UGHHHHH Need a change

Been there,done that, ASN, RN · Mar 2, 2016

Why not do public education now?

pistolchick · Mar 2, 2016

It sounds like your circadian rhythms are seriously screwed up. Bodies are just not meant for night shift. I feel for you. However, I think 2 years of medical surgical is a GREAT place to start, and I don't think it's the wrong time to start looking at other possibilities within the hospital. I've never worked in ICU or ED, so I can't speak to that, but I'm sure many others with experience will chime in here.

I'd personally recommend any new nurse do 2 years of medical surgical before moving to something else - I just think that experience is irreplacable. Now that you've done it, I see no reason you can't move on. Based on what you've written about how much you're personally suffering, I think you SHOULD move on.

Here.I.Stand, BSN, RN · Mar 2, 2016

My first thought with wanting to move to ED or ICU, was what are the odds you'd get a day shift position? What is more important to you--daytime hours, or the transfer? Something to think about.

If public health is your passion, there is nothing wrong with making the transition now--it's not one needs to "get to a point" where they are over hospital nursing, to move out of the hospital. Public health is extreeeeeeemely important! My county's health dept has at least one PHN who went to work there as a new grad.

That said, I'm an ICU nurse and think 2 yrs in med-surg is a fine foundation. There definitely will be a learning curve because it's new, just like med-surg was to you at one time. Personally I'd much rather a new ICU nurse be a little nervous than be a cowboy, over-confident and not knowing what they don't know.

In the ICU, you'll assess and know 1-2 pts in depth, vs. in med-surg you know the essentials about 4-6+ pts. When I worked the floor, I remember knowing a bit about their history but never really had time to sit and read all of the MD notes. On the floor we might have had a.m. labs to look at, we did neuro checks at the most q 4 hrs, and then of course VS and physical nursing assessment. We had one stepdown room where pts were on bedside monitors and had q 2 hr neuro checks, but that only helped for those two pts. In the ICU, we have art lines for continuous BP monitoring, ICP monitoring, sometimes Swan lines...the RRT manages the ventilator but we can see how their volumes, rate, pressure are with the settings that are being used, in an emergency we can run labs at the bedside.

Most of my shifts are a steady workflow -- not slow, not overwhelming. When I do have downtime with my pts, I can usually find another RN nearby who does need help. Getting a severe TBI admit can be overwhelming...you have to help the MD put an ICP device in, medicate to get those ICPs down, run down to CT to verify placement of the line, cool the pt, run back to CT 6 hrs later to check the progress of the bleeding/swelling, all the while the pt's family is completely distraught. (LOVE our chaplains for this!!) Massive transfusions are interesting and definitely require teamwork since you might be checking 5 units of blood products at once, have frequent labs, document those unit start and stop times (q 5 minutes.... no running a unit over 4 hrs when the pt is trying to bleed to death) and VS at start and 1 hr after ALL of those... And then, post-tPA stroke and post-neuro IR intervention pts. Those frequent neuro checks (q 15 min x2 hrs, q 30 min x6 hrs, and q 1 hr x16 hrs) make it really hard to do anything else, but we probably have a 2nd pt. Teamwork is a must!! I remember when I was on orientation, one note my preceptor gave me was to be more aware of my surroundings--not just my own pts.

A lot of time is spent keeping BPs within range, ensuring ICPs are down, giving bed baths, getting pts up into chairs if stable enough--yes even if they're intubated, preventing pressure ulcers (if your pt is in ARDS and prone, this is a very difficult thing to protect their skin!), doing family education, being that anchor for the pt's care when they might be treated by different MD teams, RT, PT, OT, rad techs, etc.

I've never worked in the ED, but sounds like it can be crazy. The one where I work has a dedicated area for the very critical pts, but I read posts here where the RN might have 1-2 very critical pts plus more stable ones. There seems to be a lot of non-emergency presentations too, like URIs, ear aches, etc.

I hope that helps! I have to get my girl to preschool now. :)

Lev, MSN, RN, NP · Mar 3, 2016

If you want to do public health down the road and are thinking of going into ER or ICU I say pick ER. The ER will give you a huge window into healthcare disparities, lack of education, and help you appreciate the overall need for better public health (all those overdoses and alcoholics - many who get discharged from the ER and never even make it upstairs).

