Why wasn't I placed in the ED?

shan_elle · Mar 26, 2017

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.

Thank you Guy in Bablyand! I will wholeheartedly take your advice to give it 110% effort and am definitely open to staying on after graduation, even though initially I didn't think I would. In fact, it would be pretty stupid not to, especially if I end up loving it.

Meriwhen, ASN, BSN, MSN, RN · Mar 26, 2017

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

Keep in mind that if there are 4 spots in the ED, but 20 students put down the ED as their #1 choice...any way you slice it, 16 of those students are getting told "Sorry, but no." Even if all 20 of you were equally, even identically qualified, and deserving of a spot, they can't take all 20. They can take only 4. 16 have to be benched. Yes, it feels unfair. But if they don't have the spots, they don't have the spots.

As far as how they chose those 4...the ED had their criteria and for whatever reason, you didn't hit all their wickets. Just because YOU felt you were one of the top students didn't mean THEY felt you were the best fit for the ED. Perhaps other applicants looked better on paper than you did. Or they sold themselves in the interview better than you. Perhaps the other applicants brought something to the table that you didn't. Or they made a better personal connection with the interviewers than you did. Or they were--or willing to be--more flexible with their schedule. Or they had better networking connections and that connection in the ED/hospital was able to vouch for them. Or it could have been plain old dumb luck and they picked 4 at random.

Who knows? It may have been you, it may not have been you. You could ask, but you may not get more than a canned generic response.

Now, what would I do if this happened to me? Take the opportunity I was given and run with it. Learn, master the knowledge, and then see what I could do with that knowledge and where it could take me.

Nowadays, most people don't start their nursing careers in their dream specialty, but instead work their way over to it. So not landing in the ED is not necessarily a roadblock or even a setback to your ultimately becoming an ED nurse. Just consider it an alternative path to be taken to your goal.

Good luck in the CVICU.

ThePsychWhisperer, BSN, MSN, APRN, NP · Mar 27, 2017

To me, there's just something about the OP that comes off as not necessarily "special snowflake-ish" or entitled...but very self-important, maybe? In any case, it's very off-putting. Subtle and not-so-subtle self-inflating statements s/he has made such as being irritated with classmates for complaining about the reading and exam questions while s/he seems to ace every exam and read every last sentence in the textbook preparing for said exam; being the "savior" medication aide, allowing everyone else to call in sick while simultaneously preparing all the medications for all of the residents on his/her own; being the martyr, allowing the past nurse preceptors to show him/her their antiquated, senseless ways of doing things, all the while breezing through the curriculum with straight A's while other poor classmates continue to struggle and obtain C's. It did not escape my notice that the OP took multiple opportunities to pat him/herself on the back while being subtle (as opposed to being blatantly overt, mind) about cutting others off at the knees. As an ED nurse myself, I can say that this type of personality is usually not one suited for the emergency department; I think they made the right decision with the CV ICU.

All this being said, take away from this what you will, as I am but one B-average ED nurse. :/

Creamsoda, ASN, RN · Mar 27, 2017

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??

Honestly, I think you should really reconsider fighting this so much. This might be a blessing in disguise. You will get an amazing internship at this kind of unit. You will develop major critical thinking skills. (in my opinion more so than the ER, but thats just me). Once your proficient in this ICU, you would have zero trouble applying to work in an ER if thats what you truly wanted. I find as an ER nurse, you would have a harder time going from ER to ICU just based on past places I have worked at. ICU hones those critical thinking skills a bit sharper. ER is more reactive and you don't have much time to think about the whys of what your doing. (I've worked both and in my experience I find this to be true). ICU just really fostered a better learning environment for me. And they clearly think it would be a great fit for you and really you should be honored. You will have no shortage of majorly unstable patients in the ICU if thats what your after.

cjcsoon2bnp, MSN, RN, NP · Mar 27, 2017

To the OP, I understand what its like to be frustrated when you don't get your dream placement and you feel like you have done everything possible to earn it. I can even understand how defeating it feels to see another candidate be given a position especially when you feel that the person is not as qualified as you. It's a normal to feel angry or upset and your first reaction be to question why you didn't get what you wanted and why someone got it instead. However, it's important to push past that first reaction and after the feeling subsides you need to engage in serious self-assessment (identify strengths, weaknesses, areas for development and future plans) and recognize the hidden opportunities. Let me briefly share with you my personal experience and maybe it can help...

