ER Monopoly

[CGB, BSN, RN, EMT-P]

Over the past year I have been working in a Trauma 1 center. My background is Trauma ICU, paramedics and have several certifications. When I interviewed for the job I made it clear I wanted to advance my career in Trauma. I had already been part of a code team, and helped stabilize Trauma ICU patients. I have seen gunshot wounds, amputation and worse. 

I figured going head on in an Trauma 1 ER would be a challenge and in a lot of ways it is. However despite my experience they recently told me "I may never work the Trauma bays". That was the exact quote from a manager. Instead I am to work patients that are not critical in any way. So basically the job I got was a Tele nurse on steroids. I don't mind doing those patients but what bothers me is there is only a small handful of nurses who are allowed in the trauma bays. 

I just spoke with a coworker who has 24 years as a nurse with half in a Trauma 1 center before this place and they are leaving because they believe the reason we can't get into the Trauma bays is because a handful of nurses will quit if they are not allowed in. Many people see it this way. 

I guess my question is, is this ethical? What can be done?

I spoke with management and I already got an answer to it which was "I may never see the Trauma bays". I was also told that there is some evidence based article that supports their thinking. If anyone can shed light on this I would appreciate it. 

[Emergent, RN]

My advice is to go to a level two or three Trauma Center. You still see all the big traumas. The only big traumas you don't see are the ones that are airlifted immediately to the level one.

The level ones are very elitist. Also they are in big teaching hospitals where Medical Residents and Hot Shots gravitate. I've heard they hog up all the action in those hospitals.

I worked in a level three that saw plenty of gang violence and serious car accidents. You'll see lots of stuff there. I personally don't thrive on traumas. There are plenty of nurses in those hospitals who would rather have a cardiac arrhythmia to deal with. My love was cardiac emergencies. I was glad there were people who wanted to be stuck in a trauma room for hours on end, I found it claustrophobic and tedious.

 

[JKL33]

CGB said:

When I interviewed for the job I made it clear I wanted to advance my career in Trauma.

I understand why you think that's an important detail but unfortunately it's quite possible they could not care less about your career goals.

They have point blank told you not to expect to work the bays; that's what it means when they say you may never see them.

So you have choices. If this is important to you then look elsewhere.

Good luck

[CGB, BSN, RN, EMT-P]

I think my issue is they should have set that at the interview instead of after I got hired and 4 months into working with them. At least I could have made an informed choice.

[kp2016]

CGB said:

I think my issue is they should have set that at the interview instead of after I got hired and 4 months into working with them. At least I could have made an informed choice.

In all honesty and given your back ground, yes they should have told you at the interview that they have a core of staff who do the trauma rooms and short of them leaving you are very unlikely to be assigned there any time this decade.

I'm assuming they didn't want to tell you anything that would lead you to turn down the job as they need skilled staff in all the roles, a little short sighted of them as it turns out. It really is up to you if you want to wait years knowing that it may never happen or start looking for a job. I would say you may want to be more direct in you next interview and straight out ask how the assignments are done and when you can expect to be orientated to the trauma rooms. I've worked in ER's where they made sure to rotate all the staff regularly and others where there was a very clear peaking order and new staff never got anywhere near trauma. 

[delrionurse]

Maybe go to a location where there is less of a pool of MD residents.

[JKL33]

CGB said:

I think my issue is they should have set that at the interview instead of after I got hired and 4 months into working with them. At least I could have made an informed choice.

Of course you are right, but that's why I say they care about their goals (filling a position any way possible) and not yours. ?

[MaxAttack, BSN, RN]

Trauma resus is a specialized skill set so yes it would make sense for a specific group to be trained and certified for that position. I've worked at three level I trauma centers. Two had nurses hired just for trauma resus and the third used specific ER nurses that had additional training.

It can be very competitive so waiting for someone to move or retire isn't unheard of.

That being said, if your manager is telling you you're not getting in that's not a great sign if that's where you're looking to go. I'd talk to the manager, find out why, and then probably look for a new job.

[Music in My Heart]

MaxAttack said:

Trauma resus is a specialized skill set so yes it would make sense for a specific group to be trained and certified for that position.

11 years of Level 1 (adults and peds + burns) and Level 2 for me... TNCC x5, ATCN x2, ENPC x3, CEN, ABLS... and I disagree... trauma really isn't that complicated... large-bore lines, blood products, antibiotics, fast-track to the OR... rapid infuser, a-line set up, cordis, triple-lumen, thoracostomy tubes, EVD, REBOA, whatever...

It is incredibly short-sighted of the facility to rely on a small group of nurses... what's the plan for a legit MCI? what's the plan for a mass exodus? what's the plan for losing half the staff during a pandemic?

Then there's retention and job satisfaction...

 

[MaxAttack, BSN, RN]

Music in My Heart said:

trauma really isn't that complicated

That's one opinion. Anything can be broken down into a series of skills and procedures I suppose.

There are - or should be - contingencies in place but teams are there because the evidence supports them.

Anyways, the core issue for this thread is that there is one at this particular hospital and it doesn't sound like OP is getting on it anytime soon. The rest of it is kind of moot.

[JBMmom, MSN, NP]

It's unfortunate that you ended up in this position after you feel you made your feelings clear in the interview. Unfortunately, I don't think your organization was interested in what they could do for you, only what you can do for them. They saw a well qualified nurse that wanted to work for them, period. They heard or didn't hear (who knows), but didn't take in to account your wishes for career goals and advancement. They weren't going to advertise it to you quickly because you were a good nurse for them wherever you were. I think they were banking on you staying just because you're already getting comfortable and potentially like your work and coworkers. It's not right, but it's where you are. You're the only one that knows whether leaving or staying is your best option. Good luck with whatever you decide!

[mdsRN2005, ASN, BSN, RN]

Emergent said:

My advice is to go to a level two or three Trauma Center. You still see all the big traumas. The only big traumas you don't see are the ones that are airlifted immediately to the level one.

Agreed!  I did level 3 for many years and some days we had nothing but trauma.  And were glad for all the help we could get, as we were often short staffed.  I'd add a level 3 that is the only facility in a small to medium town will see everything (even if just long enough to stabilize and ship) vs a level 3 or even 2 in a town with several hospitals may not get as much depending on how the ambulances are routed.  
 

 I personally always preferred cardiac emergencies like heart attack/stroke/etc.  So I'd often take the critical care rooms while another nurse that loved trauma would cover the trauma bays.  Meanwhile we had an older nurse that only wanted triage.  We all hated it so we were glad to give it up!  (We'd each take days out there when she was off or we worked overtime on a different shift so our triage skills wouldn't rust).  This is another perk of a midsize ER, they're more likely to accommodate nurses working out these kind of trade off deals.  

Regardless it sounds like you're going to have to either adjust your expectations or go elsewhere.  Sorry you're in such a tough position.  Let us know how it ends up.  Good luck!