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

TRAMA1RN · Oct 31, 2007

Trauma is my first love, gave it up to be closer to home. Most important thing to remember is be positive. Work hard and carry your own weight. The trauma center where I worked was the best group of nurses I ever worked with male and female. Think on your feet know your commonly given drugs, lots of moderate sedation used for procedures and cardiac meds. You should be fine since you are coming from a critical care unit already. Critical thinking skill is very important. Good luck!!!!

JJEDRN · Oct 31, 2007

I made the transition to full-time Ed about 18 months ago, after 24 years of Critical Care. It was the best move I ever made.

The transition? The most challenging (for me) was developing the Mental Map of the Ed Flow, and the priorities as they relate to ED. This is not to say that the Critical thinking and prioritizing is any different for the Ed, but coming from a background of being totally responsible for every aspect of a patients care, to an atmosphere of shared responsibilities and trust in your team mates in constantly shifting priorities. (I did trust my co-workers in the units, this was just a "mind-shift" thing for me...)

There is order in the chaos...embrace it! :devil:

I am taking every class I can to improve and/or enhance my ED skills.

The usual ACLS, Pals, NRP.

But also PHTLS. I would highly recommend PHTLS to anyone working the ED. I feel it would really help all of us to better understand the Pre Hospital thinking skills, expectations based on those thinking skills and priorities, and improve the continuum of care based on those expectations. EMS is a great resource, BTW.

I take my first TNCC Class this week. I think, like ACLS, it'll improve expectations and communication. Knowledge is never wasted.

Late 40's? I'm in my 50's. We have better than 30 beds and run 160 patients/day. Only a Level 3, but run a high acuity. I'm tired when I finish a 12 or 16 hours shift, ibuprofen is my friend, but I look forward to each and every day as a positive learning experience. It's a challenge, but a commitment I wish I'd made years ago.

You bring a lot to the table with your background and experience.

Being positive, open to learning, and ready for a challenge will serve you well.

Just my $.02 worth.

Best of luck to you.

JJ

gun · Oct 31, 2007

it is great that you want to switch on to Ed after working in ICU.Here in our setting we can go and work in Ed as they say that we can work anywhere if you have worked in ICU.I would say all you need is the will to run around.

Larry77, RN · Oct 31, 2007

The biggest difficulty I've seen from ex-ICU nurses transitioning to ED is time management and thinking quickly. The turnover can be mind numbing for a ICU nurse who is used to getting to know every aspect of their patient and may have taken care of them for months.

Also we do not have a dx to work with so we do not have a thought in our mind as to what to watch for as a downgrade in condition to a specific disease process, but must think more on your toes and monitor changes carefully. We do not have time to ponder changes in lab trends, we have to treat the patients symptoms first then get the labs when they come back (takes about 3 weeks I think..lol).

My best advice to you is really study the flow of charts and turnover of rooms so you aren't constantly trying to figure out what's in your rooms but can see the changes coming before they happen (ie patient's work up is done probably getting dc'd soon...hmm what's in the waiting room?). And please do not get caught up in the little things that ICU nurses tend to tinker with (ie second IV's on non-criticals, and foleys in every woman and man--have to watch the I&O's...lol).

Otherwise---HAVE FUN!!!

jjwfdc · Oct 31, 2007

You ae gonna have so much fun! The biggest challenge for the ICU nurse coming into the ER is changing from a very detailed critical thinking to a broader range. Once you get the hang of taking in the whole picture of a trauma patient, you're golden! You bring a lot to the table, so don't be afraid to flex that ICU muscle you have, ER nurses appreciate that experience. Keep your chin up and remember that even your worst day is better than the day that patient is having. You're gonna be great!

Oh, and just remember... A, B, C... : )

~JJ

Dallas_RN, BSN, EMT-P · Nov 1, 2007

Many nurses I work with have made the switch and many have stuck with it. The hardest part for them as they stated is the pt load. On the unit they had a 2:1 ratio, in the Level I trauma you'll have 4-6 pt with many being "ICU patients" awaiting to go to the floor. On the unit everything is done, IV's, central lines, intubation, critical drips started, etc difference is you'll be doing it now while trying to juggle 4 other patients.