About 6 years ago when I graduated nursing school I applied for a position in a critical care residency program in the hospital where I worked as an ED tech. I put my department as my first choice and I felt that I was the most deserving of the new grad. nurse position because I put in more hours than any other student tech. (especially nights, weekends and holidays) and when I worked I always gave 110%. Out of almost 100 candidates, I was chosen as the top 5 to interview for 1 position. Ultimately another candidate was chosen, each candidate interviewed with my manager and a group of my peers (the person chosen also worked for the hospital but not in the department). Initially, I was devastated and angry and my first reaction was to pick apart the other person (in my own mind) and hate the people who chose her instead of me. I tried to rationalize that I was more qualified (we both had a BSN but she had failed the NCLEX the first time and I had passed the first time) and that she had a connection that I didn't (her mother was one of the ED nurses in the department and I didn't have that kind of connection). At that time I couldn't engage in meaningful self-assessment and really think about what part I played in not getting the job. Look back now, I realize that although I worked a lot as a tech. and always gave 110% what I thought was demonstrating passion and enthusiasm came across as being an annoying, know-it-all student and was extremely of putting to my peers. I had to learn over time that passion and ambition need to be tempered with humility and respecting processes and hierarchy. The truth is that in life this really didn't matter, at the end of the day she got the job and I didn't and so it wasn't meant to be. I needed to move on from the situation and do what I needed to do in order to grow as a person and eventually meet my goals. Long story short is that I gained some important perspective and learned skills in mental health and med/surg. nursing, leadership, crisis management and assessment that allowed me to return to the ED later on in my career with strengths that I didn't have when I was a new grad.

To the OP, as some users have mentioned, you will now be in the CVICU and thought it wasn't your first choice I think that you are getting a great opportunity to learn some really important things about critical care (and you will definitely be able to transfer these skills when applying for an ED position). I'm not sure what the reason was for you being selected for the CVICU (even though it wasn't your top choice) but as a nurse educator I know that sometimes we have to place students in different areas than where they want to be for a multitude of reasons; some of which are related to the clinical site itself (e.g. availability of student placements, requests of nurse managers, and the preceptors available) and some are actually related to the student (e.g. student has weakness/areas for growth that do not match with the placement, student's personality or attitude isn't a good fit for a particular department or preceptor, student has strengths and potential that is a great fit for a certain area and they are likely to be hired if given the opportunity).

I have met with students who have a strong desire to be placed in an ED or ICU setting as their senior internship but they are still struggling with fundamental concepts of assessment, care delivery, task prioritization, and time management which would make the ED or ICU a poor choice for them. We don't want to set students up for failure and we want to place students in settings that will allow them to grow and flourish. Students sometimes don't realize that the med/surg. setting they are going to may have a preceptor that really loves students and allows the student to have a lot of hands-on time with the patients. Maybe the only ED placement we have might not have the same kind of devoted preceptors or the department may have policies in place that don't allow students the ability to do the kind of hands-on skills that they are looking to practice.

The point of this is that there are too many factors in place to know exactly what led you to get this placement but it sounds like you are ready to take this opportunity and use it to develop some great skills as it relates to critical care which you can use when you apply for ED jobs in the future (or you may end up developing a love for CVICU that you never knew you had). Best of luck OP and use this to learn all that you can!

!Chris :specs:

shan_elle · Mar 27, 2017

To me, there's just something about the OP that comes off as not necessarily "special snowflake-ish" or entitled...but very self-important, maybe? In any case, it's very off-putting. Subtle and not-so-subtle self-inflating statements s/he has made such as being irritated with classmates for complaining about the reading and exam questions while s/he seems to ace every exam and read every last sentence in the textbook preparing for said exam; being the "savior" medication aide, allowing everyone else to call in sick while simultaneously preparing all the medications for all of the residents on his/her own; being the martyr, allowing the past nurse preceptors to show him/her their antiquated, senseless ways of doing things, all the while breezing through the curriculum with straight A's while other poor classmates continue to struggle and obtain C's. It did not escape my notice that the OP took multiple opportunities to pat him/herself on the back while being subtle (as opposed to being blatantly overt, mind) about cutting others off at the knees. As an ED nurse myself, I can say that this type of personality is usually not one suited for the emergency department; I think they made the right decision with the CV ICU.
All this being said, take away from this what you will, as I am but one B-average ED nurse. :/

Damned if I do, damned if I don't. I'm accused of putting others down, yet am being inaccurately and aggressively judged in the one dimensional context of an internet forum. I genuinely wasn't trying to put the other student down, but instead trying to gauge how the selection process works by giving information about the situation. I'm accused of being entitled, but when I disagree that points and answers should just be handed out to students as freebies that is somehow self-inflating. I'm accused of likely not being flexible when it comes to scheduling, but when I give an example of how I helped out when my co-workers were sick I'm a martyr. I've been told I should be more open-minded and flexible, but when I embrace a new way of doing things and try to learn from it, that somehow amounts to me thinking another way of doing things is senseless and antiquated. You can't have it both ways and you've managed to put a lot of words in my mouth throughout your posting.

