Tips For New Grad ER Jobs

bill4745, RN · Oct 5, 2006

I would dtrongly suggest that you get a year of med/surg under your belt before taking any specialty position. You will be much more "marketable" for future jobs in ED or any other special area.

Larry77, RN · Oct 5, 2006

Either Med/Surg or Tele experience is what they will be looking for but sometimes if you precept in a certain ED and they like you enough you might get hired.

ACLS and PALS is a good idea for marketing yourself.

RunnerRN, BSN, RN · Oct 5, 2006

Here's my opinion from someone who started in the ED as a new grad...

There are many hospitals that offer a fellowship in ER nursing. At my hospital, we had several months of classroom review material (because no nursing school hits ER material) and critical care material. We then had a 4-5 month clinical practicum - work 40 hrs/week in the department with an assigned preceptor, with weekly objective reviews and meetings. It was very intense, but wonderful. I learned a lot, and because the hospital accepted new grads, the atmosphere in the department was very good (for the most part) for learning.

I don't feel new grads should jump straight into an ER that doesn't have any kind of program - the amount of things to learn is too great. BUT if I could do it again, I would probably do a year or two of ICU. I think ER is wonderful, but because it is usually a "cattle in, cattle out" philosophy, you don't always get a chance to fine tune your assessment skills.

If you are a smart person, sharp, willing to learn, and not afraid to ask questions, you'll probably do fine. You also need to be able to jump in and DO, instead of just standing outside of the door. During my fellowship, I went through TNCC, ACLS, ENPC, and the hospital paid for it :) Maybe get a book (Sheehy's Manual of Emergency Care is good) and start reading. I know the last thing you want to do while finishing up school is read a textbook that doesn't contribute to school, but it can help you feel more comfortable.

Good luck. Let us know what happens.

Bindy, BSN, RN · Oct 5, 2006

Don't want to be totally discouraging, but....if there is not an offical precepting program for ER then do Med-Surg and/or Tele for at least...at least a year. Even with that under your belt,( I am talking from experience ) and having twelve yrs of Echo, which gave me a extensive cardiac background, the ER on most days was daunting for me the first 6mo's. I was in a position that was precepted for 8 wks, and then they let me loose. Put it this way, I am O.K now.....don't know everything, who does?, but I now have a stomach ulcer from all the stress. Looking back I would have turned ER down and went to the ICU/CCU. This is mega stressful too but slower paced. Someone had mentioned that you can pretty much tweak your skills there and I would have to agree. Whatever you do, be prepared to self-educate when you are off work. Nursing school was just the tip of the iceburg. This is the way it is for ER, and I am sure it is for any CCU/ICU job. I wish you much success in what ever you choose. Take Care, Bindy

JMBM · Oct 6, 2006

I will join the chorus and agree that under no circumstances should a new grad try to start in an ER unless the hospital has a good fellowship/preceptor program. In fact, it would be great to find a fellowship/preceptor program for whatever department you join. It is not that ER work is any more difficult than some others - a good Med-Surg nurse on a busy floor goes home just as tired as any ER nurse. Its just that ER work involves an enormous variety of patients and conditions, all at high speed, all changing by the minute. For those of us who love chaos, its great, but its definitely not a good place to learn basics. .... Now, if you have found a good preceptor program, don't worry too much about having ACLS, etc. Normally, those are all part of the program. They can't hurt, but aren't really necessary. What I'm told our supervisor looks for is someone with life experience who understands the reality of ER work and who can explain why they want to work there. If you have no prior EMS or ER experience, think about asking to do some observational shifts in one or, better yet, volunteer in one. You'll be stocking laundry and cleaning rooms, but you'll be learning how the ER works and you'll honestly be able to tell a recruiter that you've been there and know its your home. Best of luck

