I am starting nursing school, and want to specialize in ER nursing. I worked for a local ER first in Patient Registration, and then moved up to Medical Assistant after I finished school. I love the atmosphere, the variety of injuries and illnesses that you see and the fast paced work environment. I work well under pressure, and enjoy a position that keeps me busy, constantly thinking and learning.

My question is - I have heard from a lot of nurses that a base in Med/Surg is ideal for a nurse fresh out of school. I'm curious if there are ER nurses here who went straight into the ER, and if so do you think Med/Surg would have been a good starting point? I have a pretty good knowledge base to begin with as a Medical Assistant, so the knowledge I learn in nursing school is just advanced. I'm curious if it would be more beneficial to get a position in Med/Surg first. I'm kind of impatient... I'd really much rather go right into the ER!

Thanks

I work in ER.  I had 6 med/surg years before I started in ER.  My personal belief is that if you want med/surg experience prior to ER then it needs to be more than one year.  Your first year on a med/surg floor is going to be filled with learning your meds, your routine, your paperwork.  Now do that for one year and then transfer to the ER and you are going to have a year of learning your meds, your routine, and your paperwork- which is all going to be totally different.  I don't feel that most people really get too much out of their first year in terms of learning from med/surg.  My philospy is if you want to work ER then apply to ER right out of school.  If you want to get med/surg experience first then you need to work on the med/surg floor for a couple of years or more to really get that experience.   Like I stated I worked on med/surg for 6 years before going down to ER.  I will say that this has brought alot to my ER experience and has helped me out alot.  I know however that all the things that have helped me out are not things I learned in the first year- they are things I learned over time.  There are more people that work in my ER that have started there right out of school than those that have worked med/surg first.  I think as long as the ER you are applying to accepts new grads then go for it.  I would apply to all of the ERs in your community.

I am a firm believer in Med Surg before ER mainly for those with little to no medical background.  HOWEVER, the hospital where I currently work ER has an internship program where new nurses train for a very long time to work in Emergency room straight out of the gate (followed by a contract of course).  I have trained one of them and he is doing quite well, although it was a bumpy ride.  What can I say I'm a tough preceptor.  He is doing well now.  Anyway this is in Atlanta, GA so if you are interested let me knoew.

I have been working in the ED for 16 years before that I worked 2 years in Orthropedic Med/Surg while I worked my fired 3 years in the ED I also moonlight in other departments because my husband had lost his job. You need the basics. I see nurses coming straight out of school all the time that doesn't mean they aren't wonderful nurses but you miss something by not getting that base. Most of these nurses would not know how to irrigate a colostomy or put a constant irrigation on a 3 way foley because that is something that is not done in the Ed everyday. Yes it is good to have ACLS PALS NALS ENPAC TNCC but the basic you have to learn from med/surg. I learn the best stuff from an old LPN. When I started the LPN were still the charge nurses  and that was fine by me. They knew a lot more than me.

I say GO FOR ER.....Experience will be your best teacher.  Get in and start learning.  good luck

just had to respond to this! i strongly disagree with those who believe it is better to begin nursing in the emergency room. nurses of today are placed with more and more responsibility. this means they are liable. liable not only in terms of the very real possibility of being sued, but we are all liable to the care we give our patients. there is most definitely a "learning curve". some who start will take longer to absorb the many nursing skills needed in the emergency room that must be like "second nature". there is no time to waste. when a "notification" comes rushing through the door the nurse(s) assigned to that patient must be able to handle whatever is needed, and quickly. quick assessment., quick hands on treatment. taking the time to work on the medical-surgical floor allows new nurses the time they need to become familiar with many many skills. i don't know where bits78 is talking about, but a real medical-surgical unit provides ample experiences of all kinds which provide familiarity with so many skills, many of which are sorely needed in an emergency room. i think it belittles the profession to think that you can just pick it up as you go "out of necessity". it is stupid and dangerous. time is becoming more and more limited for nurses who have many years of experience and are at times "stretched thin", a brand new nurse can and will make for a handicap for her peers who need support. i'm not saying that there aren't bright quick learning new nurses out there who could get by, but i believe that there is just too much at risk to send a newbie into that situation. i see it first hand where i work. i don't mind helping a new nurse. i enjoy teaching new nurses. i'm just saying that the emergency room isn't the place to do it.

on the med-surg floor u have access to computer labs, get to know better the normals and abnormals, u have vents, trach care, u may have opportunity to maintain chest tubes, drains, u get to know about all kinds of wound care, u take vital signs and monitor patients with many many illnesses, diabetes mellitus, pneumonia, sickle cell anemia, pancreatitis, cholecystitis, cancer patients, hypertensive patients that may become critical and be upgraded to ccu, possible cva, tia, gi bleeds, many patients that sometimes are stable enough to be monitored on regular floor are sent there but can become critical, it is a good chance to get ur legs, become adept at ur skills, and of course there are many nurses with experience on these floors too, how stupid to think that only us er nurses are excellent at assessment. some nurses also float to the med-surg floor and actually work on other floors, and then there are those who specialize in med-surg., they are a good resource. nurses take ekgs, do blood sugar tests, check ct results and know what they mean, follow up with doctors to find x-ray results, teach pt. care, help pts with initial rehab after orthopaedic surg., u take care of pts with aids, hepatitis, etoh, drug addict., anything u will find in er (since i send my pts to med-surg floor) u will find there. u will not have the urgency most times but it can and does happen. u will be involved in "codes" . i hear them over the intercom. u will be the first responder if ur pt. goes into cardiac arrest, and what u are supposed to do is start cpr-not call the code and wait, so, it is more than sufficient to learn all there is to learn. oh and of course u will give ur meds and clean pts.

I started in the ER fresh out of school and it was very tough!  It would be a little easier on you because you are familiar with the ER environment but I wasn't.  That is why I teach nursing students now and I also teach a course a emergency nursing.  That way I feel if a student thinks they may be interested in the ER they can get a 'taste' for it before graduation.  I won't say going into the ER fresh out of school is wrong, it can be done but I will say that it is tough.  You have to land on your feet and ready to run so to speak!  In the ER decisions have to be made in a very short amount of time and unless you have good critical thinking skills and nursing inituition it is very tough!  Good luck on whatever you decide to do!

I am a firm believer in getting some med surg experience before going to any specialty area.I believe med surg in itself is a specialty and offers such a wide variety of pt's and care.In gaining that experience, it will help guide one into what area they may choose next.

Four years of LVN nursing school, textbooks and classroom lectures have failed to fully calm my heart, mind, and spirit as our next trauma patient is rushed through the double doors of the emergency room on a wobbly six foot stretcher. Injuries uncertain, responsiveness still to be determined, vital signs unknown.

Knowing how to do a thorough assement, prioritizing and then, meds, labs and diagnostic procedures and treatments is going to be very important. If you know all of these required for the many emergencies that come through the door, you can potentially save lives. If you don't know, then you will need to be with a really good preceptor for as long as it takes till you learn.

I worked with a nursing student in pre- op. She went straight into ER after passing her Boards. She loves it. She had a year of learning assessments, diagnosis, meds, treatments and signs and symptoms of various health problems, before she graduated from nursing school.

Best wishes,

Kathy