What Are the Steps to Becoming an ER Nurse?

What Are the Steps to Becoming an ER Nurse?

The key to finding work as an ER nurse is to be proactive before and during nursing school. Keep reading for pro tips on how to position yourself during school and after graduation.

Job Prospects

The availability of ER nursing jobs—especially for new graduates—depends on the needs and financial status of the institutions and geographic area in question. As reimbursement becomes more and more dependent on patient reviews, hospitals strive to update the accommodations and technological capabilities to satisfy their patient populations. The expense of these updates can limit the hospital’s ability to hire or even cause a hiring freeze.

Most managers would prefer to hire a nurse experienced in the ER because it is very time-consuming and expensive to train a new nurse. Furthermore, it delays the increase in staff numbers that the nurse is hired to relieve.  Many hospitals have created fellowship programs, which include a stepwise process of training for new grads to fully integrate them into the world of ER nursing. These are valuable programs for nurses who seek a comprehensive understanding of emergency nursing and an ongoing support system.  

They are, however, pricey to the hospital, and lengthy: nurse fellows receive full salary and benefits, and these programs last between six months and two years. For new nurses, these fellowship programs can be very competitive.

Building Bridges

As with any professional field, building bridges is a key to success. For ER nursing hopefuls, forming relationships within the ER can be a very strong indicator for acceptance into the fellowship program. This can be done by finding work at the ER as ancillary staff or volunteering.  

Working as a nursing assistant before and during nursing school is a great way to expose an individual to the life of a nurse, and either reinforce or redirect their goals. If a position working directly in the ER isn’t available, then employment in other parts of the hospital can still build those relationships and improve your chances of getting a job in the ER.

Although acute care is a part of every nursing school curriculum, emergency room nursing is not.  Nursing students interested in the emergency room can find out if their school has a relationship with a site that might allow them to shadow in the ER. They can also request through their nursing school administration to do requisite clinical work there.  

A capstone in the ER is a highly effective way to set oneself up for employment there. It introduces the nursing student to nurses and management, which gives the student an opportunity to demonstrate work ethic and nursing acumen.

Skill Building

If opportunities for work, volunteering, or clinical shadowing are not available, developing relevant skills for the ER is another way to make oneself more marketable for work there. Many emergency medical technicians (EMT) go on to become nurses and already have highly sought-after skills when they graduate.  Similarly, medical assistants, phlebotomists, radiology technicians, and scrub technologists all have skills and experience that are valuable to the ER.

Because nursing schools follow a general curriculum, there is no formal way to get into the ER as a nurse. The individual who hopes to be an ER nurse must take it upon themselves to be proactive in learning about the ER, building relevant relationships, and developing the skills necessary to be successful.  Being proactive during training is a skill-building opportunity in itself, as the best ER nurses are highly motivated, humble enough to remain teachable, and bold enough to advocate for a seemingly unlimited range of patient populations.

A Day in the Life of a NYC Nurse

A Day in the Life of a NYC Nurse

Most NYC dwellers, including myself, do not have a car. We rely almost exclusively on public transportation. In the course of my career, I have commuted on regional trains, subways, buses, bike-sharing programs, and of course, my own two feet. Navigating public transportation in the crowds and the temperamental weather patterns of New York is a triumph and a skill. 

Over the years, I have learned the written and unwritten rules of New York City travel. It goes something like this: leave early, be ready to give up your seat to someone who needs it more, ride your bike as if no one else is paying attention, ride on the left of the escalator to climb and the right to stand still, wear those snow boots twice a year (but on those two days you desperately need them), expect delays, take your backpack off on the train, never use a speakerphone in public, let others off the subway before getting on, and so on. Thankfully, today I live so close to my job in Hell’s Kitchen, my commute is nearly nonexistent.

The Work

I have noticed subtle differences in the patients we see, the procedures we do, and the teams we work with in NYC, compared to when I worked in the suburbs. It is only in the city that I have experienced proximity to fame, both in the patients and physicians. One of my first jobs as a nurse was at a well-known dermatology practice where we did Mohs procedures, as well as cosmetic dermatology. The practice saw many celebrities.  

