NICU nurse thinking about working in the ER

  1. need some advice....

    i have been working in the nicu now for almost three years and am thinking about going to work in the er-the nicu is a great place to work but i want to expand on my skills and see interesting things-- i realize that they are two totally different worlds (part of the attraction to the er)--was wondering if anyone out there might have any words of wisdom or advice on making such a transition.....

    thanks!!
    Last edit by Annken on Sep 20, '06
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  2. 12 Comments

  3. by   babynurselsa
    I did exactly the same thing several years ago. Make certain that you will get a full orientation. ER is a whole other animal from NICU.
    It also takes a little time to not freak just a little when you walk by a monitor and see a HR of 70...lol
  4. by   Annken
    Quote from babynurselsa
    I did exactly the same thing several years ago. Make certain that you will get a full orientation. ER is a whole other animal from NICU.
    It also takes a little time to not freak just a little when you walk by a monitor and see a HR of 70...lol
    How did you find the transition going from just neonates to pretty much everything under the sun?

    Also is ER pretty hard physically--I mean lots of lifting etc--I wouldn't think it would be too bad not sure........?
  5. by   gonzo1
    If this is something you are interested in doing you should go for it. ER isn't too bad physically because there is always staff to help you lift, etc. And you already have experience with what all ER nurses are the most scared of--kids--. ER is a great place to expand your skills. You will see everything and get experience working with all age groups. Just make sure you get a good orientation and training as that will make transistion much better.
    Good luck and welcome to the ER
  6. by   babynurselsa
    Basically it was like starting from scratch. I told my manager when she hired me to please remember that even though I was an experienced RN that I had never had a patient over 17 lbs.
    Do not beat yourself up that you don't knwo it all about all the other populations, it takes time, just like it did when you went to NICU as a new grad.
    It is more strenuous than nicu,unless you had to move those darn monitors of the warmer shelves alot...lol. Just make a point of practicing good body mechanics.
  7. by   NICU_3_RN
    i left the ER after 3 years and went to the NICU. YOu have to remember that in the ER there are no staffing ratios, and the patients keep coming... you can't turn any away... the facility i was doing ER in had a problem with "holding" patients as well.. the day i started looking for a new job was the day i had 11 patients total, including 1 MI on a vent "holding" for an ICU bed, and 4 regular bed admits... on top of my 6 ER patients. After three years and loving it - i decided my license was more important.

    I recognize that it is not like that everywhere - but this was after 10 years of being an EMT and never having wanted to do anything else. I LOVED ER. Just don't go in with blinders, and keep your eyes open. it can be a great experience... but at what cost?
  8. by   SteveNNP
    Hey,

    I am in the middle of my ED orientation, having left my FT level III NICU job the end of August. I had always had an interest in ER, and I'm one of those people who like action. I LOVE the ED. I'm reorganizing/relearning all those conditions/meds/labs I've pushed to the back of my mind for the last 1 1/2 years in NICU. The learning curve is steep, but I'm getting a great orientation with classes and experienced preceptors. Our N/P ratio is set at 4-5:1, and management is very helpful and fair. I still PRN in NICU/PICU, to keep my certs up. It was a hard decision to leave the babies I love, but I love the fast pace, interesting dx of the ED. Granted, a few docs are butt funguses, the pt's are much bigger, and some come to the er to waste your time and patience. But hey, they're gone in a few hours, and you'll probably never see them again! You will be called upon as a NICU RN to start tough IV's, and help with the neonate/peds traumas, arrests. You will be an asset with the skills you have as a NICU nurse. The biggest thing I had to get used to was the adult vital signs AAAAH!! HR of 55!!!! and actually being able to converse with your pts. I love being able to see a cross-section of someone's life every time I get a new pt. Best of luck! PM me if you have any questions!

    Steve
  9. by   TazziRN
    Just remember that them body parts is a LOOOOOOT bigger!! Before my ER expanded we were one RN and one tech each 12-hr shift. One night I was expecting a major rollover with two male victims, the third was dead on scene. I called for help and the supe sent me two OB nurses. I put one with my tech on the minor pt and I took the other with the serious one. She was very willing to help and I set her to inserting the foley. Out of the corner of my eye I noticed she was having trouble but I left her alone. She finally told me the foley was too big. I got her a smaller one. She said that was too big. I thought, "Huh???? He's not that small!!!" I grabbed the foley, grabbed the pt, and shoved it in, and her eyes got reeeeeeeeal wiiiiiide. Then she started laughing and told me, "I'm used to them being this small!", holding her thumb and finger just a few centimeters apart. She was used to the tiny infant cath kits with the stiffer and tinier tubes; when the very limp foley wouldn't thread she thought it was too big!

