er or icu first?

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    I am considering flight nursing and have been told you need both er and icu experience. Which one should I start getting experience in first?
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  3. 6 Comments so far...

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    ICU, I asked the supervisor of the ER while still in RN school what to do first and she said you can tell 100% the nurses that have been to the ICU first before coming to the ER. She said that when a nurse has been in the ICU they will treat even an ER patient thinking about the consequences of their treatment. For instance, she said that a nurse in the ER may dump massive fluid into a woman who is severely dehydrated, but an ER nurse will take into consideration her age and health status realizing that dumping the fluid may help right this second, but will put her back in the hospital in a couple of days when she has CHF from the fluid. I have experience in neither at this point, but this is what I was told. She had been an ICU nurse before ER. It makes sense to me. Good luck!
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    I have recently been hired on as a flight nurse, with ONLY having an ICU background...Although I have never worked in the ER, I strongly suggest experience in ICU...You will learn an excellent head to toe assessment, comprehensive monitoring (Invasive monitoring devices such as PA catheters, IABP's), titration of multiple vasoactive gtt's, ventilators and how to take care of a critically ill patient as a "whole".... We also have our fair share of "Codes" as well...I have colleagues who have went from an ICU setting to the ER and said it was a "Piece of cake". I have also had colleagues go from the ER to an ICU and say it was somewhat difficult...Just my thoughts and suggestions
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    Alot of what will be required for you to be a well rounded flight nurse will require both ER and ICU experience. I will say that the majority of my experience came from the ER and EMS arena. Infact, having some type of EMS background gave me a competing edge against other nurses that had only done ICU or had only done ER. Check out the service that you are interested in working for. The company that I worked for had a call volume that consisted of approximately 90% scene flights(trauma mostly) and the other 10% interfacility transfers, cardiac, peds,stroke, burns. Some companies will market themselves exactly the opposite in which you will have very little scene flights and a ton of cardiac stuff. Just depends. I hate to see this become a battle of ER vs ICU nurses because both bring a variety of talents to the table. Bottom line, these positions are awarded to those professionals that have a broad base of experience, atleast that has been my experience with 2 seperate companies. For example, take someone that only has ICU background and has only worked with adults, this would be a difficult transition to make when now you are on scene with a pediatric trauma that requires RSI and needle decompression. On the other hand take the ER nurse that has limited experience with IABP's and now is called to transfer a patient with on in place, can be difficult depending on your experience. Get all the quality experience that you can and develop your assessment skills and critical thinking skills. Also stay in touch with your local companies and find out what qualities that they require and go for it!!!!
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    I agree with "getting all the experience you need"; I would have gone to the ER if I didn't get my job because of lack of variety of patient populations...I didn't mean to sound as if the ICU experience is "better". I was thinking ICU might be better to do FIRST before ER.....Additionally, I found it EXTREMELY helpful to take a PHTLS course (taught by firefighters and paramedics), to have some insight/knowledge/practice/learning about pre-hospital trauma care.
    -Good Luck to you!!!
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    I had always set my goal to be flight nurse as my career, even before I started nursing school. After graduation I started in the NICU, truly learning an assessment as my patients were unable to "tell me where it hurts". From there I went to an adult ICU, did ground CCT, and then finally to a rotor program. Our program partners flight RN's with flight Paramedics to cover the best of both worlds. I have not done ER, but have cared for many different patient populations as a flight RN, have done a successful surgical cric in the field, and many other "emergency" procedures. The best advice I could give would be to find out what your local flight companies require and then work where is best for you, always remembering to figure out where your weaknesses lie and making them your strength. Good luck to you in all your endeavors.
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    I would assume that you are wanting to do flight nursing in the U.S. where flights are short hops. I am a flight nurse in northern Canada, and have neither ER or ICU experience. But I do have extensive northern outpost nursing which in my experience has been very important to me in my job. It has allowed me to become flexible in my care and able to "roll with the punches" of northen flight nursing. I find that some of my co-workers that do have ICU experience sometimes are not able to function in certain situations as well as I know they could because they are so dependant on the resources they are used to having in an ICU. But we all work together as a team and draw on each others experiences and knowledge to comprise the finest and highest quality medevac company in our region. Not saying that ICU or ER isn't good experience, it is. But if one is better than the other, I would have to say they aren't, they are both good experiences to have to give you a good foundation when you enter into flight nursing, as I feel with having my northen outpost nursing.


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