[CaliRN29]

Hi ED RNs,

I am currently a new ICU nurse and I am not loving it. I am annoyed with the ******* of some of my co-workers, the slow pace of the night shift, and the silly tasky things we have to do.
I am thinking of making a switch and am considering the ED. However, I am used to 2 patients and I am not the best multi-tasker. I like to focus on one pt. and then move to the next. Is that impossible in the ED? Our hospital's ED is not a trauma center so the level of acuity is not too high.
I want to make the right move this time and would appreciate any thoughts/advice the ED RNs have!
Thanks!

[TazziRN]

No, not possible if it gets busy. You would have to be able to move from one to the other fairly quickly, but the nice thing about switching units is that you get an orientation. You can request an extended orientation based on your fears about multi-tasking. ER care is often not head to toe, but problem oriented, which means that if you focus too long on one pt you are going to tick off your coworkers.

[bill4745]

After 10 years of ICU, I made the switch and love it. In many ways, it is the total opposite of the controlled, detailed ICU. Yes, you must multi-task, sometimes to an extreme. You can go from boredom to total chaos in 30 seconds. One minute you're doing critical care, the next you're putting on a splint, then wrestling with a drug od who is trying to bite you, then trying to find someone a ride home. You must be able to walk into a room and know what to do without an order - do I line & lab, start NSS, do an ecg? What labs should I draw? You may have two critical patients plus 2-3 others (or more in some ERs). It helps to have ADD!!

[Dinith88]

Originally Posted by CaliRN29

Hi ED RNs,

I am not the best multi-tasker.

OK...read your own quote and you have the answer to your question

[ChayaN]

Originally Posted by bill4745

You must be able to walk into a room and know what to do without an order - do I line & lab, start NSS, do an ecg? What labs should I draw?

So how do you know? Instinct? Experience? Training?

[bill4745]

All three.

[loricatus]

Originally Posted by ChayaN

So how do you know? Instinct? Experience? Training?

Many times there are standing orders. For ex., chest/epigastic pain complaint-get an EKG, hook to a monitor, start a line and draw chem7-electrolytes, cardiac enzymes, start MONA (oxygen, asa, nitro w/ verbal MD approval,) etc. Abd pain:add in hepatic & pancreatic labs. A bleed is suspected: put an 18 G in and include a type and screen to the labs. The triage nurse will assign the acuity level to give you a heads up on things-you wouldn't be going into a pt. room blind.

I did the ICU to ED thing and did have the over focus problem you describe. The one advantage to that is I have caught many subtle cues that once relayed to the doc have changed the pts course of treatment. Just last night a pt that was being worked up as a cardiac case for tachycardia/fever/anxiety became an endocrine admit because I noticed a small goiter and took a detailed history that lead to thyroid issues-once I asked the doc if I could add a thyroid panel to the labs and why, he said that was an area he wasn't considering & it turned out to be a thryoid storm brewing. So, if you make the switch, you may be slower than your new peers but you will be valued for your attention to detail. Good Luck on whatever you decide.

[JMBM]

Given your reasons for wanting to leave your current job, I'm not sure why the ED would be better. Certainly, there will be co-workers you like/dislike. If anything, ED personnel tend to have stronger personalities than most. There will be plenty of silly little things you need to do - welcome to nursing. The heart of ED nursing to me is rapid change, adaptability, and multi-tasking. You have to like dealing with near-chaos. You'll see everything from sore throats to sepsis to gunshots to heart attacks to sprained ankles to foreign objects inserted places they weren't meant to be - all in the same shift - sometimes at the same time. And then there will be old Joe, the strong smelling drunk who is back for the 18th time this month and who just soiled the bed, again. You have to like working with a team, sharing work, responsibilites and covering each other. There will be shifts when you spend half your time stocking rooms and others when you don't even get a bathroom break. In many ways, ED work is as near an opposite to ICU as you can get. If you liked the focus, precision and complexity of ICU work, but just don't like the folks and the pace in your department, I'd suggest looking for another ICU or similar department. If you have a secret yearning for chaos, welcome to the ED.