    Seriously, being a NICU vet you have the critical thinking skills in place. You just need to learn to adapt them to larger pts as well. I precepted a pedi nurse to the ER once and she told me the hardest adjustment, as mentioned above, were the differences in VS and the fact that her pts held conversations with her. The rest fell into place over time.
  10. by   BsnRnShiftSuper
    A nurse in my ER came from the NICU. She is an LPN working on her BSN RN. She dove right in and now I consider her irreplacable. Orientation is important. In the ER I work in, orientation is no where near as long as most places, mostly due to the fact that we are always full on busy and short staffed. But we are the type of bunch that believes in helping each other, so it doesn't get to be an issue. It is definately 2 separate and alternate worlds though. She couldn't imagine putting a 20g iv in someone, let alone a 14g! But by the time I got finished with her, she loves it. I think it all comes down to the type of person you are and the type of nursing that you enjoy, and whether or not you adapt well to change. Good luck to you!
  11. by   shill
    hi
    “humor-‘laughter‘.. is the best medicine”…(isn’t that an ancient statement)..but it’s true, not only for the nurses but the patient themselves.. ’maybe not for the patient with abdominal pain, kidney stones, fractured ribs, or a mom to be, that’s about ready to deliver.. etc’ … oh, wait yes they can, can’t they?…”splinting”…comes to mind, remember the “patient teaching” for c & db? (just a little humor) ..and working in the er, a lot will come back to you. seriously though, when i respond to a post, i like to insert a little humor. my responses to posts, are by no means with any intentions of insult to any peoples…and i stand to be corrected for any misgivings unbeknownst to me…i’m not perfect(if i were perfect, do you think i’d be a rn in the er) ..you’re dam right i would be!!! i enjoy it immensely!!!
    he who laughs, lasts.”.. norwegian proverb
    so, with that said, on to your topic:
    as with the previous responses i totally agree, your preceptor is going to be your best buddy and is going to be the most important training you’ll get for working in the er. but make sure that your preceptor, is somebody that you feel comfortable working with, is somebody that you feel is teaching you because they want to teach you, someone that when you asked them a question, “why did you do that?.. what is this for?..etc.”, they answer your question, without an:icon_roll attitude! guarantee you’ll know all this after your first day of orientation. make the necessary changes then and there, because after your orientation, ”your on your own”,… scary huh…(just joking) well, you’re really not on your own, others around you will help. remember, you will never be taught everything that you’ll need to know, in working in the er during orientation. here is a helpful hint: :typing start now, and make a list of all the possible things that you might need to know about working in the er, you probably don’t need to write down the obvious, but it won’t hurt(just some examples: ng tube placement, gastric lavage, dka crisis, sickle cell crisis, prepping for cardio conversion, etc. etc. etc.), the list will be long, and when you go home at night check off the list of the things that you were oriented to. in the er, you will never experience or know everything!
    ”most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all”….dale carnegie
    nicu.. wow, the closest i’ve ever been to teeny tiny babies,(aside from giving birth to my own son, he was not teeny and tiny) is when i was a phlebotomist, and was called to maternity to do heel sticks, or draw blood on newborns. that was an experience itself. i have a girlfriend, that comes to my shop,(oh yeh, i’m also a hairdresser), she works in a nicu, up in the city 30 miles away from where i work. when she comes in we discuss our jobs, and it is amazing to hear some of things that she experiences there. carol says that she has to start ivs and give meds to babies that only weight in “grams”..wow! there’s no rounding to the nearest, of any meds.. as she explains, “if you round off your calculated meds, and give that same med dosage over a period of time, you are actually overdosing that baby”.. that does make sense.
    yes, start lifting weights, you'll need the musclesumpiron: ..and come on in!
    sherry
  12. by   Annken
    Thanks everybody for your advice/insight.

    I have applied for a couple of ER positions in some area hospitals--so wish me luck!
  13. by   teeituptom
    The great secret to life in the ER, Is to realize that all patients are babies.
    Just some are bigger and their poopies smell more.
  14. by   SteveNNP
    You ain't kiddin'.......had a GI bleed/DKA pt the other day. The 10x10 room was literally covered in either poo or puke. I wanted to crawl back to clean, sweet-smelling NICU....and my cute babies.

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