I never said I aced every exam or read every last sentence in the textbook. I've missed my fair share of exam questions, I just don't think multiple questions on every single exam we take should be thrown out just because we didn't agree with the way it was worded. I don't read every last sentence in the textbook, but I don't think we should be complaining about learning super cool stuff that someday a person's life might rely upon.

I didn't "allow everyone else to call in sick," management did. Prepping and administering medications for all 35 residents by ourselves was the norm for EVERY med aide. There was only ever one med aide staffed at a time and when the nurse was there she was much too busy dealing with other things to help pass meds. It's not being a martyr, I was just doing my job and was grateful for the extra hours.

I also didn't "breeze through the curriculum." I worked my butt off putting in a lot of time and effort while making sacrifices in other areas of my life. I'm sure many B and C students worked just as hard and in addition, probably have strengths in other areas that I don't. In fact, I partnered with a student who's grades aren't as strong for home health visits last term and I was so grateful to work with her! Her strengths really filled in my weaknesses and we caught things that each other missed. It was great! The reason I brought up the C student wasn't to bad mouth her. We were told we had to have As in certain classes to be considered for ED or ICU placements, so again I was trying to gain some insight into the placement selection process.

I regret that my initial post was misconstrued as entitled, self-important, and putting others down. I agree that parts of it sound ridiculous! At the time I was extremely frustrated and disappointed. I was also really worried that being in the CVICU (although an enormous compliment) would somehow inhibit me from transferring to the ED or any other unit. I came here to gain some insight because I knew I was missing something in the way I was thinking about it. Thanks to everyone's feedback I see where I went wrong and have a much better understanding of where I was placed and why. I'm ecstatic about my placement now!!

shan_elle · Mar 27, 2017

Thank you Creamsoda! I've decided not to fight it and I am very honored that I was chosen for the placement. Thank you for your insight into the differences between ED and ICU. :)

shan_elle · Mar 27, 2017

To the OP, I understand what its like to be frustrated when you don't get your dream placement and you feel like you have done everything possible to earn it. I can even understand how defeating it feels to see another candidate be given a position especially when you feel that the person is not as qualified as you. It's a normal to feel angry or upset and your first reaction be to question why you didn't get what you wanted and why someone got it instead. However, it's important to push past that first reaction and after the feeling subsides you need to engage in serious self-assessment (identify strengths, weaknesses, areas for development and future plans) and recognize the hidden opportunities. Let me briefly share with you my personal experience and maybe it can help...
About 6 years ago when I graduated nursing school I applied for a position in a critical care residency program in the hospital where I worked as an ED tech. I put my department as my first choice and I felt that I was the most deserving of the new grad. nurse position because I put in more hours than any other student tech. (especially nights, weekends and holidays) and when I worked I always gave 110%. Out of almost 100 candidates, I was chosen as the top 5 to interview for 1 position. Ultimately another candidate was chosen, each candidate interviewed with my manager and a group of my peers (the person chosen also worked for the hospital but not in the department). Initially, I was devastated and angry and my first reaction was to pick apart the other person (in my own mind) and hate the people who chose her instead of me. I tried to rationalize that I was more qualified (we both had a BSN but she had failed the NCLEX the first time and I had passed the first time) and that she had a connection that I didn't (her mother was one of the ED nurses in the department and I didn't have that kind of connection). At that time I couldn't engage in meaningful self-assessment and really think about what part I played in not getting the job. Look back now, I realize that although I worked a lot as a tech. and always gave 110% what I thought was demonstrating passion and enthusiasm came across as being an annoying, know-it-all student and was extremely of putting to my peers. I had to learn over time that passion and ambition need to be tempered with humility and respecting processes and hierarchy. The truth is that in life this really didn't matter, at the end of the day she got the job and I didn't and so it wasn't meant to be. I needed to move on from the situation and do what I needed to do in order to grow as a person and eventually meet my goals. Long story short is that I gained some important perspective and learned skills in mental health and med/surg. nursing, leadership, crisis management and assessment that allowed me to return to the ED later on in my career with strengths that I didn't have when I was a new grad.
To the OP, as some users have mentioned, you will now be in the CVICU and thought it wasn't your first choice I think that you are getting a great opportunity to learn some really important things about critical care (and you will definitely be able to transfer these skills when applying for an ED position). I'm not sure what the reason was for you being selected for the CVICU (even though it wasn't your top choice) but as a nurse educator I know that sometimes we have to place students in different areas than where they want to be for a multitude of reasons; some of which are related to the clinical site itself (e.g. availability of student placements, requests of nurse managers, and the preceptors available) and some are actually related to the student (e.g. student has weakness/areas for growth that do not match with the placement, student's personality or attitude isn't a good fit for a particular department or preceptor, student has strengths and potential that is a great fit for a certain area and they are likely to be hired if given the opportunity).
I have met with students who have a strong desire to be placed in an ED or ICU setting as their senior internship but they are still struggling with fundamental concepts of assessment, care delivery, task prioritization, and time management which would make the ED or ICU a poor choice for them. We don't want to set students up for failure and we want to place students in settings that will allow them to grow and flourish. Students sometimes don't realize that the med/surg. setting they are going to may have a preceptor that really loves students and allows the student to have a lot of hands-on time with the patients. Maybe the only ED placement we have might not have the same kind of devoted preceptors or the department may have policies in place that don't allow students the ability to do the kind of hands-on skills that they are looking to practice.
The point of this is that there are too many factors in place to know exactly what led you to get this placement but it sounds like you are ready to take this opportunity and use it to develop some great skills as it relates to critical care which you can use when you apply for ED jobs in the future (or you may end up developing a love for CVICU that you never knew you had). Best of luck OP and use this to learn all that you can!
!Chris

