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Discussion

Northern Remote to ED?

Hello!

I recently graduated in May 2016, and am currently working in a northern remote hospital where we do everything from long term care, acute, and emergency. Our emergency room mostly receives simple stuff that could be seen in a doctor's office. About only 10% of the emergs that come in are urgent. My manager told me that this statistic is the same as a regular city hospital, which I don't truly believe. I want to know if this is true? Do you guys receive a lot of simple stuff, or are the stats a little different? The reason I want to know is because I would like to work in the ED in a larger city hospital in the future. Would I be able to handle it?

My manager told me that I should probably start on a surgical floor to develop more of my nursing skills, which is true, but does that mean I wouldn't be accepted into an emergency unit? I am worried that being in a northern remote hospital would make the transition harder because we don't have a lot of equipment and the acuity of care for our patients really depends on what comes in the door. One of my colleague's favourite saying is "If you ask me have I ever seen a patient with ____, I probably have and don't remember."

On a happier note, even if I don't get a position in emerg right away, I am confident I will be able to in the future. I have taken a lot of emergency nursing courses and certifications in preparation for a position in the future.

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    I work in an urban, inner city hospital and we get gunshot wounds, COPD flares, GI bleeding, falls, MVC, burns...

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    That statistic doesn't hold true for my ED, or others I have worked in. Granted I've only worked in higher level trauma centers but non-trauma centers still get sick patients. And only you would be able to tell if you could handle it, if you can critically think on your feet and not get too stressed out in crises then you can definitely handle it. Look for EDs with internship programs, that way you can get extra education/training. And don't ever let anyone talk you out of what you want to do! :)

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    Ehhhh it just depends, I have worked in about 5 ER's. Level 1 Trauma Center, busiest one in my state. Level 2 Trauma center and it was the only trauma center in that state. Small community hospitals as well. It is true that a LOT of the stuff that comes in can be seen in primary care or urgent care centers. But I would be hard pressed to say it's near those numbers your manager gave you. That said I do not think if you are already working in the ER that moving to Surgical before going back to ER (if moving) is what you need to do. The ED is just a different type of nursing and a different world. The thinking is different, the protocols are different, the skills used can be a lot different. When you go to a bigger ED explain to them the stuff you have done and learned and typically saw in your ED and they should be willing to cater your orientation to that.

    While my trauma centers did get all the traumas and that in itself is always exciting, most of your flow of patients even in trauma centers are not going to be trauma patients. They are mostly going to be sick. Can one of the smaller community hospitals I worked at (36 bed ED with 8 hall beds) is where I learned the most. I constantly took care of critically sick patients. I did CPR on average 3-5x a week.

    Big ER's tend to have zones and you rotate zones, if your in trauma that day then you could spend your day getting all trauma patients, or if you're in fast track you could be doing primary care, urgent care stuff. But you get rotated around typically.

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    The ratio of acuity to patient numbers might be the same, but you won't get the wide variety or sheer volume. Your best bet is to be a continual learner, kick ass at your current job, and take every opportunity to proress in your practice.

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