Why wasn't I placed in the ED?

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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??

Specializes in Pediatrics, Pediatric Float, PICU, NICU.

It has only been a dozen years since my capstone clinical, but apparently a lot has changed. Yea they asked us to put down our top three choices for where we would like to be, but you were lucky if you got one of those three and I definitely didn't see as many people complaining about it like they deserved/are entitled to it like it seems there is now...

Wait until you get into your first nursing job with no seniority and get asked to rank your choice of holiday shifts to work and then have to work them all, how will you manage :laugh:

I would probably just ask. It could be as simple as your professors thought you were more well rounded and able to adapt to any environment but they didn't think that of your friend and thought she'd stand the best chance being with a buddy. Who knows. Good luck, I hope you learn a lot and I feel like the CVICU will be good for you to get in to ED later, anyway.

Thank you Ilikeletters! I'm sure I will learn A LOT!!

Honestly, at least all of this is attempted to be taken into account at your school. I go to one of the best nursing schools in my state and their choice on where they put you for you capstone/preceptorship is completely random. The majority of the students in my class got a general med-surg floor in tiny 100 bed hospitals (not saying they didn't have good experiences). The majority of my class would have KILLED to be in the CVICU. Just know that the grass isn't always greener. The person you describe yourself to be actually seems to be a better fit for the ICU than the ED anyways (I'm stereotyping, but oh well). My capstone was on an ICU and I never planned on working in an ICU and here I am months later and have accepted a job on an ICU. Keep an open mind in nursing school, it will open more doors for you :)

Perhaps it wasn't adequate, despite your feelings to the contrary.

Or, perhaps it was but the department wasn't ready to take on all 6 of the originally proffered spots.

Or, perhaps it was simply bad luck of the draw. A lot of selections, while offering the appearance of objectivity, are more about simply plugging people into spots as quickly as possible so that the decision maker(s) can move on to other tasks. It's a big thing to you but just another to-do for them.

Would I be incorrect in presuming that you've already asked this question of the one(s) who can actually answer it?

My perspective is that you're over-reacting to take it personally. What would I do? Throw myself into the CVICU assignment with gusto. I would BE the rockstar that I so fervently believe myself to be. You never know how things and people are connected. It just could be that the best friend of the nurse in the spot next to you happens to be the ANM from the ED.

And this I will add: Nobody is more of an ED junky than am I. It is simply *the* best place for a nurse of my disposition, attitude, and skill set. However, I also have a per diem gig at a large, academic medical center in which I float between the different ICUs, as well as PACU and rapid-response. I've got about as broad a perspective as one can have and I will say that if I were to choose a place to work outside of the ED, CTICU (cardiac and thoracic for us) would be the place.

I'll also add that many nurses in smaller EDs have very limited experience with critical patients and could benefit from time in an ICU such as the one where you will be.

Turn this pile of lemons into lemonade. You may end up looking back on this and being grateful that things worked out the way that they did. My own career trajectory has proved to be much different than I'd hoped or planned but it's worked out pretty well, nonetheless.

Cheers.

I think even if I did really well in my ED interview I still wouldn't have been placed there. We had a "Meet and Greet" with faculty and unit representatives a couple weeks before the interviews (ED did not show up). One of the CVICU nurses spent a lot of time talking to me and stated she'd "See me at interviews" even though it had not been determined where we would be interviewing yet. I have an inkling the decision was made after the Meet and Greet (and before interviews) that I would be placed in the CVICU...which I think is a huge compliment. It was just really frustrating that I wanted something else so badly and felt like I was not included in the decision-making process. However, I know they have a lot of students to place (what a difficult job!) and I'm sure they don't have time to have discussions with everyone!

No, I have not asked the person in charge of making these decisions because she isn't meeting with anyone until after Spring Break. That's why I came here to gain some better insight and information in the meantime. Thanks to all of you, I feel like I will go into that meeting much more informed and accepting of my placement. In fact, I don't even want to change my placement now but would like some information on how the decision was made and just to hear any feedback she has to offer.

Thank you for your encouragement and advice! After talking it out, I'm really looking forward to my CVICU experience and I think it will be a really great fit.

Honestly, at least all of this is attempted to be taken into account at your school. I go to one of the best nursing schools in my state and their choice on where they put you for you capstone/preceptorship is completely random. The majority of the students in my class got a general med-surg floor in tiny 100 bed hospitals (not saying they didn't have good experiences). The majority of my class would have KILLED to be in the CVICU. Just know that the grass isn't always greener. The person you describe yourself to be actually seems to be a better fit for the ICU than the ED anyways (I'm stereotyping, but oh well). My capstone was on an ICU and I never planned on working in an ICU and here I am months later and have accepted a job on an ICU. Keep an open mind in nursing school, it will open more doors for you :)

That is a really good point! We are really lucky in that we actually get some say in our placements throughout the entire program. I think that was part of my frustration...throughout the program I've been open minded, I haven't complained about any other placements, and I've been very flexible. So when it came down to wanting the one thing I've been dreaming about for years it was very disappointing not to get it! However, I'm learning that it's not the end of the world and I'm looking forward to the CVICU! :)

Specializes in nursing education.

