Get critical care experience before working ER?

Editorial Team / Moderator · May 30, 2009

It sounds like ICU experience would be great for you. I'd go for it. Good luck!!

SummerGarden, BSN, MSN, RN · May 30, 2009

i'm a medical surgical nurse for now... my passion is the er so i have a mentor who is an er nurse. according to my mentor in order to be good in either the icu or the er you have to have experience in both departments. so, my mentor went to the icu for a few years before returning to the er. i suspect that the above poster and your instinct is correct, you need some icu experience. i have the same concerns as you about working in the icu since that enviroment is not a passion of mine (the icu is not me).... however, my mentor informed me that during her icu years she was an er nurse working in the icu, thus she did not give up her passion. plus, working in the icu was not a miserable experience for her because the job had a purpose related to her growth as a nurse. now she is a cen flight-trauma nurse, which was her goal all along. hope this helps...

btw, congrats on landing your passion!!! i plan to work in med-surg for two years and will roll into active duty army to become a trauma nurse ... there is no way in this economy i will be able to move into the er any time soon otherwise, at least not where i live. good luck to you! :twocents:

Be_Moore · May 30, 2009

At my hospital, you don't go into the ER until you've had at least 1 year ICU experience...but we are a Level 1, so it's useful knowledge. Some ICU experience would be very beneficial to you...but would the knowledge benefit be worth the trade off of losing ER experience time? That's totally up to you to decide. Working the ICU would give you a better sense of the "total picture." But at the same time, you won't utilize a lot of the things we do in the ICU down in the ER..simply because you don't have to because you don't have the patient for that long. Look into getting your TNCC and see if there is an ATLS class you can audit...that will definitely help you in the short term while you decide on whether or not to work in the unit.

GilaRRT · May 30, 2009

I rather disagree. ER is a completely different animal, with a different pace, and a very diverse patient population. Unfortunately, medical surgical or ICU experience cannot prepare you for the ER experience.

Likewise, ER does a poor job of preparing you for the floor or ICU. This is coming from a nurse who worked exclusively in the ER following graduation. As you may guess, I do not buy into the whole year on the floor before going to the ER.

ACRN06 · May 31, 2009

I rather disagree. ER is a completely different animal, with a different pace, and a very diverse patient population. Unfortunately, medical surgical or ICU experience cannot prepare you for the ER experience.
Likewise, ER does a poor job of preparing you for the floor or ICU. This is coming from a nurse who worked exclusively in the ER following graduation. As you may guess, I do not buy into the whole year on the floor before going to the ER.

I definately don't think the "floors before ER" thing applies to everyone. It looks like you were an EMT before becoming a nurse. That experience alone gave you a huge advantage in your transition to an RN. I wouldn't expect you'd need the floor time as much as I did. I had never worked in a hospital before I was a nurse and had never had to set foot in an ER! (still have never been a patient other than docs office visits *knock on wood*) The time on the floor was good for me.

I agree that the ER is a totally different animal. Thats the beauty of it! But because of the diverse patient population it requires you to have a diverse proficiency base as well. Its not that you have to spend years specializing in everything before coming to ER, doing time with peds, then m/s, then caridac, then renal, neuro, whatever.... but I think critical care is different. Perhaps its the limited exposure I've gotten in a Level II, but it would take YEARS and YEARS for me to REALLY become competent in all critical care management. I like to be self-sufficient. I don't want to always have to rely on someone to be there to teach me for years to come, I want to know it on my own, ask questions every so often when something comes up. I want to know it in and out like I do other stuff...then when they hit me in the ER, I know exactly what to do and what to anticipate.

I think that its totally and completely possible to never work anywhere else and be an amazing ER nurse, I guess it varies from each individual how comfortable they are with it. I feel the need to get to know it more thoroughly than I do in the ER. See the whole picture as one of the other posters put it.

I just may do this... wow... never thought I'd go to ICU... I just think of the floors and shudder.

But its not the floors, its the ICU! Hopefully it'll be more of a rush than I give it credit for. I think I'm gonna listen to my instincts and go for it... Holy cow... I may have just switched specialties!

ACRN06 · May 31, 2009

Wait... so which ICU specialty do you think would best prepare one for ER?

MICU? SICU? TICU? CVICU?.....

schroeders_piano, RN · May 31, 2009

I have worked in all areas of nursing except Labor/Delivery and Scrub/Circulate. I can tell you ICU experience is great for the ER. After spending sometime in an ICU, critical care management will become second nature for you and will make your life in the ER much happier and a little less stressful.

If you are going to do ICU, you need to be in a higher acuity ICU handling patients that you might have in the ER such as a Trauma or Surgical ICU. CVICU is great, but that doesn't really relate to ER. You won't be taking care of fresh post-op open hearts in the ER, but you will be taking care of MVC patients with multi-system damage were SICU or TICU would relate better.

GilaRRT · May 31, 2009

Your best overall experience will come from a busy medical/surgical ICU IMHO.

Trauma Columnist · Jun 2, 2009

Agree with those posters who say ER is different than anywhere else - very true. Personally, I worked at a level one for 10 years and only had 1 year of ICU and 1 year of med-surg when I went there. They also hire new grads. I would advise you to join the Emergency Nurses Association and take advantage of the curriculum they have developed for a comprehensive orientation.

Editorial Team / Moderator · Jun 2, 2009

I would advise you to join the Emergency Nurses Association and take advantage of the curriculum they have developed for a comprehensive orientation.

I did the online ENA orientation modules as part of my ER fellowship, and they were fabulous!

Trauma Columnist · Jun 2, 2009

Agree Lunah...I think the problem isn't with the poster needing more experience, she needs more ER orientation. An ICU is only going to give you experience in either adults or children. For the ER, you need both and the ENA fills that need and with its fous on episodic emergency care, it is the knowledge that you need.