What Kind of Experiences before ER

Lev, MSN, RN, NP · Jan 6, 2015

Your still going to have this particular problem in the ER as well. No getting around it. At least 50% of the people that come in through my door are not satisfied no matter
what we do for them.

True, but I will no longer have to deal with them for 3 shifts in a row

Roy Fokker, BSN, RN · Jan 6, 2015

I worked for about a year and half doing Med/Surg. I often floated to Neuro-Stepdown (Art. lines/Craniotomies/Acute strokes that kinda stuff) and obviously remote telemetry (no cardio IV drips/pushes. Just monitoring.)

I'd never wanted to work Med-Surg (heck, when I was still in school, I dreamed of working in Pediatric Trauma. I had a wonderful Peds rotation in school!), but I applied for that (Med-Surg) job for two distinct reasons:

1. Somewhere in nursing school (and also partially influenced by some of the nurses on this board - I can't name names. It was ages ago. And I'm not assigning blame - just stating fact. I'm not resentful. That job taught me a LOT) - I picked up this notion that 'before a nurse can do critical care, nurse should do 2 years in med-surg'.

2. As with many new grads now - I took that job out of sheer desperation and necessity! Nobody else was hiring!

Looking back now, I can say a few things:

1. That whole "you need to work Med-Surg before you can work Critical Care" is, IMO, nonsense. Aptitude matters as much as attitude and training. As I was growing up, I figured out that as much as I didn't know what I wanted to do with my life, I concluded that I couldn't do what my Father did (Banker). I couldn't see me sitting at a desk for 8 hours a day dealing with paperwork (not saying my Father's job wasn't easy - just not for me!)

Saying "you need Med-Surg experience before you can do Critical Care" IMO demeans BOTH specialties.

2. It actually brings up one of my favourite sayings about being an ED Nurse: (for examples) "Can I take care of a hip fracture patient? Sure! Can I take care of a hip fracture patient as good as an Ortho-Med-Surg Nurse? (Ignoring my background) Probably not." "Can I take care of a vented, ICU patient on multiple drips and pressors? Absolutely! Do it all the time! Can I take care of that patient as well as an ICU Nurse? Probably not."

It doesn't mean ED nurses are incompetent - just that we don't do what the specialties do well because that's not our priority.

3. As a preceptor who has trained nurses to the department (both new grads and other nurses from various fields - including ICU) - I've found that new grads make for smoother sailing (with the obvious exceptions - but we aren't talking exceptions, but the norm.) Simply stated: They don't have any "habits"... "habits" that don't conform to the fast-paced, always-changing dynamic that is ED nursing. To put it differently - new grads in the ED get trained to be an emergency nurse from the get go...

Obviously it ends up being a longer training/preceptorship for the Department but I think it is worth it.

4. Which brings me to my final point - why work a field of nursing you don't want to just so you can gain access to something you want to? It seems wasteful to me. This isn't a diss on any nurse who is not ED. Not a day goes by when I don't thank my colleagues in ICU, Peds, Oncology, Med-Surg, Psych, Dialysis, SNF, Hospice etc. Y'all do something on a day to day basis that I could never do!

Bottom line?

Don't be afraid to explore. Don't be afraid to apply. Pay no attention to the "experience required" - apply anyway (to anything: ER, ICU, Med-Surg, Hospice whatever). After all, what do you have to lose?

cheers,

OldDude · Jan 6, 2015

I graduated from Nursing School on a Friday and went to work as a Graduate Nurse in the ER the following Monday. You'll learn everything you need to know in the unit.

Guests · Jan 7, 2015

I was an LVN prior, in various settings, but some very useful, I feel more competent with developmentally delayed patients then most others.
I did three brutal years in critical care, kept going to new ICUs thinking that each just wasn't a good "fit." Learned some awesome skills including CRRT. Realized that maybe it wasn't the hospitals that were the problem, more likely the unit after my last ICU made the mistake of floating me to ER. I fell in love with the ER.
But you know what? My three years of critical care torture was worth it, I don't freak out in codes, I don't freak with vents, I run to initiate the drips because I'm comfortable with them. It's always nice to be useful and quick when a patient is crashing. I like being useful.
However, peds patient's still scare me.

Some of our better nurses came out of the ICUs but many ICU transplants have failed to root because the chaos in the ED is tough to adapt to. Your LVN background coupled with your ICU experience combine to give you a great mix of skills for the ED.

You sound like the kind of person that I'd really enjoy working with.

(And even though I regularly rotate through a peds-only ER, the wee ones still make me want to wee my pants -- it's getting easier, though)

procrastinator911, BSN, RN · Jan 30, 2015

Have any OR nurses ever transfered to the ER? If so, how did they do?

PG2018 · Feb 3, 2015

I took an ER job because I wanted exposure - not experience per se. I wanted to learn more about the abundance of healthcare problems we frequently see in the ER ranging from primary care-oriented complaints of URI and back pain to other acute issues such as cholecystitis and pancreatitis.

Prior to my ER job, I worked at a desk for a year as a nurse managing a clinic, and before that I was a medical floor charge nurse. We never really did anything except hand out pills and IV antibiotics to the same 40 revolving patients who kept the hospital open.

My chosen profession is psychiatric advanced practice, and I only entered nursing to do this. However, I worked briefly in a psych hospital as a nurse and found that it had almost no nexus to being a PMHNP so I quit. The hours weren't conducive to school, and that was my chief exodus motivator.

