Going from ER to ICU

Esme12, ASN, BSN, RN · Jun 15, 2010

I just made the switch from ER to ICU. Anyone have any tips, words of advice or warnings to run away screaming now?????

I have been both....a ICU nurse and an ER nurse. First remember in the ICU the enviroment is completely different and a more controlled kind of chaos. Head to toe assessment are done on everyone every hour (or there about) and the patients are teathered to the bedside. Every IV line has a specific spot to infuse and cannot be a tangled mess. Hemodynamic monitoring is a learned skill, go find your acid/base balance lectures...brush up on line. Foucus changes to day to day ,head to toe survival, and long term recovery. Not just getting them past the next hour or to the OR with a pulse. lol Nutrition is big as is all end organ function. YOu get to really know your aptients and families. Having been both ICU first then ED......it is a difficult transition for either.... ICU nurses have a difficult time with the chaos of the ED :nurse:and don't like that there is so much movement of the patient from one place to another, like wise there are the true adrenaline junkies of the ED that cannot appreiciate the necessity of the preciseness of the ICU. ED nurses have much higher incidence of ADHD. :lol2: It is like apple and oranges while both fruits they are completely different. While ICU and ED are both critical care areas they are completely different specialities, appreciate now what it feels to be on the other side. Get ready to hear the "that ED can't they wait" "look at this mess from the ED" :rolleyes: Help the ICU understand the finer aspects of needing to get the patient out of the ED. About the only thing in common is that there are patients involved and code blues. Throw yourself in fully learn all that you can if it ends up not being your cup of tea and you return to the ED what you learn will only make you a better ER nurse. :twocents: This is lovingly told from 30 years of playng both sides of the fence...........:)

T14WFLY · Jun 24, 2010

I have been both....a ICU nurse and an ER nurse. First remember in the ICU the enviroment is completely different and a more controlled kind of chaos. Head to toe assessment are done on everyone every hour (or there about) and the patients are teathered to the bedside. Every IV line has a specific spot to infuse and cannot be a tangled mess. Hemodynamic monitoring is a learned skill, go find your acid/base balance lectures...brush up on line. Foucus changes to day to day ,head to toe survival, and long term recovery. Not just getting them past the next hour or to the OR with a pulse. lol Nutrition is big as is all end organ function. YOu get to really know your aptients and families. Having been both ICU first then ED......it is a difficult transition for either.... ICU nurses have a difficult time with the chaos of the ED :nurse:and don't like that there is so much movement of the patient from one place to another, like wise there are the true adrenaline junkies of the ED that cannot appreiciate the necessity of the preciseness of the ICU. ED nurses have much higher incidence of ADHD. It is like apple and oranges while both fruits they are completely different. While ICU and ED are both critical care areas they are completely different specialities, appreciate now what it feels to be on the other side. Get ready to hear the "that ED can't they wait" "look at this mess from the ED" Help the ICU understand the finer aspects of needing to get the patient out of the ED. About the only thing in common is that there are patients involved and code blues. Throw yourself in fully learn all that you can if it ends up not being your cup of tea and you return to the ED what you learn will only make you a better ER nurse. This is lovingly told from 30 years of playng both sides of the fence...........:)

Thanks for your input! :nurse:

Esme12, ASN, BSN, RN · Jun 25, 2010

you are very welcome!!!!!!!!!!! I once had a dream job.......I rotated in and out of ICU to the ED or about every 2 weeks....once a pay.....I never got sick of one place or another......good luck... :-)

pawashrn · Jul 12, 2010

the only thng I can say is remember, ER nurses treat/pack/send. Icu nurses receive/treat/ and see them again the next day, they don't leave.

LeLeeFNP · Aug 17, 2010

i hate the ICU. I used to think it was exciting. Now that I've done it for a year, I am so ready to move on. Its too routine. Same stuff every day. Monitor hourly urinary output, turn the patient every two hours, vap protocols, titrate the levo. oops now my patient is hypertensive..turn on the nipride....oops, now their hypotensive again, they need fluid...what's my cvp? PA? Wedge? blah blah blah blah blah. I can't stand it anymore.

I have only rotated through the ED breifly but during that time it appeared to be more tolerable than the ICU because of the fast pace and every day being different. However i suppose getting the frequent flyers and patients with the same type of diagnoses who get the same workup everytime could probably also get monotenous. I don't know...

anyway sorry to be negative. I guess I just saw a thread and took the opportunity to vent my own frustration. One thing I can say as a positive to the ICU is that you learn about the human body in and out. You do the same things so often that you become an expert in no time. I happen to work at a very large teaching hospital and this is the 3rd ICU i've worked in so i really can't blame the facility I work in. I basically have just lost interest very quickly. On the other hand I know ICU nurses that have done it for years and still enjoy it. Maybe it will be the same for you.

Good luck.

silentRN · Aug 18, 2010

Really just depends on the Co-Workers who surround you. I love my ICU because my co-workers are fun to be around and we hang out outside of work. It would suck to work with a bunch of battle-axes.

