Why wasn't I placed in the ED?

[shan_elle]

My cohort recently interviewed and received our placements for IP. I was one of the only students who did not receive their 1st choice, the ED. Instead I received my 4th choice, the CV ICU. While being placed in the CV ICU is flattering and a huge compliment, I've wanted to work in the ED for 8 years and have made this very clear to faculty since the beginning of my program.

I'm a straight A student, take a Gerontologic Nursing Honors class, successfully took on more patients (and more complex) than almost all of my classmates during Acute clinicals, participate in multiple extra circular activities, have 6 years of healthcare experience (including ED rotation), and have been told by multiple instructors that I would be a great fit for the ED. My interview for the ED wasn't my best, but I feel that it was adequate. I talked about teamwork, questioning physician orders, and how my personal practice affects the unit and the organization as a whole. Essentially, I've done everything possible to show that I'm a worthy candidate for the ED, yet only 4 of the 6 spots were filled! I'm having a difficult time understanding why, as one of the top students in my class, I was not given my first choice!?

One of my classmates who was placed in the ED dressed unprofessional for her interview, is a C student, has no healthcare experience, had difficulty connecting the dots in clinical and had no desire to work in the ED until she realized her friend was being placed there. I'm pretty sure she has no idea what she's getting herself into and just wants to hang out with her friend in the ED for the "adrenaline rush."

The whole situation feels like a slap in the face and I'm wondering what your perspective is, or what you would do??

[akulahawkRN, ADN, RN, EMT-P]

You may be ultimately a good fit for the ED. However, given your apparent intellect, you have been placed where you can really flex it. Being placed in a CVICU for IP is not a slap in the face, rather it's an enormous gift. You'll be challenged there far more than you ever will be in the ED. When you get through this experience, you'll have a significant understanding of the kind of care the very truly sick people need and will receive after they leave the ED. My own preceptorship was on a Neuro floor. Not a "standard" M/S floor, but one that required thinking through the care that each patient needs, being constantly vigilant for new-onset seizure and stroke because all the patients were at heightened risk. Unfortunately for me, however, that experience didn't teach me how to care for the ICU-level patient. In the CVICU you'll learn at least some basics of caring for the patient that needs multiple drips, is on a ventilator, is fed through an NG Tube, has a foley cath in place, and needs to be turned every 2 hours because they can't do it themselves, thanks to sedation.

In the ED, where I have been for the past 2 years, it's more like working the street. In very simple terms, the ED does triage. Patients come in and are sorted for where they need to go. They're discharged home, often with a prescription and advised to see their primary care physician. They're transferred out of the ED to an ICU or M/S floor or even another hospital because the patient isn't well enough to go home. Or they're celestially discharged because they were too sick or injured to continue living.

Yes, the pace is often incredibly fast. Yes, there can be some highly adrenaline-producing moments. I used to be a Paramedic, you get more of those on the street, actually. Yes, you sometimes take care of some very sick patients because you have no other choice. If you get at least some experience in an ICU, you'll have at least some basic understanding of how to care for those patients when they do show up in your ED. Then you'll be able to flex your intellect again. Because of your upcoming CVICU experience, you'll be starting off at a much better place than most folks that try for the ED as a new grad will ever be at. You'll also have a better chance at getting employed in units other than M/S because you'll have shown you can thrive in such an environment.

That's the way I see it. You can choose to see it in a similar way or not, it's up to you.

[shan_elle]

Thanks for the feedback and perspective akulahawkRN. I understand what you mean about it being an enormous gift. I just really feel like my passion lies with the ED and that I should at least be given the choice where I want to go. I'm meeting with the faculty who is in charge of placements in a couple weeks to see if they will honor my choice. I've had the opportunity to work in both settings and definitely feel like the ED is a better pace, setting, and match for my personality and what I'm interested in. With that being said, if I continue in my CV ICU placement I will still be extremely grateful and I know I'll learn a lot!!

[Lunah, MSN, RN]

Just a bit of advice — don't put others down or compare yourself to make yourself look better. Your peer who was placed in the ED was placed there for reasons that you might not be aware of. Please focus on your own merits — I have found there is much more to be gained by competing with myself than in competing with anyone else.

You said yourself that your interview was not the best; you felt it was adequate, but they might have felt otherwise. Hopefully you can get some feedback to help you understand — I realize this is a big disappointment. But you know what? In the long run, does it matter, really? What you do as a student is all well and good, but it's what you do as an RN that will really matter in terms of shaping your career. You'll see what I mean when you get there. Best of luck to you!

[shan_elle]

Thank you for the feedback Pixie RN. I will definitely remember your advice as I continue through this process! My intent was not to make myself look better or put the other student down. I think my qualifications speak for themselves and there is nothing wrong with being a C student or struggling as you learn. I offered the information about the other student in hopes of gaining some better insight on why or how a decision like this is made. I don't understand why the school of nursing would set forth certain requirements and expectations for ED placements, but then not follow them. I suppose I will have a better idea after talking to the faculty who does placements, but was curious what others thought or have experienced.

