Views on New Grads Entering the ER.

new er nurse, BSN, RN · Jul 21, 2006

I have been a nurse for a year now. The entire time has been in an ER. I have had mixed reception. Many are open to new grads and many are against it. The ones against it seem to be older nurses who had to come up through med/surg, CCU etc. Recently I overheard one of our doctors telling one nurse (against it) that no matter how much experience you have you still need to learn/relearn in the ER. You are not with a patient over an extended period of time so your assessments are different. The nurses who are accepting have been a great help especially when I have been able to draw on their experiences.

abake003 · Jul 22, 2006

hello-

i will have been a nurse for two years in february of 2007, and i began my career in the er.

i think the er is the perfect place for a new grad because you literally see everything and get to develop strong assessment skills and advanced critical care nursing skills...i think it's only the perfect place when the new grad is exceptionally mature and the orientation program is tailored to the individual's needs(mine was 6 months, including a critical care course).

i have definitely had the experience of having older nurses turn against we new grads, but most have been accomodating and helpful. the docs in my er really love us because they say we have fresh, positive attitudes and are willing to learn..this has sort of set the new grads against the old nurses.

my experience has been great because the staff is so supportive, but the acuity level in my ed is really high and so that part is stressful.

if you need to know anything else, just ask!

marybethm · Jul 22, 2006

I know that a lot of the top trauma centers prefer new grads so they can teach them from square one....and don't have to "unlearn" them. I personally think that it's great to have certain experience---like peds or esp. newborns or L and D--areas that are very specialized and not a lot of ER nurses know too much about. But being a new grad is good too. I think the most important thing is that you have a passion for the job. I loved my ER days more than any other job I've had (except the one as a waitress in an Italian Restaurant where the pizza guys were just so darn cute).

ER06 · Jul 22, 2006

Dear Erika,

I am a new RN ( as of March 06) and am working in the ER which I totally love. I had the fortune of being an LPN beforehand and have had med-surg, cardiac, ortho, some peds/ob, research, Dr.office and neuro so I don't know if I can give an un-biased answer so to speak. But I do think that having some type of patient care or floor experience is very beneficial to working in the ER. Just the basics of having hands on experience and learning good communication skills is so helpful, because as you know in the ER we see people at horrible moments in their lives and knowing how to talk to them at this crucial time is a good skill. After graduating, I completed an intense three month critical care internship, I felt was more intense than school was and not everyone made it through. If I had not gone through this internship I would not have felt prepared for the ER at the least. Being an LPN before was also priceless experience as well. There are several RN's in my ER that went straight from school into the internship and then into the ER, and I have seen them struggle with a few things, like time organization. And also like a few skills, like changing an ostomy appliance (we had a pt come in a domestic where his girlfriend ripped it off ouch!) and irrigating a post-op turp that had come back in with urinary retention 2 to clots. Anyways, hope this info helps and good luck!

NurseWilliam · Jul 22, 2006

I think that as long as a solid preceptorship program is in place, having a new grad join the ER is fine. But if no such program is in place, I feel that it is certainly better to have some experience in practice before "coming down." The hospital in which I work has an RN Residency program for the ED, in which they bring aboard 2 graduate nurses per 6 months. It has done quite well, and I speak from experience, having been one of those graduate nurses at one time. IMO, had such a program not been there, I would never not have been able to hack it. But I had a fantastic preceptor with tremendous experience who was VERY patient with me. Hospitals that have such programs benefit in training new RNs to their particular way of doing things.

Trauma Columnist · Jul 22, 2006

I have 10 years experience in a level one trauma center. I had one year of ICU and one year of med-surg experience prior to this. New grads can make it in the ER but have to have a solid (12-16 weeks) orientation with both classroom and clinical time. They must also receive ongoing mentoring for at least one year. Otherwise, you are setting new grads up to fail. In the ER, because the patient population is so diverse, a new RN (either new grad or new to the ER) needs plenty of experiences: taking care of both routine patients, critical patients (both peds and adult) and many different types of care.

We do a dis-service to both our new nurses and our patients when we throw them on the floor after little to no orientation and no mentoring. I always told the nurses that I precepted that it takes a year before you even know what questions to ask and at least two years to feel comfortable.

RunnerRN, BSN, RN · Jul 22, 2006

While I started as a new grad in the ER over a year ago, I have mixed feelings about it. It is a good place to learn, and the only place I can really see myself working. BUT I feel like most new grads need some time elsewhere first - I really feel like going to the ICU or something similar first would be beneficial. New grads don't have the knowledge or "gut feelings" to know when a currently okay pt is getting ready to go bad. Sure, you develop those things, but I do wish sometimes that I would have started out in the ICU. But I think if I had started my career somewhere else, I would have probably burned out by now (I could never do floor nursing; ICU just seems too involved for me :)) ER is unique in the "treat and street" or "stabilize and admit" mentality, and it takes a special kind of nurse to be able to do that, new grad or experienced.

