Transfer from working in ER to Tele- have you done it?

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Specializes in Tele, ED/Pediatrics, CCU/MICU.

Hi everyone,

I work in an ED and have been there for 2 and 1/2 years. I am actively pursuing employment on Tele/Stepdown units, for several reasons.

These reasons are:

-Need to get out of the super high anxiety/stress of ED

-Want to have the experience of having a quality relationship/rapport with patients

-Feel like I am an "incomplete" nurse in some ways, since I have never worked on the floor

-Desire to work with high acuity, but in a more controlled setting

I ultimately hope to transition into ICU, but have had no luck doing so directly from the ED. (Have been applying to ICU's in my area x1 year. All require ICU experience & do not consider ER "Critical Care." Very frustrated.).

My questions are:

1. Have you gone from working in an ER to working on a floor? If so, what was the experience like?

2. Do you think that some time on telemetry/cardiology will make me more marketable for ICU in the future? (since I haven't had any luck applying directly to ICU)

3. What conflicts might I feel, going from the emergency environment to tele?

I have upcoming interviews for Tele/Cardiology positions, and I am wondering if this will be helpful or harmful in terms of my ultimate goals of ICU.

Thanks for any and all thoughts! Personal experiences with transferring from unit to unit are appreciated :)

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Specializes in ER.

I have not gone from ER to the floor but I am waiting to hear back from the interviewer! I am not looking to go to tele, but to rehab. I have been in the ER 2 years and like you, I feel like I am an uncomplete nurse. I am always rushing to do things, to get the patient moved so another can fill the bed. It is unsatisfying. The stress is getting to me as well. I think all your reasons are valid. I also don't anticipate having an issue going to ICU with ER/tele experience. Good luck!

PS- Anyone who tells you ER is not critical care has never worked ER!!

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

ER is not critical care because of the lack of continuity--and yes, I have worked ER...if you have an ICU bed--transported patient comes in, stops, and you drop in ICU. If the patient stays with you, you're still open to more patients and the continuity of focus on 1-2 patient disappears. I've worked where it never stops and the door stays open so it is never a good idea to keep the patient, especially the ones who are on drips--you know what I mean--ER never closes.

I think you have a great attitude and learning to rapport with patients on a more lengthy period is a good goal.

I just hope you can tolerate the nuances of the floor. I was too ADHD to handle it for more than 2 years. It is an excellent nurse who can do it. My hats off to those who can.....

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Specializes in ICU, CVICU, Case Management.

Good luck. Have you visited the tele floor? Is there a high turnover rate on the floor? Try to find out what you can about the tele floor, see if the nurses like it, overall.

Some tele floors are glorified med/srug floors and the rapport you hope to achieve w/ patients is non-existent.

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Specializes in Tele, ED/Pediatrics, CCU/MICU.

I just hope you can tolerate the nuances of the floor. I was too ADHD to handle it for more than 2 years. It is an excellent nurse who can do it. My hats off to those who can.....

....... In response to that statement: I think I'll be ok, because I am not even the slightest bit "ADHD".... in fact, I get supremely frustrated from frequent interruptions.

However, I do see your point... the potential for it to be less than stimulating is certainly possible.

Think it will help me bridge into ICU?

Thanks again for your thoughts!

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Specializes in Tele, ED/Pediatrics, CCU/MICU.
Good luck. Have you visited the tele floor? Is there a high turnover rate on the floor? Try to find out what you can about the tele floor, see if the nurses like it, overall.

Some tele floors are glorified med/srug floors and the rapport you hope to achieve w/ patients is non-existent.

I will be visiting these floors next week, and will attempt to make contact with the staff during that time to assess how they feel about their environment.

Even if I can't have an improved relationship with the patients, I'd at least like to acclimate to the pattern of knowing everything about a few people, as opposed to needing to know a few tidbits about many.

In your opinion, will some Tele help me be more marketable for ICU?

Thanks again!

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I would think ER would be more marketable for ICU than tele.. I've worked ICU for over 13 years and thought I was burnt.. Decided to take a part time job on a tele floor.. Never again will I do that.. It's a whole different world.. More paperwork.. Less critical thinking.. Less nursing care.. After my 90 day probation period I transfered to their ICU (its a much smaller hospital than I am used to) but it was a break from the Level One Trauma at my main job..

I would say stick with the ICU search and don't stop looking.. You're more qualified as an ER nurse than a tele nurse..

Best Wishes..

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Specializes in Public Health, TB.

i work on a progressive care unit--higher acuity than med. tele, but technically not a step-down unit. We have had many staff move successfully from our unit to ICU. We have a high rate of pt turnover but certainly less than ED. I will typically start with 4-5 pts, dc or transfer 2 out and get 2 more. And some of our staff are former ICU nurses.

I think we have more pt rapport than ICU because they have many intubated pts, many non-responsive who will never recover. Most of our pts get better, although we have some frequent fliers.

It depends on the level of acuity and the staffing mix on the tele floor--do they have vasoactive gtts, acute MIs, OHS pts with temp. pacers? This could be a good experience. Or is it a glorified medical floor, which I doubt would serve your needs.

