Best place to start out: Level I vs Level III?

Crocuta, RN · Mar 8, 2008

The decision of where to start is a very personal one. You will learn many of the same skills at both facilities, and you will also learn very different things at each facility.

Since you have another week before you have to make a decision, I would suggest that you do some research into each ED before you make a decision.

Compare the orientation offered at each place. How long will it be? Are there classroom and clinical components? Will you have a dedicated preceptor, or will you have a different person each shift? Is it a homemade curriculum, or something like the ENA's orientation package?

Look into ED size, staffing and capacity. Are they always holding patients in the ED while waiting for beds? How many patients is each nurse responsible for? What are the waiting room wait times?

Talk to the nurses. Ask them how they like the facility. How is the morale? How is management? See if you can come in for a few hours to see the routine.

Each facility could be great, or it could be a disaster. Don't assume that a Level 3 is not going to be chaotic. All Level 3's are not created equal, nor are all Level 1's. The best thing to do is to do your research, compare the two facilities, and pick the one that you feel best matches your personality, goals, and interests. The rest will fall into place.

Good luck, and let us know how it goes. :nuke:

JennyAS, BSN, RN · Mar 8, 2008

Good point, Crocuta... I've actually done lots of research:

I forgot to mention that I shadowed at the Level I for 12 hours, and plan to shadow at the Level III soon. I loved the Level I, especially because of the teamwork. I actually had a resident pull me aside to teach me what was going on in a CT scan. Love the management - they have an open door policy and will even suit up and work if the ED gets overloaded. And all the nurses I talked to loved the place.

Also, the Level I is opening a new trauma center in Nov 09, and it's going to be AMAZING...

One major difference though is that the Level I has a bad reputation in this city... from what I'm hearing they hate the wait times and there are bad stories about nurses - but I've been to the Level I as a patient a few times and haven't had a bad experience. Honestly, what patient doesn't complain about ED wait times... but then again, when I shadowed there were people waiting for over 20 hours... so I don't know what to think about that. The Level III has a better rep.

As far as orientation programs go, they are practically identical since they are both Shands hospitals. 4-6 month orientations, with 12 weeks of didactic classes and at least 16 weeks of a preceptorship. The orientations are based on the ENA orientation.

Pay and benefits are also exactly the same. Same Nurse:Pt ratios (1:4-5), Level I has 32 beds, Level III has 22. Both see about 130 pts a day.

ecnav · Mar 8, 2008

Level I without a doubt. Let them build you into an ED machine!

:bowingpur

Larry77, RN · Mar 8, 2008

Another thing to think about is you may actually get more trauma experience at a level 3...at most level 1's there is a trauma team that "takes over" your patient until they are stable or often taken to surgery and the newbie's don't get assigned to this team for quite awhile even if you get your TNCC and ENPC.

Also the level 1 is probably a teaching hospital where you have to deal with med students and residents who sometimes know next to nothing which can be frustrating.

If both are the same company you can always transfer to the level 1 later...how long is the waiting list time? You might have enough experience to get in on more trauma at the level 1 when your spot comes up.

Congrats on your accomplishment and to be offered a job in ED right out of school...that's great!!!

Larry

Dixielee, BSN, RN · Mar 9, 2008

Another thing to think about is you may actually get more trauma experience at a level 3...at most level 1's there is a trauma team that "takes over" your patient until they are stable or often taken to surgery and the newbie's don't get assigned to this team for quite awhile even if you get your TNCC and ENPC.
Also the level 1 is probably a teaching hospital where you have to deal with med students and residents who sometimes know next to nothing which can be frustrating.
Larry

I agree! As an ER traveler, I have had the opportunity to work at a wide variety of facilities. At the level 1, it will be a good while before you are going to be doing any trauma. Some of the worst trauma I ever dealt with was in a town of 20,000, lots of farm injuries and car wrecks. We were 2 hours by ground away from a trauma unit, so we did a lot of stabilization and shipping.