This challenged me to put certain nursing principles to work: taking an egalitarian approach to our patients, and being especially mindful to protect their privacy. I have since had many similar experiences with patients in the OR. Working with renowned surgeons, I have to remind myself that I am there for patient care, not surgeon care. My work is to care and advocate for the patient, not to placate the surgeon — although of course, I do prefer when everyone’s happy.

Clinically, in the city, we see different traumas than in the suburbs. For example, we seldom see major traumas from automobile accidents because the city congestion precludes high speeds. Also, many patients come from elsewhere because they know the names of hospitals and physicians in New York, and have experienced failed treatment elsewhere. For this reason, we see many patients with highly complex cases.

A Day in the Life

I work a 7-3 shift Monday through Friday. Because I live so close to work, I wake up at 5:55 am. That gives me enough time to have coffee, do a brief meditation, take a shower, get dressed, and get to work early enough to change into my OR scrubs. Occasionally I’ll wake up earlier and do stretching and a workout. From there, the day is like any OR: fun, fast-paced, and unpredictable. I work as a head nurse of certain specialties, which allows me the autonomy to take breaks when the workload allows, rather than relying on relief staff. Sometimes that means I’m able to go home and relax or run an errand, and sometimes it means I take smaller breaks throughout the day of five or ten minutes to have a bite or clear my head. Although my shift ends at 3 pm, I leave after most of the day staff because I need to prep for the following day, or to assist with nursing needs as they come up. 

Most days I’m home by 3:45 pm. I often take a nap, food prep for the next day, then head to a dance class or meet up with a friend. I have a late dinner with my fiancé and work on one of my art projects: another way I keep my head clear and soul happy. Recently I’ve learned to sew and have started making clothing for myself and others. I’m lucky because, in NYC, I can decide I want to learn a new skill and then quickly find a resource. There is no lack of teachers and services in NYC.

The last thing I do before bed is catch up on homework. I’m in school for my MSN in informatics and my MBA. Schoolwork calms me and I get into bed with a leisure book between 10 and 11 pm. Other days I forego all these activities and allow myself to enjoy the home that I work to have. Sometimes I need to relax after being on my feet all day, rather than pound the pavement, and I give myself that time off. I’m kind to myself so I can be kind to my patients and my coworkers.

A Nursing Holiday Gift Guide

A Nursing Holiday Gift Guide

Whether buying as a nurse or for a nurse, there is a way to optimize the experience for both the giver and the recipient. One of the best ways to choose a gift is neither to spend extravagantly or try to find something unusual, but simply to know a little about the recipient. The most valuable gifts are either meaningful experiences or items that contribute to them. The key to gifting nurses is to thoughtfully find gifts that add ease or pleasure to their otherwise hectic life — and this holiday gift guide will help you do just that.

Experiences: Keep It Simple

There is no good reason to make gift-giving a complicated activity.  In general, the simpler the better. The overwhelmed gift giver need not go further than giving a simple and relaxing experience. There are few nurses who wouldn’t appreciate a massage, for example. Similarly, a pedicure, facial, and aromatherapy will also delight most busy nurses.

For those less inclined toward spa treatments, access to other enjoyable experiences offers a much-welcomed reprieve from the life of a full-time nurse. This might include movie or concert tickets, yoga or fitness classes, cooking courses, or sporting events. 

One thing to consider with gifting experiences to nurses is scheduling. So many full-time nurses supplement their regular work with per-diem, overtime, and continuing education. Furthermore, most hospital-employed nurses are mandated to work nights or weekends. With schedules like these, nurses may not want or be able to give up their precious free time for an activity chosen by someone else. 

A Few Favorite Things

The best-gifted items are those that demonstrate the giver’s thoughtful understanding of the nurse’s preferences and personality. For example, the candle that is reminiscent of an experience or conversation is more valuable than a random scent, which may come off as an afterthought.  Some nurses, especially those that are younger, may just be getting on their feet financially or living in smaller shared or urban spaces. These nurses probably don’t want something that’s going to jeopardize their already compromised space and storage. 

