Advice needed: ICU nurse looking at working in a Trauma ED

[deeDawntee]

Are there any nurses out there who went from ICU to ED nursing? What was the transition like for your? What were the biggest challenges? What surprised you that you weren't expecting? (positive or negative)

Do you have any advice about learning this new specialty?

I have been in the ICU for about 18 months and am considering cutting back my hours in the ICU and starting a second position at a different hospital which is a Trauma1 facility. Am I crazy? Do they hire per diem nurses for the ED (generally speaking)?

I have submitted an application and spoke to the manager over the phone. It appears that I would have a pretty good chance of getting the position, given my experience. I am the type of person who thrives on challenge and learning new things. However, saying that, I am in my late 40's and wonder if my old body would be up for what I imagine is a more physically demanding job.

Any and all thoughts, suggestions are welcome.

[PMFB-RN, RN]

I work in the ICU of a level I trauma center. The ICU nurses are part of the trauma team. When a level I or II trauma comes into the ER one of us ICU nurses goes down to the ER and takes care of the patient. The ER nurse is relegated to being the recorder and seldom gets in on the action. In our hospital the ER nurses take care of the kids with ear infections and minor stuff and ICU nurses handle the traumas. I suggest you find out who is included in the the trauma team in the hospital you are considering. Being an ER nurse in a trauma center might not be what you think it is going to be.

I also work part time in a small, rural hospital ER were there is no "trauma team". The ER nurse and the ER doc handle everything no matter what it is (we can call one of the med-surge nurses over if needed). I actually get to deal with more critical patients in that small rural ER than the ER nurses in the level I trauma center does.

[deeDawntee, RN]

Thanks everybody for all your great advice. I have my interview on Thursday. Any insight in what the interview might be like? I am very excited!!

[HM2VikingRN, RN]

I work in the ICU of a level I trauma center. The ICU nurses are part of the trauma team. When a level I or II trauma comes into the ER one of us ICU nurses goes down to the ER and takes care of the patient. The ER nurse is relegated to being the recorder and seldom gets in on the action. In our hospital the ER nurses take care of the kids with ear infections and minor stuff and ICU nurses handle the traumas. I suggest you find out who is included in the the trauma team in the hospital you are considering. Being an ER nurse in a trauma center might not be what you think it is going to be.

I also work part time in a small, rural hospital ER were there is no "trauma team". The ER nurse and the ER doc handle everything no matter what it is (we can call one of the med-surge nurses over if needed). I actually get to deal with more critical patients in that small rural ER than the ER nurses in the level I trauma center does.

Sounds alot like the hospital where I am doing synthesis....

I am using my synthesis as an interview for an ER slot in that hospital every day I work.

[Dallas_RN, BSN, EMT-P]

Let us know how the interview goes. :)

[deeDawntee, RN]

Well, my interview went great and I was truly excited and impressed by what I saw. I was hoping to not have to tell my current manager about the new job, but the manager at the ER wants to talk to my manager and I am a bit concerned because, to be honest, I am not sure how this will go over with my current manager. So, at this point, I am waiting to hear one way or another. I will let you know.

[ERbunny]

I was burnt out after 12 years of ICU, and was thrilled at the opportunity to go to the ED. The previous coments re time management are very true, veteran ED nurses will know what the phrase "ICU mentality " means. But nobody has mentioned one of the neatest things about ED nursing, and that is the opportunity for patient education. My last job in crit care was a surgical icu in Florida...our elderly pts never got extubated, so we rarely had an actual conversation with our patient. The ED visit may be your pt's only chance to get valid health info. I have mental tapes I spout in triage re untreated hypertension, old wives tales about pregnancy, domestic violence, etc, etc. If just one person gets his blood pressure under control and keeps from having a stroke, it will be worth it !!

Good luck with your transition. I found it to be the best move I could have made, and you will never never wonder if what you do matters, believe me it does.

[deeDawntee, RN]

Hi Everybody!! Guess what? I was offered the job in the ER and I accepted! I start orientation on 12/3. I am so excited. Thanks to all the great advice already. I may need your help as I get into this job.

