Interview tips for Experienced ICU nurse

bostongirl86 · Oct 3, 2012

Hi everyone! I know most of the posts are aimed at New grads going to the ER, but I'm trying to make a specialty change from ICU and a stint in case management (bored out of my mind). I may have an interview upcoming at a Level I trauma center ER that's almost 70 beds. I hope I'm not getting in over my head, but I really need this change, it's actually also a relocation for me if I get the job.
I would appreciate any tips you might have since I do have experience, but not in ER except for an occasional float. I'm guessing questions are very prioritizing oriented. But I definitely know next to nothing about trauma, I ordered a couple books to try to help me with the bridge.
Thank you for your time!

So you are looking to get back into hospital nursing? Why is case management boring?

**NickiLaughs, ADN, BSN, RN** · Oct 8, 2012

I do utilization review, which involves reading cases, then determining based on guidelines created by someone the "ideal" time frame someone should be in and out of the hospital. At first it was alright, then it became pretty repetitive. I average 30+ patients, most of my coworkers have 15 or less. I've asked for extra projects to make it more interesting and challenging, I'm just not being mentally challenged. Great hours if you are looking for a change and ok with monotony. Yeah I do want to go back to hospital nursing. I liked ICU, but think my personality might be a better fit in ER. However, the job search isn't going as well as I had hoped, the economy is wanting previous ER experience for everything, so I may have to return to ICU and eventually just hope to transfer to ER that way.

nurse2033, MSN, RN · Oct 8, 2012

I've worked in both environments and the big difference is that ICU is very structured and nurses get into a "routine". You need 50 routines in the ER as things change minute by minute. You have to be very flexible and that means sometimes letting things go, like not being able to finish everything you want to before the patient is admitted for example. Your critical care knowledge will be welcome, you just need to re-prioritize on the go.

**NickiLaughs, ADN, BSN, RN** · Oct 9, 2012

I've worked in both environments and the big difference is that ICU is very structured and nurses get into a "routine". You need 50 routines in the ER as things change minute by minute. You have to be very flexible and that means sometimes letting things go, like not being able to finish everything you want to before the patient is admitted for example. Your critical care knowledge will be welcome, you just need to re-prioritize on the go.

Thank you for that. :) I think that's one thing I need. I get a little too "ADD" which I think is why I got a little bored in ICU. I got tired of staring at the same patient for 12 hours after they were stabilized, and mostly the exact same patients-sepsis and post CABG. Hoping I get a call for that job! This economy is making the job search really difficult. I'm hoping to do my PALS and TNCC soon to make myself more marketable, but the price is a little more than I was expecting!

Editorial Team / Moderator · Oct 10, 2012

ED = ADD, ICU = OCD. Haha!

Esme12, ASN, BSN, RN · Oct 10, 2012

Thank you for that. :) I think that's one thing I need. I get a little too "ADD" which I think is why I got a little bored in ICU. I got tired of staring at the same patient for 12 hours after they were stabilized, and mostly the exact same patients-sepsis and post CABG. Hoping I get a call for that job! This economy is making the job search really difficult. I'm hoping to do my PALS and TNCC soon to make myself more marketable, but the price is a little more than I was expecting!

TNCC will help......I will tell you ENPC will suit the ED better, instead of PALS. As a manager I would caution you to about mentioning the boredom thing. We are looking for keepers. The ED is difficult to acclimate to and takes about a year.....knowing that someone is restless and are looking for excitement is a red flag because the ED is not always adrenaline and TV worthy. There is plenty of mundane in between. New staff to the ED when they are looking for excitement and are initially disappointed because they aren't "in the thick of it" right away" and are no happy with the urgent care (if included in the ED) and triage (which is actually the hardest job in the house)....grow bored and annoyed quickly and leave.

While the ED can be full of excitement....there is a TON of repetition. Every ED has their frequent flyers whether they are ETOH, drug seekers, psyche patients, indigent/homeless, the abusers of the ED for hangnails. You KNOW who is coming in by the presentation and report before they get there........you will be able to make bets on who is right. Even at major Trauma centers there is a familiarity of routine in the usual's with the homeless and local gang members. An Acute MI is a Acute MI. Next.......please.

The septic nursing home patients and croupy/febrile babies that get complete septic work ups but are seldom THAT ill. Strokes/seizures and the 99year old with dementia sent in for confusion. Bumps and bruises....lacerations with a smattering of fractures. Depending on where you live....the overnight snowfall and hand injuries on males that can't resist sticking their hand in the snow blower (funny they have all been males).......accidents with those snow falls while drama is high are seldom "exciting". You will know when the flu hits and the latest stomach bug.

But the scene does always change and the faces may not be the same day in and day out. They are usually not there when you return the next (note I said usually) day but there are those boarders that linger.

I know I have worked and managed both. I agree that case management would drive me insane and I would long for the bedside....which is where I never strayed from in the 34 years I have been a nurse......until I became ill. Examine what it is that is driving you nuts and turns you to boredom so quickly

The ED is unpredictable, yes but it is not always free of "routine". Good Luck!

