Air Tight Cliques-Level One Trauma ER Nurses/ Hospitals

Nurses General Nursing

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Most Valuable Dearest Nurses,

I have posted before about my excitement for my upcoming interview (in 11 days!!!) for a level one trauma ER in a large city in Southern California!!!:yeah::yeah:

A lot of research for this interview has been ongoing since. However my heart sunk after I have read various posts stating how it's almost impossible for a fairly new nurse (16 months acute rehab experience) to do well in a level one trauma facility :cry:. Most people say those are usually staffed with air tight cliques of veteran nurses :smokin: who not allow an inexperienced RN to work with or anywhere near them. Some suggest I should try a level 3 perhaps...get my feet wet because the ER is a totally different animal, especially those level ones with true traumas and other very real emergencies. I feel discouraged at this point...plus I have discovered it may be a night position, which I know will be hard to adjust to (I have been working days), but in this economy I will take anything.

I have posted this in the general discussion to get reposes from everyone, not just ER nurses...ex ER nurse who is in ob or med/surg/ICU...why did you leave....that sort of thing. Would love to hear from a level 1 trauma nurse who thinks a new nurse CAN make it in that enviroment

Thanks guys!!!!

Specializes in rehab.
YOU are not considered an inexperienced nurse.

The OP has 1.5 years in an LTC. THAT is not experience for a LEVEL 1 TRAUMA. She is a NEW nurse as far as I am concerned.

If I were here, I would start in a L2 ED and work my way into the L1.

For the patients' sake.

Hopefully she has a LONG (minimum one year) preceptorship.

My experience is 18 months in an acute rehabilitation Hospital not LTC

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Specializes in Cardiac Telemetry, ED.

I had one year as an LPN, one year as an RN, both years on an acute post intervention cardiac floor in a major regional medical center. Our floor was also a "dumping ground" for severely ill patients with one foot in the ICU. We did drips on that floor that only ICU, ED, and our floor could do. We did conscious sedation, cardioversions, post cath recovery, etc. Even with that experience, going to an L2 ED was a HUGE change. I'm a pretty quick study and am not stupid, but still I have lots of moments where I feel very stupid.

We have lots of experienced ED RNs who, I am certain without a doubt, dislike inexperienced nurses, which I am, even considering that I do have experience with very sick patients. The difference is, my experience is with very sick patients who have been stabilized. In the ED, they are not stable. Big difference.

Fortunately for me, one of my biggest strengths is my resilience. I am not the kind of person who goes into new situations with guns a blazin and mouth a flappin. I am quiet, I am introspective, and I am observant. I believe that actions speak louder than words, and I don't bother telling the other nurses how much I want to be a team player; instead, I do things that show the desire to be a team player. I take criticism at face value without offering any excuses. I feel they are doing me a favor to tell me when I've done something wrong, rather than talk about it behind my back or report me. So even if that criticism is delivered in a less than diplomatic way, it is useful and should be heeded.

That's how it's different in the ED. There isn't much tiptoeing around people's feelings like there was on the floor. If you are stepping on toes or messing up, people will let you know.

One of the biggest rules is that "we share". There is no "one on one" with a critical patient. When others come to help, you LET THEM HELP. Trying to be Super Nurse and handle it by yourself will not earn you any warm fuzzies from your team mates.

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Specializes in rehab.
I had one year as an LPN, one year as an RN, both years on an acute post intervention cardiac floor in a major regional medical center. Our floor was also a "dumping ground" for severely ill patients with one foot in the ICU. We did drips on that floor that only ICU, ED, and our floor could do. We did conscious sedation, cardioversions, post cath recovery, etc. Even with that experience, going to an L2 ED was a HUGE change. I'm a pretty quick study and am not stupid, but still I have lots of moments where I feel very stupid.

We have lots of experienced ED RNs who, I am certain without a doubt, dislike inexperienced nurses, which I am, even considering that I do have experience with very sick patients. The difference is, my experience is with very sick patients who have been stabilized. In the ED, they are not stable. Big difference.

Fortunately for me, one of my biggest strengths is my resilience. I am not the kind of person who goes into new situations with guns a blazin and mouth a flappin. I am quiet, I am introspective, and I am observant. I believe that actions speak louder than words, and I don't bother telling the other nurses how much I want to be a team player; instead, I do things that show the desire to be a team player. I take criticism at face value without offering any excuses. I feel they are doing me a favor to tell me when I've done something wrong, rather than talk about it behind my back or report me. So even if that criticism is delivered in a less than diplomatic way, it is useful and should be heeded.

That's how it's different in the ED. There isn't much tiptoeing around people's feelings like there was on the floor. If you are stepping on toes or messing up, people will let you know.

One of the biggest rules is that "we share". There is no "one on one" with a critical patient. When others come to help, you LET THEM HELP. Trying to be Super Nurse and handle it by yourself will not earn you any warm fuzzies from your team mates.

VirgoRN,

Thankyou for taking the time to enlighten me. I appreciate the advice. I think I'm a lot like you. I'm more of the quite type, observer. learner. I actually welcome crtiticism, and like you said its better for them to tell me upfront when I'm wrong than report me or wait untill I have harmed someone. I'm not the know it all type and will be GLAD when i get help. So its nice to know that is an ED culture.

