Move to ED from ICU?

jerry5657 · Feb 7, 2005

Hello,

My name is Jerry and I started my nursing career on a burn unit with an ICU for 4 years, then I went to a general 20 bed ICU that did everything from Trauma to post CABG, of course AMI's as well and so on. After 4 years in the ICU I always dared to think of working in an ER, and I do not regret it at all!

I liked all the cool gadgets and detailed care of ICU. There is nothing like struggeling with a sick patient all night - swan and pumps and drips I love it but the ER has just as wonderful rewards - never have I worked in an environment where Dr., Nurse, RT, and Tech's (at least where I work)work so close and as a team. In ICU people don't usually get a lot better - just enough to ship off to tele or somethng and then who knows - In the ER half your patients or more will get to go home better right now! (Not counting drug seekers who don't get what they want). I don't think I ever want to go back to such a stuctured environment as an ICU or Nursing floor - Its cool taking care of the immediate and let the ICU and floor take the next step - its a nice place.

No MARS!!!!!!!!!!!!!!!!!!!!!!

No Baths!!!!!!!!!!!!!!!!!!!!

NO CALL LIGHTS!!!!!!!!!!!!!

Floors wont like you - you bring them work and they got enough.

ICU will think your lazy(or stupid) because you don't have the pt. tweaked ICU style - but let them work a little while in an ER and styles change. Icu nurse takes 2 patients usually, three if busy - ER you keep taking patients until all are cared for. Every room will be full, and cots in the hallway as well will be full and floor nurses will not take report and will think your pushy but actually your desparate.

You will use ACLS often, you will become an a terrific IV starter and vampire.

Good hands on and good use of nursing theroy.

Well, take care

Jerry

SOCALRACERX911_RN · Feb 7, 2005

Hello,
My name is Jerry and I started my nursing career on a burn unit with an ICU for 4 years, then I went to a general 20 bed ICU that did everything from Trauma to post CABG, of course AMI's as well and so on. After 4 years in the ICU I always dared to think of working in an ER, and I do not regret it at all!
I liked all the cool gadgets and detailed care of ICU. There is nothing like struggeling with a sick patient all night - swan and pumps and drips I love it but the ER has just as wonderful rewards - never have I worked in an environment where Dr., Nurse, RT, and Tech's (at least where I work)work so close and as a team. In ICU people don't usually get a lot better - just enough to ship off to tele or somethng and then who knows - In the ER half your patients or more will get to go home better right now! (Not counting drug seekers who don't get what they want). I don't think I ever want to go back to such a stuctured environment as an ICU or Nursing floor - Its cool taking care of the immediate and let the ICU and floor take the next step - its a nice place.
No MARS!!!!!!!!!!!!!!!!!!!!!!
No Baths!!!!!!!!!!!!!!!!!!!!
NO CALL LIGHTS!!!!!!!!!!!!!
Floors wont like you - you bring them work and they got enough.
ICU will think your lazy(or stupid) because you don't have the pt. tweaked ICU style - but let them work a little while in an ER and styles change. Icu nurse takes 2 patients usually, three if busy - ER you keep taking patients until all are cared for. Every room will be full, and cots in the hallway as well will be full and floor nurses will not take report and will think your pushy but actually your desparate.
You will use ACLS often, you will become an a terrific IV starter and vampire.
Good hands on and good use of nursing theroy.
Well, take care
Jerry

Glad you like the transition into the ER. I'm an ER nurse and everything you've said is true. What do you think about an ER nurse going to ICU. How do you think I would do? Just a couple of reasons why. I would like to do Critical Care transport and having the ICU experience will allow me to be more effective in taking care of ICU holds in the ER (do you agree or disagree?)

nursenary57 · Feb 7, 2005

I have experience in ER and SICU. My journey went like this - as a new grad I went to work in a level 1 trauma center ER. Scared to death of course but I learned more in my first three months than I did in nursing school. Full time there for two years and then PRN for the last 8 months. After I had been working for 18 months I applied for a PRN position in an SICU at a different hospital. Got the job but only a four day orientation! It is supposed to be longer than that but they kind of flung me to the dogs. I had taken a critical care course and did a lot of extra reading/studying before I applied for the position in order to prepare me for the transition. The ICU RNs would ask me what I knew about something (art lines, Swan numbers, ventilators, etc.) and I would tell them what I had learned from my reading. Their reply "Oh, you don't need any help, you know this stuff!." Hold up! I just regurgitated to you what I read in a book or heard in a class. I don't have the hands on or 25 year crusty nurse knowledge that I'm looking to get! Fortunately I work with some good people who helped me along. All that was to get along to my advice for the transition. I see everyone as an individual but I'm going to make some generalities here that correlate with my experience. So here goes...

