ICU RN considering moving to ER

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Specializes in BSN, RN, CCRN - ICU & ER.

I am an ICU RN with just under 2 years experience. I am considering transferring from ICU to ER. I have my ACLS, PALS, and TNCC. As an ICU RN in my hospital, we respond to all incoming traumas, so I have experiencing with triage there. My IV skills are decent, but considering I work with mostly central lines in the ICU my concern would be that I could use some work there...

I was just curious how you would think the transition would be? Any advice or helpful hints about the possible move?

Thanks :)

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Specializes in ER.

Not being phenomenal at starting IVs doesn't matter, you'll get plenty of practice. If you're really concerned about, depending on facility policy, see if you can IV ultrasound trained and/or IO trained. When somebody comes in from the field and its a basic crew, nothing beats an IO for insertion speed.

Typically ICU & ICU stepdown nurses can make the clinical transition pretty well. They usually have the critical care knowledge and don't need to be taught a lot of stuff (vents, art lines, etc.). I have seen a couple struggle with remembering every patient isn't swirling the toilet when they first transfer. This typically gets rectified fairly quickly.

I've also seen somebody struggle with the organized chaos and lack of routine in ED. Since ICU already responds to all of the traumas you probably have some idea of this. But, I just mention it because I have seen people struggle with the lack of having a routine.

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Specializes in BSN, RN, CCRN - ICU & ER.
Not being phenomenal at starting IVs doesn't matter, you'll get plenty of practice. If you're really concerned about, depending on facility policy, see if you can IV ultrasound trained and/or IO trained. When somebody comes in from the field and its a basic crew, nothing beats an IO for insertion speed.

Typically ICU & ICU stepdown nurses can make the clinical transition pretty well. They usually have the critical care knowledge and don't need to be taught a lot of stuff (vents, art lines, etc.). I have seen a couple struggle with remembering every patient isn't swirling the toilet when they first transfer. This typically gets rectified fairly quickly.

I've also seen somebody struggle with the organized chaos and lack of routine in ED. Since ICU already responds to all of the traumas you probably have some idea of this. But, I just mention it because I have seen people struggle with the lack of having a routine.

Thank you so much for your thoughtful reply. Glad to hear my so-so IV skills will get lots of practice in the ER. No better way to learn than practice and watching expert ER nurses in action.

I did consider the chaos the ER and know that it will be a change from the ICU. Of course I am used to being busy with critical patients circling the drain and coding, but I know the ER is a different kind of busy with multiple new admits and the unknown of not knowing what will roll through the door next. Any advice for how to flip my time management to the ER?

Thanks :)

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Specializes in ED, Cardiac-step down, tele, med surg.

I'd like to know more about time management too. I'm a floor nurse (tele/ cardiac step-down) who will start next week in the ED. I think the lack of routine might be a little tough for me too, I mean a routine is usually how I've managed my time in the past. I'm excited though and ready for the challenge! Any insights are always greatly appreciated. Thank you.

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Specializes in Emergency.

The routine for time management is to consolidate. Assess, line, lab at the same time. Know your standing orders and get things moving. Chart on the fly, never wait until the end of the shift.

Good luck and have fun.

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Specializes in Family Nurse Practitioner.

Yup pretty much what emtb2rn said. Cluster care to the max and anticipate orders. Practice getting out of the room quickly. There is no time to chat. Short and sweet. If you thought the floor was crazy, you are in for a surprise. Teamwork. Ask for help when you need it.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Just remember: ICU = OCD, ER = ADD. :D That is to say, you'll have to let some of the niceties go in favor of the bare necessities! And you'll understand why some patients go up to the unit without everything being "done." Also focused assessments, not head-to-toe. The unpredictability means that your priorities will constantly shift. My biggest piece of advice: whenever you get a new patient, eyeball them ASAP — take that sick/not sick look at them. Sometimes it'll surprise you what other people miss and you'll go, "Whoa, that 'stable' person is really sick, omg!" And your priorities have just shifted again.

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Specializes in ER.
Any advice for how to flip my time management to the ER?

Others have already hit this nail on the head. Bundle care & look at Pixie's quote below.

The unpredictability means that your priorities will constantly shift. My biggest piece of advice: whenever you get a new patient, eyeball them ASAP — take that sick/not sick look at them. Sometimes it'll surprise you what other people miss and you'll go, "Whoa, that 'stable' person is really sick, omg!" And your priorities have just shifted again.

Absolutely on point. Priorities shift all the time. There are some exceptions to eyeballing new patients, which you will learn. They aren't even necessarily hard & fast exceptions but more of "if the situation allows." Every ED nurse has the patient who came in for "I think I've got the flu,"

that turned out to be a STEMI. Or some other equally unlikely scenario.

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Yeah don't sweat iv skills. You will be a pro in no time. There is a routine in the Ed, it's just different. Some like it some don't.

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Ha! I just dropped a pt off in the ICU today from the ER. And thought. Maybe I should do ICU[emoji4]

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Specializes in BSN, RN, CCRN - ICU & ER.

Thank you to everyone for their great replies and words of wisdom. I really appreciate your help. I definitely have some things to consider before making the move :)

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Specializes in ICU, CVICU, E.R..

I've just transistioned to the E.R. after been working ICU/CV-ICU for 15 years, but I still do ICU as agency to a 2 other hospitals. You should have no problem adjusting to the organized chaos you are about to embark on LOL! Your routine will be totally different from the ICU setting. All my semi-urgent patients I always slap a BP cuff and pulse Ox to have a set of vitals on the fly whenever I need to chart the mandatory "hourly vitals" or whatever frequency I need to chart depending on acuity.

Everytime I enter the patients room for whatever reason I also ask about their pain level, N/V relief, etc and chart that right away. It also helps to familiarize yourself with the different splinting techniques using Orthoglass. You tube has a lot of instructional videos. I watched a lot of them and even practiced them at home using ace bandage just to get familiar with techniques.

It would also help to watch videos on how to assist with Chest tube insertions, prepping the Water Seal Drainage, needle decompression, I'm sure you're already familiar with assisting in central line insertions. YOu'll also be doing synchronized cardioversion and TC pacing at times, there's plenty of cool educational videos on YouTube.

Everything else you will learn on the go. There are no arterial lines to set up, No ICP monitoring to set up, NO balloon pumps, No impella pumps, no PCA's, No removing of femoral arterial sheaths (awesome!) anymore! You'll be more accustomed to addressing only the main problem, or mastering the art of prioritizing multiple critical problems.

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