Trauma and ED nursing

  1. Hey all!

    Im currently an ER nurse coming up on 2 years in ED. My current hospital is not a trauma center and other than stroke has no other specialties. I love my job but really want the specialities and increased trauma. I have looked around my home state (Maryland) and the only real opportunities exist in level 2 and level 3 trauma centers. So I'm asking, what's the difference in what you see and is there a large difference in a general ED and a hospital with a trauma center?
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  2. Visit ERnurse_casey profile page

    About ERnurse_casey, ADN, BSN, RN, EMT-B

    Joined: Mar '18; Posts: 5; Likes: 9

    8 Comments

  3. by   Wuzzie
    Trauma Center Levels Explained - American Trauma Society

    You will get a lot of good experience at a Level 2 which is not so much different than a Level 1 at the emergency room level. A level 3 could be okay if it's a high volume ED or in a very rural setting but they usually don't keep trauma patients past the initial resuscitation. I have worked in centers from Level 1-3. At the level three hospital (which was a medium sized suburban hospital with an ADC in the ED of 360) we frequently got trauma arrests or bad traumas if the weather had closed in and the helicopters weren't flying so I wouldn't rule them out.

    Level 4=our staff has ACLS and some may have taken TNCC
    Level 5= we have bandaids

    Okay, I'm kidding but anything lower than a 3 won't provide the frequency of trauma care that would provide you the best experience.

    If you really want trauma you need to get your foot in the door at U of M's Shock Trauma Hospital.
  4. by   ERnurse_casey
    Im trying to! They only take ICU experience and i havent been able to stomach ICU long enough to stay 3 to 5 years. I really like the concepts of ICU and picked up on it quickly when i worked in ICU but i felt like nothing i was doing made a difference.
  5. by   Wuzzie
    Quote from ERnurse_casey
    Im trying to! They only take ICU experience and i havent been able to stomach ICU long enough to stay 3 to 5 years. I really like the concepts of ICU and picked up on it quickly when i worked in ICU but i felt like nothing i was doing made a difference.
    How bad do you want to work at Shock Trauma?
  6. by   ERnurse_casey
    Quote from Wuzzie
    How bad do you want to work at Shock Trauma?
    Its where I want to be, always where I've wanted to be
  7. by   PeakRN
    There is more to how a hosptial receives and treats trauma than just their trauma level. How many trauma centers are in the area, how much trauma is in the area, what the trauma environment is (highways, rural, urban, costal, et cetera), and relationships with EMS can all play a bigger role than what the trauma level is.

    Keep in mind that all trauma centers must have ATLS trained physicians and trauma trained nurses. How hospitals conform to this can vary, I have seen level 1 and 2 trauma centers who only have TNCC as a requirement for nurses that work the trauma pod which is a small minority of the ED staff. Virtually all of the difference in trauma levels is what happens after the ED, if you are in a "low" level trauma center but the facility is alone in a rural setting they may see more trauma than most urban hospitals, but they will just have to transfer after the patient has been stabilized.

    I would also be cautious of hospitals that purport high numbers of trauma cases, these are often inflated with transfers or cases that are of relativity low acuity. Very large hospitals may have EDs with one hundred or more rooms, so even if they get a fair number of traumas you also should consider how often you will actually be participating in trauma care.

    I have worked at Level I, II, and IV centers (the latter of which being more of a formality so that we could keep our trial/specialty patients if they were involved in trauma). The most trauma I ever saw was at the level II, but that was because there were relatively few trauma hospitals, EMS loved us, we were the closest facility to almost all of the regional highway, had a good reputation with the community (compared to the county hospital), and most importantly I could work in the trauma pod as much as I wanted (a lot of the nurses who worked there hated trauma). When I was at the level I there were 2 field traumas that I received after working there for over 2 years.

    Long rant short... make sure your tour the department and actually talk to the staff nurses before you work somewhere. Reputation and trauma level don't necessarily mean a whole lot when it comes to the actual patients you receive.
  8. by   Wuzzie
    Quote from ERnurse_casey
    Its where I want to be, always where I've wanted to be
    Then man up and get the ICU experience or find a way to get your foot in the door and amaze them no matter what unit you work on.
  9. by   Pixie.RN
    How close are you to DC? What about MedStar or GWU? Both are ACS verified Level 1.
  10. by   Bri_guy_bri
    Quote from PeakRN
    There is more to how a hosptial receives and treats trauma than just their trauma level. How many trauma centers are in the area, how much trauma is in the area, what the trauma environment is (highways, rural, urban, costal, et cetera), and relationships with EMS can all play a bigger role than what the trauma level is.
    Heed this info. I work in the NYC suburbs at a level 1 trauma center. Id say we average 2-4 traumas in a 24hr period. We are, however in a saturated market, with multiple hospitals all very close to each other. One thing that PeakRN should have also included is who the population is. Our hospital is surrounded by an affluent older population, making a large majority of our traumas geriatrics who have traumatic falls.

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