On one hand, no, it doesn't really matter in the long run. I'm sure I will gain invaluable experience wherever I end up and will definitely go into it with an open mind ready to give it my all. On the other hand, it matters a lot!! I'm paying a lot of money for my education! I should be able to learn and practice in an area of nursing that I enjoy and am passionate about. It's also a great job opportunity. I've seen many nursing students get a job on the unit where they did their practicum and I've known units to even hold positions for people if there are none available immediately after graduation. In addition, I know that the ICU is not particularly thrilled to spend so much time and effort training students when they don't plan on staying in the ICU after graduation (which I don't). Ultimately what it comes down to is that I feel like my school is placing me based on the hospital's needs and where THEY want me. After working my butt off in the program I just think they should at least give me the consideration and respect to let me choose which critical care placement I want. Why not let me do what I love!?

[Lunah, MSN, RN]

Just because you are paying tuition does not mean that a school has to place you somewhere if the interview was not your best (your own words). They owe you an education, and it sounds like you have excelled. That is wonderful! Be proud of that, ask to be moved to the ED, and go from there. Good luck.

[CX_EDRN]

I know that you're disappointed but I am sure your instructors have their reasons. Why not just ask them? I was in almost the exact same situation that you're in, wanted the ED and was placed in the ICU. I was bummed but when I spoke to my instructor she explained exactly why they placed me there and I accepted it as a compliment. I ended really enjoying the ICU and actually stayed on as a new grad. I learned so much in just a short amount of time. Of course, I did end up finding my way to the ED but I value my ICU time immensely.

Also, it really doesn't matter where you are placed in the long run. It really, really doesn't. Be bummed for a few days but then get over it and rock it in the ICU. :)

[akulahawkRN, ADN, RN, EMT-P]

Thanks for the feedback and perspective akulahawkRN. I understand what you mean about it being an enormous gift. I just really feel like my passion lies with the ED and that I should at least be given the choice where I want to go. I'm meeting with the faculty who is in charge of placements in a couple weeks to see if they will honor my choice. I've had the opportunity to work in both settings and definitely feel like the ED is a better pace, setting, and match for my personality and what I'm interested in. With that being said, if I continue in my CV ICU placement I will still be extremely grateful and I know I'll learn a lot!!

Just because your passion lies with the ED, it doesn't mean that you'll be locked out of it by having your CVICU experience. Sure you can ask the faculty why they placed you there, but I suspect they want you to have an experience where you can really get to know your patients, get really good at doing assessments, and in particular you'll learn to focus on certain aspects of care that are really important to patient care in the ED... namely assessing the ABC's and if you are already reasonably well attuned to changes in patient status because of your time in the CVICU, you'll do that much better in the ED.

I'm also a Paramedic and that experience is also very good for getting primed for the ED. However I lack ICU experience and that's something I hope to correct in the reasonably near future because even just cross-training to an ICU will make me a much better ED nurse for reasons already discussed.

[shan_elle]

Thank you for your encouragement and sharing your personal experience CX_EDRN! It's definitely reassuring and puts me at ease. One of my biggest worries was that the CVICU would be so specific and specialized that it would limit me and my ability to transfer to other units. It might be starting to sink in that placements really don't matter in the long run. The more information I have, the better I feel about it.

[shan_elle]

akulahawkRN, now that you mention it...a goal that I've always written about and worked on in clinicals is fine tuning my physical assessment. I would really love to hone that skill! I was worried that I would be "locked out" and that CVICU skills would not necessarily be transferable to ED, but it sounds like that is not the case at all. My husband is a paramedic too, met him in EMT-B class! :)

[Lunah, MSN, RN]

akulahawkRN, now that you mention it...a goal that I've always written about and worked on in clinicals is fine tuning my physical assessment. I would really love to hone that skill! I was worried that I would be "locked out" and that CVICU skills would not necessarily be transferable to ED, but it sounds like that is not the case at all. My husband is a paramedic too, met him in EMT-B class! :)

ICU experience and the management of critically ill patients will never NOT be useful to you. I have some ICU experience from deployment and that was a great opportunity, but I am always going to be an ER/trauma nurse at heart. :) You don't always get to (or need to) do a head to toe in the ED, so yes — the CVICU will be great for that. One of the best ED nurses I have worked with started in ICU and still works PRN in a CCU, and her skills and experience definitely translated.

[shan_elle]

Good to know Pixie.RN, that's helpful! Thank you everyone for taking the time to offer your valuable advice, information, and experiences! Talking to all of you has answered so many "what ifs" for me and I think I've gained a much better understanding of my placement. I'm still going to talk to our placement faculty just to hear their reasoning and hopefully get some feedback on how I can improve for future interviews. Thanks to your feedback I feel like I can actually enjoy my spring break now and not stress about where I'm going or why! :)