Trauma RN's - A question.......

  1. I am going to be changing hospitals to a major metropolitan hospital, and have the opportunity to work either Trauma ICU or Trama ER.

    My question is.......is there really an advantage to working ICU before ER?

    I briefly worked ER and got the feeling that it might be in my best interest to start in the Trauma ICU before attempting Trauma ER. This is my own observations based on skill levels, knowledge and scope of experience I have seen in a smaller community hospital RN's and DR's.

    I really don't want to open a can of worms (just thinking out loud here) It seems to me, that medical personnel with ICU experience are just, well, stereotypically better ER nurses/doctors than ones who not done ICU.

    Maybe I'm crazy?

    Any input is appreciated.

    Thanks.

    Journey (needs a break from med/surg)
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  2. 20 Comments

  3. by   EricJRN
    Moved to Emergency Nursing Forum for more responses.
  4. by   TazziRN
    I don't think so. They are both critical care, but each works differently. The ER puts people back together and the ICU keeps them that way until they improve or die.
  5. by   Larry77
    In my experience nurses have done better going from ED to ICU rather than ICU to ED...the pace gets the ICU nurses every time. They are so used to be super thorough which we do not really do in the ED. Most of the time the nurses we got from ICU would end up leaving...actually I can't think of one that has stayed, but there are several that have left the ED and gone to ICU (where they promptly gained 20lbs...lol)
  6. by   andhow5
    I don't think that one is any better than the other. I myself prefer ER, because it just doesn't stop and you never know what you're going to get. In ICU, it's a much more controlled form of chaos; but once you reach a certain number of patients, that's it, no more...

    Just go to whatever interests you the most! Maybe you can job shadow both departments for several shifts to get an idea of what you would be getting into?
  7. by   erdaynurse
    I have to agree with Larry - I am an ER nurse but I have done PRN shifts in the ICU. I like ER much better. I think you are better able to hone your critical thinking skills in the ER - plus you have the docs to ask questions or debate issues with. The ICU nurses that come to the ER usually go back to the ICU fairly quickly. I do know some ER nurses that have transferred to the ICU and stayed because they love it - I also know ER nurses that went to ICU then came back to ER. Do what you feel is right for you - both have good and bad. In the ER, there is no "we're full, no more patients for us", but we get patients stablized (hopefully) and moved or better and sent home. However, in the unit, you get to know patients and families and are able to give more in-depth care. You have a maximum amount of patients that you can get. However, sometimes you have the same patient (and family) day after day, week after week - not always a good thing, if you know what I mean!! Maybe you could work some shifts in both until you decide, like suggested in earlier reply. Good luck!!
  8. by   AfloydRN
    I disagree w/ previous because in my experience in ED we are not allowed to critically think. It is all procedure based. Theres not alot of thinking w/ that. Pt comes in w/ CHF- follow the protocol. Now in ICU- we have to be on our toes because we are monitoring the pt- not the MD. You have to be able to look at trending and anticipate whats going on. They are both good and bad. There is no nursing utopia
  9. by   Larry77
    Quote from AfloydRN
    I disagree w/ previous because in my experience in ED we are not allowed to critically think. It is all procedure based. Theres not alot of thinking w/ that. Pt comes in w/ CHF- follow the protocol. Now in ICU- we have to be on our toes because we are monitoring the pt- not the MD. You have to be able to look at trending and anticipate whats going on. They are both good and bad. There is no nursing utopia
    Interesting that you seem to think all we do in ED is follow protocols...ugh..you can stay in the ICU and watch your lab trends thank you. I'll stick to the front lines where I don't have to use my brain, only follow protocols like a little robot nurse.

    Gimme a break...
  10. by   mhull
    Quote from Larry77
    Interesting that you seem to think all we do in ED is follow protocols...ugh..you can stay in the ICU and watch your lab trends thank you. I'll stick to the front lines where I don't have to use my brain, only follow protocols like a little robot nurse.

    Gimme a break...

