Survey: Should new grads work in the emergency room?

BKPruitt · Jun 8, 2002

I do agree about the lack of "community sense" Molly. For some reason, paramedic types seem to become more hardened than the standard nurse -- the probable reasons are self evident and often serves them well in their unique situation.

The same fact might also reinforce arguments for their transition into ED rather than a complete care floor. The same hardness that must be displayed on the street while treating a 7-year-old car accident victim can lead to sound decisions when bodies build-up in ER. Care at a rabid level is second-hand to these characters.

Maybe an ER is the best place for the fresh grad RN, and former EMT/Paramedic, to develope that admittedly important "sense of community."

Marty1 · Jun 8, 2002

I too am of the belief that is shoud be on a case by case bases.

Some new grads may be EXACTLY what an ER needs however

if the ER is ALL new grads then I think it creates problems for all those around .

Shandy12 · Jun 8, 2002

All I know is that if someone had put me on a medical or surgical floor for my first year, I wouldn't have liked it at all.

I started in NICU, and it was an amazing experience. We had great preceptors, excellent orientation and support from staff.

And this was in 1975 folks. I'm still nursing, still changing areas, and just last week, started in Dialysis.

I'm exhausted after the first week, there is so much to learn. But that's the wonderful thing about nursing for me. I love to learn and the more technical it gets, the better I like it.

Just my opinion, never humble!

Lynda

RoaminHankRN · Jun 9, 2002

New grads have to start somewhere. Where did you start? When people say new grads can't handle critical care or ER because of the stress and should go to med-surg... what does that say about med-surg. I started in ER after nursing school and loved it. It's all about the person and the program. Not everyone is cut to be an ER nurse (or ICU, PEDS, etc) And the program needs to provide a strong orientation program and have staff willing to guide the new grad along. What is the saying? Don't ever say never.

**SKM-NURSIEPOOH, BSN, RN** · Jun 10, 2002

originally posted by smilingblueyes
well i dunno bout you, but med surg sure is not a nurturing environment to "grow"new nurses....

...who has time to learn when they throw you 12 patients on all ends of the hallway?...

...i still say motivated grads can make it about anywhere, given the right support.

i think the issue is more an organizational skills thing & learning how each individual unit actually operates than whether or not if new grads are capable of working in the specialty units. i sincerely believe that if new grads have their nursing foundation set, there should be :nono:

no reason why they can't start-out in a specialty area with the proper orientation & support.

let's just think about this for a moment...if one start-out working med/surg for a year or two first, how does that experience help prepare the new grad for working, say the or area? those two areas are like apples & oranges...i believe that it would be counter productive if new grads are forced to work on med/surg floors first. one reason why for me is that i believe as a result of poor staffing conditions (nursing shortage, mandatory overtime, low morale, etc), new grads might get burnt-out much quicker, become disenchanted with nursing altogether, & leave beside nursing before making that switch to those specialty area which they'd otherwise might've loved & been successful at... :rolleyes: if given that opportunity first, imo.

that's not to say that some new grads may feel that they're not confident enough in their abilities in order to work in those specialty units & end-up in med/surg a year or two because that's what they've been told to do by other, more experienced nurses, in order to improve their confidence...& that's fine...so long as they don't feel that it's forced upon them & that's really where they want to go. these individuals somehow end-up thinking that it's "safer" to start-out in med/surg than starting-out in any specialty units, like ed....when in reality, it's not...but what it is...or should be...imo...is just a personal choice.

how can having 7 to 12 patients per nurse ratio be any "safer" on a med/surg floor than having 1 to 3 patients to one nurse ratio in say critical care areas....as we're aware, most patients are leaving those critical care units at a much faster & sicker rate than they did 5, 10, & 20 years ago...more people are having open heart surgeries, for example, & are going home in record time, by the third day in some cases,...probably due to the hmos...& that can't be good odds for those home health nurses either.

it's just as easy to make vital/fatal errors in med/surg with those types of patient to nurse ratios as it is to make vital/fatal errors in specialties units like icu, ccu, sicu, nicu, or ed...either error could be caused by fatigue, stress, lack of experience or over confidence due to a lot of experience, or nursing knowledge for any one of those hospital areas including med/surg. one has to be on top of their game & really know their stuff (pathophysiology, nursing process, critical thinking, etc) in order to work in nursing period. i don't hear this argument amongst the resident doctors as to where they should start-out their residency...they just do it once they've realize where it is they'd wish to practice their craft. i know that someone will bring-up the argument of competence vs. confidence...but again...that's a personal thing. there are competent & incompetent nurses ranging in age & experience who are working in various areas...i still believe that competence can be linked to knowing how & what to do & why....where incompetence is linked to not knowing what, how, & why in doing things. yes, experience will build character & confidence, but it can be obtained in the specialty units as well as the med/surg units.

by the way smilingblueyes, i especially loved :blushkiss this:

* i would rather sew my head to a carpet than have started out there!*

rlmafo

!!!

