Level 1 vs Community ER

The excitement of trauma wears off after a while. A community ER will give you enough variety to make it interesting.

You still get trauma in community ERs, and you'll have to try to keep them stable until you can get them the heck out of there. Seems to be lots of MIs too, which can keep you on your toes.

But in the regular ER you could very well get bored with the numerous "I've had this hip pain for a year, nothing's changed but I think somebody should see it today. And lots of flu, colds, work notes, I want my daughter checked to see if she's still a virgin." etc.

Never the same day twice.

If you are new to ER, I would recommend doing Level 1 first. In level 1 they are usually more teaching focussed and have the staff and support people available to help you out. I believe that community ER is more difficult than level 1. I do work in a Level 1 trauma center and I love it, but I also have people doing my EKG's and breathing treatments for me etc. The smaller community hospitals do not have the same resources and not to mention that there are less docs and staff altogether if something goes wrong, or you get a really sick patient that you are trying to stabilize for transfer. I have been working Level 1 for a year now and am actually thinking about doing some per diem at a community hospital to try and learn more.

I started off in a Lvl 1 a year ago, and (as the above poster said) they had the resources to help me and help me learn. I went through a 3 month course, and had a 6 month preceptorship. While we get the "bad stuff" it is incredibly comforting to know that within 5 minutes of a "HELP" you can have trauma staff, cardiologists, RT, anesthesia, peds, etc etc etc in your room. And just because you go to work at a community ED doesn't mean you dont' get the "bad stuff." You just get it without warning and then have to get it the heck out of there (to me :)).

Good luck with your decision!

Having worked in both level 1 and the community ER setting, i have to say that the community ER experience was the most challenging. You do not have a ton of resources that the level 1 and 2 centers have and yet you get the same type stuff as far as trauma is concerned. The community Er will give you a chance to appreciate stabilizing the airway and sorry just couldn't get to the femur fracture even though it looks really bad. You just can't appreciate it the same if you have never been the only nurse working a low bad sick trauma, you see in the community setting there are not as many nurses working and chances are if you are taking care of a trauma there may be other victims needing stabilization too. Your cohorts did not abandon you but they are with their own sick patient.

Working in a trauma center is great fun but alot of your job is babysitting the residents that get left behind since the chief is back down stairs working another trauma, now you are left you decided what to do if the patient crashes, chances are the residents are not going to catch it, you are. Your community ER experience will prepare you for that since often times while you are in CT with your patient it will be you and the CT tech.

By the way, trauma centers get there share of the bull crap too, welcome to the world of emergency nursing!!!