Am I on the right track?

[caal19]

Hi All,

I am a new grad, graduating in a few days. I have been lucky enough to have been offered a position in a community hospital ED's residency program. It sounds like a really great opportunity. However, they don't really receive many traumas and my end goal is to be an ED nurse in a Level 1 Trauma Center. Will this limit me or help me in the future when I want to apply to a Level 1? Should I be going a different route first like Trauma ICU? Or am I on the right track to take this opportunity? Thanks in advance!

[medic 2 RN, ASN, RN, EMT-P]

I say take it, I was hired as a new grad in a Level 3 ED, and also now work PRN in a Level 4 ED. I love both jobs, no plans for going Level 1 or 2, do not need the faster paced ED, I'm and old man of 56 with bad knees!

[ayysolapsu09]

I work in a 17 bed community ER, with a Level II trauma center a county away from me. I applied for the level II, but interviewed with the community ER and was offered a position there, which I accepted. In my 2.5 years there, I have seen a few seasoned nurses from the Level II trauma center take jobs at the ER I work at to get away from the Level II ER. In my particular area, the Level II has a bad reputation with how they treat nurses and a generally toxic environment. Plus, they tend to be older and want a change of pace. Be wary of places with high turnover, regardless of how big/small the place is.

What I've noticed is that while they are all fantastic nurses and great resources for a young nurse like myself, sometimes they tend to lean on very heavily the assisting resources around them (paramedics, etc) and will be very quick to delegate work, whether they need to or not. I personally pride myself on my ability to do the brunt of my workload and delegate very little unless I absolutely have to, and I especially get really hands on with critical patients. That's just how I approach my work. This is not an across-the-board indictment, just a general pattern of how people who are used to a lot of resources tend to behave. Many do not do this, but there are some who do.

Another thing to be aware of is that while you may potentially see more traumas in a Level I or II, your "slice of the pie" may be significantly diminished until you prove yourself. Conversely, since I am one of 4 nurses sometimes at night, we do about 80% of the work on all of the patients we see. We do not have an IV team, we don't have transporters, we don't have a tube team. We have respiratory who does our EKGs, ABGs, breathing treatments and runs our vents. Our rad techs do the radiology. I do just about everything else; I pull and push my own meds, I start my own lines (with ultrasound if I need to, or EJs), I pull my own labwork (I can call lab if I need to but it is very slow to get them to help), and so on. I need my coworkers to be as good as I am (really they are better) for our team to succeed. I do so much hands-on nursing in our community ER that I know I can insert myself into any situation and be a resource, if not at least a contributing member.

You won't be wrong with either choice. Just be aware of the pros and cons of the choice you're making.

[caal19, BSN, RN, EMT-B]

1 hour ago, ayysolapsu09 said:

I work in a 17 bed community ER, with a Level II trauma center a county away from me. I applied for the level II, but interviewed with the community ER and was offered a position there, which I accepted. In my 2.5 years there, I have seen a few seasoned nurses from the Level II trauma center take jobs at the ER I work at to get away from the Level II ER. In my particular area, the Level II has a bad reputation with how they treat nurses and a generally toxic environment. Plus, they tend to be older and want a change of pace. Be wary of places with high turnover, regardless of how big/small the place is.

What I've noticed is that while they are all fantastic nurses and great resources for a young nurse like myself, sometimes they tend to lean on very heavily the assisting resources around them (paramedics, etc) and will be very quick to delegate work, whether they need to or not. I personally pride myself on my ability to do the brunt of my workload and delegate very little unless I absolutely have to, and I especially get really hands on with critical patients. That's just how I approach my work. This is not an across-the-board indictment, just a general pattern of how people who are used to a lot of resources tend to behave. Many do not do this, but there are some who do.

Another thing to be aware of is that while you may potentially see more traumas in a Level I or II, your "slice of the pie" may be significantly diminished until you prove yourself. Conversely, since I am one of 4 nurses sometimes at night, we do about 80% of the work on all of the patients we see. We do not have an IV team, we don't have transporters, we don't have a tube team. We have respiratory who does our EKGs, ABGs, breathing treatments and runs our vents. Our rad techs do the radiology. I do just about everything else; I pull and push my own meds, I start my own lines (with ultrasound if I need to, or EJs), I pull my own labwork (I can call lab if I need to but it is very slow to get them to help), and so on. I need my coworkers to be as good as I am (really they are better) for our team to succeed. I do so much hands-on nursing in our community ER that I know I can insert myself into any situation and be a resource, if not at least a contributing member.

You won't be wrong with either choice. Just be aware of the pros and cons of the choice you're making.

This is great insight and reinforces what the previous posters have mentioned. Thank you so much for the further feedback!