SuperCEN · Jun 10, 2002

I started in a small ER 17 years ago as a new grad. I shadowed a nurse ONE day and when I came to work the next day they said "Ok, you're on your own--if you need anything just holler!" The next patient that walked in the door was so cyanotic that his ears were black. I sat him on the bed and he died. It was trial by fire there but I stayed and learned sooooooooo much that first year. Even after my experience, I believe new grads can and should be hired in ER. WITH the proper internship and training of course as someone already pointed out. Experienced or not, some people just don't "have" it and will never "have" it. Not just organizational skills, but that knowledge of sick--meaning who is sick and who is not. With the shortage of RN's in Illinois we are having to hire new grads as experienced nurses are not always available. We just need to be able to wean out the ones who don't "have" it and are NEVER going to get it!! I'm still in a Level 1 trauma center--17 years and going strong!! I would be miserable anywhere else! I'm glad my first hospital gave me a chance--it not an orientation!! lol

mattsmom81 · Jun 11, 2002

SuperCen, I had to laugh at your 'orientation' (or should I say lack of).:)

Sounds like 99.9% of mine too....'trial by fire' orientations!

"Yer on yer own, kid...we had 2 nurses call in...no time to orient"

Luckily I did OK...gotta thank my good ol' Diploma school for giving me the tools to succeed.

rnetd · Jun 18, 2002

I have been an exception to others account about new grads in the ER, I have been a Mobile Intensive Care Paramedic for 9 years, and still am, My training has extended me more of an insight to the specialty of Er nursing. During this crisis that nursing faces I dont think that we should be questioning new grads in an ER or any critical care enviorment,even Med surg faces the shortage. Have I taken care of 9-12 critical patients at once ? Yes I have, the reason is we have no new blood coming into the doors of these institutions, I have always said to myself that its a good day when none of my patients dies. That New Grad thing I believe must encompase the whole person and his/her ability to cope with the constantly changing enviornment of the Er. I always heard that you must get the med/surg done but I say that Med/Surg is a specialty unto itself as are other units. I have been trained in Critical Care and CCU courses by my institution as well as triage,Trauma, etc.

jeanrnurse · Jun 21, 2002

I agree that new grads should be considered for the eD on an individual basis, but as Manager of Nursing Education in my last job, I saw it work successfully. I believe the key was that individuals were hired as ED Techs while they were in school. This gave them 1-2 years to acclimate to the ED envoronment, and give staff a chance to know them. Personality is very important in this setting--must be self-directed, flexible, quick-thinking, adaptable. People who must think things out carefully, look up the policy (although I support this!) before doing anything will not work.

If they fit in as a Tech, by the time they graduate, they usually work out as an RN. :rolleyes:

Babs8171 · Jun 22, 2002

As a preceptor, I would rather have a new grad. and 3 months

to teach them, than to get a Nurse from a Med/Surg. floor with

one year nursing exp. and 4weeks to teach them. :eek:

Nurse Ratched, RN · Jun 22, 2002

I would have been petrified to start in the ED fresh out of school, but that's me. I started on an Onc unit that got lots of Medsurg overflow. Now work med-psych and love it. Still have no desire to work ED, but I think those who have the love of the fast-paced right out of school should be considered case-by-case. Some preceptors would probably rather have a newbie that they could mold rather than a nurse who thinks she/he knows it all (whether or not they actually do! :)

TaraER-RN · Jun 22, 2002

A year ago i graduated from nursing school and was hired into an ED that I had been precepting at along with 6 other people. We got a total of about 3 months orientation along with a 9 week (once a week) ER course that teached us how to focus assessments. I did get tons of support...even from those that didn't want us "newbies" in their department. It definitely is on a case by case basis of who will make it in the ER, but you know what, I think it has NOTHING to do with being a new grad, it has to do with the person. I was actually admantly against working on med/surg first. I've taken patients up to the floor and realized I would never want to work there...I learned in my nursing school many of the same skills that I think I would have learned on a med/surg unit not all, but most. my skills and assessments in the ER have really helped me to focus on whats wrong with a patient at that time. I don;t have to worry (most of the time) about whether a patient has a had a BM or has peed for me that shift (unless they are a renal patient, etc) and I'm grateful for that. I respect Med/surg nurses, because its area I never wanted to be in...I am 100% grateful that I had the opportunity to start in a specialized area. And I do agree that CCU experience would really help me in the ER, and I eventually plan to move to that type of a unit, but yet if I had started in ICU then they would have said that I really should have had experience in another area first. Its a cycle. Some people around me don't think new grads should be there because they weren't allowed to go ito specialty areas when they graduated, and some have admitted they are jealous (and others won't admit to that)....its definitely the person that means whether they can cut it or not...and the support or training is what keeps them from killing a patient, not neccessarily the experience.