I am a nursing student and wanted to ask any ER nurses what attributes make a good ER nurse? Also, what is the length of time and where do you need to work to have the right experience to get into the ER? This is the area that I think I want to follow, so any advice is greatly appreciated.
Sonya
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January 30th, 2009 at 12:32 am
Hello! I graduated from nursing school in the spring of 2008 and started right away in the ER. Some challenges that are unique to ER nursing are:
1) Patient turnover – where I work, we are assigned 4 rooms, but we might take care of 20 people in a shift. People are always coming and going.
2) Education – education and teaching are a huge point of nursing but in the ER there is simply not enough time to be as thorough as you would often like.
3) Staying calm – you very often have seriously unstable patient and there are a lot of “unknown” factors… i.e. pt codes outside and is brought in to the ER. You have no medical history, allergies or information about that patient. You have to act quickly, calmly and efficiently without much info to go on.
4) Proficiency – you become very proficient in tasks. There is no IV team, no respiratory therapist and not many nursing assistants. You must be prepared to be an independent practitioner.
5) Violence – violence is becoming more prevalent these days, but is particularly surfacing in ER’s across the country. An ER nurse must be skillfull at de-escalating situations.
6) Humor – you MUST have a sense of humor b/c people do all kinds of crazy things!!
7) Be able to move on – you only get a snapshot in somebody’s life; of course there are always those certain patients that you remember, but you cannot get emotionally attached and involved.
8) Independence – critical care nurses in general often have more autonomy in their practice. Often there are physicians present who know you and learn to respect your opinion and judgment. You can initiate standing orders and pretty much work a patient up before the doc has ever even seen him/her. You must be comfortable to make judgment calls and be a self-starter.
There are lot of perks to ER nursing but it is not for everybody! That’s why nursing is so awesome, everybody can find an area that is their niche!
February 2nd, 2009 at 6:03 pm
Well said Lindsey. I agree with all of them. I too am a new grad in the ER, although I have worked there for a year as a tech while in school. You also have to have a sense of humor to deal with the nasty stuff, the death and destruction that happens. But the good FAR out weights the bad.
February 4th, 2009 at 8:06 pm
I was made aware that usually you have to have at least a year before entering into the ER. How did you guys get right in? In there a backdoor you go through :)What kind of facility do you work at? Small or large?
February 5th, 2009 at 12:45 am
I was a tech in the ED for almost 5 years before graduating RN school. I also did my preceptorship there. I work at a Level I trauma facility so we get everything. We are the referral trauma hospital for our region and for the southern part of the state right above us. We rarely hire new grads unless they are techs that are graduating or students who have precepted in our dept. It is hard to be a new grad in the ED with ED experience, much less a new grad who’s never been there. I worked 5 years before I started nursing and it has been TOUGH. But I’m getting through it and knock on wood, so far all my patients have been A & O x 3 and breathing on their own when they left me. LOL
March 18th, 2009 at 1:55 am
I am a new RN that just finished a residency program at an ED. I found it was really easy to get into the ED right out of school. I work in a mid-sized ED it has about 32 beds but is expanding to 52 beds by the end of the year.
I agree with the first posting. ED nursing is really rewarding but you have to be prepared, its a little more demanding than many other areas of nursing, but if you have the personality for it its a great place to work.
When you graduate just look for ads for ED residency positions, many ED’s like to hire new grads, at least thats what my manager said. I found in my area that most of the ED’s had new grad positions open.
Good luck!
January 3rd, 2010 at 2:52 pm
I have been a nurse for almost 11 years. The first 2 were spent in critical care/telemetry, then I moved on to the ER.
I highly recommend at least a year of nursing experience in medsurg/tele prior to working in an ER. The ER is really not the place to learn how to be a nurse. Time mngt, technical, and critical thinking skills are crutial in a busy emergency environment. Most new grads are not yet efficient at these. You may have 4 critically ill patients without any help, but who needs what and when first? It’s not something taught, it’s something you learn through experience.
