and you shouldn't either. Work ER, just in a different facility. That ratio isn't safe for anyone, much less a new graduate.

[mtreyes]

i am also a new grad and was accepted to work at the ER... is the 13 weeks of training already being paid? i failed to ask my future boss...

[JoeMacERRN]

Not in a busy Level 1 ER. The new grad that wants to work in the ER would do themselves the most benefit by working med/surg or on a tele floor for a year first.

[shannclt]

I am a new grad adn have been working in a 34 bed ED as a tech for a year. I wanted to get an idea if I would have the confidence to be safe and competent before taking on the role as a nurse.

I did accept a position and will start a 3 to 6 mo orientation hopefully in Feb. 13 weeks does not seem adequate for a new grad expected to take on more than 6 - 8 patients at a time. I would question their full expectations of you as a new grad and a tentative time frame they see you advancing at in the ED with a specific number of patient load. Remember how hard you have worked for your license.