• Natalie Nicole Wilson

The Emergency Department - is this a place for new grads?

So, you want to work in the Emergency Department right out of nursing school, but the word on the street is you need to work on a medical-surgical (med-surg) floor before you step into the ED. You may have heard comments like "the floor is where you learn time management and really perfect those nursing skills" or "new graduates can't think critically" or "you will be more comfortable after a year on the floor". Let's talk about this.

This could be a very unpopular blog post and is not based on facts or research, just my personal opinion. So take it for what it's worth. Should you work in the ED as a new graduate nurse?

Before it can be argued one way or the other, it's important to note that some facilities simply do no take new graduate nurses in their critical care departments. As much of a bummer as this is, you simply cannot control these decisions, and it's best to regroup. As more facilities are taking new graduates in their critical care areas, they are becoming extremely competitive, so it's always good to have a plan B.

Jumping into this convo, there are valid points on both sides of this; however, at one point I was a new grad nurse in the ED, so OF COURSE, I'm pro new grads in the emergency setting!! When I refer to a new graduate nurse, I'm talking about directly out of school. It's so weird because I feel like I'm still in this category. I have several reasons as to why I stand behind this.

1. I think we desperately need new graduate nurses in every area of nursing. New graduates bring compassion, eagerness, and an energy that cannot be replicated at any other point throughout the nursing career. The emergency room is no different. At some point, the future of emergency nursing will be them! I believe they (can) enhance morale. The key is to be a part of a new graduate program where the facility is familiar with training and investing in new graduates. This, in my opinion, makes the transition much easier.

2. Most skills can be mastered in the ED. I actually cannot think of a better department to master those skills directly out of nursing school. During most of my shifts in the ER, I place IVs, access ports, place foley catheters, set up arterial lines, place NG/OG tubes, and more. You will get your fair share, believe me!

3. Time management is relearned from unit to unit. I understand, to a point, that starting on the floor may be helpful in learning time management. But, I have also seen floor nurses struggle after transferring to the ED, as I would transferring to the floor. Each unit has a completely different flow and patient population. For instance, in the emergency department, we prioritize and do a focused assessment. If a patient comes in with chest pain, I don't prioritize checking for skin breakdown. If they come in as a stroke, I don't assess when their last bowel movement was. I treat their EMERGENCY. This can be hard to grasp when coming from a different unit. Therefore, I totally disagree that time management can only be learned on the floor. It can be learned anywhere and is re-learned when transferring to a different unit. If you know you want to be in the ED and you're able to obtain a job there, wouldn't it be easier to just learn their flow right out of the gate? Sometimes it's harder to drop old ways and relearn new ones.

4. A good program will not throw you to the wolves. Most programs require a certain amount of time and training in the department before moving you to more critical parts of the emergency department, such as triage and trauma.

5. You will not miss out on the whole patient care experience. Believe it or not, you actually wear numerous hats as an ER nurse. Some days I'm a med-surg nurse, an icu nurse, a psychiatric nurse, etc. You get it ALL.

6. Your happiness is important. I don't see any reason, even being a new grad, for anyone to be on a floor they do not wish to be on. This causes BURN. OUT. and we need to avoid this at all costs. Nursing has a variety of areas to choose from, and no nurse should be in an area they feel unhappy. Period.

My advice is to make the most of every clinical rotation. Go into every experience with an open mind and willing to learn your heart out. If you feel interested in a particular unit, do more than just shadow. Spend time on that unit by either getting a nursing tech position or shadowing hours. Know yourself and what that unit entails. Are you cut out for what you will be doing on that unit? The best news ever - once you obtain that degree, hop around to as many departments as you want. That the beauty of nursing. You can do it all.



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