ER to ICU - In the ER you are a jack-of-all-trades. In general, you know a little bit about alot of different things. The big difference in going to ICU is the technical aspect. Swans, art lines, drains, monitors, balloon pumps, ventilators, etc. You will know a lot more about the patient's history and will come to understand pathophysiology because you will see these patient's with these conditions over a long period of time. (Notice how ICU nurses can be a pain in the *** about history when you call report with an admission...)The nurses who understood patho the best in the ER I work in used to be ICU folk. Be a bull about getting a great orientation.

ICU to ER - You definitely learn ACLS (and PALS if you work with kids but it is a breeze compared to ACLS). IVs too. The big plus here is teamwork with docs. Don't have to worry about calling somebody and pissing them off at 3am when you just have to walk out of the room and there they are dictating. But the biggest change is pace. It is usually screaming along in the ER for almost the entire shift (once again my experience is working at 2 different level 1 trauma centers - I don't know the flow of a smaller hospital). Now the SICU I work in is in a large hospital and we get some pretty sick people but it is usually much slower pace. Usually. To help with your ER transition you have got to know where everything is because as long as you've got an airway box, ambu bag, suction, IV kit and some fluid you can make some magic happen. Or at least keep the grim reaper at bay for awhile.

Going from one to other can be done. You just need a few things - 1) time management which ties directly into 2) critical assessment skills (in the ER you take a quick peek in the room and if they are breathing normally and not blue they can wait a sec), and 3) what the hell is this piece of equipment and how do I use it to make them better?

Good luck on the transition. If you have any questions email me and I'll answer best I can. Nursenary57

mattsmom81 · Feb 7, 2005

A step down?? No that isn't a true perspective...except in light of losing some ICU skills such as swans and high tech gadgetry we work with, but you can always offer to float back on occasion if you want to keep up with new 'gadgets' there. :)

I started in ER and moved to ICU as I craved the longer relationships. Funny now when I float back to ER now and then the short time frame I have with patients is the biggest perk. Plus its nice having a doc within shouting distance.

Good luck to you...I think its good for us to get a change now and then in nursing...keeps us sharp. :)

madore57 · Feb 7, 2005

I'm considering moving to the ED after 2.5 years in a Cardiac ICU that handles Cardiac, Medical, and occasionally Surgical ICU patients. QUOTE]
I went from a Surgical Oncology Unit to a Surgical Specialties ICU to ER. I still work in both ICU & ER. The perks of ER: it's a much faster pace; you meet a lot of people; you do a lot of different things - great variety; there's always something funny going on. ICU: usually a much slower pace; if you know your stuff, there are no surprises - you generally know how your shift is going to go as soon as you get report; you develop a closer relationship with your patient - sometimes this is good - sometimes this is bad.
Anyone who says moving to ER is a step down lacks knowledge. An excellent ER Nurse is something you have to see. I feel ICU did help me in my move to ER because of my knowledge of cardiology and critical care meds. Then again, my Cardiac Cath Lab and EP Lab experience has helped me a lot too. You see a lot of cardiac patients in the ER - knowledge of Cardiology and rhythm and ECG interpretation skills REALLY come in handy. Even my OR experience has helped me when it comes to to opening chests, suturing and putting in burr holes. PACU experience helped with all those conscious sedation patients. IV Nurse experience is still one of my greatest assets. Everyone who comes to the ER has something different to offer the bunch. If you like to be busy, like variety and like to continuously learn new things - you'll love the ER! By the way - give your patients their call bells & bathe the poor elderly souls who are parked there for days.

sleddogrn · Feb 7, 2005

Thanks for the replies! Looks like it will be a positive experience where I can use my existing skills. I'm beginning to think the two specialties are very compatible. I'm used to fast-paced since we get a certain number of codes and crashing open hearts. I hope to hone that 'edge' and get better at my IV starts. For To Libmi, I'm a little tired of fiddling with the ICU technology right now (kind of like working on cars all the time), but you will definitely learn a lot from IABP's, Swans, CVVH, Vads, etc. You end up learning a bunch of pathophysiology and a LOT of cardiac stuff if you are in an icu with cardiac patients. You WILL do better at ICU holds. We have an ER nurse who moved to Critical Care Float and after her internship she did awesome. You'll do well switching the other way. Glad I got the reply about the move 'downward', I hate it when nurses from one specialty put another one down, but they're my friends and I tend to listen to them (sometimes, not this time). And they don't want me to move, of course. Thanks again everyone!

