ICU to ED RN

[otterpop1989]

Hello,

I have nearly 2 years experience as an ICU RN (straight out of school), but I've always had an itch to try ED nursing. I'm going back to school and thinking about applying to a per diem ED position. For those who have made the transition from ICU to ED, how difficult was it? What are the key differences between ICU and ED? For nurses who are exclusive to ED, have you noticed any struggles for ICU nurses who transition to ED? What would you recommend I review to ease this transition?

I greatly appreciate any advice you can give me!

[PeakRN]

I went the opposite way, I started in the ED (and the fire service before nursing) and then went to inpatient critical care. I have seen plenty of nurses come from the units down to the ED though.

I wouldn't reccomend trying to start in the ED PRN, it is such a different environment you really need to spend a good amount of time to get used to the flow. The unit is more about perfection, the ED is somewhat organized chaos.

Often the ED doesn't even diagnose or treat the problem. We often discharge patients with diagnosis of low risk chest pain, feared condition ruled out, or something vague like abdominal pain. The ED is responsible to look for emergencies, so it is not uncommon to rule out those emergencies and then refer to an outpatient provider.

The same holds true for many patients who are admitted. We triage the patient, provide some stabilizing care, and then appropriately disposition the patient.

Keep in mind the the ED takes care of everyone who comes in. You will see newborns, kids, adults, and old folks. You will see CEOs and the homeless. Those with critical illness to those whose problems don't even warrant a PCP visit. Trauma and complex medical. Even if you are in a specialty ED this holds true. I had adult gunshot victims, MIs, stokes, and laboring moms when I worked in a pediatric trauma center. We got plenty of sick kids transferred from the university adult ED.

The ENA has a lot of education for nurses new to the ED. I would consider ACLS and PALS to be a absolute minimum, NRP and STABLE are great it your hospital doesn't have a NICU response to the ED. TNCC and ENPC are also good to have, although if the ED will pay for it I would consider holding off (having them will help you get considered).

[Party_of_five, BSN]

Some ICU peeps can hang, some can't. It depends on your personality and your level of OCD-ness LOL. The ER is all about controlled chaos. I'm not sure they would hire you on a PRN basis. There is a lot of training involved. I guess it would depend on the ED. We do have a few ICU nurses that do pick up as needed but they all worked ER first.

[Dragonnurse1, ASN, RN]

I have been out of nursing since 2003 but I was a new grad that went straight to the ED, 2 weeks of orientation with one of those weeks being with my preceptor. After 2 weeks went to nights on my own and spent 9 yrs 4 months and 17 days there before a severe latex reaction/allergy knocked my legs out from under me.

That said we had a lot of nurses float to the ED to see if they would like to transfer - not one stayed. One even called the nursing supervisor and asked to go home as she was beginning to panic. The best new grads were ASN/ADN, for some reason the BSN new grads always seemed to need 12 weeks or more on orientation which, at that time, was considered too long.

My ED was barely controlled chaos, they had a hard time with the steady stream of patients, non stop ambulances and the residents on top of that. Survival in the ED depends on your ability to track multiple patients and not let the chaos unnerve you.

The focus of the ED is different, we receive, stabilize and admit or greet 'em treat 'em and street 'em. Trying to think of the range of patients I had, GSW's, stabbings, wrecks, traumatic amputations, burns, and everything in between. You need to be able to go from cruising to mach speed instantly and you also never get the "rest of the story" on some of your patients.

I applied to my local hospital right before my last quarter and wanted the ED. I worked as a "PCT" (patient care tech) until graduation. I graduated on a Friday and was working in the ED as a new grad the following Monday. Perhaps you could do something similar. When I was beginning school I was advised if I wanted the ED to go straight there as you continue your education and hone your skills differently in the different areas of the hospital. I was told the ED was unique and they were right. From pushing Methylene Blue on my first patient to starting Levophed on my last I loved everything about the ED.

[tachyallday, BSN]

From someone that did many years of PICU & ICU, and now works in the ED. I would not have been able to walk into a per diem job ready to fly as an ED nurse.

I think you may not know what you don't know. The ED is so different. You need to learn how to juggle your critical patients along with perhaps 3 other patients at a time who all may not be very sick (or might be), but you need to move along their care just as fast too (and make room for the next one), because you never know who is walking into the waiting room or who is coming through the ambulance bay.

I used to think any "lower" level of care that ICU would be no sweat. The truth is, it was hard for me to float to tele, and hard for me to take peds med surg assignments. And I have to sometimes force myself to not get too wrapped up in minutiae that are not important to emergency care. You need to learn how to divide your time, instead of 100% focus on 1-2 patients (or 3 for that year I worked in FL).

I know the rest of the hospital thinks the ED doesn't do real patient care, and I used to think that too. The truth is, there is no way to get it, unless you've worked there. If you're interested, I would suggest, going FT ED, and taking a per diem ICU job?