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Discussion

Heading to the ED from ICU

Hello All,

I am starting in the ED in about 2 weeks. Currently I'm working about an hour and 15 minutes away from home and on my way home after my last shift, I ran off the road. Terrified me and made me realize that I really am unsafe after a 12 hour night. My biggest fear is hurting someone else. Ironically (or fortuitously!) the NM of the ED down the road called me that same day. I had submitted my application weeks ago and hadn't heard anything so I assumed they were looking for someone with experience. But I had an awesome interview, it lasted for 2 hours! Even though I've not been given the "official" word, the NM told me to expect a call by Monday at the latest. I met the staff and they were very nice. One nurse was very honest with me and told me not to expect to feel "at home" for the first few days because most of the staff had been there 20-30 years. I really appreciated that heads up, as I can be thin skinned at times. However, no one was standoffish at all while I was there.

SO, here I am half excited and half nauseated! I've never done any type of ED nursing, I come from critical care for the last two years. My patients come to me mostly fixed up, stabilized, you know what I mean. I'm pretty nervous about how I'm going to handle a truly unstable patient. It's not a large hospital, the ED has 13 beds and has Critical Access designation. I feel that it's a great place for me to learn, because they do get everything initially before sending them down the road somewhere if necessary. I'm pretty concerned that I'm going to just freeze when something bad comes in. Even though I have 2 years of critical care, it's in neuro and while we do frequently get borders from other ICU's, we never get the cardiac patients so I'm not as strong with cardiac as I would like to be. I'm also worried about trauma because they are always put back together when I get them. Ugh, I'm making myself sick just typing this! LOL

I would love to hear from those of you who moved from the critical care setting into the ED and how you made the switch. I know it's going to be a whole new way of thinking for me. And I'm also interested in any literature anyone wishes to recommend.

Thanks for listening!

PH

Featured Replies

relax!! that's the first piece of advice i have to give you. it will take time but your point of view will alter some. remember that not every one who comes in will be critical! your coworkers will test you but hopefully they won't throw you to the wolves. trust in your knowledge base. you won't freeze when it matters and if ya do - your coworkers will help. take a deep breath and enjoy it!

speaking as a former ICU/CCU/OHRR nurse, RELAX! I just started in a free standing ER, after working for a cardiology group for about 5 years. I was petrified about starting in the ER, for many of the same reasons you've expressed.

Things I've learned .. already...

--you will use your stethoscope infrequently! We (as ICU nurses) are used to a head to toe assessment. In the ER .. it's problem based, or focus based. In other words, if the guy comes in with a mangled toe, I'm not necessarily listening to breath sounds. It sounds weird, but you'll figure it out.

--it's a team effort, really! I had a pt the other day who walked in with chest pain. We brought him straight back, and triaged him (not sure if that's the correct word .. did his history, etc) at the bedside. Turn out, he was infarcting. I stayed with him, giving NTG, etc. I overheard the ER doc on the phone with the cardiologist. I came out of the room ... and the other nurses had called report, as well as called EMS for transfer.

--peds is something I need more experience with. I'm not sure what it is, but I start quaking whenever I see an age under 13! We get a lot of kids in our ER, too! I can't avoid it, so I need to learn to deal with it!

Bst of luck to you .. keep us posted!

I work in both so i'll try to see what i can do . First there a saying that state: icu nurse know a lot about a little bit and ER rn know a little bit about alot. You'll see that in the ER we aproach problem differently.We are not as concern to understand the all pathophysiology of what we do. Cause most of our nursing is "short term". Our role is to make the person stable and send. I find my "ICU thinking" come very handy in many situation. But sometime we want to do to much for a patient. Like someone said in an other post no need to auscultate a broken toe. But you knowledge of system aproach will come handy in very sick sepsis patient on ventilator.

Since there a lot to learn in the ER cause we can have any kind of patient, it can come overwhelming. When I started I figure out what was my strenght and my weakness. Read more about your weakness and built your knowledge on that.95% of the patient present with:SOB, CP,abominal pain, Headache,trauma, seizure an toxicology. One of my worst kind of patient, and for many RN in the ER, gynecologic patient. There great book out there that can help you to get better in those field. I find developing the problem aproach instead of sytem aproach in the ER is very useful.

One of my latest great finding in the book section is:

Lange current emergency: diagnosis and treatment(ISBN 0-8385-1450-2)(ISSN:084-2293). It descripbe a good problem aproach. Also you can find some good book at:

www.ena.org

Hope it help!

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