ER to ICU....

HyperTension · Aug 11, 2009

As somebody to bounces back and forth from ED to ICU / Open Heart Recovery, I do remember that first transition.

Yuppers, it's a bit overwhelming at first. I was used to the philosphy of "Either way, they leave the ER (Upstairs, out the door, or downstairs), and all of a sudden I have the same patient... for 12 hours..... and family.... are you on crack????

It's a completely different mindset, with emphasis on trends (more often subtle) vs. in the ED of stabilize the obvious and refer on to the needed floor / department. Your ED background will be a big asset when things fall apart and "following your gut", but it's going to take time to get the degree of control and finesse that a seasoned ICU nurse will show.

Also, the big thing in the ED is protocols. Granted, every ICU has them as well (some more than others) but once you develop a rapport with the attending you can have a pretty fair degree of latitude that you can manipulate regarding care and treatment, but please understand that it takes time...

I've told students / new grads that it takes about 2 years to develop into a seasoned / decent ER nurse. It takes that long (maybe longer based on the institution, patient population, and staff) to evolve into the same for ICU/CCU.

Best advise, maintain a degree of humility, even if you already know what is going on. Ask for a tough preceptor. Listen, listen, listen. Don't push for easy assignments. Sooner or later, you will be on your own, and you will appreciate it later.

Now, regarding humility. I'm going to make a few broad statements, not pointing fingers, but more observations that I've seen over time. ICU nurses are traditionally control freaks. Thats why we love the waveforms, drugs, and procedures that occur on the units. Hell, nothing is more entertaining to me than a profoundly septic person, and on multiple drips (meaning more than 6) that require titration, and all the waveforms / numbers you can throw at me, and slugging through all this to optimize therapy for my patient. Thats NOT the way of the ER nurse. Excitment, blood, yelling, and 2 large bore IV's and then it's time to call report, and move on to the next. You will probably encounter people that look down on your background for a variety of reasons when you move to the unit. Some of these points are a degree of merit, but its more of a perception difference than anything else. Take a breath, let it roll off your back, and move on. Over time you'll develop a sphere of comfort / competence that will "shut them up" :), but it won't happen soon enough. You'll come into your own, but find a few strong, competent people, and emulate them.

Good luck, have fun, and keep on thinking, learning, and applying the knowledge that is passed on to you.

missnurse01, MSN, RN · Aug 14, 2009

I did just this, and had a shorter orientation then new grads did (i assume that is what you mean by internship). Is it doable, yes, should they still give you a more than adequate orientation-yes...can you ask for more time if you need it, yes. From what I have seen about other nurses making the same transition is that the mind set issue is the biggest problem to over come-you really need to consider yourself like a new grad nurse...that is how big the learning curve is. Yes, you know that dopa can be used for low b/p, do you know why, what might be better for a particular pt, when it should not be the the pressor chosen? In the ER I felt that we were task masters, doing tasks and procedures, and at some ERs, very limited critical thinking done. Tasks are less important in the unit, critical thinking more. Just because you know how to do many of the tasks required for a unit nurse, does not necessarily mean that you are ready to come off of orientation---this is an issue I have seen for those of us that made the ER-unit leap. It's hard to change mindsets!

Just ensure that you will get adequate orientation, and go in with the right attitude (that of learning), and you will do fine!

good luck!