Product purchases don’t have to be elaborate or expensive so items that support and simplify a healthy lifestyle are appreciated by most nurses.  This might include cooking appliances, meal prep containers, a new yoga mat, foam roller, fitness subscriptions, or healthy recipe books. The nurse who dashes back and forth between school and work might appreciate an upgraded backpack or carrying case.

Nurse to nurse gifts might be the simplest kind because working in teams allows nurses to get to know each other well: individual tastes, goals, and work ethic. In this context, the best gifts might be those that are directly related to work. Nurses on their feet all day would probably appreciate new compression socks or a scrub cap with their favorite movie character. A nurse in neurology or neurosurgery would do well with a penlight that clips onto their ID badge. And of course, one can’t go wrong with a stethoscope.

The Thought Does Count

Gift-giving during the holidays doesn’t have to be overwhelming. A little attention to detail and creativity are all it takes to make gift-giving and receiving a positive experience. The old adage, “It’s the thought that counts,” proves true around the holidays.

Addressing Language Barriers with Patients

Addressing Language Barriers with Patients

A fundamental tenet of culturally competent care for patients is providing clinically and personally pertinent information to patients in a language that they understand. As the diversity of non-English language speakers increases in the United States, nurses may find a new area of priority in advocating for their patients to overcome language barriers.  

Fortunately, the Office for Civil Rights within the U.S. Department of Health & Human Services (HHS), serves to protect non-English speaking or limited English-speaking patients. Nurses, however, can do this on a smaller scale in their daily work.

In accordance with Title VI of the Civil Rights Act of 1964, and the guidelines for developing a language access plan by HHS, health care institutions that receive federal funding must provide language assistance services suitable to the communities that they serve. This is assessed and implemented based on a stepwise approach appropriate for the patient population, qualified language service personnel, and interpretation devices and technology. Furthermore, health care personnel will be trained sufficiently and regularly to maintain an understanding of both the logistics and necessity of utilizing these services. This is especially true for nurses, who often have initial and ongoing close contact with patients.

Be Mindful

Patients who speak limited or no English may be unwilling to admit that they do not understand the nature of their health care visit or its intended outcome. This is a detriment to both the provider and patient as the provider may proceed with a treatment plan with the belief that the patient is cooperating. It is easy to see how this can create increased stress and fear for the patient when actions are taken on behalf of their health that they did not corroborate and may not agree with. Regardless of the reasons for the patient’s decision to withhold their lack of understanding, health care professionals can take responsibility for establishing mutual understanding and help prevent these occurrences.

Utilize Available Technology

Fortunately, technology provides many resources today that allow for effective interpretation between providers and patients. Most hospitals have a team of on-site personnel that are credentialed interpreters in languages appropriate for the patient population of that site. For those languages that are less common, there are many devices, including phones and tablets, that provide immediate 24-hour access to remote medical translators in virtually every language. Many of the written documents that patients are exposed to are now offered in languages other than English as well.

Find a (Qualified) Translator

With a full understanding of the services offered, patients may decide that they prefer a family member to translate. Although it is not ideal because family members may lack health literacy, it is the patient’s prerogative to make that choice. If the patient requests that a bilingual nurse translate, he or she can only do so if the nurse has been credentialed in accordance with their facility’s policies related to medical interpreting. This is especially true regarding important documentation such as informed consent and does not include casual conversations or explanations.

It’s not a lack of resources, but a lack of understanding, that prevents non- or limited English speakers from getting what they need in health care today. Despite all of the services offered, providers may still try to take shortcuts for the sake of efficiency. As patient advocates, nurses can be mindful of patients and ensure that understanding is complete by utilizing interpreter services and reminding providers of the services available.

7 Ways to be an Amazing Preceptor to a New Grad Nurse

7 Ways to be an Amazing Preceptor to a New Grad Nurse

The key to being an amazing preceptor to a new graduate nurse is to always remember what it’s like to be a brand new nurse. The idea that “nurses eat their young,” if true, is neither helpful to the new nurse nor to the patients that they care for. Starting a new job is stressful enough, so facing untoward behavior from a preceptor or new colleagues only further discourages the new nurse, and potentially hinders their skills development and patient care. Here are seven ways to be an amazing preceptor and support new nurses and their patients.

