Trauma ER or Level 3 ER!?!?

Okami_CCRN, BSN, RN · Oct 10, 2008

I work near a Trauma I level center and as far as I know they have never taken new grads. They like RN's to have a few years of previous ER experience and have ACLS and PALS certifications prior to hire.

I would recommend starting at the Level 3 medical center. I would imagine it would be a much nicer learning enviroment since you already work there and the staff knows your strengths and weakness.

CraigBSN02 · Oct 10, 2008

You stated that your goal was to become a flight nurse. If that's the case, the big messy ER is where you'll need to get some experience.

However, that may not be the best place for you. Allow me to explain...

Critical care/flight nursing is an advanced specialty requiring a large knowledge base and repeat exposure/practice. The specialties include critical care (preferably in a SICU or STICU) that *must* include being supremely comfortable with airway and cardiovascular management; and first responder/trauma experience. You need to keep the learning mode going for the next several years in order to get a strong foundation for this career. That being said, academic institutions are usually the best places to obtain that information. However, you need to pay very close attention to the new graduate orientation/preceptorship: does it include ICU time or is it a nuts and bolts this-is-how-the-ER-works orientation? The longer the better with orientation; 18 months is not uncommon and should be considered normal, The more variety of skills, the better nurse you will become. Emergency nursing is something where you need to have a working grasp of all the major disciplines of nursing: adult, pediatric, trauma, L&D, gerontological, cardiovascular, etc.

Sometimes, those "backwoods podunk ERs" can give you the best experience of them all. Working there, you are out there on an island, so to speak, and you have no backup except a airlift to the big boys, but it's YOUR job to treat, stabilize, and transfer the train wreck that just got deposited into your waiting room/EMS bay. You have to be confident and know your stuff. If one of these smaller places can offer a comprehensive internship that you feel is a good fit for you, then take it! You can always get hired at the facility of choice in one year when you are magically anointed as "experienced" by the HR staff.

Bottom line: take a critical care position that will provide the broadest exposure possible, and work your ass off learning every thing you can about critical care nursing. Attend CCRN meetings; join ENA/ACEN; get your EMS licensure and start volunteering on BLS/ALS rigs for ride time. Get certified in CEN, CCRN, CFRN, in addition to the standard ACLS/BLS/PALS. You will need to pay your dues in the form of years of experience before you can even think about applying for a flight nurse position. These coveted positions routinely get 10-20 times the number of applicants for the number of positions available. My friend has interviewed in three places; one position was available at each place and there were nearly 90+ applicants per position.

Hope this helps, and I hope it doesn't scare you too much. Let me know what kind of internship UAB offers and I'll give you my teo-bit opinion. I can say that UAB has quite a good reputation for emergency nursing even all the way out here in the northeast.

Take care,

-Craig J.

RN, BSN and others... :-)

ernrs2b · Oct 10, 2008

if the trauma center offers a preceptorship take it! that's my advice/I started off small in a level 3 and transferred later to a trauma center and was amazed at what the new grads that went through the program know, they will take in to consideration you are a novice and teach according, then you can go to any other ER

Thornbird · Oct 10, 2008

Take the preceptorship if you can. To work in a Trauma Center one usually needs a certification such as CEN or CCRN along with certifications such as ACLS and PALS. Use the level III for experience, also try for ICU experience. Doubtful you can get a job as a new grad in Trauma Center but once you have all your certs, your experience in a lower level ED will help. Critical Care Nursing has a severe shortage due to burnout. It's a tough specialty to learn but you should have no problem later getting a job.

If you have time, you might want to take some EMS courses. That kind of background, especialy if as a paramedic, is considered very helpful. Also gives you a chance to get to know Trauma Center staff for when you go for interview.

Thornbird · Oct 10, 2008

If you want to be a Flight Nurse, Paramedic certification is usually required. There are RN to Paramedic programs since pre-req's are similar.

CraigBSN02 · Oct 11, 2008

If you want to be a Flight Nurse, Paramedic certification is usually required. There are RN to Paramedic programs since pre-req's are similar.

More precisely, you can challenge (sit for the exam) for a paramedic certification as long as you have a BSN and a active RN licensure.

-Craig

RN, BSN, and others... :-)

Thornbird · Oct 11, 2008

More precisely, you can challenge (sit for the exam) for a paramedic certification as long as you have a BSN and a active RN licensure.
-Craig
RN, BSN, and others... :-)

Not in most states, FL is the only one I know of. This rumor for some reason persists. Most states now adhere to the National Registry of Emergency Medical Technicians standards for education, training and licensing of paramedics. This requires paramedic training for paramedics. If an RN is licensed in one of the two or three states that allow RN's to take the exam, the licensee can't get reciprocity in any other state. Also, paramedic exams are both written and practical.