Am I on the right track?

MotoMonkey, BSN, RN · Apr 28, 2020

First, congratulations on graduating, this is a super exciting time.

I would take the offer that has been sent your way. It would be terrible if you turned down the offer in order to try and get something "better" only to not get anything else and be wishing you had taken the first offer.

I don't see anything wrong with taking a first job in a community hospital ED. Personally I think residency programs are a huge benefit to new grads and can give them the support and learning they need to succeed.

I understand the feeling of wanting to work in a level 1 and to do all the exciting things, but you have to learn all the little things too, all the skills and assessments that go along with being an ED nurse. A community hospital should allow you the opportunity to learn to deal with all the bread and butter work of an emergency room the abdominal pains, and the chest pains, the respiratory distresses, as well as things like nausea, vision problems, lacerations, diabetic emergencies. As an ED nurse you will have to know how to do it all, so for a first job I would take any opportunity that will teach you your ED nursing foundation because those are the skills that will help you progress in the future.

speedynurse, ADN, BSN, RN, EMT-P · Apr 29, 2020

Honestly, the opportunity for an ED nurse job is not always easy to obtain. In addition, level 1 trauma centers have their own issues - they have a lot of physician residents and others who are in the learning process, so sometimes you do not get all the skills that you think you will. Look at it this way - any ED job will give you critical care nursing experience which will make you much more employable anywhere.

caal19, BSN, RN, EMT-B · Apr 29, 2020

Thank you both so much for your support and input! I completely agree with both your points. I've heard many times that the ED can be too intense/too much for new grads. A community ED may be the perfect starting place to build my foundation before I advance. And it's always greener on the other side, right? I may not even get to work on the skills I think I will in a Level 1. Great point, thank you.

So, for later down the road, is it necessary to have trauma experience to get hired at a Level 1? Or as long as I have any ED experience I should be a qualified candidate?

speedynurse, ADN, BSN, RN, EMT-P · Apr 29, 2020

I have had plenty of ER nurse coworkers that have gone from non trauma hospitals to level 1 or 2 trauma centers. Trauma experience is not required to get into a trauma designated ER. (And even once you go to a trauma center, it could actually be a good few years before you are in the trauma bays). What I do recommend is getting some trauma education once you get some ER experience - TNCC is fantastic and a course that only lasts a couple of days.

caal19, BSN, RN, EMT-B · Apr 29, 2020

2 hours ago, speedynurse said:
I have had plenty of ER nurse coworkers that have gone from non trauma hospitals to level 1 or 2 trauma centers. Trauma experience is not required to get into a trauma designated ER. (And even once you go to a trauma center, it could actually be a good few years before you are in the trauma bays). What I do recommend is getting some trauma education once you get some ER experience - TNCC is fantastic and a course that only lasts a couple of days.

Great, thank you so much for the insight! I am so excited to start this career!

MotoMonkey, BSN, RN · Apr 29, 2020

Like speedynurse pointed out. In a smaller hospital there are less staff to do all the different jobs and skills, therefore you will likely be required to be a bit more of a "jack of all trades."

Also, while a community hospital may not have a Trauma designation, you never know what is going to roll through your doors. Joe in the community gets his arm caught in the mechanism of his tractor his wife doesnt know that your hospital isn't "trauma designated" she just knows that she needs to drive him to the nearest ED. I've heard many stories of the wacky things that end up rolling through community EDs.

caal19, BSN, RN, EMT-B · Apr 30, 2020

4 hours ago, MotoMonkey said:
Like speedynurse pointed out. In a smaller hospital there are less staff to do all the different jobs and skills, therefore you will likely be required to be a bit more of a "jack of all trades."
Also, while a community hospital may not have a Trauma designation, you never know what is going to roll through your doors. Joe in the community gets his arm caught in the mechanism of his tractor his wife doesnt know that your hospital isn't "trauma designated" she just knows that she needs to drive him to the nearest ED. I've heard many stories of the wacky things that end up rolling through community EDs.

Great point! Thank you. This calms any reservations I had about the experience I would obtain from this position. Glad to know I'm on the right track ?

abbatar, BSN, RN · May 7, 2020

Hey! I work in a large hospital that is a Level 1 trauma center and comprehensive stroke center. I completed an ED fellowship here last year right after graduation from a BSN program. I wanted the same as you - level 1 traumas and to see it all. I live in NY close to the city so there were a lot of options of hospitals (not sure where you're located). I wanted to start my career in a top ED because I wanted to be able to go anywhere after it. They always say you're a sponge your first year of nursing, so I wanted to take advantage of that.

