Get critical care experience before working ER?

[ACRN06]

I'm losing sleep (literally) over something so I'm on allnurses.com at 2am begging for some insight!

I'm gonna try to cut to the point and not drag the quesiton out with unnecessary details..

Basically I LOVE ER, always have, always will. I KNOW ER is where I ultimately wanna be.

However.

I came to the ER after a few years on the floors, so the vast majority of ER patients from fast track to acute to step-down unit-ish I totally picked up and handled no problemo. What I'm lacking is experience in the critical care department. Traumas. ICU players. I just don't that experience behind me. And its really been bugging me lately.

The hospital I'm at didn't do any special training classes. They stuck me with someone for a few weeks then I'm on my own! Its all learn-as-you-go.

Its frustrating. I WANT to learn this stuff back and forth but when you only have a critical patient for a few hours before handing them off, its hard to get the experience enough to feel totally comfortable, to know what it means when that vent alarm goes off and how to fix the problem, to know the usual dosing on various drips, which ones work better than others, what you can expect with different ones, etc etc... blah blah, you just can't get that when you only have the patient for a couple hours before shipping em off! Plus you only get assigned to the trauma rooms every so often so your chance for experience is totally just luck of the draw.

What I've been tempted to do...and here's where my big question lies...

Would it be a good idea to work in the ICU for a year or two, then come back to ER after getting in-depth critical care experience??

Go somewhere with a concentration of criticals and learn it back and forth, work with all the different pumps, lines, situations, see what happens AFTER the ER stabilizes them, etc...

Maybe I'm just impatient... maybe I'd be miserable being back in the non-ER environment and regret it. I really love ER, and I learn something new every day, but its like you're EXPECTED to know all this stuff to care for the patient, but I haven't been trained in it or ever had experience with it, but HERE YOU GO! HERE'S YOUR PATIENT!

What do you think?

I'm moving soon, and changing jobs at the same time... so now would be the time to do it if I did... Should I apply for ICU or ER positions?

Was my last hospital just crappy at training and I should go somewhere with a better training program?

Or would it be beneficial to go and get that experience?

Or should I just keep learning as I go?

Thanks!!!

[RedSox33RN]

I went right into the ED after my graduation from nursing school. But I think the big difference was that they had a 6 month "ED school" which was fantastic, and we were with preceptors for all of that time, which also included classroom work and many different in-services and classes for Basic Arrhythmias, ACLS, PALS, etc.

I have heard both sides of the "issue", whether an RN should get Med/Surg and ICU experience before the ER, or can go straight to the ER. I think it not only depends on the person and how motivated they are to learn, but also the quality and length of any preceptorship and "ED school" (if they have one) and the ER department itself. The ER I began in was not a trauma center, but because of where it was located and the lack of other hospitals around (and the size of the ED also - this one was 65 beds), we got everything from GSW and stab wounds to psych to MVA's to sore throats - you name it, we got it, and a lot of it! If we missed one GSW, unfortunately (or fortunately, depending on how one looks at it!), there was likely to be another before the shift was done. That's just how it was there.

The only thing about that ED was Peds had a separate ED, so I never saw a pediatric pt unless it was a pregnant minor. That was a separate "ED school" which I did not do, but really wish I had. Peds is not separate where I am now, and I feel very ill-prepared for peds trauma or acute illness, still.

How is the education dept where you are? Does the ED have a separate educator if it is separate? That person may be best to advise you on your career in the ED.

I still consider myself a "new" nurse at 2 1/2 years in the ED. I still ask a LOT of questions and do a lot of reading. I'm glad I entered how I did though, and did not do M/S first. I have done some work per diem after I first licensed in M/S, and will agree with everyone that it is so totally different, that really almost nothing I learned or did on that M/S unit applied to the ED. In fact, every hospital ED I've worked at now (where I am now is the 3rd, and I don't want to move again!!) uses completely different software than the in-pt units. Why I don't know - maybe someone here knows why?? Maybe there just is no good software that can cover both ED and in-pt units or something?

In any event, I think whether or not you go to the ICU for experience depends on you and how/what you want to learn, and your facility and their education dept and what they will do for you.