Please advise: trauma center v. non-trauma center

[LG1137]

When it rains, it pours After graduating nursing school in May and passing my NCLEX, I've had the hardest time finding an ED position. This week, I've received two offers. Both are good and I'd like to make an informed decision.

One is with a rural hospital in a cool mountain town of 10,000 residents and not much of a tourist influx. It's a Level IV trauma center. The other is with an urban 40-bed ED, downtown and at the intersection of two interstates, and it is NOT a trauma center (the manager emphasized this to me a few times). The ED is very busy with all other medical cases.

So, my question is particularly about the second offer. What could I be missing by working at a large ED that does not take traumas? Would I ever be hindered when changing jobs? Am I missing out on something that I have to experience? THANK YOU for any insight.

[ERnurse1983Ontario]

The second offer sounds like you would see a variety of cases and be able to gain valuable experience in prioritization, not that you wouldn't get that with the smaller ED but more so with the larger one. A trauma four center still would not see many major traumas to begin with and would most likely ship or redirect traumas to a more acute care center anyways. There is much more to the ED than trauma care. Start at the larger ED and then after putting a year or two in, maybe transition to a larger center. Your skills will be transferable no matter where you go.

[sserrn, BSN]

How can an ER not take any traumas? I guess it's in a state with a poorly developed trauma system? A level IV trauma center may or may not see much trauma, but it will definitely transfer most after stabilizing the pt. I would base my decision on which hospital has a better orientation program. Smaller hospitals often cannot offer the same level of training as larger facilities. How many weeks of orientation will you get at each? What classes are required/offered at each?

[LG1137]

It doesn't take trauma because the only Level I in the state is a mile down the road. This hospital that made the offer is a 500-bed, with cath lab and stroke center, but I guess the university takes all trauma.

Excellent suggestion about the orientation and available training - I will certainly look into immediately, as I don't know exactly what their programs are.

[Lunah, MSN, RN]

Sometimes smaller is better when it comes to EDs and starting out. I started in a freestanding, 15-bed ED. We saw a bucket load of sick-sick folks and also some nasty traumas. Because we didn't have pharmacy, anesthesia, or RT services, we became very skilled and self-sufficient. I have to admit I really enjoyed working per diem in a Level 2 after that -- having a bunch of support services was really nice, having the whole hospital attached -- what a difference! Haha. When it comes down to it, humans are humans and are going to get sick or do dumb things or have accidents, no matter the size of the town, and that the ED is the ED is the ED, no matter where you go. Even in non-trauma-centers, you will see some traumas roll through your front door, usually when least expected. I'd say definitely go with the one that seems to support you better as a new grad in the ED in terms of orientation and education. Good luck!!! :)

[Nurseadam]

non trauma then work per diem at a trauma center after a year or 2...

[hiddencatRN, BSN, RN]

How can an ER not take any traumas? I guess it's in a state with a poorly developed trauma system?

Or it's in an area with a ton of other hospitals that specialize in trauma. In Philadelphia for example there are 4 adult Level I centers and 2 pediatric Level I centers, and a bajillion other hospitals within city limits. Well, maybe not that many, but there are a lot of hospitals of varying sizes within Philly that aren't trauma certified. The non-trauma centers still get walk-in traumas, but everything from EMS goes to a trauma center.

[LG1137]

Thanks for the input everybody - this really helps!

This hospital actually administers the EMS program in the city. EMS brings medical emergencies to the hospital, but the traumas divert to the university.

I'm going to shadow a nurse for 4 hours this afternoon, before the manager wants me to decide whether to accept. Any continued input will be appreciated :)

[Esme12, ASN, BSN, RN]

That is good....shadowing another nurse. That may help. But I would go for the smaller ED you will actually "see" more trauma for when the weather is bad and patients can't be transferred immediately. But the other has a cath lab....hummmmm.

I agree with lunah....orientation program is the key.

[LearningByMistakes]

I would take the level IV trauma center designation out of the equation. Not knowing where it is, or anything about it, my guess is that it's the ONLY hospital in that area and would get the same amount of trauma without the designation (the designation is probably useful only for reimbursement purposes). Just my thought, do with it what you wish.

[NickiLaughs, ADN, BSN, RN]

I think the 40 bed ER at the 500 bed hospital would give you a lot more opportunity. What if you discover your heart isn't in ER? The bigger hospital will have more opportunities for transition than the smaller one. I'll also bed the new grad training program is much more organized at the big hospital with more support. The small hospital you will likely have to become self-sufficient very quickly. You would likely be able to transition to a trauma center after a couple years of ER experience either way. :) Congrats on your two jobs offers!

[VICEDRN, BSN, RN]

I really don't think the fact that the smaller hospital is leveled a four is relevant. It just means they participate in the network.I agree with posters above. I started in a smaller er and felt that I got more experience that way but I then moved to a trauma center. The urban hospital will likely bring sicker people but less autonomy. Up to you...