ED Experience: Where To Start?

[PacoUSA, BSN, RN]

I have ZERO emergency department experience, but am thinking of entering that specialty after I decide that I am ready to transition from several years in med-surg/cardiac/telemetry. Ideally, I'd like to start getting my ED experience at a Level I trauma center but most of them offer jobs that require at least a year of ED experience. However, I have seen some Level 2 facilities offering fellowships for nurses that want to transition to ED from another specialty.

I was wondering whether starting in such a fellowship would be ideal to start out. I guess what I am asking is: by starting out in a fellowship at a level 2 facility, would I forever be stuck only working at level 2 facilities or will I be eventually competitive enough for jobs at a level 1 with the right experience (of which I'm thinking, after 2 years at the level 2 facility and CEN certification)?

Thanks for all replies!

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[medic978]

I don't think that you would be stuck in a level 2 trauma center. Not that a level 2 is a bad place to be. I work at a level 2 and there is very little we have to ship out I think that if you have a good background you should be ok with the transition. I really like the er I worked a cardiac Tele floor for a few months but it just wasn't me. Just be ready for the craziness and take everything as a learning experience.

[ERGirl83]

I think a fellowship sounds like a great place to start. Typically, fellowships and residencies provide additional instruction outside of the traditional 6-12 week orientation period. This kind of additional knowledge can do nothing but help you, and make you a better ED nurse.

Working in a facility with a less acute trauma accreditation doesn't pigeonhole you forever, and in some cases can even help. I started my nursing career in a Level 4 trauma center, which is to say we don't see much trauma. After 1.5 years, I just accepted a job in a Level 1 trauma center. The thing is, at a "lower level" facility, you often don't have as much support staff, which means you get to see, and do, more on your own. For example, had I started out at the local Level 2 trauma center, techs would have started all of my IV's and foleys, all critical patients and trauma patients were moved to trauma bays and new nurses couldn't care for those patients for at least 1 year (typically more like 2-3). But, at the Level 4 facility where I worked, we had no techs, or even housekeeping, and for many hours a day, only 2 RN's on at a time. Which meant that even though we didn't get a lot of trauma, when we did, it was all hands on deck. Meaning I was able to participate in the care and treatment of critical patients from day one. It was a baptism by fire, but I learned so much more that way. For example, recently we admitted a STEMI right before I got off shift. I accompanied the patient up to the cath lab, and they were short handed, so I stuck around and helped up there. The pt coded, and it was all hands on deck. It was an incredible experience, I learned a ton, and had a blast, and would definitely consider working there in the future. It's also an experience I would never get in a larger facility.

I say take any ED position you are offered, and if you're offered one with extra instruction like a fellowship or residency, then all the better. The only downside of the facility I just left was the lack of additional education, which started to feel like a real problem, and is a huge benefit of the facility I'm going to. So, if I can go from a Level 4 to a Level 1 in less than 2 years, you will definitely be able to go from a Level 2 to a level 1.

Also, I'm not sure if you've ever worked at a Level 2 trauma center, but it isn't exactly a trumped up instacare. Before I became a nurse, I was a tech at a Level 2 trauma center, and we saw just about everything. Pediatric neurosurgery coverage was the only thing preventing us from being a Level 1, and that was pretty much the only thing we shipped, well, that and burns, which didn't interest me anyway. I saw just about anything and everything you can imagine. I think you might be underestimating the kind of experience you can get in a Level 2 center.

Also, don't kid yourself either, even those fancy Level 1 trauma centers have their fair share of frequent non-sick patients demanding to be treated like they are at the Ritz, and your run of the mill abdominal pains. It's not all trauma all the time. That's just TV talk.

[PacoUSA, BSN, RN]

Thanks for all your advice. I feel better pursuing something at a L2 now if they will have me. Both my experiences so far have been at L1 university centers so not sure how I would feel going somewhere that's more community. I would still love to be in a teaching environment. I just figured I might miss out on major stuff but sounds like that would be minimal, and nice to know I can always go to L1 later.

[ColoradoED_RN]

Take whatever you can get. I worked tele for a year before landing a position in an ED, which is a Level 2. I can promise you won't be missing out on much! Good luck!

[NurseOnAMotorcycle, ASN, RN]

I work at a level 2 trauma center. Where I am the nurses who I hang out with from the level one trauma center tell me that they don't really get to do as much as I do because of all the med students and residents practicing their skills on the patients. Some of them have transferred over to ours.