Trauma RN's - A question.......

BlueEyedRN · Dec 7, 2006

I've floated to the ED a couple of times which totally does not make me an expert, but I do think it would beneficial to have experience in the ICU first. It is a completely different world, but having the perspective from both sides could only enhance your nursing practice. The ICU is a much more controlled environment, but the patients can still be very unstable. The last time I worked, we had codes on three different patients and two nurses got called down to a trauma code in the ED, so I was watching 6 patients in addition to my own two, one of which had 8 different drips barely keeping him alive. You'll definitely learn how to deal with crises involving very sick patients, which can only be a plus. I think another benefit would be that you would have a better idea of what is important in the long term. From what I've seen, ED nurses are very focused, a crucial trait in emergency care, but sometimes they fail to see the whole picture. I know that is one of the reasons the departments clash in our hospital. I think it would be awesome for a nurse to have both perspectives and abilities to handle both areas. You'd be a supernurse. Personally, I prefer the controlled chaos, but I have nothing but respect for the ED.

obliviousRN · Dec 16, 2006

I say ER then ICU. I think you'll never get a clear answer on this one.

One thing is for sure. I use my critical thinking skills every day in the ER. EVERY DAY. It's not just all protocols. In fact, we have very few set protocols. Every pt is different, right? You have to use your noggin' all the time. Think CP to acute MI to nitro - what about right sided? You have to be able to recognize that so you don't harm your patient. A protocol is not going to tell you that.

I think ER vs. ICU is a long standing war that we will never solve on this board. It's bad in some hospitals, it's great in some hospitals (the relationship between the two).

All I know is that I respect a nurse who is a good nurse no matter WHERE they work. I don't look down on someone for working in a dept that may seem all "protocol"

CVICURN2003 · Dec 17, 2006

I think that both places "require a brain" and critical thinking skills. I float to the ER at times and have to definatley change the way I do things. (I usually do CVICU). But, that does not mean that one is "harder" than the other. Both you have to think quickly and follow "protocols". I happen to be a HUGE control freak and just find it hard on ME to be in the ER because it is a different atmosphere. God help the person that comes into my ICU room to "help" and does things I don't know about. Things just run different in the ER, 4 nurses work with one pt, which is great, and I would get used to it. Do I want to go to the ER? No. But I do have a huge respect for the talent of my peers. Pts in the ER can talk too much...:))

Trauma Columnist · Dec 17, 2006

I have done both: I did a year in a med/ccu combo before I did 10 years in a level one trauma center. Love the ER, was bored sitting still in the ICU. For me (who wants to physically move during my shift), the ER was a much better fit.

Advanced Practice Columnist / Guide · Dec 17, 2006

I too have gained some perspective in both clinical settings. I was a nurse in the ED of a Level I Trauma Center located in an inner city environment (Detroit, no less). Lots of gunshot wounds, MVC's, injuries inflicted from violent acts, what have you. It's always a rush getting called to the trauma room to try to resuscitate a patient, resident docs cracking open a chest to explore for tamponade, attempting to start multiple trauma lines, ACLS drugs, it's a bloody mess but it can be enjoyable for someone who likes to see blood and gore.

However, the downside was that there's probably 100 nurses on staff in our ED and each nurse had to take their turn being assigned to trauma call. Because of that you don't get the same experience on a daily basis. On some days, you are tasked with merely making sure that all the urgent care patients sitting in the waiting room are dispo'd. I also often wondered whatever happended to the likes of Mr. So and So who lost an entire leg after being run over by a car because I don't get to see these types of patients anymore once they've left for the OR.

When I became an NP, I ended up being hired in the SICU of the same hospital. Although my role involves managing fresh open hearts for the cardiothoracic surgery service exclusively, our unit gets a share of overflow trauma beds. Oftentimes, I would stick my nose in the room to see the action once a trauma patient arrives from the OR. Believe me, these ICU nurses are not sitting around! It's just as busy and chaotic as when the same patient arrived in the ED. There may be less blood and gore but the patient is by no means stabilized (duh! that's why the patient is in SICU).

I guess the moral of my story is that for someone who has a keen interest in trauma, it would be ideal to do both. General Surgery residencies actually expose the doc to both settings and many times, that is the reason for a doc to choose the surgery residency over the ER residency. But I do agree with someone's remark that it's probably better to start out in the ED first and then transfer to SICU.