That said I don't want to work anywhere else. Best of luck, I'm sure you'll adjust just fine. :)

GenXnurse · Nov 1, 2007

I think several people above have hit the nail on the head. However I will drive it in a bit further.

1) ICU Nurses generally have the most difficulty with knowing everything about their patients to working very quickly on the fly. If you can become more comfortable with chaos you will do well.

2) One of the primary differences between ED nursing and ICU nursing is a problem oriented approach vs. a systems approach.

For instance- I was having a discussion with an ICU colleague who was irritated with an ED nurse for "missing" a blood sugar of 300. I asked, "What did the patient come in for?" Answer: Difficulty in breathing resulting in intubation. So- here is the difference- It's not that the ED nurse didn't care about the blood sugar it's just there were more important things to attend to. As stated in the above posts, you can have 1-2 ICU patients with 2 more patients that need care. Sometimes nurses need to understand (on both ends) that there is a continuum of care ie: Care can continue from the ED to the ICU if something needs to be attended to.

So- you do bring great skills to the ED. Learning to adapt those skills to the ED is going to be your test. Also, if you have a fear of pediatrics, strive to take as many kids as possible during your orientation to get over your fear. That is the #2 complaint I hear from ICU transfers- "I don't like taking care of/ starting IV's in kids."

Good luck- Sounds like you are a life long learner.

NurseDawgJess, BSN, RN · Nov 2, 2007

I'm new to ER and work in a Level 1 trauma hosptial. My preceptor used to be an ICU nurse. So far she's been a great teacher and her experience is highly respected and appreciated by the doctors and nurses. Good luck in your new endeavors.

CritterLover, BSN, RN · Nov 2, 2007

i went from working in a high-acuity trauma-only icu to working in a fairly small, inner-city er

it took me a long time to get used to discharging patients. something i never did in icu, and you do it anywhere from 10-50 times a night in the er.

as others have said, you need to learn to deal with more patients at a time. some you won't even have to do anything for other than assess and discharge, and finding time to run in and assess your patient before someone "helpfully" discharges the patient for you can be challanging some days.

you have to do things more quickly. the faster you get it done, the faster they leave. that is very different thinking from icu. our docs expected labs to be drawn and in the lab, being run, within a few minutes of ordering them. they looked for resulst after about 20 to 30 minutes. if it took me more than 15 minutes to start on a set of orders after the doc had written them, i felt like i was getting behind.

it takes a while to get used to not having total control over your patients. you'll go in to medicate someone to find out the emt has taken them to xray. or you'll go to discharge someone and find out someone already did -- oh, and there is a new patient in his place.

i think, though, that the toughest adjustment for me was the sheer number of patients i saw on a nightly basis that had absolutley no business being in an er. i realize that this has been discussed over and over again in the er forum, but it really opened my eyes up to see the "er abuse." people that use the er as an std clinic. bug bites that i wouldn't even bother taking benadryl for. chronic dermatits that is "itchy tonight." the sniffles. many times things i wouldn't even bother my pcp with, let alone darken the er door. it can be very frustrating because -- as has been mentioned in other threads -- the non-urgent patients are often the most demanding (they have to get to work, you know). while icu can have its frustrations, at least those patients need to be in the hospital.

i'm sure you've read through the threads on the silly things people come to the er for; if you haven't, you need to. they are funny when you are sitting at home reading them off the computer. it isn't quite so funny when you're the one getting cussed out because you aren't taking their daughter's "lac" (paper cut) seriously enough. (it is funnly later, though)

all that said, if something happened to my current job and i had to get a new one, i'd pick er over icu (don't work either right now)

deeDawntee, RN · Nov 2, 2007

Thank you everyone for all of this great advice. Hopefully, I will be able to interview for that position next week. I have been more and more unhappy at my job. Last night, I had two stable ICU patients and I was bored out of my gourd. It is hard enough staying awake all night but I lose my mind without enough to do. I am actually going to see what it would take for me to shadow someone this weekend in the ED in the hospital where I currently work. It isn't a trauma hospital and not a county hospital, so I have no idea how much ER abuse goes on...

The more I hear of all your helpful information the more it seems that ED nursing would be great for me. I will let you know....

Altra, BSN, RN · Nov 2, 2007

Good luck to you deeDawntee. :)