SOCALRACERX911_RN · Feb 7, 2005

I have experience in ER and SICU. My journey went like this - as a new grad I went to work in a level 1 trauma center ER. Scared to death of course but I learned more in my first three months than I did in nursing school. Full time there for two years and then PRN for the last 8 months. After I had been working for 18 months I applied for a PRN position in an SICU at a different hospital. Got the job but only a four day orientation! It is supposed to be longer than that but they kind of flung me to the dogs. I had taken a critical care course and did a lot of extra reading/studying before I applied for the position in order to prepare me for the transition. The ICU RNs would ask me what I knew about something (art lines, Swan numbers, ventilators, etc.) and I would tell them what I had learned from my reading. Their reply "Oh, you don't need any help, you know this stuff!." Hold up! I just regurgitated to you what I read in a book or heard in a class. I don't have the hands on or 25 year crusty nurse knowledge that I'm looking to get! Fortunately I work with some good people who helped me along. All that was to get along to my advice for the transition. I see everyone as an individual but I'm going to make some generalities here that correlate with my experience. So here goes...
ER to ICU - In the ER you are a jack-of-all-trades. In general, you know a little bit about alot of different things. The big difference in going to ICU is the technical aspect. Swans, art lines, drains, monitors, balloon pumps, ventilators, etc. You will know a lot more about the patient's history and will come to understand pathophysiology because you will see these patient's with these conditions over a long period of time. (Notice how ICU nurses can be a pain in the *** about history when you call report with an admission...)The nurses who understood patho the best in the ER I work in used to be ICU folk. Be a bull about getting a great orientation.
ICU to ER - You definitely learn ACLS (and PALS if you work with kids but it is a breeze compared to ACLS). IVs too. The big plus here is teamwork with docs. Don't have to worry about calling somebody and pissing them off at 3am when you just have to walk out of the room and there they are dictating. But the biggest change is pace. It is usually screaming along in the ER for almost the entire shift (once again my experience is working at 2 different level 1 trauma centers - I don't know the flow of a smaller hospital). Now the SICU I work in is in a large hospital and we get some pretty sick people but it is usually much slower pace. Usually. To help with your ER transition you have got to know where everything is because as long as you've got an airway box, ambu bag, suction, IV kit and some fluid you can make some magic happen. Or at least keep the grim reaper at bay for awhile.
Going from one to other can be done. You just need a few things - 1) time management which ties directly into 2) critical assessment skills (in the ER you take a quick peek in the room and if they are breathing normally and not blue they can wait a sec), and 3) what the hell is this piece of equipment and how do I use it to make them better?
Good luck on the transition. If you have any questions email me and I'll answer best I can. Nursenary57

Thanks nursenary for the advice. FYI your email did not show. I know orientation is the key, do you have any preferance on teaching hospital vs nonteaching hospital to start at. MICU vs SICU?

SarasotaRN2b · Feb 7, 2005

Ya know, SleddogRN...I think you got it right in your last sentence of your last post...they don't want you to leave. It seems as though ER personnel develop strong friendships with each other due to the craziness at times, and maybe your friends will feel left out and won't have as much to talk about. It seems to be two totally different work environments.

Good luck with your choice!

Kris

nursenary57 · Feb 7, 2005

Thanks nursenary for the advice. FYI your email did not show. I know orientation is the key, do you have any preferance on teaching hospital vs nonteaching hospital to start at. MICU vs SICU?[/quote
All of my experience is in teaching hospitals so I can't give an accurate assessment on non-teaching institutions. My home unit is SICU but I float to MICU. Both have their share of sickies but SICU seems to be a little more fast paced with an overall larger number of sicker patients. That situation could very well be reversed in another institution. email is [email protected]
Yeah, my name is actually Pyke Bobo. I should be famous just for that. Any of you guys got questions I'll do my best to answer or at least find out. Like most people I'm better at advice! Now I'm off to enjoy a night of not wiping *** or pushing on someone's chest.

jerry5657 · Feb 8, 2005

Glad you like the transition into the ER. I'm an ER nurse and everything you've said is true. What do you think about an ER nurse going to ICU. How do you think I would do? Just a couple of reasons why. I would like to do Critical Care transport and having the ICU experience will allow me to be more effective in taking care of ICU holds in the ER (do you agree or disagree?)

Going to an ICU Is a good step toward CC transport. Your experience in ER will give you confidence in tough times and ICU will sharpen the details of critical care. Take all the classes and training you are offered that you are able too. Good Luck!

11:11 · Feb 8, 2005

I think an ICU nurse is a perfect fit ro the ER. Its the whole reason I went into ICU.

I was told a few years ago that if I wanted to be a good ER nurse go to ICU first.

That doesnt mean that a good ER nurse has to come from ICU, or that an ICU nurse can swim in ER. But overall I think it applies.

I'm an ICU nurse by trade but casual in a couple different ERs and dont have a hard time pulling my weight as long as I know where most stuff is.

I think one thing about ICU is you have to be able to switch speeds well. You might have a decent assignment, only to be pulled of to take care of a miserable one. So I think ER nurses are also a good fit. Just make sure you get a decent orientation and hopefully some classes. Ask a lot of questions, make friends with the satellite pharmacy, and dont be afraid to use your ancillary staff. Dont be afraid to make MD's come to the bedside either or anybody else for that matter-

Break a leg

11