Rural ED nursing - a 180 turn

[crckt]

I'm a travel OR RN that really only has OR experience in large urban hospitals. I'm planning on hanging my travel hat for a little while and looking for a change of setting. I intend to spend the next couple years in a rural area along the Pacific coast, and thinking about getting a job in a free-standing community ED.

From what I understand it's 7 bays, and they do lab work, x-rays, and generally stabilize critical patients, and then ship to the main hospital 20 minutes north. It is staffed by 1 MD, 1 RN, and a couple techs. This is super intimidating to me to think about such a vast change of specialty without other RN colleagues for support. Am I setting myself up for failure? The job listing says they want 2 years ED experience, or the ability to go through their ED nurse training program. But I have a feeling I get a few weeks training and then hit the ground running by myself.

I love the idea of solidifying an array of skills I haven't been able to do much of as an OR nurse and really being an expert on critical thinking and first responding. I just don't know if it's really possible to make such a huge change if I'm not already trained and comfortable as an ED nurse.

Thoughts?

x-posted to Rural Nursing board

[Spidey's mom, ADN, BSN, RN]

Hello! Welcome to rural nursing. :)

I worked for 9 years in the ER in our little rural hospital in Northern CA - not on the coast though.

Our ER consists of a small triage room with a gurney and VS and a desk and computer; the main ER is one room with three gurneys and curtains and a small room off to the side for more private types of exams. So, you could have a total of 5 patients. We've had them in the hallway but that is very rare.

There is one RN who is also the Nursing Supervisor for the entire small hospital. We have two EMT II's or Paramedics. One physician. The medics also man our ambulance.

Our hospital has a lab and an X-ray department with a CT scanner.

The more critical patients are of course stabilized for transfer via helicopter for the most part. We admit the others to our hospital. We used to have a sort of step-down ICU but ended up changing that and admitting those patients to the floor, 7 rooms which can accommodate 14 patients. There is one room that is saved for postpartum though.

Personally, I truly enjoyed working in a small town ER. I miss it. I worked in a bigger city ER after that and it just wasn't the same. Seems like there is more time with patients and a greater sense of camaraderie and teamwork in a smaller ER. But that may just have been my experience working rural first.

Maybe you could ask to shadow the RN for a few days at a small rural ER and see how it flows. There are lots of small town ERs in America. I hope you get some more answers to your thread.

(Edited to add . . .hey we could use some ER nurses here too).

[360jRN]

Yes... You would be setting yourself up for failure. Just like there are surgeons that I'm sure you worked with and cringed when you saw you had a case with them - there are plenty of ER physicians that fall into the same category. And that's not even referring to personality, ego, etc. I have worked with physicians that would have to essentially be carried through a critical patient or emergent situation. And I've seen experienced ER nurses that work with such physicians and receive a questionable order, hell that's putting it nicely, and will go to carry it out until another nurse says something to them or the physician.

My mind is just racing thinking about this scenario and I can't get my thoughts completely formulated. Lol!

To keep from just rambling I'll just say, go work in a rural ER. But work in one where you're part of a team with experienced ER nurses; that's how we learn what to do and most definitely what not to do.

Best of luck!

[Lunah, MSN, RN]

In my opinion, this type of setting requires a very strong ED RN. You could shadow and interview and see how you feel, but I think you'd be setting yourself up for failure, yes. Or at least a lot of tachycardia and sleeplessness.

[crckt]

Thanks, all. I think I'll check it out in person and see what I think, but I will probably want to transition into a setting where I have more support while I learn.