What's the best path towards Emergency nursing??

Trauma Columnist · Feb 18, 2004

Nowadays with the nursing shortage being so acute, you can probably get hired into an ER right out of school. Our ER does. Make sure you have a good orientation. Our orientation for our level one trauma center is 12 weeks. Good luck...

suzanne4, RN · Feb 18, 2004

Since you are already familiar with the ER, you would probably do okay going directly into it. Just make sure that they give you an adequate orientation and do not rush to put you out on your own. And get a good preceptor. You will find that will be your most important person to have around you for the first year or so.

Good luck.

petiteflower · Feb 18, 2004

I think that it is important to take at least a year on medsurg and hone your nursing skills. Some people do really well going directly into ER, but it is difficult many times for a new nurse. Being proficient and very comfortable with the basic skills is important. Can you do med surg and float to ER? Congratulations on your upcoming graduation---good luck!!! :) :balloons:

trsnurse · Feb 18, 2004

I am with PetiteFlower- I am a firm believer in training prior to ER, Med-surg, Telemetry, Heck anything is better than nothing. Things happen quickly in ER's, and you will be more likely (at some point) in a situation that makes you uncomfortable; rather it be your skill level, or the acuity of your patient. No matter what you do, your preceptor is the key; make sure you have a good one, and don't get rushed out of orientation. I was an LPN prior to going to ER as a new grad. (ADN), I still found my self to be insecure. My preceptor was very bright, but hard on me and I found myself alone alot. Basically I had to learn by fire. I hated my orientation to the ER, I felt as though all my experience meant nothing, my education-gone. I even tried taking Zoloft to get through my orientation with this "strong" nurse (I mean that in every sense of the word). It didn't help. So like I said, I had to learn by fire. I think I did well, I am now one of the permanent charge nurses, I love the ER, and my best friend-well that would be my ER preceptor, some how we made it to being best of friends, of course not until my orientation was long over with. We practice very much the same, (she's still the better ER nurse). But there are things you learn, and one of the things I learned was that new grads don't belong in ER, of course that is not meant to offend or discourage, it is only my opinion. EXAMPLE: A 43 y/o white male checked into triage, c/o chest pain, I bring him into the triage chair, he begins to tell me about his chest pain, I am writing his history, and he quits talking to me, I look and he has appeared to have passed out, me and others get him to a stretcher, wheel him to the treatment area of the ER, put him on a monitor, he is in cardiac arrest, duke power times 3, brought him back (shock X3), but where was my preceptor? Not with me. I was scared to death, almost quit my job. wanted to give her He**. but instead cried for three days and decided, I can do this, with or without a preceptor, hence learn by fire. Be ready if this is the decision that you make. It is a tough road, dont know what I would have done had I had no experience at all. maybe I would have quit, or maybe I would have, thought my patient was okay, and not known that he was in cardiac arrest-who knows, I see new grads all the time in our ER, and they scare me. But good luck in your venture.:) and CONGRATS ON YOUR ACCOMPLISHMENTS OF BECOMING A NURSE.

sun_chica · Feb 18, 2004

Thanks for advice everyone, it's nice to get a feel for what people in that field think:nurse:

trsnurse · Feb 19, 2004

Don't get discouraged, if ER is in your blood you will end up there eventually. But good luck

Thanks for advice everyone, it's nice to get a feel for what people in that field think:nurse:

Joshua21 · Feb 28, 2004

I was the same way when I graduated. I was hell bent on getting into the ED and Med/Surg was not for me. Fortunately no ED was going to adopt a new grad at the time and I put my time in on Oncology then ICU and CCU before ED.

Looking back, omg, what was I thinking. I was living proof of ignorant is bliss. I was way over my head in knowledge, experience and skills and had not a clue.

Now, if I could do it over again, at least! a year cardiac/tele floor nursing, two being the minimum ideal. Like it as much as not, when crap hit's the fan it usually comes back to cardiac. Next break into SICU or CCU or both for atleast a year, again two would be an ideal minimum.

This would be my recommend for a new grad who wants to fast track to the ED, more experience being better. Why put in the time? You develop that sixth sense, your "feelers" if you will. You'll learn to recognize when a patient is going downhill. Critical Care will give you skills and knowledge that are invaluable in a crisis. I do know from my own experience that few new grads will heed this advice and not realize it's worth until looking back.