**NickiLaughs, ADN, BSN, RN** · Oct 16, 2012

TNCC will help......I will tell you ENPC will suit the ED better, instead of PALS. As a manager I would caution you to about mentioning the boredom thing. We are looking for keepers. The ED is difficult to acclimate to and takes about a year.....knowing that someone is restless and are looking for excitement is a red flag because the ED is not always adrenaline and TV worthy. There is plenty of mundane in between. New staff to the ED when they are looking for excitement and are initially disappointed because they aren't "in the thick of it" right away" and are no happy with the urgent care (if included in the ED) and triage (which is actually the hardest job in the house)....grow bored and annoyed quickly and leave.
While the ED can be full of excitement....there is a TON of repetition. Every ED has their frequent flyers whether they are ETOH, drug seekers, psyche patients, indigent/homeless, the abusers of the ED for hangnails. You KNOW who is coming in by the presentation and report before they get there........you will be able to make bets on who is right. Even at major Trauma centers there is a familiarity of routine in the usual's with the homeless and local gang members. An Acute MI is a Acute MI. Next.......please.
The septic nursing home patients and croupy/febrile babies that get complete septic work ups but are seldom THAT ill. Strokes/seizures and the 99year old with dementia sent in for confusion. Bumps and bruises....lacerations with a smattering of fractures. Depending on where you live....the overnight snowfall and hand injuries on males that can't resist sticking their hand in the snow blower (funny they have all been males).......accidents with those snow falls while drama is high are seldom "exciting". You will know when the flu hits and the latest stomach bug.
But the scene does always change and the faces may not be the same day in and day out. They are usually not there when you return the next (note I said usually) day but there are those boarders that linger.
I know I have worked and managed both. I agree that case management would drive me insane and I would long for the bedside....which is where I never strayed from in the 34 years I have been a nurse......until I became ill. Examine what it is that is driving you nuts and turns you to boredom so quickly
The ED is unpredictable, yes but it is not always free of "routine". Good Luck!

Thank you Esme12 for your information, I see why you have an entire thread dedicated to you! I was an LVN prior and worked in a clinic type environment and loved it. I think the variety of patients kept me going. In the ICU I frequently can have the same patient for several weeks, with the same family. I know I need to really address this prior to anything. I've ended up having 3 ICU jobs (one I left d/t relocation, the second I left d/t no hours and getting called off twice a week, and the third I left because of this case management job that everyone said I should take...oops). So my track record looks awful right now, and I think that's my biggest deterent to getting a call for an ER job. I've only had one call for an ICU job. Hopefully something will happen soon.... because if I stare at this computer much longer I may throw it out the window.

FlightJunkie · Oct 16, 2012

Great things said here and I can't agree more. I think a lot of it has to do with personality. Some are wired for it and some aren't. Even if you aren't "wired" for it, that doesn't mean you can't learn to be a good ER nurse. I would say just keep an open mind and listen to your preceptors. I've precepted nurses from GN to Floor RN to ICU RN and there is not formula for predicting how each will do. I've seen all be extremely successful. In my opinion though, the ICU RN tends to have problems with time management. Some simply cannot grasp the fact that they have to move on to other patients. You cannot spend hours with one pt and let your other pts be neglected because you are stuck in your ICU routine. This can be a big issue, in the ER, your job is to find the easiest quickest way to get it stabilized and done, take your time and you are doing a bad job. In the ICU, your job is to take your time and be thorough. The easy quick way is not an option there and your patients will suffer. See the difference? This is just a common thing I have seen with some ICU RNs, and not all have this issue. I wish you well. The ER is my first love and I know that you can absolutely love the job!

Aaron

**NickiLaughs, ADN, BSN, RN** · Oct 16, 2012

Great things said here and I can't agree more. I think a lot of it has to do with personality. Some are wired for it and some aren't. Even if you aren't "wired" for it, that doesn't mean you can't learn to be a good ER nurse. I would say just keep an open mind and listen to your preceptors. I've precepted nurses from GN to Floor RN to ICU RN and there is not formula for predicting how each will do. I've seen all be extremely successful. In my opinion though, the ICU RN tends to have problems with time management. Some simply cannot grasp the fact that they have to move on to other patients. You cannot spend hours with one pt and let your other pts be neglected because you are stuck in your ICU routine. This can be a big issue, in the ER, your job is to find the easiest quickest way to get it stabilized and done, take your time and you are doing a bad job. In the ICU, your job is to take your time and be thorough. The easy quick way is not an option there and your patients will suffer. See the difference? This is just a common thing I have seen with some ICU RNs, and not all have this issue. I wish you well. The ER is my first love and I know that you can absolutely love the job!
Aaron

Thanks so much! I think I could make the time management transition. I was an LVN first and worked in a SNF with 38 patients and also did a clinic/urgent care. I think that's why I'm getting bored in every ICU....the same patient for weeks...ugh. The hard part is scoring the job in this economy.