I think you are being a bit harsh, MMJ. The OP has thanked other members for their advice and stated she understands the opportunity being presented to her- though upset initially. I get it, we want what we want when we want it, but not everyone has the ability to change their mind when presented with good advice!

"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."

And yet, the additional not-so-subtle dig. OP: This continuous "I deserve an ED placement/ Why can't I have what I want?" makes you seem VERY much like a Special Snowflake. You will do well to lose the attitude and remember that, as a student AND as a new grad, you DO NOT call the shots. Others with far more experience and knowledge than you do.

Specializes in nursing education.

What would I do? Throw myself into the CVICU assignment with gusto. I would BE the rockstar that I so fervently believe myself to be. You never know how things and people are connected. It just could be that the best friend of the nurse in the spot next to you happens to be the ANM from the ED.

^^^THIS!!^^^ every student needs to understand this, from day one in first-ever clinical.

It has only been a dozen years since my capstone clinical, but apparently a lot has changed. Yea they asked us to put down our top three choices for where we would like to be, but you were lucky if you got one of those three and I definitely didn't see as many people complaining about it like they deserved/are entitled to it like it seems there is now...

Wait until you get into your first nursing job with no seniority and get asked to rank your choice of holiday shifts to work and then have to work them all, how will you manage :laugh:

Yes, a lot has changed! Especially at the university that I attend. From the very beginning they've told us that we should follow our dreams and advocate for what we want. They don't believe in the traditional "you have to do x amount of years on med/surg before you can work elsewhere." I think they try their best to support students' interests and passions.

I will manage quite well! Years ago I was hired as a medication aide and before hiring me they were so short staffed that other med aides had not been able to call in sick or go on vacation for a very long time. My first few weeks EVERYONE was constantly calling in sick. I picked up extra days and worked 16 hour shifts doing VS, CBGs, insulin, and preparing & administering meds for 35 residents by myself! Also, I love working any holiday and am open to day or night shift. :laugh:

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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!?

Whether or not your intention was to put down your peers, you do come across as putting down your peers. The faculty who made the decisions of where to place each student have access to far more information than you did. You got one of your chosen spots, just not your first choice. Continuing to insist that you've been wronged because someone else (someone you say is inferior to you) got ED and you didn't makes you look immature, ungrateful and perhaps "special" as in "Special snowflake." Please make up your mind to do your absolute best in ICU, learn all you can and to NOT tell everyone you encounter that you have no intention of staying in the ICU. Who knows -- you might actually enjoy it. If you keep an open mind.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I thought I was the only one who was put off by what I perceived as the OP's entitlement. To be honest if you went into the interview with the same type of underlying tone of entitlement that your post appears to have, I am not surprised that you didn't get it. That being said, follow everyone else's advice, make the best of the clinical, and keep on moving.
Nope -- you're not the only put off by the OP's attitude and entitlement.
"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."

And yet, the additional not-so-subtle dig. OP: This continuous "I deserve an ED placement/ Why can't I have what I want?" makes you seem VERY much like a Special Snowflake. You will do well to lose the attitude and remember that, as a student AND as a new grad, you DO NOT call the shots. Others with far more experience and knowledge than you do.

meanmaryjean, I respectfully disagree with your assessment of who I am as a student and as a person. To me, being a "special snowflake" or feeling entitled means thinking you deserve something that you did not earn or work hard for. I've certainly met, if not exceeded, the requirements that prove I'm capable of being successful in an adult critical care placement. Thanks to the insightful posts and feedback on this forum I've come to accept and realize that while I may be a good fit for the ED, perhaps the CVICU is the best fit for me. My faculty who have more knowledge/experience than I do were able to see this more easily than I. Even before realizing this, I still saw my CVICU placement as a compliment and was prepared to go into it with an open mind, ready to learn, and giving it everything I've got. I'm extremely grateful for this placement and am now even more excited to be placed there!

I have no attitude to lose. I very much appreciate the faculty and other nurses' experience and knowledge, which is why throughout the entire program I've never complained about other clinical placements and have gone into them with an open mind. In fact, I get irritated when my classmates are constantly asking for certain exam questions to be dropped or complain about the amount of reading that is required of us! During clinical I've worked with RNs who want me to do things in their very particular way that doesn't make much sense to me. What do I do? Keep my mouth shut, do it their way, and learn from the experience. I'm no special snowflake.

Specializes in NICU.
We had a "Meet and Greet" with faculty and unit representatives a couple weeks before the interviews (ED did not show up). One of the CVICU nurses spent a lot of time talking to me and stated she'd "See me at interviews" even though it had not been determined where we would be interviewing yet. I have an inkling the decision was made after the Meet and Greet (and before interviews) that I would be placed in the CVICU...which I think is a huge compliment.

I have a feeling that CVICU asked the faculty "Which of the students has what it takes to be a CVICU nurse". The faculty suggested you. That is why a straight A student got their 4th choice. Give CVICU 110% effort. They are probably looking long term of possibly offering you a position after graduation. This is a huge gift, don't blow it. You are definitely on the radar of the hiring manager for CVICU. That is a very good spot to be in when everyone is looking for a job post graduation. There is no guarantee that ER would offer you a position after graduation even if you had got placed in the ER.

Do your absolute best and let things happen. When you graduate, apply to ER if you still have the desire. If you get hired in the ER, you will have gained very useful experience in CVICU.

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