Straight out of school and going into the ER

Specialties Emergency


Hello all!

I am about to graduate (2 weeks!) and have already accepted a job at a small ER in my area. I am SO excited because I have always wanted to do ER and critical care. When I say always, I do not mean "Once I started school I knew I liked ER". I mean when I was growing up, my mom worked in the ER and I always found an affinity to it. So many people have told me "You will like it and then you will hate it" and other stupid advice like that. I am a tech that works in an ER and ICU already so I see a lot of the stresses that go on in both areas.

My main concern is I am 100% FRESH MEAT! I want some good and sound advice on how to be the best I can be. I don't want to be the new kid that does nothing and I want people to see my drive and determination to be absolutely awesome. Since I am new though, I really have no idea what to do.

I want reality and honesty from pros :)

Thank you all! :sarcastic:

I am actually quite surprised that your ER would take new grads. I know of none in our area that will let any nurse work in the ER without 1 year of clinical experience under their belt. Even if a new grad gets floated to the ER, they are assigned tasks to do to help out that DO NOT include patient care; some of such are med recs for admissions, set up and take down of suture rooms, taking pt's to radiology, etc.

Since you are going to be working there, the best advice I can give is to keep your eyes open and get into every room you can to see what is being done for the patients. ER nursing is nothing like floor nursing; it is fast paced and can mean life or death for patients, as you are probably well aware. Don't let the more experienced nurses make you feel like you have nothing to offer, and take their advice and criticisms with the attitude that they are trying to make you a better nurse. Some of the best nurses can have a really hard time teaching new nurses and come off as mean or highly critical. The hardest part of learning in an ER is to not take everything personally because emotions can run high which puts everyone on the defense.

Good luck and remember that everyone you work with was once a new grad and they lived to tell the tale :)

Specializes in ED.

I was hired into the ER as a brand spankin new nurse. Ask questions. I've been in the ER for 1.5 years, I still ask questions everyday. If you are offered the chance to sit in on a procedure or do a procedure, do it, even if you've been there done that. Every pt is unique and every experience is just a bit different. Don't be afraid to be firm with patients and their families and don't take anything personally. When you don't have a lot going on, ask your coworkers what they need. Want me discharge that patient for you ? Need me to triage? Want me to get a line and labs?? Teamwork is a huge component of what makes the ER work.

Specializes in ER, Addictions, Geriatrics.

There is a thread that one of the other members made here that has great answers to your question. I believe the poster had combined several threads of the same nature so that there would be one giant helpful thread! Good luck!

Specializes in Pediatrics Retired.

I graduated from nursing school on a Friday and started working in a pediatric ER the following Monday; with no previous hospital experience. You're way ahead of the game since you're familiar with the hospital environment. You'll learn everything you need to know from the ER staff. My only advice is to listen to everyone. I learned more about starting IVs from the ER Tech than I ever did from other nurses. Congratulations and good luck.

Hi! I started as a brand new nurse with no patient care experience in the ER! Ask questions!! Take advantage of your orientation!! You got this!

Be humble: Everybody can teach you something and everybody can help you out... from the docs to the techs to the clerks to the housekeepers... each one of them can make your life harder or easier... all within the scope of their duties. Don't **** 'em off.

Be diligent: There's always something that somebody needs done so there's never an excuse for you to be sitting around or standing around. Offer your assistance to your colleagues, walk into rooms to help, be proactive.

Be careful: keep your guard up because the ED can be a volatile place... watch for their teeth and their nails... and headbutting...

Be gentle: A lot of tension can be defused with a calm, quiet, gentle approach... but know when to get loud.

Be wise and trust your instincts: Calm patients can become violent very quickly, stable patients can crump in a second, if you think you need another line, you probably do... and don't be afraid to ask to doc to go re-assess the patient.

Be thick-skinned and forgive easily: The ED can be a high-stress place for all kinds of reasons and it's easy to step on people's toes... it's to the benefit of everybody when we can let the dust-ups settle and still get along well.

And don't forget: The best IV line is the one that works... sure, we like 20's in everybody and 18's or better in most... but... I can push RSI drugs through a 24 so we can secure the airway and I can give ACLS drugs through a 24 and keep them alive, all while we're trying to find a better line.

Get in there and rock it, momma!!


Oh, and think about what *might* go wrong *before* it does...

Thank you all! I am looking forward to becoming an ER nurse!

I, also am fresh meat! I graduated last week and start in the ER in June. I am lucky to be in a new grad program that trains/orients for 6 months prior to start.

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