ED to ICU

[ERnurse_casey]

Hello all!

I am a current ED nurse for 2 years with an additional 10 months experience as a tele obs RN prior to ED. I am looking to step into an ICU role for the increased knowledge to someday go into trauma or transport nursing (which require ICU experience). I had attempted to work in ICU previously but ended up resigning after being miserable at work everyday. Have any other ED nurses made the move to ICU? What was your experience and do you have any tips? The drips and technology fascinate me but I love an ED pace. I have looked into trauma ICU but many require prior ICU experience.

Thank you

[Pheebz777, BSN, RN]

Sorry for the late response. Let me give you some insight. I am the total opposite. I've been in an ICU environment for 15 years and just recently transitioned to the E.D. 2 years ago. I find the E.D. fast paced, minimal charting (compared to ICU), and I've learned a lot of new things I've never encountered in the ICU. Something as simple as cauterizing using Silver Nitrate, using Rhino rockets, treating small lacerations with dermabond, etc, etc.

In the ICU we do have chest tube insertions, central line insertions, pericardiocentesis, thoracentesis, and other invasive procedures so that's not new. I really get on my A game when severe cases come through the door ex. gun shots, stabbing, MVC's, etc, we never see this in the ICU. We do the aftercare and continued monitoring of these patients.

In my personal experience, in the ED, the MD's call the shots and we implement them. In the ICU, we mainly call the shots (titration, getting STAT ABG's, EKGs, (while trying to get a hold of the MD and waiting for them to call back), there are also many protocol sets to follow (DKA, Heparin drips, Argatroban drips, IABP, Impellas,etc) so you need to be on top of everything going on with your patient.

In the ED, I've learned a lot of "real world" skills like creating splints with orthoglass, dressings, managing sprains, and I've also learned a lot about pediatrics.

In the ICU, you'll gain a lot of knowledge and understanding on how medications work, hemodynamics, managing vents, IABPs, but the pace is not as fast as the ED, unless you have a Code or unstable patient.

[gromit1084]

Interesting insight from Pheebs!

I am an ICU nurse so its interesting to hear about the difference.

To answer your post, its a red flag that you were previously in the ICU and hated it. You might be in a different place in life and perhaps you will enjoy it more the second time around, but chances are that if you hated it then, you will probably hate it now. I would really think about why you hated the ICU and if things have changed for you regarding those reasons (perhaps it was too detailed, too stressful, too overwhelming in specific ways?)

Good luck

[CCU BSN RN]

I wonder about your geographic area and the acuity of your hospital. I think that would make or break an ICU experience. A busy level 1 trauma center in a major city...going to be a lot more exciting than a small hospital with a 4 bed ICU. I'd say a trauma or CVICU might bring more excitement to the table, but you're still looking at a major change in thinking between ED and ICU nursing.

Going from a stabilize and ship out mentality to one where you scrutinize every minor decision and carefully assess for minute changes, where you follow policies and procedures to a T and lose all your MacGyver skills...It's definitely an adjustment. Which is not to say you shouldn't do it, but to be kind to yourself when you're making a big transition like this. And to be kind to your colleagues who will put up with you and teach you how to be a little more OCD. And keep telling yourself that your ICU career has an expiration date. You likely only have to buck up for a year or two, max. You can tolerate any nursing job for that period, as long as it's not abusive or toxic. You'll learn a lot of useful skills, but it'll totally suck for at least six months, more than likely.