How to choose an ER?

  1. Hello all,
    I am graduating in December and I am going to take a position in an ER residency program. I have had conflicting advice about this, so I thought I would go to the source and ask everyone here.

    The choices are the "Big-Bad, only level one trauma in the area, indigent care hospital", a well respected children's hospital, and a metro hospital that does a little of everything, but is master of none.

    I think at the first hospital I would see it all, do it all, and be somewhat exhausted and taken advantage of. Probably worth it, though, for the first few years of learning.

    The second hospital is a very good facility, I know things are done right, but I also think that my learning would be more limited in terms of pediatric only, and I think as an ER it's a little slower paced.

    The third hospital seems like it has a good program, but they don't have nearly as much trauma, and while they do have a small pediatric section they do only minor emergencies there, everything else goes downtown.

    Should I start slow? Or, should I start out with the first place and just learn as much as I can right off the bat? As far as my interests go, I love the ER and I like trauma. I like adults and children. In the course of my career, I hope to work with both populations, eventually. The only other concern I have is that within the next few years I hope to have a child. I imagine that doing so would bring about the same challenges in any of these work settings.

    Any opinions are welcome. I am shadowing at both of the adult hospitals next week. I had clinicals at the Children's Hospital. I have to decide very soon.

    Thanks!
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  2. 14 Comments

  3. by   bill4745
    Start slow.
  4. by   TazziRN
    Residency program? Are you a med student? Nurses go through preceptorships.

    I agree about starting slow. You will have a lot to learn and it would be better to have a slower introduction rather than be overwhelmed.
  5. by   S.T.A.C.E.Y
    TazziRN: While searching for jobs across both the US & Canada I found a few hospitals that called them 'New Graduate Residency Programs'. Still a preceptorship, but I guess it just sounds better.

    New Graduate Residency Program
  6. by   HRM672
    I am a nursing student, not a med student. In my area these programs are called residency programs. They are a combination of preceptorship and classroom hours. There are some specialties and hospitals that have only the preceptorship. With these two, the bigger facility has six months of preceptorship and classes and an additional 18 months of classes; the smaller facility has 4 months of preceptorship and classes and that's it.

    Thanks for the input!
  7. by   EDValerieRN
    I went for big bad level one. I figured if I could make it there, I could make it anywhere. I personally don't have regrets, but I don't know what to tell you. It depends on how you feel about each ER. Talk to some of the employees, see what they think... check on ratios, benefits, scheduling, all that stuff. I'm sure one of them will come out on top.

    Usually those big bad ER's won't let you do the traumas and such until you are an experienced nurse anyways... just a thought.
  8. by   RunnerRN
    Are you up for the Lvl 1? Is so, go for it! You will (hopefully) be in a setting where people are helping you succeed and strengthen your weaknesses. Go there, learn all you can, suck it up for a couple of years, then you will be able to go to any ER and succeed.
  9. by   EmerNurse
    I agree with the folks who say to go and see each ER. See how the staff works together, get an idea of where they place newer nurses (in my ER, newer nurses are started out in the "back hall" with less acute patients). If you know you'll be working a certain shift, try and see what it's like on THAT shift. It can make a difference.

    If you go and visit and seem to have a quick raport with the staff - understand their jokes and attitudes - relate to the atmosphere - that's where you should go.

    It's hard to start in an ER for the first time, but if you relate well to existing staff and get along well, it's MUCH easier to learn.
  10. by   CritterLover
    Quote from emernurse
    i agree with the folks who say to go and see each er. see how the staff works together, get an idea of where they place newer nurses (in my er, newer nurses are started out in the "back hall" with less acute patients). if you know you'll be working a certain shift, try and see what it's like on that shift. it can make a difference.

    if you go and visit and seem to have a quick raport with the staff - understand their jokes and attitudes - relate to the atmosphere - that's where you should go.

    it's hard to start in an er for the first time, but if you relate well to existing staff and get along well, it's much easier to learn.



    agree 100%.

    any of the ers will give you good experience. but you need to check out the unit culture of each. having good, supportive coworkers can make all the differnece. as can having, nasty back-biting, selfish coworkers. the first can turn a nightmarish, beyond hectic, horrible night (or day) into a bearable learning experiene. the second can turn a slow, "easy" night into a nightmare.

    ask to shadow a nurse for a few hours at each of the ers (they shift you would be working). take the job where they make you the most welcome.
  11. by   HRM672
    Thanks for all of the input. I will shadow both next week, and see where I seem to fit in better. After reading your replies, it seems like you all think that the people in each place are more important than the hospital or program itself. Hopefully I can get a good idea of that by shadowing.

    Thanks!
  12. by   TazziRN
    Ah! I learned something new. I had a 12-week, dept and classroom, intense preceptorship, and I've never heard of nurses going through a residency. I think I like that term better!
  13. by   Dixielee
    I have been a nurse 34 years, work ER in a very busy, 52 bed trauma/referral center, and my advice is to start slow if all other things are fairly equal. Why kill yourself, set yourself up for failure or at least misery if you don't have to. Would you send an infant to kindergarten and expect it do well, or would you start by teaching him how to walk and talk first.

    Nursing school does not teach you to be a nurse. It gives you the opportunity to learn how to be a nurse. Patients are sicker than ever before (they used to die sooner), hospital stays are shorter (only the sickest are allowed to stay, everyone else is kicked home to recover), technology is more advanced than ever and changing quickly. Computerization may make your documentation look better, but it slows things down in the ER.

    The chances of getting sued or even charged with a crime if you make a mistake are greater than ever before.

    When you are young and energetic and want to change the world, the tendency is to jump into everything with both feet to experience the thrill of the chase, the trauma, the drama. But, I have seen too many young, bright nurses burn out and leave nursing completely.

    Trauma nursing is tough to learn even as an experienced nurse. I have seen nurses with 10+ years in another specialty struggle in the ER. It is a different world that changes minute to minute. You may be dealing with mundane flu symptoms, belly pains, and lacerations one minute, and next thing you know you have 3 patients with multiple gun shot wounds, or multi vehicle MVC with major trauma fly in and take the rest of your shift. You have to be ready to go with the flow and be ready for the constant change.

    Lots of us say we like change, and that is what keeps ER fresh and interesting. But you must have your assessment skills, judgement and generaly maturity down pat before you can truly succeed and feel comfortable. Many trauma centers are staffed with lots of medical interns and residents who are also learning how to be physicians. You as a nurse will have to be SURE when something is ordered for you to do that it is safe to do so, that you are not causing harm. It is your responsibility to give safe care, even if you have been asked to do something unsafe, or give an inappropriate med. That DOES happen, you will be held responsible for your actions.

    Sorry for running on and on, but I just hate to see new grads dumped into situations that are not good for them and not good for the patients they care for. So, why not learn to be a nurse first, then learn to be a trauma nurse. Just this old nurses opinion. It is probably worth what you are paying for it!
  14. by   HRM672
    Thank you, DixieLee, for your very thoughtful reply. I DO value the opinion of experienced nurses, it's one of the reasons I love this website. Thank you!

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