Esme12, ASN, BSN, RN · Aug 18, 2010

i hate the ICU. I used to think it was exciting. Now that I've done it for a year, I am so ready to move on. Its too routine. Same stuff every day. Monitor hourly urinary output, turn the patient every two hours, vap protocols, titrate the levo. oops now my patient is hypertensive..turn on the nipride....oops, now their hypotensive again, they need fluid...what's my cvp? PA? Wedge? blah blah blah blah blah. I can't stand it anymore.
I have only rotated through the ED breifly but during that time it appeared to be more tolerable than the ICU because of the fast pace and every day being different. However i suppose getting the frequent flyers and patients with the same type of diagnoses who get the same workup everytime could probably also get monotenous. I don't know...
anyway sorry to be negative. I guess I just saw a thread and took the opportunity to vent my own frustration. One thing I can say as a positive to the ICU is that you learn about the human body in and out. You do the same things so often that you become an expert in no time. I happen to work at a very large teaching hospital and this is the 3rd ICU i've worked in so i really can't blame the facility I work in. I basically have just lost interest very quickly. On the other hand I know ICU nurses that have done it for years and still enjoy it. Maybe it will be the same for you.
Good luck.

You are awfully young to be so burned out......I feel bad for you feeling so down. You should be proud of all that you have accomplished.....a lot of people couldn't do all the lines and meds. The ED is the same work ups but there is always the element of suprise and unpredicability.......what is it that makes it feel so mundane?

T14WFLY · Aug 18, 2010

i hate the ICU. I used to think it was exciting. Now that I've done it for a year, I am so ready to move on. Its too routine. Same stuff every day. Monitor hourly urinary output, turn the patient every two hours, vap protocols, titrate the levo. oops now my patient is hypertensive..turn on the nipride....oops, now their hypotensive again, they need fluid...what's my cvp? PA? Wedge? blah blah blah blah blah. I can't stand it anymore.
I have only rotated through the ED breifly but during that time it appeared to be more tolerable than the ICU because of the fast pace and every day being different. However i suppose getting the frequent flyers and patients with the same type of diagnoses who get the same workup everytime could probably also get monotenous. I don't know...
anyway sorry to be negative. I guess I just saw a thread and took the opportunity to vent my own frustration. One thing I can say as a positive to the ICU is that you learn about the human body in and out. You do the same things so often that you become an expert in no time. I happen to work at a very large teaching hospital and this is the 3rd ICU i've worked in so i really can't blame the facility I work in. I basically have just lost interest very quickly. On the other hand I know ICU nurses that have done it for years and still enjoy it. Maybe it will be the same for you.
Good luck.

Thanks for your honesty. I can see what your saying. My first week I did a lot of standing and sitting. In the ER, I was on the move constantly. It's like going from ADHD world to OCD world. I'm still trying to get more detail oriented. It's a lot to get used to. I am learning a lot and I think it will be good for me. I still work ER relief, so I picked up a shift the other day to keep up on my skills. I haven't started a single IV in ICU. Everyone has PICCS or Central lines. I miss IV's. I am going to stick it out in ICU and hopefully I can use the best of both specialties to help shape me into a better nurse. Hopefully, I can move on to flight nursing someday and then I can apply what I've learned in both areas. Good luck to you and thanks for your input.

T14WFLY · Aug 18, 2010

"ICU nurses have a difficult time with the chaos of the ED and don't like that there is so much movement of the patient from one place to another, like wise there are the true adrenaline junkies of the ED that cannot appreiciate the necessity of the preciseness of the ICU. ED nurses have much higher incidence of ADHD. It is like apple and oranges while both fruits they are completely different. While ICU and ED are both critical care areas they are completely different specialities, appreciate now what it feels to be on the other side. "

I can definately see what you are saying here. I may be one of those adrenaline junkies. However, I am not giving up yet. I have much more to learn first.

Esme12, ASN, BSN, RN · Aug 21, 2010

Thanks for your honesty. I can see what your saying. My first week I did a lot of standing and sitting. In the ER, I was on the move constantly. It's like going from ADHD world to OCD world. I'm still trying to get more detail oriented. It's a lot to get used to. I am learning a lot and I think it will be good for me. I still work ER relief, so I picked up a shift the other day to keep up on my skills. I haven't started a single IV in ICU. Everyone has PICCS or Central lines. I miss IV's. I am going to stick it out in ICU and hopefully I can use the best of both specialties to help shape me into a better nurse. Hopefully, I can move on to flight nursing someday and then I can apply what I've learned in both areas. Good luck to you and thanks for your input.

That's how I did it!!!!!!!!!!!!!

Esme12, ASN, BSN, RN · Aug 21, 2010

"ICU nurses have a difficult time with the chaos of the ED and don't like that there is so much movement of the patient from one place to another, like wise there are the true adrenaline junkies of the ED that cannot appreiciate the necessity of the preciseness of the ICU. ED nurses have much higher incidence of ADHD. It is like apple and oranges while both fruits they are completely different. While ICU and ED are both critical care areas they are completely different specialities, appreciate now what it feels to be on the other side. "
I can definately see what you are saying here. I may be one of those adrenaline junkies. However, I am not giving up yet. I have much more to learn first.

I'm an admitted adrenaline junkie! BUt the experience in both was an asset in trauma flight. It is not all trauma and there is a lot of flying of critical patients from a small ICU to major medical centers.....thye ICU freally helpled....stick with it. Flight nursing is an AWESOME job. I really miss it.......