Start out ER or MED-SURG?

[KalipsoRed]

Howdy, I'm a nursing student from Saint Louis and I graduate at the end of this year. I have worked at Barnes Jewish Hospital in the ER for the past 3 years as a registrar/secretary and I plan to do an externship and become a tech in this department this comming summer. My hospital would let me start out as a new grad. in the ER and provides a fellowship for this. However, my teachers in class tell me that MED-Surg is where every new graduate should start out. I have asked around work a bit to start recieving a poll as to what other nurses say. So far what I have gotten is that MED-Surg is a great place to learn very accurate assessment skills that are so essential to nursing, however it lacks greatly in learning and keeping up to date with procedures. In fact most of the nurses that I work with are disscusted with floor nurses because they can't even put IVs in most of the time and other basic procedures such as Foleys. I'm 2 semesters from graduating and I haven't put a Foley into a person yet, or been able to draw blood or start an IV. Isn't that scary? It was even more scary to me that when I was doing clinicals last semester a doctor ordered an NG tube for a patient and the RN responsible for that patient had been out of school for an entire year and had never inserted an NG tube. Yet she was expected to go in there by herself and do it! I know that this is not a very difficult procedure, but s**t she hadn't gone over the procedure in over a year and had no previous experience to draw from (well unless you believe that inserting one on a plastic dummy is experience, which I don't). So there's my fear. I would love to hear other nurses opinions as to weither it is better to start out in the ER or MED-Surg.
Thanks!

[cougarnurse]

I would first ask your instructors if you could get some hands-on experience with the foleys, etc.

I would start Med-Surg., mainly as you would learn 'norms' for the hospitalized patient, THEN go ER. Then again, everyone is different.

'Cat'

[Mrs.Nurse]

This is just my opinion, any nurse who works a med/surg floor for an entire year and has missed an opportunity like placing an ngt didn't take advantage of the chance to place one. As a new grad you have to take the initiative and say "hey i want to start any IVs that need starting, or put in a foley if its ordered". I worked a year after graduating on a med/surg floor and still do it prn. The time i spent there, no matter how stressful it got, taught me things i could have learned no where else. Another thing, even it a charge nurse is angry because they must take time to teach and watch you perform something you've never done but need to learn, ask for help. A job in the ER has it's benefits, but you would be limiting your skills to only doing so much for the patient. I think floor nursing take advantage of the 'whole nurse'. That's just my opinion, I'm a woman, we're full of those things.

[KalipsoRed]

Thanks for the responses so far! I've tried very hard to volunteer to do procedures when they come up, but their are 8 people in my clinical group spliting a floor that has on average 18 to 20 beds. Our clinical experience is only one day a week and 4 hrs long. It is from 8am - 12pm and I think you would agree that this is not an optimal time period for experiences. I guess that I've just been getting "unlucky" with who I've been assigned to. When I volunteer to do any body, most of the people who need procedures done are assigned to one of my fellow students. The fact is that we all have very little experience and no one is willing to give up their experience for a classmate, and I really don't blame them. The most procedures I ever remember occuring during our clinical experience at a time was 2. And there were many times where no one on the floor needed anything other than bedbaths and meds. I think this is a real disadvantage to getting my BSN first off. The program is very theory based with fewer hours of clinical experience than most of the ASN programs I checked out, but I just wanted to get it over and done with in one shot.

[ang82]

I agree with what the other people are saying, start out on med/surg. I think that it is an invaluable experience because you are able to hone your nursing assessment and skills. You will deal with a whole gammut of medicatons and a whole host of different disease processes. Down in the ER, you will only deal with the immediate problem the patient has and treat that. The ER can be a busy and crazy place to work and I believe having your "nursing shoes" underneath you first (by working on med surg) will make you a better assest to the ER when you get down there.

[Crouse]

You mention that you have limited clinical experiences in your BSN program. I have heard that when you are a new BSN grad, the hospital knows that you are green and breaks you in gradually. I have also read that there are staff educators with whom you can consult to help you continue to learn.
http://forums.ultimatenurse.com/imag...lies/smile.gif

Someone please correct me if I am wrong.

Crouse

[Mrs.Nurse]

That's a beautiful thought, but not realistic. I've seen so many BSN and ADN grads start at the hospital where I'm employed eaten alive. They are thrown into the field we call nursing expected to know everything and are looked down upon when they admit that they don't know how to do something. It's very discouraging to say the least but the more new grads I talk to the more I hear about this happening. I'm sure there are hospitals which are the exceptions, I just don't happen to work at one.

[cougarnurse]

There is soooo much to teach any more. The schools around my area require students to be CNA's prior to Clinical; frees up time for other nursing foundations.

'Cat'

[Crouse]

So, if a nurse turns down an assignment because she is not ready for it, not qualified, what do "they" do to her?? Or if she asks to be trained to put in NG tubes before doing her first one?

I think that nurses in my state (TX) are required by law (to protect patients!) not to accept an assignment for which they are not prepared.

I sure would want that if I were the patient! It should be the supervisor's problem to find staff for her acuity of patients.

Furthermore, I question whether hospitals should accept patients if they cannot find the staff to care for them properly.

Idealistic I still am.

Crouse

[TriageRN]

Holly hades...hello, my career will and always be run mostly by me..and if I want ER, I will go ER!

Med surge is vital to know, but it is not like you won't get med surge type of experences in the ER! Many pts go home from day surgery only to come to the ER with complications and you have to treat them, and sometimes get delays in admitting to the floor and you have to med/surge it up baby! I can't think of a single thing I do now besides different paperwork that I haven't done in the ER!

If you have the energy and drive for the ER, best you start in the ER frankly! I wanted to...did the med surge thing because there was no room in the ER's for me (too many students knew someone in Er and got in before me). I got one time in the Er only and excelled, but they wouldn't hire me in ER once out because "I didn't have enough ER expereience". Guess what...7 years later and having to work other areas...I am still "not qualified"........UHGGGGGGG!

Don't make the mistake I did...fight for the ER position and get it! That is the same for other areas (hey try surgery or OB...they really won't hire you unless you know someone and have experience!!!!!!!!!!).

Good luck and start right by being your own career planner...take advice with a grain of salt (they aren't you!)...but do what makes you happy. There is far to much burn out to not!!!!!!!!

Anyway...that is how I see it now 7 years hindsite!