The ICU is very similar but also very different than the ED. If your heart is with emergency medicine, then start there. The SICU sees patients after we work them up in the ED, so it would be helpful for you to see the continuum of care, BUT it's a different situation being a nurse for them when they first come in to the ED. I do not think you will be at a disadvantage if you start out in a non-trauma setting. You can always work your way up. Starting at the hospital you were offered a position at will definitely not put you at a disadvantage. Best of luck to you!

caal19, BSN, RN, EMT-B · May 7, 2020

1 hour ago, abbatar said:
Hey! I work in a large hospital that is a Level 1 trauma center and comprehensive stroke center. I completed an ED fellowship here last year right after graduation from a BSN program. I wanted the same as you - level 1 traumas and to see it all. I live in NY close to the city so there were a lot of options of hospitals (not sure where you're located). I wanted to start my career in a top ED because I wanted to be able to go anywhere after it. They always say you're a sponge your first year of nursing, so I wanted to take advantage of that.
The ICU is very similar but also very different than the ED. If your heart is with emergency medicine, then start there. The SICU sees patients after we work them up in the ED, so it would be helpful for you to see the continuum of care, BUT it's a different situation being a nurse for them when they first come in to the ED. I do not think you will be at a disadvantage if you start out in a non-trauma setting. You can always work your way up. Starting at the hospital you were offered a position at will definitely not put you at a disadvantage. Best of luck to you!

Thank you for your input! Would you mind sharing your experience completing the ED fellowship? Did you "see it all"? How was the learning curve? Did you feel the fellowship really helped in transitioning you to a professional nurse?

abbatar, BSN, RN · May 8, 2020

9 hours ago, caal19 said:
Thank you for your input! Would you mind sharing your experience completing the ED fellowship? Did you "see it all"? How was the learning curve? Did you feel the fellowship really helped in transitioning you to a professional nurse?

I had a great experience in my fellowship. It was 10 weeks of classroom didactic experience, followed by about 5 months of preceptorship. When first starting on the floor with my preceptor, I felt like I would never be able to be on my own. They started us with taking 1-2 patients, then 3-4, etc. building up our independence with tasks and such. I feel like I learned so much on fellowship and I felt OK to go out of my comfort zone with things because I knew I had my preceptor to ask questions and such. Now, I feel prepared to handle more of those things that were "out of my comfort zone" as a brand new nurse. I had a really good preceptor who would ask me questions and "quiz" me throughout the day which helped me critically think and make those connections so I wasn't just tasking. They tried to get us to see as much as possible on fellowship and if there was ever something rare or cool, other preceptors would share with us, show us the patient, etc.

I think the fellowship was crucial for helping me transition in the ED. Some floors you can get away with a less extensive orientation, but for critical care settings like this, I think it's so important. After being off preceptorship and being on my own, I felt nervous but prepared. I still ask for help and ask questions, but there's always a more experienced nurse around to answer. Some days are harder than others on your own, but that will be with anything. Highly recommend a fellowship program if you're able to do one.

caal19, BSN, RN, EMT-B · May 8, 2020

14 hours ago, abbatar said:
I had a great experience in my fellowship. It was 10 weeks of classroom didactic experience, followed by about 5 months of preceptorship. When first starting on the floor with my preceptor, I felt like I would never be able to be on my own. They started us with taking 1-2 patients, then 3-4, etc. building up our independence with tasks and such. I feel like I learned so much on fellowship and I felt OK to go out of my comfort zone with things because I knew I had my preceptor to ask questions and such. Now, I feel prepared to handle more of those things that were "out of my comfort zone" as a brand new nurse. I had a really good preceptor who would ask me questions and "quiz" me throughout the day which helped me critically think and make those connections so I wasn't just tasking. They tried to get us to see as much as possible on fellowship and if there was ever something rare or cool, other preceptors would share with us, show us the patient, etc.
I think the fellowship was crucial for helping me transition in the ED. Some floors you can get away with a less extensive orientation, but for critical care settings like this, I think it's so important. After being off preceptorship and being on my own, I felt nervous but prepared. I still ask for help and ask questions, but there's always a more experienced nurse around to answer. Some days are harder than others on your own, but that will be with anything. Highly recommend a fellowship program if you're able to do one.

That's fantastic, that's exactly what I want out of a residency/fellowship. Thank you! I'm so excited