I been reading through these forums and I'm wondering if you can help me decide if I want to accept a job or not in the Emergency Department. I'm a new grad who is about to start at a 6-bed Emergency Department hospital with around 10 other beds for observation and acute care. I'm starting in two weeks but today, I received a phone call about my schedule and they said they are no longer going to do a orientation or a training program and they wanted to just have me start on the floor with the other nurse. The nursing director reassured me and said that I will learn from the other nurse but I don't know how I feel starting in a emergency room without any previous nursing experience and without an orientation to the unit.
Do you think I should dive in or am I putting myself (and patients) at risk?
You are right WAheartnurse. It is foolhardy to assume that staff are able to function with no orientation. But the offer is there. I am still trying to put my head around who would make that kind of an offer. I think it needs more clarification. Like I said, one would need a minimal orientation just to function at any level. And I was hoping to convey the amount of work one would need to do to have any chance of success. It would require a major commitment on the existing staff as well. Guess I got a little too encouraging in my post!
I still remember a time 6 months out of nursing school when I took a job as a night supervisor in a medium sized (over 100 beds) rural hospital. It was a busy place. I had not applied specifically for that position and I asked the director of nurses why she would consider someone with my experience and suggest the job to me. She told me that she liked grads from my school and that she had faith in me. "Oh, and by the way," she said "you are the person that will be staffing the ED at night." I told her I had no experience and that I would need an experienced person to be in the department. "No problem." said she. I went home and agonized over whether I could do the job or not. After much consideration I accepted.
What she had probably meant was she had no problem having me staff the ED since no dedicated staff ever showed up in the ED other than me. Between the supervisory job and the ED it was the steepest learning curve of my career. As far as I know, no one was harmed by my actions in the ED (although there were a couple of medical decisions that I questioned out loud at the time and I still question). I have to think that Someone upstairs had their hand over me. Usually the most critical cases came in on my 2 nights off during the week when the other very experienced RN was on. Though rare, some nights I had no ED cases. I remember being in the ED, calling to cover staffing for the next morning and troubleshooting for the floors all at the same time. It was not an ideal situation.
I left for personal reasons after about 1 1/2 years. I was offered the job of reorganizing and upgrading the ED when I left. I did not think I had the experience to do the job and I told the director so. My personal reasons kept me from staying anyway.
Emergency nursing has changed a lot since then. I did not think I could do ED nursing when I took that job all those years ago and it opened a door for me to at least consider a career in ED nursing at some point. I came back to it 5-7 years later and thoughtfully planned my education and career in ED nursing. When I felt there was a gap in what I needed to know I found a resource to fit the need and I had a lot of help along the way.
LostnNaked, hopefully you have a better idea of what it is going to take to get started in an ED. If you are still interested I would encourage you to negotiate for what you need as you start the job and that should include orientation.
Specializes in Oncology; medical specialty website.
I think I should say yes because I need the job but I think I'm also putting myself at risk as well as my patients. What if a ambulance brings 4 or 5 trauma cases back to back and it's just the other nurse and me? I won't know where anything is at and I would be expected to fulfill all these tasks from the get-go. At least with orientation, I could work with someone who will show me how they do things, instead of learning by error.
At the same time, I won't know where anything is nor do I even know how to document. It's quite a big jump but I'm also thinking, maybe I need that.
Which is more important to you: having this job or having a license you can use to accept another job offer?
Specializes in Oncology; medical specialty website.
Thank you for answering my question.
Just because the ED is small does not in any way, shape, or form, mean that you will not get really sick people. I'm sure you will be bypassed for traumas, STEMIs, and strokes, but those things come in through the door sometimes and you have to stabilize and transfer rapidly. In the meantime, you still have your abdominal pains, vag bleeds, and ankle pains streaming in.
It's important to know where your supplies are, particularly rescue supplies and gear, but also small stuff like bandaids. When you're trying to move patients through, it's not a good use of your time to be looking high and low for even something as simple as some roller gauze.