2 years of floor experience to the ER is entirely doable. I did it and I love it. It took me a year to feel competent even with my two years of floor experience. Now they are sending me all these sick patients and psych patients because they think I can deal with them so I have a whole new level of feeling overwhelmed. You will get to love the monitors and the turnover. It is a blessing and curse in the ER. Unless you have lots of ER boarders. However, having a boarder is sometimes nice when you are busy. In the ER there are overall less expectations than on the floor for customer service. You feel like a real nurse - not a maid or pill pusher - every single shift. Go for it.

Since you are experienced now you can ask for day shift when interviewing and in the ER there are all sorts of other cool shifts that you may not have even heard of such in increments of 8, 10, and 12 hour shifts. 7-7, 8-5, 11-11, 3-3, 8-7, 3-11, 7-3 and more. If there is a wait list for day shift get on the waitlist as soon as orientation is over. 10a-2a are the busiest hours in the ER.

hbarlow · Mar 8, 2016

I have considered jumping right into public health but really feel like having that hands on experience in the hospital is important. I have done courses at my work- PCRN, WTA, ACLS, and am about to do PALS- but found that getting elbows deep really brings in to life with me. I want to make sure I have the experience so I can really affect people rather than just the knowledge because it's that personal experience that made it more real than the book knowledge. I just never want to do anything half-a$$ed. :)

hbarlow · Mar 8, 2016

Thanks! I'm a little nervous but really know I want to make this change! How did you get into ER? I found that a lot of the applications ask for previous ER experience- which I do not have. I was thinking of emailing the manager of our ER to see about doing some shadowing then applying once our hiring freeze is over.

I have been doing classes with my work (ACLS, PCRN, WTA, and am about to do PALS). What are the things ER managers look at when hiring someone? Currently my resume has RN, BSN with 2yrs med/surg (experience with Vents/trachs, palliative care, woundcare- the kind here you see tendons, VO for AMS/Suicide/Homicide), 2yrs PET tech (prior to RN), a decent amount of volunteer work in the community- including sex-ed for the elderly (fun project for school). There is other stuff but that is pretty much the important stuff plus my references are pretty solid. How can I make this more impressive? I feel like it's kinda weak.

Lev, MSN, RN, NP · Mar 8, 2016

Acls and pals will help. You can also do the nih stroke scale certification (free online).

Nonyvole, BSN, RN · Mar 8, 2016

Apply for those ER jobs! What's the worst they can say...no?

hbarlow · Mar 8, 2016

I have thought through that long and hard and have considered that I can force myself to be a nightshift nurse for a bit longer if it means I meet my ultimate goals. Plus if I truly hate it I can always take the money I've saved (not going out means not spending money haha) and become a wandering nomad- which I have personally always thought to be an underrated career option. But in all seriousness I would try for dayshift but hard work and passion makes a big difference for me. I feel like ICU I could really thrive in because I am already super attentive to my patients (they really like giving me the ones that surprisingly go downhill when the previous shifts say everything is fine- example: recently caught pulmonary edema before the guy coded with a doc fighting me stating he was "just sleepy" even with the evidence- and he was supposed to be my most stable person). Like I said before, I love my coworkers! We are really a team and even when I doubt myself because of a doc or an unruly/truly mean person we are there to support each other. I just hope that whatever unit I end up on the atmosphere is the same.

How did you get into ICU? My hospital has an ICU transition program that I was thinking of but don't know how to make myself stand out. I have been doing classes with my work (ACLS, PCRN, WTA, and am about to do PALS). What are the things ICU managers look at when hiring someone? Currently my resume has RN, BSN with 2yrs med/surg (experience with Vents/trachs, palliative care, woundcare- the kind here you see tendons, VO for AMS/Suicide/Homicide), 2yrs PET tech (prior to RN), a decent amount of volunteer work in the community- including sex-ed for the elderly (fun project for school). There is other stuff but that is pretty much the important stuff plus my references are pretty solid. How can I make this more impressive? I feel like it's kinda weak. My unit had a period of time where we had intermediate beds as well but that just meant slightly more work (hr+ long dressing changes, Q1hr eyedrops, lower BP, etc).