Transfer to the ER?

SteveNNP, MSN, NP · Aug 13, 2008

What do you see yourself doing as an FNP? Peds? Cardiology? Primary care?

The ER will definitely improve assessment/critical thinking skills, etc, but depending on your plans after graduation, it may be more beneficial to stay... JMHO.

Trauma Columnist · Aug 13, 2008

Agree with Steve - what are your goals? If it is to work in ER/Urgent Care setting, go for it. Otherwise, with the stress of school, probably not a great time to change jobs.

My RN experience is 10 years level one trauma center, 1 year in ICU and 1 year med-surg. Absolutely loved the ER.

Joan Z · Aug 13, 2008

Actually, it might be a good thing to get some experience with other ages and different types of problems. My RN experience was mostly a CICU, some distant ER work. I did part of my clinicals with a FNP in an ED setting. I loved that time, really helped for skills that I didn't get a lot of in school or in the primary care setting (suturing, reducing shoulder dislocation, etc).

However, your focus as FNP will be primary care. There is a real difference between the rush of being the ED RN and the midlevel in training. It was hard for me since I wanted to jump on the big stuff instead of the walk-ins with strep throats... Like both Steve and Trauma point out, depends on your interest.

jlcole45 · Aug 13, 2008

To be honest I'm not sure yet what I want to do with the FNP - other than advanced practice. That's why I choose it over ANP. I want to be flexible as we are not moving out of the area. I will tell you that I would be more likely to accept a acute care job over an office job, simply based on my personality. We have a large hospital here and there are opportunities in house for FNP's. In addition, there are several out lying small hospitals who use FNP's as their mid level practitioners in the ED.

I have 20 years experience. I was a ED junkie from day one - straight out of school to a level one trauma center, got my EMT did all the CE classes I could, got my CEN, flew for a year with a rescue/transport helicopter. After working ED for years I found that I wanted to learn more about critical care and transferred to ICU and have spent the last half of my career working with adults and mostly with surgical hearts/lungs.

Currently working on a progressive care unit - 1 day po hearts and fresh lungs. We have lots of chest tubes, some drips, epidurals, no vents. I took this position because at the time I was looking for day, weekend shift and it fit the bill. Now I am ready to stretch my wings again.

I've got two offers so far in EDs in outlying hospitals - one is a night shift in a nice newly renovated ED, 25 beds, 6 fast track, 4:1 ratio, nice space, everyone actually has their on work space with a computer, 1 doc and 1 pa during busy times, but it is 80 miles round trip and they are not offering the great of pay. The second offer is in a 10 bed ED, 1 doc, 1 FNP during the busy times, the nurses there really like their docs because they teach them, no fast track, 2-3 nurse in the back, older ED (they don't even ave a med pyxis) but its only 20 miles from home and it is 11a - 11p shift, the Ed supervisor promised she could be flexible with the schedule related to school, and they are offering the best base pay so far.

I have a third interview tomorrow in the ED of my current employer. It is the largest ED, level 2 trauma and regional med center. This a night shift position but the reputation is not so good - nurses are more aggressive and cut throat, etc ... but this is where one could see some interesting cases. Down side is that I would actually take a bit of a pay cut and it's night shift. The upside would be I could stay with my current employer and not have to change retirement, benefits and I build tenure. That is if I get an offer.

As far as the stress and change goes .... I thrive on it.

Trauma Columnist · Aug 14, 2008

I think you have answered your own question Janet - sounds like the ER would be a good fit for you. I second the concern about the extended commute. With gas prices plus just the amount of time you would spend on the road, it would make more sense to go with one of the smaller, closer to home ERs. Good luck.

BTW - I'm taking a part time job in a community ER as an APN and I noticed that the ENA has several position papers about APNs in the ER. Might give you some more ideas too.

jlcole45 · Aug 18, 2008

Trauma RN,

Thanks. I interviewed last week for the ER in the hospital I currently work in, and I am hopeful. If offered the position I will take over the others, because of it's size and I can stay with my current employer.

I know they called my current NM last Friday because she approached me at the desk and asked me in front of everyone "Are you changing jobs?" Perhaps I should have prepared her for the reference check. One never knows in these situations if you should show your hand or not.

My current NM is pretty good but she lacks tack at times and has trouble keeping staff. It's one of those really tough floors that chews up and spits out new grads like crazy. Demanding CV surgeons, critically ill patients, with lots of tubes, wires, and drips.

All I can say is she better not have said one negative thing about me - because it would be an out right lie and obvious attempt to keep me. I don't mean to sound full of myself, but I know that I am a good employee and nurse. The NM in the ER herself said she thought I would be a good fit, so if I am not offered the position and I found out it because of my current NM then I will quit and take the ER job that's a bit further away.

jlcole45 · Aug 18, 2008

Thanks also for the article tip. I will go look them up.

Trauma Columnist · Aug 18, 2008

Hope you get the job - let us know.