    Thanks larry, I couldn't have said that any better myself.

    Both places have a difficult and demanding job.
  11. by   augigi
    Time management will be much easier if you go ED -> ICU, as others have posted.
  12. by   ernelsone
    Quote from AfloydRN
    I disagree w/ previous because in my experience in ED we are not allowed to critically think. It is all procedure based. Theres not alot of thinking w/ that. Pt comes in w/ CHF- follow the protocol. Now in ICU- we have to be on our toes because we are monitoring the pt- not the MD. You have to be able to look at trending and anticipate whats going on. They are both good and bad. There is no nursing utopia
    Quote from Larry77
    Interesting that you seem to think all we do in ED is follow protocols...ugh..you can stay in the ICU and watch your lab trends thank you. I'll stick to the front lines where I don't have to use my brain, only follow protocols like a little robot nurse.

    Gimme a break...
    I smell war here..lol ..
    I've worked to both department before and I can attest that this two are entirely different world, but I love the challenge more in ED than in ICU.. Peace
  13. by   Dinith88
    Quote from AfloydRN
    I disagree w/ previous because in my experience in ED we are not allowed to critically think. It is all procedure based. Theres not alot of thinking w/ that. Pt comes in w/ CHF- follow the protocol. Now in ICU- we have to be on our toes because we are monitoring the pt- not the MD. You have to be able to look at trending and anticipate whats going on. They are both good and bad. There is no nursing utopia
    I tend to agree with Afloyd (but i'm biased because i work ICU, my shifts in ER are limited to a handful). ICU nurses are given more autononomy (in the form of ordering labs,xrays, etc.),deal with more advanced equipment, and are (most of the time) without the help of a near-by doctor.

    AND despite what you think/hear/see on TV, aside from a few large urban settings, the vast majority of ER's are more medical/office than critical-care. There's a good chance that on any given shift an ER nurse wont care for a critically sick patient, however the icu nurse takes care of critically sick patients all day every day.

    As far as trauma...i disagree that 'er puts em together, icu keeps them that way'. it's more like this :"er stabilizes them as best they can, OR puts them back together..and icu blah blah blah". Contrary to popular belief, trauma surgery doesnt take place in the ED. The main thing about ED is that when a trauma patient comes in, you get to cut clothes off, deal with alot of blood and excitement, run them to cat-scanners...start lines and help the doc w/procedures (chest-tubes,etc). BUT, bad trauma patients do better if they LEAVE the er (for surgery) as soon as possible. (Level I and 2 trauma centers are clasified as such NOT because they have a better ED(though they usually do), but because they have SURGEONS available all the time).

    And if you think icu nurses dont run (and get fat), you're delusional...and/or it's not a typical icu.

    And someone else said it well...on a busy day, er nurses are pulled in a gazillion directions for a gazillion patients...icu nurses are pulled in a gazillion directions for 1 or 2. The difference being the number (and acuity) of patients.
    Last edit by Dinith88 on Dec 7, '06
  14. by   BlueEyedRN
    I've floated to the ED a couple of times which totally does not make me an expert, but I do think it would beneficial to have experience in the ICU first. It is a completely different world, but having the perspective from both sides could only enhance your nursing practice. The ICU is a much more controlled environment, but the patients can still be very unstable. The last time I worked, we had codes on three different patients and two nurses got called down to a trauma code in the ED, so I was watching 6 patients in addition to my own two, one of which had 8 different drips barely keeping him alive. You'll definitely learn how to deal with crises involving very sick patients, which can only be a plus. I think another benefit would be that you would have a better idea of what is important in the long term. From what I've seen, ED nurses are very focused, a crucial trait in emergency care, but sometimes they fail to see the whole picture. I know that is one of the reasons the departments clash in our hospital. I think it would be awesome for a nurse to have both perspectives and abilities to handle both areas. You'd be a supernurse. Personally, I prefer the controlled chaos, but I have nothing but respect for the ED.

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