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ENP or Emergency Physician?

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Hello,

I'm 25, a man, and changing careers into nursing. I'll start an ADN program in the fall and plan to slide right into a completion program thereafter for my BSN. I plan to tech in the ED or CCU all throughout school. When all is said and done, I'll be 29 with a BSN. My goal is to eventually become an NP in the ED, but I'm worried about how much autonomy the ENP has. I have yet to experience level1 trauma and that's a subspecialty I'd like to learn more about.

I did poorly in my undergrad (cGPA 3.3) and do not have to time/finances to do a post-bacc to try to get into med school. Plus, I'm not really sure I'd even want to become a physician. The problem is that I'm starting to second guess myself. I'm wondering if when I'm an ENP, I'll be allowed to perform procedures and be somewhat independent and not have to constantly feed the Dr's ego. I want to be actively involved in the severe cases in the ED and not just the bystander or supporting role. Do any of you know ENPs that have fullfilling careers in the ED? I know I'll want to pursue NP, because I need the analytical/diagnostic side of healthcare, I can't feel like I'm just a soldier and not making some critical decisions.

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Trust me, even as an RN you will be making plenty of critical decisions. Vast majority of the time I already know what the patient's diagnosis will be before my provider even sees the patient. Residents and brand new PAs often ask the RNs what they should be doing. Attending is doing a procedure with the resident during a code(or trauma), guess who's running said code in the meantime?

Guess who notes the first changes in patient condition? It's typically either the nurse or the tech. Wanna take a guess how many times I've told a provider they need to go see a patient more or less immediately? Often times without the quick thinking and decision making of a nurse or tech, regardless of the providers actions the patient would still die or have a bad outcome.

Be a Charge Nurse for a day after you've got some experience under your belt. You make tons of decisions that impact life and death. Should to new grad that is 3 days off orientation really get a patient with stroke like symptoms when they're already have a hard time keeping up with their two ESI-4's and a septic patient. Or should you give it to the nurse that's been there for 5 years with a STEMI that'll be rolling out the door in the next 5-10 minutes?

If you work in an ED at all, you'll make critical decisions and contributions everyday.

Edited by Bobjohnny
grammatical error

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Do you plan on getting the np specialty NP? As far as I know there is one in Georgia for emergency but that's about all. Just curious

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I'm sure opportunities will vary some with location; but I'll tell you what I learned in my locale. I spoke with two of the attendings I had worked with in the ER for a few years. They said they'd be very happy to have me as an NP; but they made it clear that all the cases that interest me most and always have - the cardiacs, significant traumas, and the like - would always go to the MDs. The NP role, as they see it, is going to be with the urgent care cases and the mild-to-moderate ER cases, depending on how busy the MDs are. The only way for me to work the full range of ER cases would be as an MD or DO. The story may be different where you hope to eventually work; but that's the case in the all the decent ERs within an hour's drive of my home.

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In EDs I've spent a lot of time in in two states (NM/TX) that's the way it works too.

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Do you plan on getting the np specialty NP? As far as I know there is one in Georgia for emergency but that's about all. Just curious

If i do choose the NP role, I would go for an Emergency specialty. I know of Emory, Vanderbilt, Loyola, and I think Northshore (Chicago) has one too. I found this site and it gave me a glimpse of some of the procedures an ENP might be allowed to do: Trauma Nurse Practitioner - Training & Education - Trauma, Critical Care, and Burns - Division of Surgery, UCSD

I appreciate all the feedback and I definitely agree with you guys. I'm sure the most intense/interesting cases will be swiped up by the MDs/DOs, and if it's a teaching hospital, all the residents and students will get to assist ahead of me. As for now, I just want to get my BSN and be an ER nurse. If after a few years I find myself craving more of a provider role, maybe I'll consider going back to school for NP or DO.

Any of you guys work level 1 trauma? How much can an RN do in that setting? I've heard that trauma units will have a special trauma team that is dedicated to responding to incoming cases, but I'm unsure of the specific an RN would play during a GSW or full code.

I've never experience level1 and who knows, level 2 might just be all the crazy I can take anyways. I'm excited to be pursuing nursing and I'm dead set on ER only. I transport now and pretty much all of the floors and units are boring except for the ED and CCU.

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Emergency/acute care NP can do quite a bit esp if you're working life flight.

I still ill want to work in the Ed when Im finished.

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I work in a Level 2 trauma 32 bed ED. I graduated last May and started ED straight out of nursing school and I absolutely love it! As a nurse I've had a lot of autonomy but also have the back up of the MD/DO right at hand if I need them. I think your best bet is to get through nursing school, land an ED position and see for yourself which one you'd rather see yourself doing. I've thought about going back to school. If I do, it will be for an MD/DO in ER medicine. But for now, I'm satisfied being an RN and I'm loving the experience I'm getting and the cases I've been able to work even as a new grad. Focus on your studies, stand out in clinicals, always be willing to help out and be a team player and you'll have no problems in an ED.

Good luck!

I'm not telling you it's going to be easy, I'm telling you it's going to be worth it.

Author: Art Williams

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Emergency/acute care NP can do quite a bit esp if you're working life flight.

I don't know where you get that idea.

Actually, many (probably most) flight programs have no provision for an NP working a more advanced or expanded scope than the rest of the flight nurses. The broad exception to that observation is that many NICU transport programs use NPs to good advantage. If someone wants to work as an NP on an adult program, they'll have to look around for a program that will allow them to work to the same scope that they would in-house. Again, it isn't all that common. I worked under two Chief Flight Nurses who were ACNPs. Their knowledge and skills were certainly a benefit to us; but there was no formal arrangement to define their job in-flight as any more than a flight nurse. They did come prepared to do some skills the rest of us didn't do; but it was more ad hoc. The biggest advantage we got out of them was their knowledge/education, more than actual skill performance. Based on my general experience, that is more often the case in flight programs across the US. YMMV, of course.

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I trained in a level 1 trauma and our NP's are only in fast track or diagnostic/ clinical decision units. Our trauma unit is run by ERP or trauma team when called. It's a teaching hospital too so 99% of the time it's managed by residents supervised by ERP.

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In the hospitals I've worked in it has depended on the experience and volume of pts seen. I've seen an super experienced NP at a high volume level 2 trauma place chest tubes, intubate and manage critical care pts. This same NP does fastrack (pelvic exams, I & Ds, diagnose UTIs, etc) at a low volume small non trauma ED. I've seen trauma nps. They help the trauma docs manage the pts and often often are involved in many of their procedures.

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It depends on the level of trust you have with your ED physician and your skills/experiences. It also depends on who you work for. I've worked out in a rural hospital where the midlevels could pretty much see and do everything the physician was. I've also heard of rural areas having EDs run by midlevels. I've worked in large urban hospitals where the midlevels only saw level 4-5, and rarely a level 3. Again, it just depends.

I'm currently an ER RN going to FNP school, and have been approached to join the ER practice after I graduated and it was explained to me there was different levels of functioning of the midlevel depending on your experience and comfort (both yours and the physician).

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