ERnursing4me · Oct 6, 2006

As a new grad starting in an ER, I feel I have learned more in the 3 months I have been with my preceptor than I would have ever learned in a general med/surg/tele unit. I think regardless of which department you want to start in or where your long term goals are you have to want to learn, be open to any chance to learn and show your coworkers you are willing to jump in and help out. The ER is something that you either love or hate. I was so tired of people telling me I needed experience in general dept, but I dont know of any other dept to gain assessment skills, procedure skills, critical thinking and thinking on your feel skills. If you want it and work hard you can succeed...approx 80% of the nurses in my ER started there as new grad and some have been there over 10 years....need I say more

Good luck and go for it!

one more thing: you need a good clinical partner/preceptor regardless of where you start

rjflyn, ASN, RN · Oct 7, 2006

Im going to go with the find a hospital with an internship or ER nurse training program. As far as all the certifications while nice to have if you dont have the experence that goes with you they are just more information one has to process while learning the ER.

As far as med/surg first goes this topic has been discussed here in numerous threads. My take is having done ER for going on 19 years is personally it is easier to teach a rookie than it is to unteach someone coming from the floor with bad habits.

Rj

S.T.A.C.E.Y, LPN · Oct 7, 2006

Thanks for all the replies everyone. I've read many of the forums here on allnurses about starting in the ED as a new grad, or getting med-surg experience first. Personally, I've hated my time on the med-surg floor, but can't get enough of the ED. That was why I came into nursing, and that is 100% where I want to go. I agree with all of you on finding a hospital with a good fellowship/preceptorship program specific to new grads. I couldn't imagine being tossed into the ED without one. Online I've been reading about some of the big teaching hospitals, and the new grad programs they have. Several of these programs really interested me, especially with the classroom time & preceptored time. I was thinking that they would likely be competitive. I was just curious as to what those programs usually look for.

The way I figured, most nsg students would probably have relatively the same clinical experience; so what are managers looking for to choose between candidates? Sounds like certifications aren't the ticket. Pre-hospital experience? Clinical experience at that hospital? Locals preferred vs distance? Good answers to clinical problems in interview? Testing Process? Life experience? Does BScN get a step up? Grades? Thanks!

HM2VikingRN, RN · Sep 17, 2007

Either Med/Surg or Tele experience is what they will be looking for but sometimes if you precept in a certain ED and they like you enough you might get hired.
ACLS and PALS is a good idea for marketing yourself.

The ER that I will probably be doing my synthesis rotation at has 2 PT RN jobs available. I am taking this oppotunity to audition for a job.

RNcDreams · Sep 18, 2007

Hi there

I am a new graduate in the ED right now, and the facility I am at is small. It is a 30 bed ED, and I have a preceptor who has been a nurse for >25 years. She is basically the reason the program works. Orientation is 6 months (less if they find you are progressing faster) and for the first half of it, I spend 16 hours a week in class. I am in the midst of ACLS.

The ED is a place where asking questions, knowing your own weaknessess, and being a motivated learner are musts. You will sink if you are not willing to go home after a shift and practice rhythm strips or look up drugs or whatever the topic of the day might be.

I knew med-surg was not for me.... and I was told time and time again that I needed "a year of medsurg."

If you know that you enjoy emergency, make it a priority to practice assessments before you get there.... start practicing strip interpretation.... learn your code drugs... and be ready to learn and ask, ask, ask!

It is worth it to aggresively work for what you know you love.. if you have had some exposure to the ED and think that you can step up to the plate, give it your all :)

It seems that those who seek out the ED with genuine interest and concern for their skills (like you have) tend to be just fine... as long as you have a great preceptor and a supportive program.

Speak up for yourself, never stop learning, and thrive where you belong!! :)

sabbady · Jun 1, 2011

I can tell you that I am a med surg nurse with 3 years of experience, looking to get into the ED, so far without success. I don't like med surg and am pretty sure the ED is the right place for me. Everyone also told me that med surg would be a great first experience/foundation for the ED and what I am finding is that a lot of places will not hire me with this. Some of told me that tele is what I really need--one nurse recruiter said that I'd need at least 2 years tele experience to transition into their ED. So my suggestion, from a different experience perspective, is go for the ED--if one takes you or if you find one with the critical care course that takes new grads. I know that I am not giving up on this, as this is what I really want and have already put enough time into med surg.