It's important to be familiar with the policies and procedures of your workplace. These vary vastly from facility to facility. At my last place of employment, I did lots of pediatric procedural sedations, wound infiltration with topical anesthetics, cardioversions, and so on. At my new place, anesthesia does anyone under 12, nurses don't infiltrate, and the cardioversion policy is ancient.
I think the orientation period is important because the focus is getting you up to speed on all of these sorts of things before expecting you to do patient care. It protects you and your employer because there is documentation that you have demonstrated competency of certain things.
In my opinion, by not giving you a formal orientation, they are setting you up for failure.
It's likely that this hospital is hurting financially, and cutting out orientation is one way to save a few bucks. Unfortunately, it's at the risk of patient safety, IMO.
Some people are quick studies and could jump into a situation like this and do just fine. But I would never in a million years count on this.
I worked in a small ED; not trauma certified, no NICU. I was in triage with a woman in pre-term labor when I heard a scream. Ran in to the ED to see a pt. being wheeled into one of our Trauma rooms. He'd been stabbed. Needed chest tube, blood...the whole shebang. He had to be transferred across town to the hospital that was trauma certified.
Meanwhile, back in pre-term labor land...(Get the picture?)
Thanks for your response! You brought up everything I'm concerned about. The nursing did say it wasn't in their budget to train me as they usually do but I'm thinking why are you hiring a fresh out of school new grad if that's the case.
..because they think you're not experienced enough to know any better.
My advice: be careful. The last thing you would want is your coworkers and your patients confusing inexperience with incompetence.
I know this from experience because my orientation program was cut short due to budgets and unavailability. By starting immediately without a real introduction, you're going to be thrown into a role you may not be ready for. CNAs, techs, and even the MD will look at you and expect you to know what you are doing. It's going to hurt your ego and will hurt your passion.
If you do go this route, remember to keep your head up and keep learning.
I feel for you - I understand that the nursing world is not a kind place for new grads. When I was a new grad I was offered a job similar to this - small ER, only 2 nurses at night. I knew that for me, I was a bright shiny penny and didn't have enough nursing skills or street smarts to survive. I ended up taking a job in the NICU that has been a true career/passion.
The way I look at it is this - you've worked hard for your license. Do you really want to lose it because the hospital couldn't/didn't want to take the time and orient you and you end up in a bad situation?? I'm a little shocked that this can even be allowed, especially as a new grad.
I run as fast as I could from this situation. Even as an experienced nurse, I would never accept a job with NO orientation. You are a new grad and you need a sturdy foundation. You need atleast 12 weeks of orientation where you'd be allowed to ask questions, make mistakes and learn. I don't care if its a 2 bed ED, you still need to learn how to be a nurse first, this comes with time.
You can always find another job, however if you loose your license, your career is over. Think long and hard about this. Is it worth it?
Today I did have a phone conversation with the nursing director and one of the nurses on the unit today. Here's what I found out: so there are always two nurses on the floor with one CNA and one MD. The nurse told me that the cases are usually not acute although there are a lot of times where a patient has to be transferred out. At any given time, there could be no patients or back to back patients. The nurse told me their craziest day was with 30 patients in one shift and it was just the two nurses! Overall, the nursing director said that the introduction but as for formal training, I will not receive it. I will just be one of the two nurses and I will learn from whoever I'm working with.
When thinking about it, taking this job would be risky especially because my learning will be based on the other nurse. If it's busy then I'm on my own and learning by fire. Also, the ability to teach comes with experience and a plan; how will I know the other nurse will actually build my foundation. I need structure in order to learn.
The nursing director did say this was a stepping stone job and that they hire new grads so they can get experience. He wasn't expecting me to stay for more then two years.
I never did get a full answer of how the previous nurses where trained though. In the job description, it said I will receive x amount of training.
I have been thinking long and hard about it and I decided not to accept the position.
Footballnut
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You are right WAheartnurse. It is foolhardy to assume that staff are able to function with no orientation. But the offer is there. I am still trying to put my head around who would make that kind of an offer. I think it needs more clarification. Like I said, one would need a minimal orientation just to function at any level. And I was hoping to convey the amount of work one would need to do to have any chance of success. It would require a major commitment on the existing staff as well. Guess I got a little too encouraging in my post!