A smaller, less acute ER will give you a lot of exposure to a variety of situations. You will get your assessment skills down, get a chance to triage and get your feet wet without the pressure and chaos of a trauma center.

You can always move "up", but will have great learning experiences at a smaller ER.

Also, bear in mind that trauma centers also see the mundane stuff that makes us all crazy sometimes. The back pain for 6 months, the abdominal pains that get full workups and never find anything wrong, the drunks, the overdoses, the toothaches and the middle of the night visits for the most bizarre things you can imagine, usually transported by EMS!

Trauma is actually a small part of what you do in a trauma center.

Get your feet wet, don't be afraid to learn new things, and don't discount what you can learn in a smaller facility. You will have less back up, may or may not have board certified ER docs, and will find yourself thinking on your feet a lot! Get some good resources, either books or PDA programs, but have some good ones available, you will need them. Good luck.

meandragonbrett · Mar 9, 2008

Trauma is actually a small part of what you do in a trauma center.

Depends on how the facility's unit is set up. Some hospitals have an Emergency Room and a Trauma ED that takes care of nothing but GSW, KSW, MVC, etc. with two separate sets of staff members.

Good luck in your decision!

KatieBell · Mar 10, 2008

For certain, I would head to the level one. Since they are both close, it is unlikely that much trauma gets seen at all at the Level three. (Different story if you were going to a rural level three, where you would be doing a lot of stabilization and shipping...)

I've worked at all levels of hospital ER's now from a 6 bed critical access hospital to the Monster level Ones. Personally, I learned more at the Level Ones. I also found that after working at a Level one for a long time, that travelling to smaller hospitals has been a piece of cake, even the busy smaller hospitals.

I've seen some nurses have a lot of traouble transitioning from a smaller ER environment to the Level One environment (and some who did great), but I have never yet met someone from a Level one environment, who couldn't adjust well to a smaller hospital.

Best Wishes. Enjoy your first year out there.

cary-rn · Mar 20, 2008

I would recommend starting at the level 3. But it is your decision.

After I graduated I worked float pool for 6 mon-1 year, then transferred into a level 3, I learned alot, you get a wide variety, you ship a lot of pt's out to higher level of care facilities. But in regards to trauma you defineatly see more at the level 3 where most of the time unstable pt's go to get stablized for further transport. You learn how to prioritize and determine level of care for your different types of pts and you are able to learn how to triage many different types of pt's

I now work at a level 2 trauma center. I enjoy it and defineatly take care of higher acuity pts, we sent alot of minor things to urgent care, so alot of things are filtered out. I am finding that we are getting those sicker pts that I sent out of the smaller hospital and getting the stablized trauma pts now, it gives you a better perspective of what they do at smaller hospitals and gives you more understanding. Ive seen new grads start in the ed and you will most likely get a good long orientation.

In my opinion you will get a better understanding of the emergency room system starting at a level 3 then eventually going to level 1 after you have learned and polished your assessment and prioritizing skills.

There are pros and cons to both facilities. In the end it is your decision.

untamable07 · Mar 20, 2008

What was the starting pay offered at Shands as a newbie?

rgroyer1RNBSN, BSN, RN · Mar 21, 2008

What about a level II, I started out in a level 2, I have also worked in a level IV-wow let me tell you they get some real trauma at a level IV.-lol

EmBeMap · Mar 24, 2008

I am a nursing student as well and had to pick between a lvl 1 and and lvl 3 er. I ended up taking the lvl 3 job. I am currently working in the lvl as a tech. I can tell you im so glad I got my feet wet in the lvl 3 because the pace is nuts. I love every minute of it, but I can't imagine I would have survived in lvl 1 as my first exposure to healthcare. I say go with lvl 3 and transfer in a year.Good luck and invest in running shoes. My motto is always be patient oriented and provide the most compassionate care in a timely manner. And whatever you do don't be slow with pain meds and anti emetics.