On a lighter note, working in an ER is always fun, entertaining, and exhausting. You’ll find a “certain” personality type that attracts to the ER and you’ll know immediately if you fit that category!
January 4th, 2010 at 8:23 am
always remember, you don’t have to know it all. ED nurses are amazing, and very knowledgeable. Be patient and you will get there, so don’t be afraid to admit you don’t know or are unsure. Part of being a safe nurse is knowing your limits and knowing when and how to get help.
November 17th, 2010 at 2:36 pm
I am 16 and in 10th grade I was woundering how good grades have to be to be a ER nurse? My sister is a nurse and it seemed pretty intresting.
I know im young but I need to look to c what i would like to do. Any advice would be great.
April 11th, 2012 at 7:45 am
I’m a new grad RN – formerly middle school teacher – and I got hired on in the ED where I did my practicum. I’m at the teaching hospital/Level 1 trauma center attached to the university where I got my BSN. I also worked as a tech in the ED (not the same one) while I was in school. Without having that prior experience I wouldn’t have been able to do so well in practicum and impress the management enough to hire me. Unfortunately, most nursing programs don’t include emergent care in the curriculum. You might get to spend a day or two down in the ED during clinicals, but that’s about it.
Emergent care nursing is so overwhelming at first because you can see ANY kind of patient at any given moment. Depending on the department’s organization, you may have four to five patients, and they could all be very different. Psych, trauma, medicine, OB, adults, geriatrics, pediatrics, all come through the ED. Patients can be in and out in as little as thirty minutes, or they could be down there three or four days when they’re admitted to the hospital and there are no beds available. You might have a simple finger lac in one room and a highly critical ICU patient next door.
The key to dealing with all of this is understanding the principles of triage. What are their symptoms? Which diagnoses do the assessment and history point towards? Who is most critical? What tests need to be ordered first? The only way to get good at this is to watch other seasoned ED nurses and rely on their experience until you build your own. With every patient you lay eyes on you’re building that “sixth sense” seasoned RN’s have.
If you start as a new grad in an ED where the staff are helpful and supportive, you should do fine. If they are the kind of nurses who eat their young then I’d be worried. I’ve heard most managers say they like new grads because they can train them to think ED from the beginning. One or two nurses have told me you need medsurg first, but most disagree with that mentality. I do too, actually. I’ve seen very, very good floor nurses transfer to the ED and drown because it’s a completely different kind of time management. I think medsurg can contribute med knowledge and assessment skills, but you can just as easily learn these in the ED. Should probably have a good foundation coming right out of school anyway.
February 10th, 2013 at 2:03 pm
I graduated nursing school in Dec. 2011. I worked in a “wellness” center, so all my nursing school experience is useless as of now bc it was not being utilized. I just got accepted at a Level 1 trauma (magnent!) hospital. They only hire 2 new grads a YEAR bc this hospital is THE top hospital in the state. I did my preceptorship in this ED, and it was amazing. I am trying to my research to freshen up my skills, and came upon this posting. The advice here was excellent and I am very excited to start making a difference in my community!
February 12th, 2013 at 5:40 pm
Most hospitals today are looking at their bottom line. It is cheaper to bring a new graduate nurse on board in the ED versus an experienced RN. With almost 14 years combined experience in both the ED and critical care units I enjoy precepting nursing students in these areas. When I am in the ED and I am working with students I am able to see which students would be good candidates for the ED and those that are not. It is my opinion, for whatever is worth, that a nurse entering into the ED must have the critical care background, skills and thinking in place. To place a nurse in the ED without any of these acts skills or background sets that person up for potential failure. Many times I’ve seen new nurses start in the ED and end up having to resign because a wrong medication was pushed or worse yet a sentinel event occurred. Before starting in the ED make sure that you have a preceptor who was willing to teach you and take you under his/her wing and guide you through the potential hazards and perils working in the ED. Also make sure that the preceptor program is one that is not taught on the computer but actual class time. Best of luck!