What does it take to be an ED nurse, and should a new grad even try?

SDS_RN, RN · Dec 20, 2007

I just graduated in 06 and I have worked on Surgical and Pediatrics for about a year and a few months and I just made the move to the ER and just had my first day off of orientation on Tues. One of the advantages of working on surg was that I got to know the docs in the facility and what they like so that also helped make the move easier for me. I am glad that I had the surg/peds experience before going to the ER, however I feel like I lost a lot of my nursing knowledge and skills because surgical and peds really are quite specialized. I have pulled my nursing books back out and have been on the internet looking stuff up like crazy because I like to know what I'm doing and I want to make sure I'm doing is right. I'm liking the ER but now I have to build my confidence back up again and I feel like I'm starting all over again. I guess that's how it is with any new job or task that you take on. I just try to keep a good attitude and ask questions when I don't know the answer.

I also had the strong drive to end up in the ER after graduation and I'm glad that I have fullfilled that goal. I am looking forward to my new journey learning to be a good ER nurse.

I think that to be a good nurse no matter what area you are in it takes the guts to stand up and ask questions if you don't know something and to admit the mistakes you make and learn from them. Take full advantage of your orientation and ask for more if you need :idea:it. Good luck to you and if the ER is where you want to be then you need to go for it.

flychick08 · Dec 20, 2007

Maybe some of you who are more experienced can tell me what it means but getting "eaten alive"??? I guess I am super naive, but does that mean just people making a bad atmosphere for you at work? Or criticizing??? Just the phrase scares me if that is common for new nurses.

Sorry....let me try to clarify that last statement. I mean that you very well may feel like you are in over head as far as pt. acuity, the demands of the pt.,the demands of the docs and your co-workers. They all aren't TRYING to make things hard...they all need everything done quickly and correctly. I think alot of grads (God Bless Them!) come out of school and have a overly-rosey picture of what nursing is in general. ER medicine is tough....physically,emotionally and mentally. I'm not saying you can't do it. In fact, if you are sure....please give it a whirl!!! I just want you to be happy in the field after the first year or two and not wish you had gone into accounting instead.

SDS_RN, RN · Dec 20, 2007

When you first start out as a new nurse some of the older more experienced nurses will give you a hard time and the doctors will expect you to know your stuff if not then you will get your butt chewed. I have had mine chewed a few times but it will only take one time and you will not forget it. You just have to learn not to take it personally and learn from the experience. Don't let people scare you off by talking about being thrown to the wolves or into the lions den. You take what you learn and apply it. Most of the time when the docs know you are new they will be patient and try to help you learn. Like I said I just started in the ER and all of the ER docs have been very helpful and the nurses I work with have really taken me under their wings to make sure that I do well and if you find the right facility they will do the same for you.

mmutk, BSN, RN, EMT-I · Dec 21, 2007

I don't think comparing the ICU and the ER is even fair, you are either one or another. You ethier enjoy on having multiple patient's with a wide range of complaints and acuity... Or you like having 1 with a high level of acuity (boring to me).

I say if you think you want some ER, DO IT!

I started out in the ER and have loved it ever since.

futurecnm · Dec 21, 2007

I think my main concern is that i don't know what it is even like in an ICU. I have only shadowed in a small hospital ED for 2 shifts. I have never been in an ICU. Our clinicals have been on general med/surg, cardiac, neuro, ortho, and oncology. We don't even have an ICU rotation scheduled because of lack of clinical sites in this area. It is SO hard as a new grad to decide what you want to commit to when you have no clue WHAT you are getting into!!!! It is quite frustrating, I feel that we should at least experience all units before graduation. At least I will get to do some peds, l&d and ob before the end of the year. I also did 2 shifts in mental health, but not enough to really know if I like it.

gentle_ben_RN, ASN · Dec 21, 2007

What does it take to be and ER nurse......let's see.......

1. A great pair of shoes because you will be on your feet 90% of the time and will probably be wading through a ton of crap (figuratively and literally) from the patients, doctors, and even the little volunteer people.

2. Nerves of steel for the above mentioned who will stomp repeatedly on the very last surviving nerve that you have left.

