ER or ICU?

  1. Hi!
    I am a student nurse who is interested in working in critical care. I need to select a site for my senior preceptorship, and was wondering what the best setting for this would be - working in an ICU unit or in the ER. It seems the ER would give a much broader view of urgent care, yet the ICU is where I would like to work.

    Any comments or suggestions are appreciated!

    Thank you.
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  2. 15 Comments

  3. by   kaycee
    In my opinion ER & ICU are totally different. Even though you need critical care skills for both, you use them is different ways. I suggest if your heart is set on ICU, then do your senior preceptorship there. If your really not set on anything go for the ER it's a great experience(I'm partial of course.) Good luck to you in whatever you choose!
  4. by   Ellen in Ont
    I agree completely. They are totally different and have completely different focuses. If you really want ICU then apply for your apprenticeship there. It will go a long way in getting a job there when you are finished. It will also give you a feel for the ICU and help you to decide if that is the area for you.
  5. by   CEN35
    i can't answer that one? i would say er............but thats where i wanted to go, and where i am. in your case? why would anyone dream of going to a particular unit, and then not go there? i think thta says it all!
  6. by   502Nurse
    Thanks for everyone's feedback! I figured it was best to go for a preceptorship in the area I'm most interested in. I guess my main concern is I'm not positively sure where I want to work. I'm at that entering-senior-year crossroad, where I want to work in several different critical care environments, and not sure which path to choose!

    When nurses enter the ER, what is their background/experience? Do nurses from the ICU float to the ER and vice versa? How exactly is the ER critical care different from ICU critical care (stress wise, knowledge wise, etc.)? What makes a good ER nurse?

    Thank you again for your much needed wisdom!

  7. by   mikemw
    I can't tell you about differences between ICU and ER because I have never worked in an ICU. I have workled Surgical telemetry and ER both of which are considered Critical care, but differ significantly in types of patients seen.

    You asked about baackground for a nurse going to ER in our ER nurses coming to ER for the first time have experiences that range from new grad to 15 plus years in nursing with a variety of nursing backgrounds. I think a years experience in ursing is a good idea before going into a critical care area but not necessary. I saw this because in the ER you have to be able to care for patients in all categories of nursing. ER patients run the spectrum for newborn to over 100 years old. From minor problems like colds and sore throats, to dialysis patients and cancer patients experiences complications with their treatments or disease process. You also have to be able to care for all levels of trauma from I hit my finger with a hammer to life threating trauma codes and cardiac codes where you MUST know what to do How to do it and DO it NOW.

    This leads me to your next question what makes a good ER nurse. FLEXABILITY. If you like routine then the ER is not for you. If you work well under pressure, can shift from the adrenaline high of a trauma code to the soothing tone needed for a child who needs an IV but isn't about to let you stick them because they know it will hurt. Then when you are about to will this battle another crisis (2nd code) comes in and you must leave this task and return agian later. And now deal with the upset parent as well as an uncooperative child. While the person in the next room is demanding their pain medicaine now. You get the point.

    The interesting thing is I've seen new grads handle this type of stress better than some nurses with years of experience. A lot depends or your life experiences and personal nature. Don't let lack of experience keep you from trying. Knowledge and skills can be learned.

    We do have nurses from other units that come work PRN in our ER. We have some flight nurses who pick up a few extra hours as well as nurses from ICU, and one Nurse Administrator who works with us on a regular basis. In my opinion He is not only and excellent nurse but a skilled administrator (He also works ICUs often) I think this is what makes him such a good administrator. He stays in touch with what it is like in the units. By the way the med surg nurses also like him .

    If you are concerned about lack of experience with skills and knowledge ask around in your facility and see if there are in-house workshops that you can atttend. Also don't be afraid to ask those who are skilled at a certain task to help you improve.

    As for ICU I know that the patient we send to ICUs are very sick and definately need highly skilled nursing care as most are tetering on the boarder of life and death and nursing care recieved could make a difference in outcomes.

