Does the level of trauma center matter?

[SR8811]

Hey Friends!

So I am a new RN currently employed where I worked for 2 years as an LPN in radiation oncology. I got my first choice of preceptorship back in August and was placed in an ED, and I am now applying to different local EDs to start my career as an RN.

My question is:

Does it make any difference on future job prospects whether you are trained in a level 2 trauma center vs a level 4? Both are with the same company, and offer a residency for new grads. So far I have only applied to the level 2 trauma center ED, but was thinking about applying to the level 4 as well just in case I am not picked for an interview with a level 4.

My worry is if I luck out and get interviewed with both and they both magically like me, or if maybe the level 4 trauma center contacts me first prior to hearing from the level 2.

Should I hold off on applying to the level 4 because the level 2 would look much better on a resume?

Basically my future goals are all with emergency departments, but I will either be relocating after a couple years to a neighboring state, or possibly even travel nursing to EDs.

The level 2 is in a shady area and would be higher stress due to the population in the area. The level 4 is in a rich area and it's obviously a smaller ED. Not that any of this matters because I want to go where the training will be better and what will look better.

Thanks!

[Party_of_five, BSN]

Any job is better than no job. Apply for both and take the one that makes an offer! Trauma centers are rated as #1 being the highest level of care and go down. A level 4 would most likely mean you stabilize and transfer to a higher level of care.

[NurseVoldemort, BSN, RN]

Working at a level 2 vs level 4 won't matter much. Experience in an ED is good regardless. So many trauma centers do things differently, so if you ever decide to transfer to a higher level trauma center they will likely not train you to be on the trauma team right away until you get to know the department first and then they will train you to their process. So experience at a 2 vs a 4 won't make you any more or less marketable.

However, keep in mind that when applying for a job, if it is with the same company the HR department will be seeing your applications first and if you submit multiple applications it just kind of looks bad.. My advise would be to maybe talk to an HR rep at the company first. Do both ER's hire new grads? Many ER's don't, so maybe you'd be more likely to get in with one than the other. I think calling and talking to a nurse recruiter (HR person) will help guide you to which job you are more likely to be able to get without making yourself look desperate by applying to every ED job they have posted.

Good luck!

[SR8811]

56 minutes ago, NurseVoldemort said:

Working at a level 2 vs level 4 won't matter much. Experience in an ED is good regardless. So many trauma centers do things differently, so if you ever decide to transfer to a higher level trauma center they will likely not train you to be on the trauma team right away until you get to know the department first and then they will train you to their process. So experience at a 2 vs a 4 won't make you any more or less marketable.

However, keep in mind that when applying for a job, if it is with the same company the HR department will be seeing your applications first and if you submit multiple applications it just kind of looks bad.. My advise would be to maybe talk to an HR rep at the company first. Do both ER's hire new grads? Many ER's don't, so maybe you'd be more likely to get in with one than the other. I think calling and talking to a nurse recruiter (HR person) will help guide you to which job you are more likely to be able to get without making yourself look desperate by applying to every ED job they have posted.

Good luck!

This is great information thank you. I am being careful of that. Both positions are open to new grads who had their preceptorship in an ED and offer a residency. I have only applied to one ED and was considering the 2nd. I am trying to find the number for their HR but for whatever reason it has been hard to find. Thanks again!

[telern1, BSN, RN]

Congrats on making the jump!

I've only worked in 2 Level I's in my career so far. But in our interview process we do evaluate where a RN has gained their experience before. And in working in a Lev I ER, I know you'll get some very sick patients.

So if you're lucky enough to have a choice between a Level II or IV, I'd pick the II. They're going to see a higher acuity patient than the IV and your experiences will grow faster at the II.

But not knowing the job competition for your market, times may be tough. Good luck!

[PeakRN]

Trauma level is one of my pet peeves when it comes to EDs and medical centers as a whole. I've worked in Level Is and undesignated centers, and currently work in a level IV.

The higher the trauma level the less you will be doing as a bedside nurse. The trauma team that responds to the ED in a level I may be 20 or more people not including the ED. You may have trauma surgeons, trauma residents/fellows, trauma PAs, trauma nurses, ICU attendings, ICU residents/fellows, ICU PAs, ICU nurses, ICU charge nurses, OR nurses, anesthesia attendings, anesthesia residents/fellows, CRNAs, RTs, phlebotomy/Lab, pharmacy, multiple ED nurses, the ED charge nurse, ED EMTs/Paramedics, and so on...

A level III or IV center may have an ED attending, ED RN, ED charge, and nobody else. Or you may have anything in between.

The trauma that a lower level center sees with have more care provided by each person proportionally compared to the high level trauma center (read: less people equals a bigger piece of the pie). Higher level centers are also more likely to require years of experience before you can step into the trauma room than lower level centers.

Trauma volume varies regionally and isn't necessarily correlated to volume. There are level III and IV centers that see significant trauma daily, especially in geographically isolated regions. There are also level I centers that see very little field trauma and rely on transfers to keep up their status. Those transfers also have almost all of their stabilization provided by the sending ED or transport team.

Personally I have seen far more field trauma in my level IV (including many GSWs, stabbings, roll overs, and so on) than when I worked in the level I.

More than anything else the learning opportunity is yours and is what you make of it. Many nurses have worked in level I centers and never left fast track or low acuity medical pods. Many nurses have worked in level III, IV, or undesignated centers and learned a lot about managing complex medical, trauma, and other patients.

Any nurse who assumes that level I experience makes a great nurse... well you know what they say about assuming.

[tridil2000, MSN, RN]

If given the choice for a level 2 or a level 4, I would pick the 2. A level 4 would bore the hell out of me - but, that's me.

[Mebzone05, BSN]

I work at a level 3. I have several friends that work at level 1's. At the level 1's they have a code team, stemi team, stroke team, trauma team etc. My hospital has none of that. We do it all.

[SR8811]

Hey friends!

Thank you all for your comments!

So a little update.. I ended up getting an interview and was offered a position at the level 4 trauma center.

There ended up not being a residency position with the level 2 as I thought there was, so it was never an option at this time.

During the interview they had mentioned they are a level 4 and while that's lower than a local big hospital, that means if something comes in every room could be a trauma room. Of course a lot gets transferred out of this hospital but like I believe someone mentioned above, if you're not the nurse assigned the trauma room at a higher level trauma center, you won't get to be part of it anyway.

I am excited to start! Again, thank you all for the comments!