Er vs ICU

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    I am a ER nurse and im love every minute of it, it's something always going on at work you never know what to expect. But sometimes I think about switching to the ICU but I want to know what all do ICU nurses do differently from ER nurses, floor nurses etc.
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    I think the biggest difference between ER nursing and floor nursing is that in the ER, you never know what you're going to get and no two days are the same. You're ALWAYS learning something new. That's what I love about it. I worked on PCU for 2 years along with occasionally floating to ICU. In the ICU things are less predictable than on other units but I feel like I was always doing the same thing. I needed a change...which is why I switched to the ER.
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    ICU has it's exciting moments, but much of the nursing care involves attention to detail-- skin surveillance and hygiene, positioning, meticulous documentation of titratable drips, etc.
    Janet_RN likes this.
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    ICU is more long term thinking.
    Not just "I need to get their BP down" or "great, we got a heartbeat back on this code" but more of what do we do now to get them discharged from the hospital healthy (or as healthy as can be). You need to be ready to deal with the same patient for days (or even weeks) vs the few hours from ER. ICU does have it's exciting time, but a lot of it is watching the patient to see how they respond to treatments. Depending on the hospital, many docs rely heavily on the nurses for what should happen next since the nurse is there and the doc is not, or just got there.
    Family dynamics also come into play more in the ICU. IN the ER, most family (if any are even around) don't know what is going on or what should happen. But in ICU, you have time for more family to come and family has time to do research online; what treatments should be happening and how things should be going. They can get on you about how your not doing it "right".
    You also have constant assessment and re-assessments to do, and the charting is a whole lot more.

    I found one of the biggest things to get use to in moving from ER to the ICU is in the ER, if you need something the doc is right there (or you just do it and get permission after, not that anyone would ever do that), but in the ICU, you know you need something, but you have to call and wait for the doc to get back to you on it. It gets frustrating.

    I really think all ER nurses should work 6 month or more in ICU and all ICU nurses should work in the ER for 6 months or more. You gain some really good skills in both and understand each side better.
    Janet_RN likes this.
  8. 1
    Quote from Nalon1 RN/EMT-P
    ICU is more long term thinking. Not just "I need to get their BP down" or "great, we got a heartbeat back on this code" but more of what do we do now to get them discharged from the hospital healthy (or as healthy as can be). You need to be ready to deal with the same patient for days (or even weeks) vs the few hours from ER. ICU does have it's exciting time, but a lot of it is watching the patient to see how they respond to treatments. Depending on the hospital, many docs rely heavily on the nurses for what should happen next since the nurse is there and the doc is not, or just got there. Family dynamics also come into play more in the ICU. IN the ER, most family (if any are even around) don't know what is going on or what should happen. But in ICU, you have time for more family to come and family has time to do research online; what treatments should be happening and how things should be going. They can get on you about how your not doing it "right". You also have constant assessment and re-assessments to do, and the charting is a whole lot more. I found one of the biggest things to get use to in moving from ER to the ICU is in the ER, if you need something the doc is right there (or you just do it and get permission after, not that anyone would ever do that), but in the ICU, you know you need something, but you have to call and wait for the doc to get back to you on it. It gets frustrating. I really think all ER nurses should work 6 month or more in ICU and all ICU nurses should work in the ER for 6 months or more. You gain some really good skills in both and understand each side better.
    great answer I love it
    Janet_RN likes this.
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    I switched from ICU to ER both level 1....I would say icu you have time to learn your patho and pharm really well because you spend more time with the patient and the path to differential diagnosis is quite a learning experience. On the other hand you must be ready to deal with highly emotional families and patients for a while. The ebp driven ADLs can drive you crazy and throw your day south.
    ER....all we do is stabilize and off to surgery or ICU and next please! But I have had the most interesting diagnosis to date!
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    Quote from Nalon1 RN/EMT-P
    I really think all ER nurses should work 6 month or more in ICU and all ICU nurses should work in the ER for 6 months or more. You gain some really good skills in both and understand each side better.
    I cross-trained to the ER after I finished my orientation in the ICU (so we could float "safely") WAY back in 2001. WOW! It was a totally different beast but it did give me a great deal of insight into how ER nurses roll (in particular--faster decision making and focused assessments). I agree that I think it made me a better, well rounded nurse.

    By the way Nalon1- your description of the differences between the clinical areas was great & very accurate


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