3. A good sense of humor because you will either have to laugh or cry and it's better to laugh I say.

4. And finally, find out how to do 10 things at one time and how to be one step ahead of the game and you'll be fine.

So...good luck....if I can do it so can you.

flychick08 · Dec 21, 2007

Hey....I don't know where you work, but I work in a large city ED and you have multiple pts. and sometimes 50-60% of them are high acuity. And we are a well-staffed ED in comparison to most. We have a very low turnover because our director absolutely WILL NOT hire new grads into the dept. It's unfair to them and to the rest of the staff that has to make up for it. You MUST be able to handle high acuity pts. efficiently and then you can begin to think about being able to handle lesser acuities on top of that as well. :rolleyes:

futurecnm · Dec 21, 2007

Hey....I don't know where you work, but I work in a large city ED and you have multiple pts. and sometimes 50-60% of them are high acuity. And we are a well-staffed ED in comparison to most. We have a very low turnover because our director absolutely WILL NOT hire new grads into the dept. It's unfair to them and to the rest of the staff that has to make up for it. You MUST be able to handle high acuity pts. efficiently and then you can begin to think about being able to handle lesser acuities on top of that as well.

many hospitals here hire new grads in ED. Obviously they would like experience but there must be a shortage because they end up hiring new grads. Maybe high turnover?? I don't know, but even the bigger hospitals are more likely to hire a new grad then a smaller one. They have better training programs.

SDS_RN, RN · Dec 21, 2007

When graduation comes up you feel overwhelmed and scared because your instructors will no longer be there to hold your hand and you are on your own. At some point we all leave the nest and you have to go on, rely on your new knowledge, skills, & new coworkers as you get started. It should be exciting for you to move from student to RN. When you interview find a facility where you feel comfortable and ask if you can visit all the areas they have to get a feel for how they are ran and talk to the nurses working on those floors. We all have to start somewhere and when you start you will learn so much more than you did when you were in school. The old saying says that experience is the best teacher.

There are so many different areas in nursing and you just have to experience them to find out where you fit. I loved working on the surgical floor but I had to see if there was some other area that I was meant to be in so now I'm in the ER. Just start out somewhere that will be interesting to you and if it's not the ER right away then make it a goal of yours to at least experience it at somepoint in your career.

I work in a town of about 15000 people and our ER does require at least one year of experience and I know that they prefer people with ICU or rural ER experience. Some of our rural areas will hire new grads though because of high turn over. I was fortunate to get my position because I already worked in the facility and got high remarks from my coworkers and director on the previous floor I worked on. Most of the nurses I work with now have been in the ER for 20+ years and they are still passionate about it. They are the people that I look to as my mentors and resources to help me gain more experience & knowlege. I have not been in the ER long but I've been there long enough to know that I like what I'm doing and I like the variety of patients that roll through the door every day. You will find what works for you eventually but just get out there and get the experience, then you can go anywhere from that point.

mmutk, BSN, RN, EMT-I · Dec 22, 2007

We hire occassional New Grads at our ER too, w/past EMT or ER Tech experience, then train em like we want em....

laurainri · Dec 22, 2007

I am starting the ER in January as a new grad. I went for an interview as a student intern earlier in the year and was told the only position that the had available was in the ER. I took it just for the expierence because I thought that it would not be for me. Guess what.... I loved it and I am planning on staying. They give a 6 month orientation on top of the internship (follow a nurse at all times..not used as a tech). So pretty much I will have a year's training under my belt before I am on my own. I have found that every nurse in the ED very welcoming to the new grads and they tell us that they want us to exceed cuz somebosy has to take over when they collapse from exhaustion

10MG-IV · Dec 30, 2007

All through out Nursing School I worked summers in a 400 bed hospital.

I had the fortune of having a grumpy grouchy Army nurse as my Charge nurse. And in Charge she was. well I greeted her and informed her I was here to WORK and I wanted to learn

By the end of the first summer, I had learned so many tricks of the trade and I was organized. by the second summer I had her trust, and by the third she said, "Dawlin, when you get out of school,you can be my nurse any day."

If you work in the environment prior to "getting dumped in the stew" you will be ahead of the game. So many new nurses have the deer in headlights look when you tell them, "ok start a 18g IV, draw the lab,put in the foley, get the urine and... you might need restraints."

but in reality, that is (routine) all in a days work in the ER.

So, work in a ER as a grunt, then you will have the feel of the department. I started out in the ER Major Trauma Center back in the 70's and wouldn't change anything. Too many good and funny memories, only if I would have started that book.......:redbeathe