Experience before small town ER?

[MJPN2012]

So, I've been working at a medium sized hospital for one year, on med-surg, but after 5 months I went prn and have worked 1-2 days a months while I finished my BSN. I never have found love for the hospital that I'm at. 1-2 days a month is enough. They are constantly very understaffed and can't keep nurses. The morale and teamwork seem terrible and I don't actually feel like I'm learning much from the crazy workload that only allows me time to follow orders and get my work done. I wish I had the time to actually get to know a patient and provide better care. But at this point, I don't know if it's the hospital, the drive, or med-surg that I dislike more. I need to experience something else to compare. I'm wondering if I would like my small town ER better, for the closer drive and better reputation. It's critical access and they actually only have the ED, until they expand.

My main question is, is my experience enough to prepare me for that position? Should I tough it out and prepare better? I also have a few years of home health experience if that helps me any..

[Bob Loblaw]

Life is short, if you don't like med-surg its time to move on. I work ED, we hire new grads, MED-SURG, travelers, etc. If you want to get to know your PT's, ED might not be place for you. I find it very task and time orientated. In and out, if you fall behind with one PT the rest suffer and the Charge will be on you to pick up the pace. My usually load is 6-8 pts, so 60 minutes in an hour and 6 pt's- they get @ most 10 mins each if equally divided (actually, many get alot less than that in an hour). Hopefully once they get "settled in" I can move onto another. I imagine they have an orientation period so try it, you have nothing to loose and maybe everything to gain.

As far as under-staffing, I'm still looking for a facility that is "right staffed". We also have high turnover, most say they go to Doc offices or walk-ins and say less work, more money. Plus no nights, weekends, holidays, call shifts (when short you can count on a call shift just being another assigned shift till some gets hired and put in rotation)

"from the crazy workload that only allows me time to follow orders and get my work done." Sounds like everyday to me, many times I put in my own orders before a doc even sees them, short staffed also includes providers. We have standard order sets with alot of leeway that we work from and depending on how I triage the PT determines how fast they get seen, so you have to be able to make critical decisions constantly and quickly and be able to live with the results.

[GM2RN]

I would say that it depends on how large that ED is and how many nurses will be working with you when staffing is at its lowest for the shift. You have no ED experience, so if there will be enough staff to make sure you have help when you need it, then go for it. If, however, there would be only 1 or 2 nurses on at a given time as is the case with some small EDs, then I recommend you get some ED experience at a larger hospital first.