Good Luck!

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Specializes in ED, ICU, MS/MT, PCU, CM, House Sup, Frontline mgr.

in your opinion, will some tele help me be more marketable for icu?

thanks again!

yes a tele floor is marketable for an icu job. however, if the floor is a general medical surgical floor calling them selves "tele" med surg, rather then a med surg floor that is more of a cardiac step down unit, then may be not! the reason being some hospitals do not allow their m/s tele floors to give drips or accept seriously ill patients. so be sure to question the "tele" floor about the kind of patients you get and your responsibilities (administering drips, access to your own cardiac monitors, training needed for the floor, etc.). btw, i know of ed nurses who never worked ms who work pt in an icu. is it possible for you to work pt in an icu before transferring ft? just curious. i wish you luck.

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Specializes in Tele, ED/Pediatrics, CCU/MICU.
btw, i know of ed nurses who never worked ms who work pt in an icu. is it possible for you to work pt in an icu before transferring ft? just curious. i wish you luck.

well, based on my little notebook where i keep track of job applications, i have applied to...... 35 separate positions over the past year (2009). these are at both community hospitals, tertiary care centers, and teaching hospitals. these are full time, part time, and per diem positions.

i aggresively call them each week or two, repeatedly utilize professional networking, and attempt to directly contact nurse managers. i have even been able to organize shadowing at several large icu's, and have repeatedly made attempts to speak with those nurse managers to no avail.

*(just to clarify, i work in a community hospital, so i do not possess trauma experience. we also ship out anything cardiac that's serious, as we do not have a cath lab. i think this has greatly disqualified me, but it is what it is).*

---on the rare occasions that i am actually able to speak to hr/ a recruiter/ nurse managers, this is what i am told:

a.) er is not critical care, and you need critical care experience. i even got an interview for a very intense pedi cicu, and they decided my interviewing skills were great, but that i lacked the correct experience.

b.) i need icu experience to work in icu... rrggghh

c.) i have even been told it might be an issue that i haven't done a formal "tele" certification/worked on tele, even though i took a class as part of my novice nurse training program and am acls/pals/tncc certified.

i have started to take it personally; i wonder if i am just poorly qualified. people sometimes ask me why i haven't tried to get a job in a bigger ed/then try to switch to icu after a year; my answer is that i can't spend another day being anxious, tense, and feeling like i can never make the patients happy. i acknowledge that i need to remve myself from the emergency setting, for my well being. i know that i love acuity, but in a more controlled setting.

i decided after awhile to think outside the box, since it's doesn't make sense to expect different results from doing the same thing over and over again. i wasn't making any progress or getting anywhere trying to squeeze my way into icu's, even on a part time basis. nobody is interested in me around here because i don't have any icu experience. i have even made attempts to train in the icu in my little hospital.... and i received a very blunt "no" due to staffing, money, and the fact that they do not give a full orientation to per diems & currently lack ft positions.

my thinking was that if i can obtain employment in a large teaching hospital on a serious, high acuity telemetry unit, i will be both more prepared in terms of knowing how to care for patients over the long term (as opposed to "temporarily" in ed), and get more intense cardiac training. in combination with my ed experience, i just might be a better candidate. i think being in a tertiary care/teaching hospital will perhaps give me more opportunities to advance/move about within the facility. aftert 6 months to a year, i'd hope to make attempts to move forward into icu.

i currently have two interviews upcoming, one of which is at a level 1 trauma/burn hospital which also specializes in cardiology, peds, and oncology. it appears to be a great hospital, 800+ beds, with plenty of specialties/opportunities to advance clinically. the floor i am interviewing for is in a new cardiovascular/heart center. my feeling is that the acuity level will be on par with what i need.

what does everyone think? any and all opinions are appreciated.

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Specializes in Public Health, TB.

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My thinking was that if I can obtain employment in a large teaching hospital on a serious, high acuity Telemetry unit, I will be both more prepared in terms of knowing how to care for patients over the long term (as opposed to "temporarily" in ED), and get more intense cardiac training. In combination with my ED experience, I just might be a better candidate. I think being in a tertiary care/teaching hospital will perhaps give me more opportunities to advance/move about within the facility. Aftert 6 months to a year, I'd hope to make attempts to move forward into ICU.

I currently have two interviews upcoming, one of which is at a Level 1 Trauma/Burn hospital which also specializes in Cardiology, Peds, and oncology. It appears to be a great hospital, 800+ beds, with plenty of specialties/opportunities to advance clinically. The floor I am interviewing for is in a new Cardiovascular/Heart Center. My feeling is that the acuity level will be on par with what I need.

What does everyone think? Any and all opinions are appreciated.

I think this sounds like a great plan. My employer is trying to prevent people from changing positions more frequently than once a year. You may want to check into that before you change jobs. And who knows, you may love cardiology and stay in the tele unit. Our stat nurses say my unit does way more cardiac than ICU--they seem to be mostly respiratory and neuro.

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