If you can tough it out and put in the time, the ED when you enter it will be so much more rewarding in the long run.

Good luck!

veetach · Feb 29, 2004

I agree with those who are recommending some time on a MS unit. It isnt a bad thing to work med surg, it is a great learning experience.

as for the BSN thing, we have more 2 year nurses in our hospital than 4 year, there is no demand for a BSN vs and ADN. the demand is for a safe practitioner with a valid PA license.

EMTPTORN · Feb 29, 2004

To go to er as new grad you need without a doubt:

1. 100% self confidence in your assessment skills

2. The ability to do the everyday skills w/o help (ie get your iv's, lab draws, 12 leads, ng's foleys) many times in the er i work in THERE IS NO ONE TO HELP YOU WITH AN IV, ETC.., YOU ARE TOTALLY ON YOUR OWN..........

If you don't have #1, then forget about it, suck it up and get some exp.

If you have 1, then do you have 2? Working as a tech could get yOU some exp in these skills. Techs where i work can do all skills mentioned above except for IV starts.

I am a firm belIEver that you do not need med surg exp to go to the er, that IS AN ABSOLUTELY STUPID AND UNEDUCATED STATEMENT TO MAKE. it is no different than saying you cannot go to medsurg without going to the er first........so, do not listen to the naysayers, if you have confidence in your assessment skills (and truly are good at them not just a p.e. but having some intuition) then learn the repetive skills (iv's etc...) and do it.

I would also highly reccommend taking ACLS/pals before trying to get a job, it will make you more marketable and show you are determined.

I was a new grad in ER and worked over a decade as a Paramedic before becoming a Nurse. Being a Paramedic taught me a helluva lot more about working in the ER than nursing school.

One other suggestion......this is if you have a few extra bucks....get a PDA with a drug guide in it.......i have the pda version of davis drug guide and everytime i am to adm a drug iv/po/im/ whatever i look it up and it tells you the implementation of that particular drug.......plus peak times, cost of drug at pharmacy, etc.....

Good Luck in your Endeaver, and if you do not want med surg, then do not do it.........but you better be good or you WILL fall on your face hard, or kill someone. Everynight in the ER there is that potential.

EMTPTORN

veetach · Feb 29, 2004

EMTPTORN wrote >> am a firm belIEver that you do not need med surg exp to go to the er, that IS AN ABSOLUTELY STUPID AND UNEDUCATED STATEMENT TO MAKE. it is no different than saying you cannot go to medsurg without going to the er first........so, do not listen to the naysayers, if you have confidence in your assessment skills (and truly are good at them not just a p.e. but having some intuition) then learn the repetive skills (iv's etc...) and do it.

This is entirely YOUR opinion and one not based on experience but judgement. Stupid? Uneducated? where do you come off making accusations like this? Your background as a paramedic obviously gave you an advantage when working in the ED. The individual you are replying to is NOT a paramedic, but a unit secretary.

there is a definate difference when one comes directly to the er as a new grad with no previous experience. We have discussed this topic over and over and over on this forum. There are those who believe that new grads need nurturing and training and the ED is not the place to do that, and there are new grads who have gone right into the ED and done well. (most of them had previous experience, whether it be a paramedic or an emt or an ed tech) I am not going to rehash this discussion beause it is getting boring.

Did you really mean to say stupid and uneducated???

angel337, MSN, RN · Feb 29, 2004

i was an ed tech that that is now a nurse and i can't really say if med surg would have helped or not. i do agree that the hands on skills you learn as a tech (blood draws, foleys, ng's, iv's) make it 100% easier for you to navigate through the department. critical thinking skills and knowing how to prioritize is what i think is needed most in ED. I work with some nurses that have been in ED for 10 years and they still freak out when the real "emergencies" come in. it takes time. there is no perfect nurse. everyone does things differently and in time will learn what works for them. don't be afraid to ask questions, ask everyone, the Docs, residents etc..;. you will be respected for being conscientious and thorough. i was afraid to start in ED also but i think any entry level nursing position is scary because it is new and you are aware of the responsibilty that you now hold. i love the ED and can't imagine doing any other kind of nursing (for right now). good luck