Critical Care/ICU versus ED

  1. So, I am thinking I want to do trauma/ED as a specialty. The NP I wok with (she is in Cardio, but did critical care as well as ED for many years prior) said that either working in critical care (i.e in the ICU) is pretty much the same as the ED. Namely, that ED IS critical care.

    Do you agree?

    My reason for asking? Once I obtain my BSN and actually get into nursing, is it best to start directly in the ED or do ICU first? I have seen some discussion before about not jumping straight into the ED right after graduation.

    Thanks!!
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  2. 10 Comments

  3. by   Goodoldnurse
    You might see about doing some clinical time or shadowing someone in the ER before you jump in. Some love it, others can't wait to get back to the ICU. Those that love it are happy with the "treat them and get them on their way" while some want to care for the family members also. Both require good assessment skills, but they are not the same atmosphere. Good Luck!
  4. by   TazziRN
    ED is critical care but it's different enough that it's not for everybody. I agree, shadow someone or request cross-training so you can float over.
  5. by   marilynmom
    I agree with the others, get some experience in those areas first. Apply at a hospital nearby as a nurse aid....my hospital has a program for nursing students called the Student Flex Pool where the only requirements are to work two 8 hour shifts a month; you can cancel any shift up to 24 hours in advance and can schedual ahead or same day schedual--that is it and it pays well ($12/hr). You work all over the hospital (including the ER and ICU, peds, med/surg, oncology, renal, etc) as an aide and then later on as a tech.

    I also did a day in the ER while on my med/surg clinicals and LOVED it! But I disagree, the ICU is totally different than the ER--the ER is critical care, but it's not ICU.
  6. by   banditrn
    ICU is more controlled, and you will have equipment and procedures that you'll never see in the ED.

    On the other hand, ED is more of by the seat of your pants type place - quiet one moment - chaos the next.
  7. by   jamonit
    well, i can tell you from my perspective as a soon-to-be graduating nursing student (just 3 more weeks! YAY!) that i prefer the ICU, like banditrn said, it's more controlled and i have just 2 highly acute patients to really perfect my assessments, learn all about the many lines and toys, and really understand the labs and pathophys....i love my clinicals there.

    the ED on the other hand is nuts. i had a shift today and i don't think i've ever ran that fast (and i'm a runner). it was fun, but made me uncomfortable, like i didn't get real assesment practice and that i was kinda in the way (as nursing students often feel). if you like fast-paced, IV tossing, blood sucking, code running, pt's in beds in the hall throwing up and yelling drunken things, the ED is right for you. hahaha, i'm exagerating, it was fun, but i'm an ICU girl. you'll get a feel for what you like in school, believe me.

    best of luck!
  8. by   AfloydRN
    HAving worked them both for many years- ER and ICU are nOT the same. ER is a package them up and get them out of here mentality. ICU is where they go. ER is pretty much protocols and pathways and ICU actually encourages you to think. I found I had alot more autonomy in the ICU. The older I got, I was soooooo tired of the ER patients. In the ICU the patients are all actually sick and should be there. Not true in the ER.
  9. by   MomNRN
    Quote from jamonit
    if you like fast-paced, IV tossing, blood sucking, code running, pt's in beds in the hall throwing up and yelling drunken things, the ED is right for you.

    I couldn't have said it better myself. That is exactly why I love it!
    "Treat 'em and street 'em!"
  10. by   Jen2
    It all depends on what you think you will like. In the ED you will see anything and everything across the entire life span from neonate to geriatric. From the sprained ankle to the traumatic arrest that has had both of their legs amputated by the dash board of their car and you have to put towels under the door in the trauma bay to stop the blood from runing out into the hallway. You will begin to initiate and titrate every drip on every patient population that exists. There will be times you will have MANY ICU holds as well as other step down patients that you are responsible for yourself. It is a high litigation high acuity area most times depending on what type of hospital you work in. You will have no clue what is wrong with your patients. You will need to assess the patient and come up with a worse case scenerio based on your assessment skills without all of the fancy toys hooked up to the patient. I feel a sense of satisfaction to work up an acute MI by myself and then walking out to tell the attending that he needs to fire up the cath lab becasue we have a STEMI in room 10, and do it in 30 minutes of less. The reason I chose ER was becasue I enjoyed all of my nursing school rotations and couldn't choose where I'd be the happiest. I decided to go to the place that gets to see all of those things in small doses without having to deal with the same patient population and the same illnessess day in and day out. You gotta have ADD. My husband is an ICU nurse and he loves every minute of it also. He likes knowing every single thing there is to know about each of his patients. He likes having the time at the bedside and managing the drips on more of a long term basis to see the effect that they have on the patient. He also wants nothing to do with a patient unless they are 20 years old or over. He loves his high acuity patients but likes the controlled environment in which he gets to practice. We both agree that we couldn't do each others jobs, but respect them and like them equally. Its about finding your own niche.
  11. by   chip193
    Quote from AfloydRN
    HAving worked them both for many years- ER and ICU are nOT the same. ER is a package them up and get them out of here mentality. ICU is where they go. ER is pretty much protocols and pathways and ICU actually encourages you to think. I found I had alot more autonomy in the ICU. The older I got, I was soooooo tired of the ER patients. In the ICU the patients are all actually sick and should be there. Not true in the ER.
    I don't have a single pathway or protocol in the two ERs I work in. It is all critical thinking on my part of where to go/what to do before the doc sees them, which can be 2-3 hours.

    I'm sitting in Triage tonight and I've ordered at least half-dozen x-rays, done at least 4-5 IVs on my waiting room patients, and sent at least 50 labs down.

    It is what is expected here...without a protocol.

    Chip
  12. by   jewelsg627
    I would LOVE to shadow two nurses (one ED and one ICU) but I wonder if that would be a problem with HIPAA. Perhaps, though I could shadow at the hospital I work at since I am an employee???? Hmmm...

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