Melissa94RN, BSN, MSN, NP · Jul 22, 2006

Personally, I think that a new grad could be fine in the ER with the proper training, but in my experience most of the hospitals in my area are terrible with orientation. The nurses end up trying to fend for themselves and it can be a disaster. I was thankful for my experience prior to entering the ER but again, I had little or no orientation, kind of on the job training. In the hospital that I presently work, they require 1 yr of floor nursing prior to ER. Someone stated in a prior post that it takes a couple of years to feel truly comfortable and I truly feel that is true. After 9 yrs in the ER, there are days when I learn something new or see something that I have never seen before. I think though that is why the ER is definitely for me as I keep learning everytime I step through the door.

ICUNurse11 · Jul 22, 2006

Thank you all so much for your input. This will help me a lot!!!! :thankya: :)

debbyed · Jul 23, 2006

Since I've been in the ER for >20 years I have seen attitudes change including mine. When I started all graduate nurses were supposed to have a year of Med/Surg. experience. I was lucky in that I had worked as a monitor certified tech in a Step Down Unit {PCU} so I started on the step down floor. When I started working in ER's all applicants were expected to have a year of experience.

Over the years and after precepting more nurses than I can remember I can honestly say it has nothing to do with experience. You are either an ER nurse or you are not. ( The same probably can be said for Peds, OB/GYN, Psych. etc.)

At my current hospital we will usually take 2 new grads per semester regardless of how many openings we have. We feel that they need extensive orientation and a prolonged preceptorship to be successful. Taking too many new grads would be unfair to both the new grads and the staff. In our area we have combined with other hospitals to run a learning program for Critical Care/ER new grads. For about a month they have two days of lecture/clinical lab per week and complete the rest of their hours on their assigned unit at their home hospital. We also include ACLS, Pals, ENPC, and TNCC. Althought our hospital is not a level 1 trauma center we are seeing more and more walk-in/drop off GSW's and stabbings. This gives our new grads a solid Educational Base at a time when they still have good learning/study habits.{As opposed to us older folk who cring at the words class or test:uhoh21: )

As well as new grads we are also importing Nurses from the Phillipines (again 2 at a time). I have to admit at first I was concerned about this. But we treat them the same as new grads and I wouldn't trade any of my new international nurses for the world.

In both cases the preceptors (as well as the preceptee's) know within a few weeks if the ER is the right fit for them. When it is not, that staff member is placed in another unit within the facility. Not only do we want to train our young nurses but we want to keep them. Usually loyality repays loyality. Just this month I have a Phillipino Nurse returning to the ER. He came over about 2 years ago and found he wasn't ready for the ER . It was apparent that he was struggling and therefore not enjoying the experience. During discussions between his preceptor and himself it was decided that he needed some Med/Surg and PCU experience. He had come from a very small hospital and was unfamiliar with much of our equipment and standards of care. He decided to move to an opening on the Oncology floor but has continues his learning with ACLS, PALS etc. The staff is thrilled he is returning as a much more confident, happy RN. He has been assigned a new preceptor and will not be rushed. Both He and his preceptor will know when he is ready.

As to what I takes to be an ER nurse, I would say Self Confidence, Assertiveness, The ability to take constructive suggestions, And more importantly a new grad needs to understand that they don't know everything and must be willing to ask questions. The new grads that scare us and ultimately do not success in the ER are those who think they know it all, don't ask questions, and don't take the advice of more seasoned nurses.

For any of you who are still in school and are intrested in ER Nursing - GO FOR IT - Just make sure you choose a position that gives you the support that you need to succeed. Check to see what kind of orientation and preceptorship they are offering, what continuing education they provide, and what their expected time line is. If they expect you to be functional on your own in less that 6 months you may want to check around. Remember, this is a sellers market, you are in demand. Demand a program that will give you the best chance of succeeding. We need nurses. and in my case...Especially ER nurses because I would like to retire with the knowledge that when I need emergency care I will have not only a knowledgeable nurse but a satisfied/content nurse at my bedside.

gotwire · Jul 23, 2006

ER is a whole other animal, because it is so diverse. I worked in an ER and trained new grads, we only took 2 a year, they went through CC classes for 2-4 weeks, then 6mo training in the ER, they worked their preceptor schedule. We had great success, but we had a great orientation system in place. I still think critical care experience is good to have, but it is not required, not all good CCU nurses make good ER nurses. It requires a certian personality type, as does all the different areas do. Good luck!!!