So keep an eye open for more posts on this thread. I appreciate all the support!!

:lol2:

[deeDawntee, RN]

Hi all my ED nurse veterans!

I am in the middle of my preceptorship and I am having an issue with something I never even imagined and I was wondering if this was a typical issue out there?

The problem is that if there are trauma and/or medically emergent patients coming in the team is called to the "stabe" room (stabilization room), which means all the Docs, Residents etc ALL leave the other patients and go in to the "stabe" room for the learning opportunity. In the meantime, the other patients sit and wait.... I had a patient come in with a blood glucose of over 600 and it took me over 2 hours to get an insulin order and even then the order was incorrect (from a med student) and it took another hour for the Resident "in charge" to write me another simple order of 8 units of Reg Insulin!!!!!

My poor patient would have left AMA (or whatever it is in the ED) if I hadn't spent lots of time and energy encouraging him to stay.

So, I am having an issue with this hurry up and wait mentality. In my preceptorship, I am being urged to go faster, faster, faster...and I know I do need to get more efficient, but when I have to wait HOURS for a simple order, it seems obvious to me that the focus is NOT to move patients through as fast as possible...so I am opting for doing my part at a more comfortable and thorough pace. Am I wrong? Or is this just part of the job?

What is the ideal scenario? Can anyone tell me? Is it move in and out of the patients room, assess them, chart, get the IV and labs and then wait (for however long) for the orders, implement them, then move them along to discharge or admission??? Is that about it?? In the hospital where I am working they don't do verbal orders to the nurses, the Docs are expected to enter everything themselves...

Does anyone see this happen where they work? Is this a breakdown in the system of this particular ED? I would appreciate your insight!

Thanks!!

[PMFB-RN, RN]

Hi all my ED nurse veterans!

I am in the middle of my preceptorship and I am having an issue with something I never even imagined and I was wondering if this was a typical issue out there?

The problem is that if there are trauma and/or medically emergent patients coming in the team is called to the "stabe" room (stabilization room), which means all the Docs, Residents etc ALL leave the other patients and go in to the "stabe" room for the learning opportunity. In the meantime, the other patients sit and wait.... I had a patient come in with a blood glucose of over 600 and it took me over 2 hours to get an insulin order and even then the order was incorrect (from a med student) and it took another hour for the Resident "in charge" to write me another simple order of 8 units of Reg Insulin!!!!!

My poor patient would have left AMA (or whatever it is in the ED) if I hadn't spent lots of time and energy encouraging him to stay.

So, I am having an issue with this hurry up and wait mentality. In my preceptorship, I am being urged to go faster, faster, faster...and I know I do need to get more efficient, but when I have to wait HOURS for a simple order, it seems obvious to me that the focus is NOT to move patients through as fast as possible...so I am opting for doing my part at a more comfortable and thorough pace. Am I wrong? Or is this just part of the job?

What is the ideal scenario? Can anyone tell me? Is it move in and out of the patients room, assess them, chart, get the IV and labs and then wait (for however long) for the orders, implement them, then move them along to discharge or admission??? Is that about it?? In the hospital where I am working they don't do verbal orders to the nurses, the Docs are expected to enter everything themselves...

Does anyone see this happen where they work? Is this a breakdown in the system of this particular ED? I would appreciate your insight!

Thanks!!

*** Seems absurd that you would have to find a doctor to get such a basic order. In my unit I would have just given the insulin as we have standing orders for such situations.

[Altra, BSN, RN]

Though there will be times that the docs are backed up beyond belief, this does seem to be a breakdown particular to your ER.

It's human nature to want to go & see "the good stuff" but common sense that not everyone can do so every time -- some resident is gonna have to draw the short straw and sit this one out and attend to moving the bread & butter patients along.

Can you not give meds with a verbal order? As in, if necessary, walking over to the resident who's gowned & masked in anticipation of the gory trauma he's about to be brilliant in and saying, "hey, the patient in Room 8 has a glucose of 623 ... I have NSS running wide open, how much regular insulin do you want to give?"

What does your preceptor have to say about this? Chances are, he/she can clue you in to how the nurses in that particular ER get around that kind of situation.