1. Assume they don’t know.

One of the most problematic instances between preceptors and new nurses is the preceptor’s assumption that the new nurse knows something they don’t. This could involve speaking in jargon specific to a specialty, teaching complex skills without a basic understanding, or delegating tasks to a preceptee that they are not capable of carrying out. Keep in mind that no matter how many hours the new nurse spent in clinical, learning to be a nurse and being a nurse are two very different things. Use language that a layperson could understand and explain terminology in a non-patronizing way before using it.

2. Answer questions objectively.

Even if a new nurse asks a question that seems too elementary, never express judgment or criticism toward them for asking. The last thing a patient needs is a nurse who is too frightened to ask questions for fear of being ridiculed. It is essential to every nurse’s growth that they learn and practice in an environment that supports their learning and development.

3.Address the social atmosphere.

While the main role of the preceptor is to teach, observe, and assess a new nurse’s aptitude for working independently, it is also worthwhile to discuss the culture of the organization they work in and how to thrive in it. For example, if a boss is very lenient about swapping assignments but strict about tardiness, this is worth divulging to the new nurse. Some hospitals have policies about taking breaks that are interpreted very differently in each unit. Sharing this information with a preceptee could save them the potential embarrassment of breaking an unwritten rule. This would also further reinforce the idea that they are supported by their predecessors. Nurses who like the place they work and who trust their colleagues are generally better nurses.

4. Encourage work/life balance.

While it is not necessary to exchange personal details, it is worthwhile to encourage the new nurse to take care of themselves appropriately in their work. Many new nurses are so frightened when they start working, they may not want to ask where the restrooms are, where they can get a glass of water, or when lunch is for fear of seeming uninterested in the content of their training.  One of the first activities any amazing preceptor should do with their new trainee is take them on a tour of the unit and show them the facilities available to them. Encourage the new nurse to speak up if they need to use them. Nurses who go without do not make better nurses. 

5. “See one, do one, teach one.”

Having a simple outline for training a preceptee such as “see one, do one, teach one,” allows the trainee to fortify and demonstrate their understanding. Many new nurses find that their preceptors allow them to do too much, or not enough. Neither are optimal for allowing the nurse to practice new skills with the fundamental understanding to back it up. Showing the new nurse a skill, then having them perform it, and then having them teach it gives them understanding, skill practice, and a test of their complete understanding. Many hospitals now require nurses to complete documentation for each skill. “See one, do one, teach one,” is an effective way to work through training and skill assessment.

6. Don’t be afraid to pass on precepting.

Just as not every preceptor is made equal, so too with every new nurse. If a preceptor finds that they cannot establish a positive rapport with a new nurse or vice versa, they are empowered to request a switch. If interactions between the preceptor and new nurse are not founded on mutual understanding, the training will likely not be optimal. Similarly, if a nurse has been inundated with precepting and needs to take time between training nurses, they should honor that. A new nurse would likely benefit more from a preceptor who can be enthusiastic about training.

7. Be open to new nurses’ observations and feedback.

Many nurses who have been in a job for a long time take for granted the state of things without question. If a new nurse points out a policy or system that seems ineffective or inefficient, it is worth considering that it is coming from a fresh pair of eyes. Even if the temptation is there to criticize the nurse for being presumptuous or idealistic, consider the value of a new nurse who is so enthusiastic about their work that they are willing to critically think about ways to improve.

No experienced nurse got to where they are without a beginning. Ask the best nurses how they got to where they are and they will likely credit a preceptor who believed in them and pushed them to be their best. Any nurse can be an amazing preceptor, as long as they have an attitude of both compassion and tact in which a new nurse can thrive.

Listen to the Chapter Podcasts for Jonas and Kovner's Health Care Delivery in the United States


Gain a better understanding of the current state of the US health care system and how it might impact your work and life.

You have Successfully Subscribed!