Soran · Feb 17, 2015

I started in the ER right out of school. There's a 3 month orientation phase where for about a month I go through various floors/units and the other 2ish months was with my ER preceptor. I've been off orientation for about 2-3 months now and I love it. It's hard at first trying to keep up with the speed. The ER I work in is the busiest in my state and we have a time we try to have patients in and out/admitted in. It's been such a huge learning experience and well worth it.

NurseKarlyn · Feb 17, 2015

I worked for about a year and half doing Med/Surg. I often floated to Neuro-Stepdown (Art. lines/Craniotomies/Acute strokes that kinda stuff) and obviously remote telemetry (no cardio IV drips/pushes. Just monitoring.)
I'd never wanted to work Med-Surg (heck, when I was still in school, I dreamed of working in Pediatric Trauma. I had a wonderful Peds rotation in school!), but I applied for that (Med-Surg) job for two distinct reasons:
1. Somewhere in nursing school (and also partially influenced by some of the nurses on this board - I can't name names. It was ages ago. And I'm not assigning blame - just stating fact. I'm not resentful. That job taught me a LOT) - I picked up this notion that 'before a nurse can do critical care, nurse should do 2 years in med-surg'.
2. As with many new grads now - I took that job out of sheer desperation and necessity! Nobody else was hiring!
Looking back now, I can say a few things:
1. That whole "you need to work Med-Surg before you can work Critical Care" is, IMO, nonsense. Aptitude matters as much as attitude and training. As I was growing up, I figured out that as much as I didn't know what I wanted to do with my life, I concluded that I couldn't do what my Father did (Banker). I couldn't see me sitting at a desk for 8 hours a day dealing with paperwork (not saying my Father's job wasn't easy - just not for me!)
Saying "you need Med-Surg experience before you can do Critical Care" IMO demeans BOTH specialties.
2. It actually brings up one of my favourite sayings about being an ED Nurse: (for examples) "Can I take care of a hip fracture patient? Sure! Can I take care of a hip fracture patient as good as an Ortho-Med-Surg Nurse? (Ignoring my background) Probably not." "Can I take care of a vented, ICU patient on multiple drips and pressors? Absolutely! Do it all the time! Can I take care of that patient as well as an ICU Nurse? Probably not."
It doesn't mean ED nurses are incompetent - just that we don't do what the specialties do well because that's not our priority.
3. As a preceptor who has trained nurses to the department (both new grads and other nurses from various fields - including ICU) - I've found that new grads make for smoother sailing (with the obvious exceptions - but we aren't talking exceptions, but the norm.) Simply stated: They don't have any "habits"... "habits" that don't conform to the fast-paced, always-changing dynamic that is ED nursing. To put it differently - new grads in the ED get trained to be an emergency nurse from the get go...
Obviously it ends up being a longer training/preceptorship for the Department but I think it is worth it.
4. Which brings me to my final point - why work a field of nursing you don't want to just so you can gain access to something you want to? It seems wasteful to me. This isn't a diss on any nurse who is not ED. Not a day goes by when I don't thank my colleagues in ICU, Peds, Oncology, Med-Surg, Psych, Dialysis, SNF, Hospice etc. Y'all do something on a day to day basis that I could never do!
Bottom line?
Don't be afraid to explore. Don't be afraid to apply. Pay no attention to the "experience required" - apply anyway (to anything: ER, ICU, Med-Surg, Hospice whatever). After all, what do you have to lose?
cheers,

Thank you for posting this. This was probably the best thing that I have read. I've had so much difficulty in getting into a hospital. I have been doing skilled nursing and home care for the past couple of years. I finally was able to snag an interview with an ER. At first I was scared, because it could be a difficult transition. People keep saying, "Oh, thats scary," and that I should probably do med surge first. I have no interest in that. Anyway, thanks again for posting that.

Just.Blessed.RN, BSN, RN · Apr 1, 2015

I started in the ER right out of school. There's a 3 month orientation phase where for about a month I go through various floors/units and the other 2ish months was with my ER preceptor. I've been off orientation for about 2-3 months now and I love it. It's hard at first trying to keep up with the speed. The ER I work in is the busiest in my state and we have a time we try to have patients in and out/admitted in. It's been such a huge learning experience and well worth it.

That sounds like the perfect way to do an orientation. I'm graduating in December and I am really considering doing my last semester in ER. Hopefully I will be placed and hired at a hospital that is as committed to training new nurses as yours!

tachybradyRN · Apr 1, 2015

I had 5 years of experience prior to transferring to ER - 1.5 in MedSurg, 2 in tele, 6 months in observation and 1 year in ICU just prior to transfer. I transferred to ER when I got accepted to a Family Nurse Practitioner program - I needed a change, and wanted to see a greater variety of patients than I would see in our adult ICU. Been in ER about a year and a half now.

turnforthenurse, MSN, NP · Apr 7, 2015

I had nearly 2 years of progressive care experience (and during that time I would also float to ICU & CCU) before moving to the ER. It was a pretty easy transition for me. I highly recommend new grads to obtain experience elsewhere unless the ER at their facility offers an extensive new graduate program. Where I work orientation is about 12 weeks for new grads which isn't nearly enough, IMO.

gmsc11 · Apr 8, 2015

I am currently volunteering in the emergency dept (trauma level II), I have been told that the job will be given to me there when I finish nursing school which will be this May, I am super excited but scared at the same time... As a nursing student right now, I feel like I can't really function like a nurse yet but I haven't started preceptorship yet, hoping that I will feel more confident at time of graduation... Did any books help u in particular? any other suggestions on what to prepare for?