From small ICU to big ER...feeling like I may have made a mistake!

[pookiechew]

Hello everyone! This is my first time posting and I am looking for some advice and insight. I just left my PT charge RN position in a 6 bed ICU in a small community hospital to take a PT staff RN position in the ER of the biggest medical facility in our region - a level II trauma center. I started as a new grad in the ICU that I was working in and stayed there for 9 years. I loved the people I worked with but, being it was a small community hospital, they were struggling financially. Although I don't feel like they will be closing the doors of this facility, I felt like it was time to move to a place that was more financially stable and I thought it would be exciting to try something different.

I have been orienting in the ER now for 4 weeks (working 2 shifts/week) and I am very overwhelmed. I thought I had prepared myself for how big of a change it would be but I am struggling to adjust. The pace makes me feel like I am going to miss something with my patients or make a mistake. I went from feeling competent in my job to feeling like an idiot most of the time. I just don't know if I am cut out to be an ER nurse.

I have voiced my concerns to my preceptor and my orientation coordinator and have agreed to give it a couple more weeks. My preceptor feels like I am being too hard on myself. I do feel like I would eventually be able to function but as to whether or not I would ever enjoy it, that remains to be seen.

Am I throwing in the towel too soon? Have any of you gone from one specialty to another and just had a feeling this soon that it just wasn't for you? I have to say I miss the comfort of my small ICU. Thanks in advance for any replies!

[LadyFree28, BSN, LPN, RN]

You are in a new specialty; so in essence, you are now a beginner again,and while it's uncomfortable, you still have a framework of your own nursing practice to build on, which is a positive sign.

I experienced the same conundrum when I was a new grad in CC; I knew I wasn't ready, and went in another direction and used my previous experience to help me GT my new position as an ER nurse.

I also practice my 3 C's of becoming a proficient nurse:

Competence: follow policy and procedure and best practice;

Consistency: Be consistent in following best practice

Confidence: meaning; be confident to ask questions, learning and be confident in figuring things out-even when you don't have the answers.

You will get it; if the feed back is that your are being too hard on yourself, then you are doing something right! :)

Best wishes.

[lvnlrn]

ICU nursing is focused, constantly reassessing, 2-3 patients at a time (usually), detail-oriented.

ED nursing is different. You have anywhere from 2-5 patients, and you don't know what's wrong with them usually. You get your patient in the room while assessing just how sick they appear, put them in a gown, get them hooked up to the monitor, start your IV & get your labs, get urine & ECG, (whatever, depending on the complaint). While you're doing their ECG & IV, you're asking them questions, assessing them. Hook up some saline, give them some Zofran if they're nauseated. Implement standing orders, chart. Wait for MD to see the pt and go on to the next patient. You should be able to do all that in 30 minutes or less (this example is a vitally stable patient). Get your next patient and repeat. Go back to patient #1s chart, hopefully the ED MD has seen them & written orders. Fulfill orders. If patient #2 not seen yet, start on #3 or help your team out. Eyes on the monitor whenever you pass the nurses' station, eyes on the patient when you pass by their door. (I never close the curtain/door when I'm out of the room unless they ask). Start a new patient, reassess the other patients you have. Pop in at least once an hour, throw in a quick set of vitals.

Status change? Get your vitals, intervene, get the MD. I like the autonomy of ED nursing. BP in the 80s, tachycardia? No hx of CHF, heart issues? Throw up a liter of saline and see if VS improve while you're waiting for the MD to get in there. I had a 20 yo F patient last night with altered mental status, straight cath'ed her for urine the color of tea, her LFTs are through the roof, so I went ahead and ordered an ammonia level. The MDs (95% of them) are fine with this, once they know the nurse.

I am not surprised this is a big adjustment, especially coming from a small town ICU. Get the patient, vitalize & stabilize them, and either ship them out or get them upstairs. ED nurses are not the most detail oriented. We don't care about doing comprehensive skin and head to toe assessments. I give report to the floor nurses: "Any skin issues?" "None that I saw."

Are you taking ENPC & TNCC? Those courses are great. I am willing to bet you are doing great right now, but maybe are trying to do too much.

I hope this helps. ED nursing will help you multitask, prioritize, and give you more confidence in other areas of nursing. Between ICU & ED experience you'll be a rock star. :)

[rearviewmirror, BSN, RN]

I thought about giving up until I got somewhat comfortable and that took 2-3 months. the biggest challenge I think for transitioning er nurses is throwing away the habit of accustomed pace of unit/floor and embracing the constantly changing priorities; to put it in harsher light, not giving a damn was the most crucial step for my transition, because really, if you have ambulance, cp work up, abd pain work up, and someone wants blanket, you only got one body to do one at a time. so yeah they can wait, stop caring the petty things and do what you have to do. good luck.