    Best of luck in wwhich ever area of nursing you decide to persue.

    MIKE M
    Last edit by mikemw on Jul 17, '01
  8. by   502Nurse
    Mikemw:
    Thank you for your thoughtful and encouraging reply! It is so helpful to hear the insights and experiences of someone who is actually "in the trenches."
  9. by   debbyed
    Although Iam an ER nurse I would suggest to you to choose ICU. The experiences in ER are great, but they are fast and furious with no follow through on what you have done. We either "treat and street" or "treat and ship". In the ICU setting I feel you would have more of a chance to learn the When's, Why', Where's and Who to's as well as seeing results of you actions and decisions.
  10. by   ERnursie
    I worked in an ICU after school was done. I did that for almost 3 years. At that time I had been working in EMS for about 7 ears and the ER seemed a better fit for me. I now work in the ER and have been for about 1.5 years. I love every minute of it. Lots of variety and you still use your brain. I found the ICU to be the same thing everyday(vents,swans,pacemakers) The patients rarely talked back. I get the same experience in the ER (except swans)and i have other patients who get better quicker and actually go home. Depending on your personality, if you are a creature of change...the ER is for you. (i sound like a saleman)
    good luck with your choices. You can always move if you are unhappy. We also have an ICU float pool that floats from ICU and ER. Maybe that is for you.
  11. by   Stormy
    I tend to agree with Debbye. ICU experience will promote more indepth knowledge of the whys and wherefores, facilitating integration of book knowledge with practical knowledge. ER is fast paced with no or little follow up. As well, your assessment skills will be more finely tuned in ICU.
  12. by   Bozo180
    I couldn't agree more with Stormy. I commenced my post-graduate work in a busy Trauma / Burns ICU. I found this to be a massive learning curve and gave me the chance to hone in my assessment skills and general pathophys knowledge. I've since worked in theatre, AnE and in remote settings and can thank my time in ICU for much of the knowledge I've gained.
    Also, in my experience ICU has a greater number of nurses and doctors who are willing to teach you all the little (and big) things which you don't have time to learn in uni/college/school.
    As long as you recognise that one ventilated patient can take as much time to care for as 6 patients in a surgical ward you should be fine.
  13. by   PButler
    I have worked in both ER and ICU, although I have much more experience in ICU (Trauma/Surgical). It's best to go where you are most interested in working and the area that best suites your personality. To work in ICU you have to have the most in depth knowledge of A&P and pathophysiology, as well as a lot of technical skill and knowledge. Once you have ICUexperience you can work anywhere with ease. The downside of ICU is the less glamorous aspects of providing total care to pts (Code Brown!) ER is great in it's own way but the job is much more task oriented and you don't have time to be as intense about understanding what's going on in every body system. You can always switch areas if you don't like where you are. Good luck
  14. by   dewp_63
    I have recently moved to the ER after 10 years of ICU work. I just finally burned out... The major difference I see in ER work is the variety, as others have pointed out. I finally came to realize that there are only so many ways to take care of a vent (or CHF, or MI, or GI bleed), and that much of what you do in ICU is just fill in the blanks. I became most frustrated with hourly UOP and VS that have been stable and normal for days on end. The charting in ICU is usually voluminous - and no one ever even looks at what you have written/typed.

    I sound bitter - BUT I feel that I could not function in the ER without the base I learned on the floors and ICU. My assessment skills were honed in the ICU's, as I could see a single patient (or two) over a longer period of time and compare assessments. In the ER, you see them for such a short time, and then they go home or go to the floor/unit/morgue. The assessment and problem solving skills I learned in the ICU makes it easier for me to anticipate the MD/PA's priorities, the patient needs and the ways to get the best outcomes in a timely manner.

    so, I guess the bottom line is : go where your heart tells you. ER is fun, but you have little continuity of care (unless they're "repeat offenders" as we call them). ICU is a major challenge and you WILL learn!!! Good luck!

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