Emergency nursing or IMCU

emtb2rn, BSN, RN, EMT-B · Jul 16, 2014

Hey everyone,
I have been a nurse for a year now on a Renal/Pulmonary Med-Surg floor. I have been offered a job on a Cardiovascular IMCU floor for full time nights and also a ER for full time nights. I am having a hard time making a decision. I enjoy being busy, having multiple tasks to do at a time, and having critical patients to take care of, My favorite days are when I'm running around all day, not having time to take a lunch and not being able to do charting until after my shift is over. Any advice?!?

Advice? While I'm OK with a busy day, I'm not OK with choosing to not take lunch and saving charting until the end of your shift. You'll need to tighten up your time management. Staying late because you choose not to chart is OT the boss will not want to pay. And even more important is the potential to burnout.

That said, you won't see a stream of critical patients in either IMCU or the ER. IMCU is stable enough to not need the unit and in the ER you'll see everything under to the sun from "why are you here? to too unstable to transport to the unit.

Guest219794 · Jul 16, 2014

Job shadow each.

Without knowing each department, it's hard to know which is busier.

In all likelihood, the the IMCU will be more consistently technically challenging. Cardiovascular IMCU patients have actual medical needs. (many ER patients don't.) It is even possible you will deal with more emergencies on IMCU than in the ER. All of your patients are, by definition, at risk.

OTOH- other than emergencies, probably not much in the way of procedures/interventions at night on IMCU. Anything can happen in the ER.

From renal/pulmonary to cardiovascular isn't all that much of a shift. It will be an environment you will adapt to quickly with familiar systems and approaches. ER is a whole different animal.

If you haven't spent any time in an ER, you really should before you make a decision.. Often people- including nurses- are surprised at what we do.

Personally, I love it. Spent two years in an ICU, loved the technical aspects, hated the rest. Spent 1 night floating to tele- hated it. The rest of my time has been in the ER, and I like the unpredictability and variety. And autonomy. I am expected to be proactive and stabilize situations without input for the docs. Sometimes I am bored for days, and sometimes I run my a** off all week. Pediatric febrile seizure in the room next to my geriatric femoral neck fx.

zmansc, ASN, RN · Jul 16, 2014

If you were in our ER, there is no delaying the charting, so you will have to keep up with your charting. There are a lot of times when I don't get to "take lunch", but I almost never go a whole shift without. There have been many shifts when the house supervisor has been called and told (s)he was buying us pizza or on days the cafeteria was told to bring x meals for the ER staff as we didn't have time to break for food.

I would second the suggestion to shadow in each unit, and find out what you like about both. Personally, I think you can't go wrong, both would give you new experiences and force you to learn both medically and in personal growth.

Guests · Jul 20, 2014

Ditto regarding charting...

The cases in the ED can evolve so quickly that you'd BETTER have your charting current or you're going to (a) be unable to be accurate and (b) at risk for accusations of falsification. This is true in the ICU, as well.

Pace... the pace in the ED tends to be more frenetic than in the ICU. Of necessity, the ICUs are very controlled while the ED is very fluid.

While I'd value the experience that comes with some of the ICUs, I would get bored. This sentiment is echoed by many of my colleagues who've come out of the units.

From what little you describe, you'd probably prefer the ED environment but, as has already been said, you'd do well to spend several hours shadowing in each.