91CRN · Dec 17, 2006

I have done SICU, MICU, CVICU, CCU and am currently in the E.D. where I've been for the last 7 years--done lots of other things too. I agree with just about everything being said to a certain degree. The biggest thing I agree with is that it's just DIFFERENT. Obviously I prefer the E.D. because that's where I've stayed. All areas in NURSING not just critical care require critical thinking skills. In my personal opinion, the easiest area that I;ve worked was SICU, why?; because it was the best fit for me and my personality--I don't happen to live near a hospital that has a SICU without an MICU component--yuckola!--why don't I like medicine cases?; personal preference of course, they tend to be chronic in nature. No one--no where in my many years of experience EVER worked strickly(or even primarily) off protocol, and in the E.D. it's been my experience that we practice less off protocol than in the ICU--does it mean I'd dis any of my colleagues and the work they do--no--the protocols are there so that when we CRITICALLY recognize something needs to get done--we can do it without getting a Drs order. We don't tend to need them so much in the E.D. because as previously mentioned--we work side by side with the docs most or much of the time (at least in my E.D.). I just have to talk about the equipment. I don't think that machines/equipment should scare anybody; I say that because a lot of new nurses are intimidated and they shouldn't be--they're just tools--in many cases they make your job that much easier--you just have to learn to use them and that's generally pretty easy. I am being required to go back to the ICU; where I've spent years--years ago; to qualify for the graduate program I wish to attend. Does that seem right to you? Oh, I guess now that I'm a student again I should learn to answer the question being asked: I think it's better to get experience in the ICU first before going to the E.D. (and I think clinically the reasons for that are obvious), but I don't think it should be a requirement. One of our best new nurses is a new graduate--she's smart, pays attention, has common sense and cares. It's harder to go from ICU(somewhat controlled) to the E.D. because of the pace, but it can be done--I did it. E.D. to ICU I think would be easier--but go to a different hospital because all the ICU nurses typically think the E.D. folks are incompetent--

Just my 20 dollars worth

stillpressingon · Jan 19, 2007

(I usually do CVICU).

Stupid question: what's CVICU?

Wait a sec. Is it cardio-vascular ICU? :idea:

91CRN · Jan 19, 2007

Yes,

CVICU is cardio-vascular ICU; in my experience primarily post op major vascular cases and hearts.

chip193 · Jan 21, 2007

I am going to be changing hospitals to a major metropolitan hospital, and have the opportunity to work either Trauma ICU or Trama ER.
My question is.......is there really an advantage to working ICU before ER?
I briefly worked ER and got the feeling that it might be in my best interest to start in the Trauma ICU before attempting Trauma ER. This is my own observations based on skill levels, knowledge and scope of experience I have seen in a smaller community hospital RN's and DR's.
I really don't want to open a can of worms (just thinking out loud here) It seems to me, that medical personnel with ICU experience are just, well, stereotypically better ER nurses/doctors than ones who not done ICU.
Maybe I'm crazy?
Any input is appreciated.
Thanks.
Journey (needs a break from med/surg)

My wife is an ICU nurse. I'm an ER nurse.

Let tell you a little story about what we bring to work with us and what we do when we get there.

Jamie has a large black bag. In the center are critical care reference books, snacks, trashy romance novels, and her stethoscope. On the sides are her personals - like cash, etc. She comes into work and takes report on her two patients. She eyeballs the patients, checks the lines, and makes a grid that lists everything that she needs to do for the two patients hour-by-hour.

I bring a Palm Pilot, two pens, and sneakers. I start running and never stop. I don't have any grids. I take report my five to fourteen patients (if I'm on a clinical day - up to 50 if it's one of my charge days) and off I run.

There is a control thing to the ICU. There is no control in the ER.

That's the big difference. And, oh yeah, in the ICU, the patients are really sick. In the ER, that's not necessarily the case!

Jamie hates doing the ER. I'd go nuts in the ICU. We're both very good at what we do. I remember on night where I got suckered into an ICU hold in PACU where all I needed to do was sit on this guy for 12 hours. It was the worst night I've ever had. She'd do that well - it was very controlled.

As for needing ICU to work in the ER - nah. Some of the best ER nurses have never worked Med Surg, never mind the ICU.