Chris, thank you so much for your thoughtful reply and taking the time to share your story. Your post was extremely helpful to me in how I can better think about the entire situation! Yes, I am ready to take the opportunity and am really excited about what the CVICU has to offer. I've been researching and watching videos about the CVICU and I'm beginning to think it might be an even better fit than the ED. I'm really glad I came here for more information and am grateful for all the valuable feedback....and I'm sure the placement faculty will be glad too! :laugh:

amzyRN · Mar 27, 2017

Be glad you got the ICU placement. You will learn a ton of stuff and have time to digest it. Like someone else mentioned the ED is not all Trauma and codes. Also having some ICU experience and knowledge base will assist you in your eventual transition to the ED. I wish I would have done ICU first prior to ED nursing because I'm am now realizing weakness in my knowledge base. In fact, I may take some time away from the ED to get some real ICU experience (with ICU ratios-which you might not get in the ED when caring for ICU patients).

cjcsoon2bnp, MSN, RN, NP · Mar 27, 2017

Chris, thank you so much for your thoughtful reply and taking the time to share your story. Your post was extremely helpful to me in how I can better think about the entire situation! Yes, I am ready to take the opportunity and am really excited about what the CVICU has to offer. I've been researching and watching videos about the CVICU and I'm beginning to think it might be an even better fit than the ED. I'm really glad I came here for more information and am grateful for all the valuable feedback....and I'm sure the placement faculty will be glad too!

And that's the attitude of someone who is willing to roll with the punches and turn this into a great opportunity! If you keep this up you will end up with a great learning experience (and perhaps a new job in a highly sought after setting!) Things happen for a reason my friend, even if we don't always understand it at the time.

!Chris :specs:

2mint · Mar 27, 2017

...
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....
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....
Turn this pile of lemons into lemonade....
Cheers.

OP, see how this ER nurse speaks? Big EGO with no disdain for the occasional humble pies.

I'm the same way, a few weeks prior to getting off MS orientation, I was the go-to for hard IV sticks :smokin:

I am going to the ER training soon. I was hired for ED, but as a new grad, I along with some new hires had to board in MS until our basic skills are up to snuff. All of us are sure of ourselves.

OP, are you known to:

1) Vocalize your opinions, but follow up with possible solutions? (i.e., Do you complain AND offer solutions to your complaints?)

--> opinionated shows passion, which invariably shows leadership potential.

2) When **** hits the fan, are you at the scene? It could be something as simple as a Pt being rude to your co-worker/classmate, are you there just in case he/she needs help/backup?

--> this shows teamwork

3) How big is your ego?

--> Too big and you're a liability i.e. 'can't be taught'; too small and you're too timid.

4) Is that other C student more sociable than you?

Lastly, OP, based on your responses so far, you cared way too much about what strangers think of you, not a good trait of ER nurse--simply "ain't nobody got time for that ****" :nono:

ps

Top student going to ICU is a correct placement.

babyNP., APRN · Mar 27, 2017

OP, you are "acting entitled" because you are owed nothing from your nursing school other than a good education and a practicum somewhere. It doesn't matter even if they had put you in a med-surg rotation. As a nursing student, you are not entitled to any particular rotation in school.

Venting on here is okay. Saying the process isn't fair is okay. But don't do this in the real world. You will do yourself no favors at all. Life is unfair and you have to roll with the punches as a student and later as a new grad RN.