ICU RN becoming an ER RN

Nursingluv101 · Sep 15, 2015

The kids fear takes time to get over. I hated ICU loved the ER. It just depends on your personality. Some ICU nurses I know absolutely hate the ER, both are different. Similar but different. Good luck.

ParalyticAgent · Oct 12, 2015

Take ENPC as soon as possible! Knowledge is power.

Kids are not tiny adults- their physiology makes their course of treatment and clinical presentation much different.

**NickiLaughs, ADN, BSN, RN** · Oct 16, 2015

I did the same as you! I was ICU, then adult only ER and now finally I get some peds. Sick kids are rare. I expected to see a lot more when I came to my new ER. I'm not gonna lie, a hearing and I'm still not confident with them. Partly because it takes practice and with few opportunities, it just doesn't happen.

i give a lot of Tylenol, Motrin, etc and monitor fevers. Ive only had a sick baby once and they got moved quickly to a resus area. I've attempted IVs on 2 kids under 5 and failed both times. I was upset, but they ended up going through several nurses before the lines were successful.

airway is huge with kids, most of their emergencies are more airway focused. You'll breaking pals which helps a lot with that. Triage cap refilling an additional assessment tool as opposed to adults. One of my emergency books has a section on peds and I've read it so many times but unless the practice is there...I'm just not gonna be competent the way I want to be.

you may get more peds than me depending on your type of ER and the area.

Med administration on kids is prob another scary thing. Everything is weight based so you want to ensure an accurate weight upon their arrival. Some peds boluses are given just multiple flushes. (I had a duh moment and felt all kinds of stupid when I watched a former picu nurse help me) syringe pumps are commonly used and most facilities want you to use some sort of catch system whether it's a buretrol on the tubing or a pump to ensure correct dosing.

I hope this helps and I hope you love ER as much as I do.

akulahawkRN, ADN, RN, EMT-P · Oct 16, 2015

Disclaimer: I'm a relatively new ER nurse myself... but I've had some quality street time as a Paramedic, classroom time as a substitute teacher, and experience as an athletic trainer before transitioning to nursing.

It's a little late for me, so I might ramble a bit, please bear with me.

I'm actually not that afraid of taking on peds cases, though they can be absolutely terrifying. PALS only gives you one way to assess peds, so you really should take another course like ENPC or PEPP. I've taken PEPP years ago and it was absolutely an eye-opener, though not a comprehensive course in caring for pediatric patients. You'll get to know the PAT well. Good screening tool.

The thing that is probably scariest with peds is that their physiology is different from the adult, in particular their compensatory mechanisms are different and they can actually look OK until they're right about to crump. You'll get good at figuring out which peds are merely ill and are (mostly) there because of a worried parent and which ones are truly sick and about to start circling the drain.

One of the hardest things with peds is that often they're just too young to really understand that we're having to do things (like start IV lines) to them that aren't all that nice so that we don't have to do it later. I've had a couple of young kids that just flipped out while we were obtaining IV access and as a consequence, caused very strong vasoconstriction which made the process of getting a line that much more difficult.

As others have stated, make sure you get a good weight and perhaps even height early on because peds meds are based on either ideal body weight or actual weight. Some meds have a range and some have a very specific dose/kg. Double-check your medication calculations and if you see a little critter that couldn't weigh more than 20 lbs and you see a weight of 44 kg... something is wrong.

The one thing that does scare me about peds is remembering the appropriate developmental stuff for each age range and seeing what's different from that. Sometimes you might see something that is just "off" and that might clue you into the idea that the cute little critter is a lot more sick than is being let on. With peds, often the family is as much a patient as your actual patient. Know how to treat both.

Another thing that gets interesting is gaining a kid's trust. They trust you or they don't. They think you're fun, or you're just not. Just never lie to a kid. Tell a kid that something isn't going to hurt and then you stick them with an IV isn't a great way to gain trust.

In any event, you're coming to the ER with a good background. You've likely got the skills and then some. Just be ready to move fast because sometimes you'll have 3-4 sick patients to manage at the same time or you'll have 3-4 "clinic" level patients that are in and out so fast that you'll be on to the next batch of patients before you know they're there and if you wait to chart, you'll potentially get so far behind that you might forget details.

I've still got a lot to learn, but I think your learning curve will be much shorter and easier to manage than mine is... I'm a new grad that was lucky enough to start in the ER. It's a LOT of fun!

dannythegreat07 · Nov 5, 2015

just as a general coming from icu to er you are going to have to try and throw out that whole head to toe assessment and do focused assessments. time is everything in ER.