ER Monopoly

[CGB]

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]

mdsRN2005 said:

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! 

I agree with you. In a big city, the big traumas go straight to the Level One. I worked in a smaller city, and the Level One was quite a distance away. The flight crew arrived with an ambulance crew who transported them from the airport. They went by fixed wing over the mountains to Seattle.

 By the time the patient gets to a level one, he is sedated and intubated, and in the hands of the flight crew. All the heavy lifting has been done. 

In Washington state where I live, there is only one Level One, Harborview, which of course is in Seattle. Harborview also services Alaska and Montana and Idaho. So as you can imagine, other hospitals have to be capable of stabilizing and packaging for transport. 

 

[Medic2RN72, BSN, RN, EMT-P]

Go to a level 3 trauma center or even a CAH. Level 1s are overrated. There is a pecking order. Drive YOUR career, don't let someone else steer.