Starting out in Trauma

VICEDRN, BSN, RN · Mar 25, 2012

Seems like most facilities require TNCC but you may already have that as an ICU nurse. My Level One Trauma Center requires PALS and ACLS as well though you list those.

My facility requires you to start as an ER nurse and have some experience in ER before they let you get your TNCC and start working in the trauma area. If you were a new grad, a year would be required before they let you take the course. Otherwise, it kind of depends on how you do in the ER and how aggressive you are about pursuing TNCC.

With your background, they are gonna want you on med alerts/critical care areas which makes sense but isn't consistent with your goals.

Added: We rotate through the trauma center as long as you are TNCC qualified. We don't have a dedicated trauma staff.

Altra, BSN, RN · Mar 25, 2012

No dedicated trauma nursing staff in either of the Level I ERs where I've worked. If you are considering the trauma ICU ... your previous experience will be very beneficial. To a certain extent, critical care is critical care. One thing I've repeatedly heard said about TICU vs. MICU is that a far greater percentage of TICU patients actually get better. The flip side of that, however, is the young, unexpected deaths and that is a whole different emotional realm from the MICU scene where it is often about working through a family's denial regarding futility of care.

I totally understand where you are coming from regarding the culture shock with a switch to a small community hospital. It didn't work too well for me either.

Now, if what you meant is that you're considering switching specialties to emergency nursing ... that is a whole different topic.

Dixielee, BSN, RN · Mar 25, 2012

Our trauma center also rotates nurses thru the trauma area. You should expect to begin as an ED nurse and learn the system, the flow, the thought processes of an ED nurse etc. ED nurses process things differently than ICU nurses and once you make the switch you will know what I mean. I wouldn't bother with the CCRN, because a CEN is going to be much more beneficial to you if your plan is ED/trauma.

As an ED nurse you will get to see a little of everything. Don't expect to be involved in a major trauma every day. There is a lot of mundane stuff that comes in that still needs to be handled. There are a number of other life threatening problems such as MI's, CVA's, sepsis, etc that can take every single bit of time and skills you possess.

My facility requires all ED nurses to have ACLS, TNCC, ENPC but PALS is optional. More than 50% of our nurses are CEN's.

Good luck with your decisions. I have worked a number of areas in my career, but I always come back to the ED :)

SWAT RN · Mar 26, 2012

Thank you all for your comments. This is very helpful information. Pretty much reinforced what I kinda already knew which is that I need to start looking for ER jobs, Im sure I will get TNCC if Im in a Level One facility. Been thinking about CEN instead of CCRN. But maybe I will just do both, nothing like an over achiever!

mybrowneyedgirl, BSN, RN · Mar 26, 2012

Most ED's would pay for your certifications, and I cannot imagine and ED that wouldn't hire you on the spot based on your great passed experience and training. Good luck!

Altra, BSN, RN · Mar 27, 2012

Just to be clear ... in the ER you'll have days where you're the trauma nurse ... and days filled with sore throats and ear pain and back pain x 1 year. And even "traumas" aren't all the good stuff -- I've discharged patients 30 minutes after they exited the helicopter.

Good luck to you. :)

BostonTerrierLover, BSN, RN · Mar 27, 2012

I would recommend shadowing a Trauma Nurse!!! That is the way I got into the arena. It's like a ride-along with cops. You will get to see the whole picture come into focus. There is more downtime than I think most people know, so you will have a chance to ask all the questions you want. Whatever you decide to do. . .

Good Luck!

sserrn, BSN · Jun 8, 2012

Actually, the only Level I TC in our region has a dedicated trauma nsg staff; they don't rotate the ER nurses through shock trauma (or vice versa). So some ERs do have literal trauma nurses who only work traumas.

justami · Aug 7, 2012

Hi
Ive been a nurse for 7 years. 6 years in a couple ICUs, most recently 3 years in the MICU at a very large inner city Level One - tons of sepsis, shock, CRRT, Rotoprones, Oscilators... rarely a few GSWs, head traumas, etc. Usually the traumas we took care of were transferred from the TICU because they were in profound shock, multiorgan failure and needed CRRT and/or rotoproning. Ive got plenty of experience working with Residents - I actually enjoy that for the most part and would love to go back to a teaching hospital. As a result of some serious burnout, I left the MICU a few months ago to take a SWAT position at a small community hospital and I HATE IT. The goal was to take a little break (management issues). Turns out I should have probably just taken a couple weeks off. Anyway, now that Im out of the ICU Im finding out I really want to get back to my original plan - trauma nursing. I have no ER experience and very very very very little TICU experience. My question is where do I start? Im pretty sure it varies from one facility to another how the traumas are run. I know some have TICU nurses who go to the traumas while others send their SWAT nurses or ER nurses rotate through. Any seasoned Trauma nurses have some advice for a wannabe? Already have ACLS, PALS. Should I even bother with CCRN? Would ATCN/ATLS help? Thanks.

I get the feeling that what you are actually looking for is more like Medevac nursing,i.e, you go to the scene of the accident and transport the patient via helicopter to the ED.

You should know that even in a level 1 trauma your participation on a daily basis will be limited. First it could take a year before they even let you near a trauma pt, there can be some individuals who have "been there forever" who think it's their domain and are reluctant to let others participate. And also in some teaching hospital level 1 ED's the medical residents do everything, from putting in IV's to foleys and your role is extremely limited.

At any rate, apply for jobs that will take you where you want to go.

PG2018 · Aug 9, 2014

I want to be on a hospital SWAT team!

Of course, I read that as Special Weapons And Tactics.

Here.I.Stand, BSN, RN · Aug 13, 2014

I personally would do ICU vs. ED. I do SICU myself (my hospital's TICU and NeuroICU is the SICU; we get a relatively small number of general surgery/CVTS pts) and full disclosure have never worked ED. Our ED nurses are assigned to the stabilization area, vs. the ICU nurse, but I don't know what the role of the RN vs. the resident looks like.

But based on what a nuthouse our ED waiting room looks like, compared with the number of trauma pts who are admitted to the SICU, the trauma nursing seems to be a very small portion of the ED. Now we're an inner city level 1 TC, and my state borders several states that MAY have a level 2 TC or two, so we see a lot of severely, SEVERELY injured people. We get your typical MVCs, GSWs, stab wounds etc. but also some horrific farming accidents by nature of my geographical location.

But for every shock trauma pt that comes in, there are dozens of others that present to the ED with N/V/D, headaches, sore throats...even a family with head lice. Yes, head lice. At 0100.

I'm sure it is awesome to care for those shock traumas as they emerge from the helicopter, but as an ICU nurse, trauma care is a much larger percentage of what I do. And really, they frequently leave the stabilization area NOT stabilized. :no: They might roll up during a brief window of opportunity, and then we do the massive transfusion, start the drips, etc. to buy them some time to get to the OR. And then we get to combine Nursing 101 with the high-tech and really make these people better. :)