Autry

ER - Clay County FL - night shift 1:4 on paper, 1:5 not abnormal and the most I have had is 1:10 because we were holding admits. We have one ER tech in the waiting room and it is mandatory they remain there and one tech in the regular ED - no other ancillary staff except 1 secretary.

Pretty sure if I tried to ask any of my ER nurses to take more than 5 patients... they would look at me like I needed the psych bed. I work in a 50 bed ED in N FL and we have typically 5:1 with very little ancillary assistance. (we have approximatly 1:10 tech ratio), but they are typically busy transporting admits upstairs until we run out of inpatient beds. When I work at a 31 bed ED in S. Texas, we typically had between 6:1 or 8:1 dependent on staffing. I never really felt like I couldn't keep up, but the charting was 'by exception' and we had more ancillary help. (ie: Phlebotomist in ED, more ACPs). I'd be curious to know how much ancillary staff you have to assist you with the higher ratios, and what their capabilities are.. ie: do your ACPs start foleys, NGT, INTs? Do you have techs who can triage, start IV's, cast/splint, etc?

I agree with most of what has already been posted, but one thing I didn't see, that has made the biggest influence on my time in the ER, has been the ability to work as part of a team. You can be a nurse anywhere. You can get the skills you need to use for any situation and the book knowledge from so many sources, but the only place you can really learn to be a successful ER nurse is in the ER. My first shift in the ER (after working 3 years on a step-down telemetry unit), my unit mentor asked me what the biggest difference was that I had noticed so far... and without hesitation, I replied "you guys help each other!". Don't get me wrong, I had a wonderful staff of folks to work with on the telemetry unit and still remain friends with many of them today, but the team-work in the ER is completely different from any other unit anywhere. It's one thing to get assistance moving or changing a patient, or having someone there to help you with things you don't understand to begin with, but it's totally different when you get the cardiac red, the stroke alert, or the respiratory distress and all of a sudden, there are people helping you that you may or may not have even realized were working that shift. Before long, you've got your patient stabilized and waiting for transport and you're in the next room helping someone else with their patient. That team-work is probably the most important thing in the ER and probably the most taken-for-granted. Since I've been a nurse-leader with my department, I've seen more than one new grad not figure out how to be a 'team player' even with coaching, and see them treading water for their first several months before they realize that the expectation is not that you're able to handle each crisis on your own, but that you're part of the team that can resolve the crisis and move on to the next. The ones who don't make that realization or cannot make the connection are the ones we gently persuade to find a different department where they can be more successful. Some of them have been excellent nurses, but in order to be a "good" ER nurse, you have to understand that your team is one of the most important tools in your orificenal. (especially to help with those other skills.. until you've become a master at most of them yourself - the things mentioned by my colleagues in previous posts.. IV starts, NGT placement, etc.) Good luck to you in the future! I hope you do well and find a great team for yourself!

"I have an opportunity to do an RN to MSN program. I would be able to do a wound care based capstone and the networking would be prime for getting into a wound care specialty." You're answering your own question with this statement. If wound care is what you want to do, then why would you question an opportunity that provides you with exactly what you're looking for? There will never be a shortage of wounds, no matter where you want to work, and with the specialization, certifications and contacts you can make in an MSN program I wouldn't question that decision at all. If you're not sure it's what you want to do, what benefit would the BSN have over an MSN? (I currently cannot think of any benefit to having the BSN vs MSN... as they are just levels of education, not levels of experience.) Best of luck to you in this decision!