Thoughts on starting off in the ER as a new grad?

Published

I am a senior nursing student and will be graduating from school with my BSN in 10 days. During my last semester, I completed 168 clinical hours with a preceptor in a very small emergency department (7 beds). I loved my experience in the ER but feel that I didn't get a lot of experience with critical patients because much of the community treated the ER as more of a clinic. I was able to get a lot of experience with IVs, focused assessments, meds, and a few foleys, but I never had any very critical patients.

What are your thoughts on working in a larger ER right out of nursing school? I know that the ER is where I'd like to end up, I am just worried that I still have a lot to learn still.

Up Vote Up Vote ×
Specializes in Emergency, LTC.

I just graduated last month and passed my NCLEX 2 weeks ago. Tomy absolutely delight I got hired onto a Level II ED and should be starting in the next few weeks. I will be going through a 12 week orientation plus weeks of didactic classes. I would say if Emergency Nursing is your passion then go for it. I would absolutely recommend applying for residency positions as those will best fit your transition as a new grad.

So exciting!

Good luck!

Up Vote Up Vote ×

thanks so much for your advice! i will definitely consider applying for a residency. congrats on passing NCLEX and getting an ED job!

Up Vote Up Vote ×

I went straight from nursing school into the ED and I have loved it. It's tough and you have to hit the ground running though. I would look for residencies (I think this is essential) and carefully consider them to make sure that they are supportive and lengthy. I had a 6 month internship and I think that anything less than 3 months might set you up for failure (depending on the hospital and acuity of patients that is). The ED can be a great learning environment and I continue to learn something new every day. Just know yourself and know what you need to succeed. Don't listen to the naysayers and go for what you want. Good luck!

Up Vote Up Vote ×
Specializes in RN.

Hard for metro comment on this. I have been orienting in ER and am on my 7th week, this will be my final week, which I am ready for. From posts I have read on this site people have graduated and went straight to ER. I cannot imagine it though without the med/surg experience I have had. When I graduated and worked m/s, the time management concept alone was a big lesson!!!!....good luck

Up Vote Up Vote ×
Specializes in ER trauma, ICU - trauma, neuro surgical.

If you think that you can handle the stress, then do it. It's a little crazy at first, but if you can go with the flow, there's no reason to not go there. Med/surg and ER two completely different worlds. They will train you to be an ER nurse. Coming from the another area will give you experience in time management, but you will learn time management as an ER nurse (it is completely different). You have to be willing to drop all your planned tasks for the new trauma pt rolling in the door. Plus, I don't think there's anything that can really prepare you for the ER. You thrive in the chaos. But, the ER will teach you that. I didn't want 8 pts with 2 pages of nursing home meds and bed pans. I wanted monitors going off and pts landing on the helipad. No one is going to shame you for not earning your keep on the floor. If you really want to go to the ER and end up being on the floor first, all you are going to do is wish you were in the ER. And, you aren't going to be the primary trauma nurse on day two. You are going to get 6 months of solid, non-stop training. I think the people that don't go to the ER first just aren't ready for the stress and chaos. And, that's fine. Everyone has a different comfort zone. But if you want to go, then go. If you want it, it's not bad at all. Do what you makes you happy.

Up Vote Up Vote ×

Thank you all for the great advice! I will definitely apply for ED jobs :)

Up Vote Up Vote ×

If it really interests you and you feel you are up for the challenges that the ER brings (stress, physical demand, spontaneity, etc.) then I would say go for it. I am a new grad about 7 months into my RN career and started at a level 1 trauma center at my graduating university's hospital. We have a residency program that I am enrolled in but I feel the only real benefit for me is the relationships with other new grads and discussing our endeavors. We have an evidenced based project we are working on but personally I have had enough of that in nursing school. Anyways, the ER is a great place to start out in my opinion. It has given me the opportunity to polish my skills (IVs, foleys, NGs, EKGs, etc), introduce me to drugs from each class, taught me how to prioritize my patients, improved my assessments (my classmates who are on a cardiac floor have forgotten how to do a neuro assessment for example), and has taught me how to stay calm in truly chaotic moments. It seems the pressure that comes with the job has fine tuned my nursing skills. There will be plenty of unexpected moments. For instance I was assessing a patient with "flu-like symptoms" and my charge came in and said "Hey, I'm taking this guy out, you have a STEMI coming in 2 minutes." Being able to go with the flow is extremely important. And not taking things too seriously also helps. In the heat of the moment a co-worker or MD might yell at you or say something harsh. But 99% of the time they mean no harm and it is only because of the situation. All in all I say go for it. Just know what you are getting in to.

Up Vote Up Vote ×
Specializes in Emergency Room.

Go for it!! I started out Level II and now work Level I. Been working over 3 yrs with only ER experience. I love my job and I hope you will too.

Up Vote Up Vote ×

When getting an ED job as a new grad, it is important to be a self starter and to constantly be educating yourself about the things you don't know or fully understand. They say ED nurses know a little bit about ALOT instead of being an expert in a little. Watch YouTube videos of procedures. Read books and journal articles whenever you can. Ask questions!! " Fast fact for the ER nurse- your orientation in a nutshell" was a great starter book for me. And remember that even the most seasoned nurse still has *** moments where they face something brand new and scary! Good luck !!

Up Vote Up Vote ×

I started at a Level 1 trauma center right out of school. I did my capstone semester in a 26 bed ED and went from that to a county ED. Unfortunately, many ERs are treated like clinics, so you will get that anywhere. When you are interviewing find out about the culture of the staff. A good ED has a staff that works together and never leaves any nurse to fend for themselves. Teamwork is imperative in an ED. No critical patient is ever treated by just one nurse in our ED. We all pitch in and help out to make sure that everything is done and the patient is cared for appropriately. Your training program is important too. We do an 18 week residency where we are in class and prevented in clinical. It's huge in us learning how to be a good ED nurse. Again, find out about the culture, management, style of the ED, etc. Good luck!

Up Vote Up Vote ×
+ Join the Discussion