Which ER is best fit?

Ciale · Apr 4, 2012

ER tech of one year here...go to the 'burbs. Less risk of early burn out. Also, did you tour both departments? See if you can observe on a trauma day. It will give you a chance to see what kind of leadership is on staff and how they are during stressful situations. Mgmt/leadership makes a huge difference. Compare the nurse/patient ratio. Do residents run the show or are all the docs attending? In my neck of woods, the inner city hospitals are "teaching" and so arrogant residents who don't know what they're doing call the shots as opposed to the suburb hospital that doesn't have any residents on board, only experienced trauma docs. HUGE difference.

jesse'sgirl · Apr 4, 2012

I spent a few hours at both. In my hospital, the RN appear to have a good relationship with the docs (both residents and attendings.) THe nurse manager was very prompt when communicating with me, although maybe because I've met her before while working as charge nurse on the floor - I work telemetry.

The suburban hospital - their interview process was rigorous, but felt like a factory line - at one point I was encouraged to wrap things up so they could move on to the next applicant. Also, I did not have a chance to get contact details of the suburban hospital nurse manager - I attempted to get their details by calling and asking HR and calling the ER directly but was gaffed off. I specifically said I wanted to send a thankyou to the nurse manager for the interview but both HR and the manager's secretary didn't get back to me (I spoke to them personally.)

Not sure if that is relevant or not.

The suburb hospital offered me part time day shift, also not sure if that is wise considering I am not an ER nurse (yet). Is it smarter to start as full time to get my skills up to scratch quicker?

Pneumothorax, BSN, RN · Apr 4, 2012

ER tech here.

Not all residents are arrogant gasbags, some of them are actually pretty nice, and some you can see how scared they are bc of their greeness in a situation which is ok. we are a teaching hospital and all learning. our attendings are great too!

Im at a level 1 facility and we are the downtown, hotspot place to go.. OD,GSW,trauma , stroke , cardiac issues u name it we get it. I havent been in my position very long (only since dec) but every time i go to work its something different. Ya, i admit. It kinda gets old with the drug seekers wanting their dilaudid, and girls coming in for urpregs that a trip to the dollar store could fix , but its all part of it u know? Cant be all blood and guts hahah.

Ive found personally working during the day is kinda....meh. & its more like working at an urgetn care clinic than a downtown ER. the shift draaaaaaaaaaaaags on.

I would start part time (at your current hosp) just to see if you truly like it. so that on that last day of your shifts u arent dreading it. I think that would be helpful.

People at the subburb hospital dont seem very nice. lol.

Also- ive never heard of a level 3 trauma center. .... sure its not level 2?

shoegalRN, RN · Apr 5, 2012

I am an ER nurse in a Level I teaching hospital, urban core, county ran, and most of our patients are homeless, uninsured, or under-insured.

I would not have it any other way.

I LOVE working with the residents. The nurses, residents, and attending docs, as well as the internal medicine team all have a great working relationship. We also have a great relationship with the Trauma surgeons.

I work weekends nights only, and look forward to going to work every weekend because I know I'm gonna be entertained, if nothing else. I learn something new every time I go to work, and couldn't see myself working in another ER any where else in the city. This includes suburbia.

Ciale · Apr 7, 2012

Original poster, as you can see it's really going to be a personal preference. The burb hospital sounds like it's bigger and "fancier" for lack of better word which means they probably have butt loads of applicants which would explain why HR seemed rushed and impersonal. They kinda have to be. I wouldn't necessarily let that sway your decision or take it personally. Go with your gut. Also, I'd hit the ground running and work full time so you can get your skills on point quickly. It's all about the marriage of quickness and efficienecy in the ER. Good luck! Keep us posted on your decision

jesse'sgirl · Apr 13, 2012

Ok, so the suburban hospital came back with a full time day shift position (plus good pay increase) that I'm taking. Looking back at my previous post, I think I left out some significant information.

The city hospital i work at now is not a trauma center, more like an urgent care center for the down and outs, prisoners etc.. it also gets half the number of ER visits per year that the surburban hospital gets.

Talking to floor nurses at the suburban ER, due to gentrification within the city, a lot of gang activity (bloods, crips, MS-13) is moving into the county - bad for the residents but good if you're an ER nurse who secretly loves that stuff. So while it's in the burbs it's actually still kind of rough and tumble, plus it is right next to the county jail/courthouse. Of course, the counties further south get more and more middle-class, but the county immediately south of the city absorbs a lot of the craziness.

I should probably reveal that I'm talking about Baltimore City, with astronomical rates of crime and violence so the counties are still more shady than some other cities in America.

The burb hospital is under the umbrella of the University of Maryland Medical System (home of Shock Trauma that takes the truly hardcore trauma from the inner city) so excellent learning opportunities for a brand new ER nurse.

And aside from all that, right now I am burnt out from nursing in inner city Baltimore (in a charity hospital, no less). Even on the floor I have seen stuff that makes me think - am I a cop or a nurse right now?! - feels like I'm working in a prison. A break from the city will rejuvenate my love for nursing, and who knows, in a year I might come back to the city refreshed.

RoxCRN · Apr 14, 2012

To OP, IMHO I think each ER will have its own demographic of patient and injury types, and your choice will depend on what you care to see, treat and experience. For example, the first ER that I worked in was a rural hospital, level II trauma center. But I swear this is were I saw some of the best traumas, like the motorcycle MVA's (lots of open road and less cops = high speed accidents with deer) Crush injuries from farmers being wedged by their cows against the barn wall, or blunt chest traumas from the horses kicking or stepping on their riders, GSW with shotguns from hunting expiditions gone bad...even participated in an open thoracotomy in the ER because flight wasn't flying and the level 1 ended up at our hospital for stablization, our surgical team didn't make it there for over an hour due to the weather. AND that patient lived! There were alot of pediatric drownings and boating accidents in the summer because we were smack dab in the middle of a bunch of lakes and rivers. On the flipside I now work at the level 1 trauma center closer to the city and while I still have had some extreme trauma's, and the traumas are more frequent, they are more to the high speed MVC's because the close proximity to the expressway, small caliber GSW's from the gang altercations, oh and a whole lot more intoxicated need to sober up Im gonna pee on you patients than I ever saw at the rural hospital. So I think it just depends.....and remember in the ER you never know what you are going to get, you will learn early not to be suprised when a patient tells you he/she put WHAT? WHERE? :)

Ciale · Apr 17, 2012

even participated in an open thoracotomy in the ER :)

You know you have a hard-on for trauma if this statement instills both envy and a surge of adrenaline in you. Jealous. The most.

OP, sounds like you made a good decision and a pay raise never hurts either. :)