How can a ICU RN switch to ER Nursing?

MichaelFloridaRN · Mar 5, 2008

While I would not want to leave SIC for anything, I do have a friend who has switched to the ER at out hospital.

She said the best thing to do is to be humble and follow your preceptors suggestions as close as you can until you are able to safely make your own ER judgments.

She told me that the main difference is the fact that while in ICU you tend to check a patient out 100%, in the ER she tends to do a quick head to toe but mainly focus on the actual problem. For instance when she told me when they treat a scratch on an arm, they mainly focus on making sure to stop blood loss, prevent infection and check the tetorifice status. While in the ICU you have much more time to spend with your patient and go into every detail of their status. The time in the ER does not allow her to be this thorough.

Hope that helps you some, just go for it and I hope you enjoy it. Going back if you do not should be easy since ICU nurses are always in demand.

deeDawntee, RN · Mar 5, 2008

I have just made the same move, although I am continuing to work in the ICU as well. What the previous poster said is exactly right, you concentrate on the presenting problem, and don't get caught up in every detail as in the ICU. Also, you work very closely with the other nurses, often employing a "team nursing" approach. In other words, someone else may discharge your patient while you are taking the next as the paramedics roll them in the door. The biggest challenge for me was acquiring a global awareness of all the patients, orders and maintaining that ever-precious "flow" through the department. (a little frustrating, since frankly, it is rarely a nursing issue...)

Your ICU training will serve you well, as you are comfortable with very ill patients. Other than that, ED nursing requires a lot more patient and family interaction, education and being a calming, therapeutic presence. It is VERY different in many regards compared to the ICU and I would HIGHLY recommend humility as you orient to emergency nursing. It definitely requires a more comprehensive set of nursing skills. At first the environment will appear chaotic and beyond your ability to control, and soon will see that there is some order in the chaos....

Good luck. Personally, I love having a foot in both worlds!

Blee O'Myacin, BSN, RN · Mar 6, 2008

:smokin:Hello all haven't posted in quite awhile. I have been a nurse for almost two years. I have been in ICU since graduating nursing school. I actually have been in a surgical heart ICU for 1 1/2 years. I know ICU is not far from ER nursing, but I want to know which way I should go about switching specialties?

Interview. Take a tour of a unit and see what the vibe is like. I have no regrets going from the ICU to the ER - I use my critical care skills all the time.

Blee

fignal01 · Mar 6, 2008

Well, I've spent most of my 27 year career in ER's. I always thought that working in an ICU would be similar, so I took a position managing an ICU. I found out quickly that ER and ICU nursing couldn't be more different from each other. The environments and the way you practice are completely opposite in many ways. So, I think your first move should be to ask the ER manager if you could shadow one of her staff nurses (in other words don't expect to be paid) for a shift or two. That way, you can see if it is really what you think it is and if you like the environment.

If you do decide to make the transition, you will have to give up your ICU habits of being thorough and detail oriented--you won't be able to do detailed assessments on every patient, worry about patient's hygiene needs, and things like that in the ER. Also, you will have to develop some very different organizational skills--you've been working in an area where you typically have 1-2 patients. In the ED, I've had up to 26 that I was the only RN assigned to--they weren't critical or anything, but I still had to keep all of them straight. You will have to learn to be very flexible--no more controlled environment, you won't know what will walk in the door at any given time.

ER nurses and physicians are a different breed, and they often form tight social circles that can be hard for newcomers to break into. As others have advised, be humble. If you have a criticism of their practice--keep it to yourself--no criticizing until you've been there at least 6 months and people have accepted you. Share your ICU skills if and when asked, don't try to "teach" them to the ER staff--trust me they won't appreciate it. Go out to the bar with them after work if invited, or to other social functions. I have found over the years that a person's success in the ER depends much more on personality than anything else.

Good luck!

:twocents:

KatieBell · Mar 7, 2008

I switched from neuro ICU to the ED and for me it was the best move I ever made.

My biggest problem when switching was realizing that I was not going to be able to visualize my patients 100% of the time, and that there was no need to for most of them...

For a while I wanted to put everyone on a monitor, but I soon got over that.

They really are different areas, I personally prefer the ED, itjst has a nicer rhythm to it for me, and the Docs and Nurses are "more fun" but the best way is to try it and see if you like it. :nurse:

SDS_RN, RN · Mar 7, 2008

I made the switch from a med-surg floor and it was hard for me to break away from trying to meet all of the pt's & families needs. We would have crazy busy nocs but it still doesn't compare to what you do in the ER. The ER is completely different from all areas of nursing in my opinion. I need to get in & get out. Focus only on the problem area stabilize it, notify the doc, and roll onto the next.

I would have to agree that personality has a lot to do w/ it as well. I work w/ nurses that went to school together and have worked together for 20+ years and they are a family. They have been very gracious to me and work hard to help me since I'm the newbie. I love it and I'm glad I made the move. I love all the different types of pts that come in some interesting some stupid but it's great.

I had very minimal experience w/ critical patients & I wish I would have had some prior ICU experience to back me becasue those pt's scare the hell out of me. I look forward to the challenge they present to me and am excited to learn more and do more as I continue.

Good luck to you I hope you like it as much as I do.

bill4745, RN · Mar 8, 2008

Ten years in ICU, now 4 in ER. Wish I switched years ago. There is never a boring moment, never a shift that I don't learn or do something new. You are constantly resetting your priorities (the place can go from quite and controlled to overwhelming chaos in 5 minutes), you get to think and act on your own-for example, a pt comes in c/o sob with recent diagnosis of pneumonia. We use our judgment and send labs, order CXR, breathing treatment before the doc even knows the pt. is there. I also have found the ER staff form much closer relationships than other nurses, which adds to my enjoyment of ER. I will do this until I retire.

AfloydRN, BSN, RN · Apr 13, 2008

I started in ER and went to CCU. I am now back in ER. It;s a different way of thinking. ER is the quick fix. Fix the problem- usually by some sort of protocol- and get them out of there. Well- where do you think they go? To CCU. CCU, in my opinion, is more like- now their here- what all else do we need to look at. It's more troubleshooting for the next few days. You know, warding off evil spirits! If they came in w/ CP- R/O MI- STEMI , what do I need to look at for the next 12 hours.