Job in Trauma 2 ER vs. Trauma 1 ER

[PacoUSA, BSN, RN]

I'm considering a transition to the ER after 2 years of med/tele. I work at a level 1 trauma hospital, of which the ER is as well. However, the dynamics and personnel at this hospital and the ER are such that I am not inclined to request transfer to this ER and want to leave this hospital altogether. Additionally, other trauma 1 hospitals where I would like to work require ER experience that I do not have yet. I have started considering applications to trauma 2 level ERs (qualifications more akin to what I have now) but am concerned that it will preclude me later on from applying to trauma 1 ERs. Should I be concerned? Also, I would like to accept some travel assignments later on after a few years as an ER nurse and am concerned that working at a trauma 2 hospital will be not enough experience. Will getting CEN certification after 2 years at a Level 2 ER trump the lack of experience at a level 1? Thoughts?

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[Emergent, RN]

A level 2 hospital you will see plenty of big traumas! I work at a level 3 and we deal with big traumas since level 3s are a the highest level we have in our area. We don't have a neurosurgeon on call, therefore cannot be a level 2. But, those patients come to us and we deal with the inital trauma, then transfer out by air to Harborview.

It all depends on where you live. I know I did agency at an ER over by Harborview in Seattle. They don't get traumas, as a rule, since they are in the same neighborhood as Harborview. Yet, I work at a hospital that gets plenty of traumas, even though we only are rated level 3.

[Lunah, MSN, RN]

I agree with Emergent. Before I joined the Army I worked per diem at a big Level 2. It received traumas by helo and was the go-to trauma center for the area. You'll likely get great exposure and experience. And don't discount what rolls in the front door, too. I've seen some crazy stuff come in via triage, even in a freestanding ED. Good luck in getting to the ED!

[KevDNYC]

Hey Paco,

I think a Level 2 would be sufficient with a CEN after a year or two. Level 2's receive everything under the sun. I've worked in an ER in the middle of the South Bronx for a couple of years. It's very demanding, but I enjoy the hell out of it. Be ready for the ER experience though, as it has the one of the highest and fastest turnover rates out of any unit!

[That Guy, BSN, RN, EMT-B]

I work in a regional Level 2. Best part...no residents to hog all the traumas.

[PacoUSA, BSN, RN]

Thanks for your feedback, everyone! Emergency nursing is only one of several specialties I am interested in pursuing. But if I do end up pursuing emergency nursing, I wanted to know what the right direction would be. I hear good things about the trauma 2 ER that I am looking at (and some bad things) but I also hear the same of the ER in my trauma 1 hospital. So I guess its kind of a wash?

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[PMFB-RN, RN]

The main difference between Level I & Level II is, level I has neuro suregery in house, Level II has them on call. Before accepting a job in any trama center's ER find out if the ER nurses staff the tramas. In some hospitals the ER staff are not part of the trama responce team. In our hospital it is an SICU RN who is the trama RN and the ER RN mostly runs to get things and records VS. Some other hospitals are like this as well. Check first. We have had a number of nurses who come to work in our ER and be very disapointed that the bigger the trauma, the less likely they are to even enter the room.

[sandseaandstone]

I've worked In a level one trauma ER, and then eventually did agency for ERs. In my opinion, I liked the level one better because when stuff went down you could page a trauma code and everyone was there ( for example: brain bleed- neurosurgeon is called in and does a burr hole) VS. working at a level III and having to sit on that patient and ship that patient who might not get the same treatment for a period of time. I would suggest applying to the level one and jump in if it's where your heart is. Good Luck!!

I jumped to a level 1 ER after 2 years at a rural critical-access ER (level none, I call it) along with about 8 months per diem at a level 4 ER.

All ERs, even the tiny ones, provide experience.

That said, the jump entailed a STEEP learning curve.

[PMFB-RN, RN]

I jumped to a level 1 ER after 2 years at a rural critical-access ER (level none, I call it) along with about 8 months per diem at a level 4 ER.

All ERs, even the tiny ones, provide experience.

That said, the jump entailed a STEEP learning curve.

I am unable to notice an difference between level I and level II. At the level II when a neuro trauma comes in the call in the neuro suregon, meanwhile in the in house neuro PA or NP handels the imaging and pre-op. The MD comes in and goes to the OR. I don't even notice a difference between door to OR time for neuro trama patients. Everything else is the same.

[1fastRN]

I am unable to notice an difference between level I and level II. At the level II when a neuro trauma comes in the call in the neuro suregon, meanwhile in the in house neuro PA or NP handels the imaging and pre-op. The MD comes in and goes to the OR. I don't even notice a difference between door to OR time for neuro trama patients. Everything else is the same.

Second this. I work in a level 2 and we are the go to hospital in the area. Nothing gets transferred out. We actually get all the transfers... I think the main difference is credentials like how you mentioned on call vs on staff. We get the worst of the worst and we deal with it all. The closest level one is a good distance anyway so it's all logistics. There's nothing our ETD can't handle. We have a very high census as well. Great experience for sure!

A lot of our "Level 1" cases come from other hospitals after the preliminary workup is done.

Even some gnarly neuro stuff often starts at another facility because EMS is just trying to get the patient out of their rig alive. Once they're tubed, have a central line, and have all the drips running, they do critical-care transport over to us.

The one thing we get exclusively are the burns because we're the regional burn center... of course, they don't spend much time with us in the ED... get 'em up to the burn unit ASAP.