I don't have any critical care experience, and that is what a lot of people are worried about...with good reason. but i think that if they contacted me for an interview, then it must be possible to learn this stuff as a newbie, otherwise they would specifically be looking for someone with 5 plus crictical care experience or something. The way I see it is if they have faith In me, I should have faith in myself. I will give it my all.

Thanks gain for the tips.

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Specializes in Cardiac Telemetry, ED.

Well, it appears to be the culture in MY ED. Part of your orientation process will be figuring out who is who and what is what. Things may be different in the ED where you will be starting. While I do believe it is possible to be a successful ED RN without being loud and aggressive, you do need to have a thick skin, a backbone, a strong stomach, and a bladder of steel. You can't be wishy washy.

Good luck. You're in for the ride of your life!

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Specializes in Surgical Trauma Burn ICU, Oncology.
I told you before you're going to need thick skin.

Don't show your weakness...and whether or not there are mean people are irrelevant. These people are like war vets. They've seen it all and if you can't handle the load they will eat you.

Don't come here whining about them. I don't like inexperienced people; they will only get in the way.

I am not going to sugar coat for you.

Former L1 nurse.

I work in a level one surgical trauma burn ICU and I graduated this past May. I am making it just fine. I am blessed that I have super intelligent experienced nurses that work with me and help me to understand things I don't know yet, all which have no problem doing so.

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Specializes in rehab.
Well, it appears to be the culture in MY ED. Part of your orientation process will be figuring out who is who and what is what. Things may be different in the ED where you will be starting. While I do believe it is possible to be a successful ED RN without being loud and aggressive, you do need to have a thick skin, a backbone, a strong stomach, and a bladder of steel. You can't be wishy washy.

Good luck. You're in for the ride of your life!

Alright!!!! Here I come:

Backbone-Check

Bladder of steel-Check (I already had one lol)

Thick skin-Check

Strong Stomach-Check!

:D:D:D

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Specializes in ICU/Critical Care.
Alright!!!! Here I come:

Backbone-Check

Bladder of steel-Check (I already had one lol)

Thick skin-Check

Strong Stomach-Check!

:D:D:D

Bladder of steel should be a requirement for nursing. LOL.

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.
i was years an icu nurse already--taking post op traumas.

so yeah...i was already basically "initiated" and didn't have a huge steep to learn.

i'd been working with the same people already, and they knew me.

yes, but once upon a time (even if it was like 20 years ago) you were an inexperienced, green, wet-behind-the-ears new nurse who knew nothing about caring for trauma patients. you were provided an environment to learn (work), worked with others who knew way more then you, you studied your butt off, continued to grow (work), and have the knowledge and experience you have today. the point of my post is that all nurses who wish to be a trauma nurse should be given the same opportunities to learn and grow. of course, i know that not all will survive, but it is not necessary for more experienced nurses to make life more difficult. in fact, it is out right dangerous.

if new grads are not being supported properly in our work environment then the care provided to our patients will not be good (which is why i made the statement that the eat-your-young types get in the way). besides, we are all professionals. our rn=your rn even if our experience does not.

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Specializes in Emergency, critical care.
Alright!!!! Here I come:

Backbone-Check

Bladder of steel-Check (I already had one lol)

Thick skin-Check

Strong Stomach-Check!

:D:D:D

You asked for a change on a previous post....looks like you got what you wanted....Ain't America Great?

Good luck with getting the job....you ARE in for the ride of your life....

ADD to the above list: 4 or more effective stress management skills

(I rollerskated for 20 years---now yoga; play hard: ski, boat, rock climbing vacations frequently (4 0r 5 days off every 3 months is a vacation); 2 or 3 really good friends that you can say anything to; 1 or 2 ER conventions/ continuing ed. activities a year (great for confidence when w/ the experienced nurses); music....

Pay attention to managing stress ....find and do what works for you...I've noticed through the years, the sharpest ER nurses feed both mind and body.......

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Specializes in Cardiac Telemetry, ED.
You asked for a change on a previous post....looks like you got what you wanted....Ain't America Great?

Good luck with getting the job....you ARE in for the ride of your life....

ADD to the above list: 4 or more effective stress management skills

(I rollerskated for 20 years---now yoga; play hard: ski, boat, rock climbing vacations frequently (4 0r 5 days off every 3 months is a vacation); 2 or 3 really good friends that you can say anything to; 1 or 2 ER conventions/ continuing ed. activities a year (great for confidence when w/ the experienced nurses); music....

Pay attention to managing stress ....find and do what works for you...I've noticed through the years, the sharpest ER nurses feed both mind and body.......

A freakin men!!!!!!!!!!!!!!!!!!!!!!! After the shift I had tonight, let me tell you, that yoga class will feel great tomorrow!!!!!!!!!!!!!!!!!!!!! And yes, I need to vent to someone who won't judge me for what I have to say.....need it badly!!!!!!!!!!!!!!!!!!!!!!!

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Specializes in rehab.

Trixie33! I DID ask for a change! Thanx 4 putting up with my other whine-fueled posts about looking for something new and challenging. Well, something new and challenging has found ME. I will take it head on...be careful what u wish for :D

Thanks for the advice!

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

When I started in the ER I figured who the biggest,meanest,most newbie-eatingest nurse in the unit was...walked my happy butt up to her and said "I can't make you like me but please God stop me before I kill somebody". She was speechless, followed by rolling on the floor laughing. We've been friends ever since.

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