Soon to be New Graduate

zmansc, ASN, RN · Mar 4, 2015

I don't believe that ER nurses eat new nurses alive, at least that is not my experience. I do believe there are nurses who have better dispositions to teaching new grads than others. I hate the "eat their young" thing because I just don't see it any more than I see it in any other profession. We deal with life and death, and as such when you make a mistake in a critical situation, or don't move fast enough or whatever expect a short, direct, command so that the rest of the team can progress. Don't take it personal, it's the situation. If however someone is being a jerk to you when you are dealing with patients that are not that critical, then that is a true jerk who needs an attitude adjustment regardless of whom they are talking to.

As for where to start, I would suggest if your goal is a Level 1 Trauma Center ED job, then apply to every Level 1 Trauma Center as many of them have programs for bringing in new grads. Start your application process early, cultivate the best references you can, and work towards that goal. I have heard the "new grads need to work on the floors" argument many times, I personally don't believe it. I didn't, and I did fine. Many of my coworkers did, and most of them said later on that it didn't help them significantly, mostly it wasted a year where they could be learning how to be an excellent ED nurse.

Good Luck on your journey.

l3angr33nrn · Mar 11, 2015

Congrats on finishing up and joining the club soon! I've been a nurse for coming up on 3 years, and I personally started off in a big Level 2 Trauma Center ED as a new grad, and I now work full-time in an ICU and am currently in the process of going contingent in another ED at the same time. As you probably guessed, I never bought the idea that all new grads need to start off on the floor first, but now I do feel that there are a lot of factors to consider.

First off, I do feel now that it's probably a good idea for a lot of new grads to start on the floor first, but not all. I always knew I wanted to do critical care in the either the ICU or ER, I just loved that level of involvement and critical thinking involved in both specialties. However it is a STEEP learning curve in the ED as a new grad because you're expected as an ER nurse to know a little bit about everything and how to spot and respond to an emergency fast. You have to have a tough skin because you will be critiqued by your peers, you also be willing to work super hard and run your a$$ off (because it's an ED and it's crazy) and ask a ton of questions because that's the best way to learn (same as any area of nursing, really). I've seen a lot of new grads not do well in both the ED and ICU, and it seems to mainly be because it can be super overwhelming in general, let alone as a newbie RN. I also have seen new grad nurses do amazing in the ED and ICU too, so I just feel you have to be really honest with yourself before you dive in--the first year will be intense and scary no matter where you are, but I personally feel the extra intensity of the ED and ICU make them particularly stressful as a new nurse. All that being said, I wouldn't have done my intro into nursing any other way :)

Next do NOT be afraid to ask peers, management, etc. about the orientation and working conditions. I asked to shadow before I got the new grad position in the ED so I could see what it's like before I even applied, and I think that helped me out in applying too because the nurses and manager could see how I worked and jived with the staff before they committed to hiring me. And the orientation is so, so, SO important. I've heard of EDs where as a new grad hires got 6 weeks of unit precepting and nothing else, which is really scary to me personally. I got 3.5 months of precepting on the unit, not including days of class time only where I got my BLS, ACLS, and other tele/ciritcal care nursing training. Once I got off orientation, I was always set-up with a resource person for the rest of the first year, which meant there was someone working on the same part of the unit with me who was volunteering to answer any questions I had, check in with me throughout the shift, and help out if possible. My unit also limited the amount of new grads hired into the unit, which was a bonus. For instance, at one time we had 100 nurses on staff throughout all shifts and out of that 100 only 10 were new grads, and they were spread out over the 3 kinds of shifts, so I always felt like I was working with a good amount of experienced RNs at any time. I just felt like I got a ton of support, and you should be on the look-out for things like that, because once you're out there working on your own, that's your license on the line and it's important to have support, especially during that crap-tacular first year as a nurse. Now there were nurses that weren't supportive of new grads on that unit, but you'll find that anywhere, so you'll have to just feel everything out once you get on the unit and you'll quickly figure out which ones you can and can't go to when you need help or advice. And ask to be in on every code you can--no one runs a code like the ED, and you can learn a hell of a lot in those situations.

Now I left working in the ED full-time because I wanted to do more full-time work with the critically ill patients, and even though I love the ICU and am glad I moved, the ED will always have a special place in the heart. This is all my long-winded way of telling you that if you've done your research, found some great places with good new grad programs, and have a little exposure to the ED and still want to work there, then by all means go for it and good luck! Like zmansc, RN said, apply to every new grad ED program you can find, it is entirely possible to skip the floor and become a bada$$ nurse! Best of luck!

rearviewmirror, BSN, RN · Mar 11, 2015

As I always say, if you want to be an ER nurse, go and be an ER nurse. Do you think yr and half of floor experience helped me become an ER nurse? (chuckle). Hope you land an ER position!