Starting an ER job with no orientation?

[LostnNakedNursing]

Greetings!

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?

[nurse2033, MSN, RN]

"You'll learn as you go" is the lamest excuse you could hear from any manager or director. This tells you where the bar is set, low. I heard that exact statement once, and eventually left because I couldn't work under those low standards. (I had plenty of experience so I got by just fine.) If you really need the job, take it. It will be stressful but if you spend off hours studying and learning you will eventually "get it". But you will have to learn the job on your own. Sure you can learn from the other nurses, but they will be busy with their own practice. The idea of a preceptor is they are able to do the job, and focus on teaching you as well. As far as your question about risk, if you are assertive in knowing your limits, asking for help, and knowing when to say "no" you can protect your license by sticking to your nursing principles. But, you probably will be asked to take patients you aren't comfortable with, too many patients, or asked to do procedures with little training. As I said, if you need the job, take it, but fasten your seat belt, it will get bumpy! Good luck.

[Anna Flaxis, BSN, RN]

I know this was a difficult decision for you. I understand you need a job, but I think you'll sleep better at night having made this decision. Good luck in your future endeavors.

[Footballnut]

"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 have had the feeling through most of this conversation that the director does not value the ED very highly. If no one stays that long then who is teaching you? All the best as you continue your job search.

[MarilynKenworthy]

As a long term ED nurse, I have always advise students nurse to gain experiences elsewhere before coming to ED. It will benefit you long term. My current ED do not take new grad. I would think really hard and with the advise gain in this forum rethink again. I wish you all the best in your career future!

[gcupid]

I don't think I'm going to be assigned to another nurse. From my understanding, there are always two nurses on the floor with one CNA and the ED doctor and I will be one of the two nurses. They were vague on how exactly will I be learning from the other nurse. The impression I received was "go out there and learn as much as you can"

Welcome to nursing..

[lvnlrn]

I think you made the right decision. Some of the ED nurses I work with (we're at a level II trauma center) came from tiny EDs in the middle of nowhere. They are able to be so independent because they literally have to do it all in these tiny EDs until help comes. I heard one story of a patient who was intubated and couldn't be flown out for two days because of bad weather. I almost think I'd rather start a Level II ED with little to no orientation because there is always someone else around to answer questions. In these tiny EDs, you're pretty much it.

[LostnNakedNursing]

Thanks again everybody.

I have one last question. Am I justified in declining this job offer? Outside this board, I'm feeling a "new grad entitlement" passive feeling from people (counselors)

[emtb2rn, BSN, RN, EMT-B]

Yes, you are totally justified in declining that offer. The situation as described would have done you and your patients no service.

Good luck going forward.

[Anna Flaxis, BSN, RN]

I agree wholeheartedly with the above.

[TrevyRN, BSN, RN]

... justified? Of course!

Accepting the job and declining the job both had risks and benefits, and you weighed them and made an informed and intelligent decision.

:-D

If you really want to be an ER RN, don't let this discourage you from applying to more jobs in the future. If it's for you, it's for you.

Take it easy and good luck!

[harrird]

Could you come in on your own time a couple shifts and shadow without pay? That would allow you to get a feel for supplies and housekeeping stuff.

[theantichick]

ED is my dream. I graduated in December and would not accept the job as you've described it here. I didn't get the ED internship I wanted which would have given me several months of formal ED training and preceptorship. Lacking that I took an LTAC job to learn to be a nurse and gain the skills I need to try again for ED later. I would have been scared witless to take an ED job without proper orientation and that's with paramedic experience. FWIW I think you made a smart choice.