How to decide between ICU/ER?

[bagface]

I'm sorry if this has been asked before but I am asking for advice from some seasoned professionals. I am getting ready to start clinicals in August, however I already know which fields I have interest in and would like to go into when I graduate. I'm just hoping someone can give me a lead as to what may be a better fit?

Some of the reasons I think the ICU would be interesting/beneficial:

-Intimately getting to know a patient and seeing them (hopefully though not always) progress towards better health.

-Knowing the ins-and-outs of the human body to keep someone stabilized

-Dealing with only 1-2 patients and getting to devote all my time and energy on just two people

-The hospital I work for the ICU nurses have a VERY close bond, you never hear them complain about one another, they are a team, and they would do anything to help one another.

-Seeing an end to someone's story (whether they recover or pass on).

-Eventually I would like to be a flight nurse - and from what I understand a lot of flight nurses come from the ICU (at least at the Hospital I work at this is more common) because of their ability to keep patients stable during transport.

Some of the things that worry me about working in the ICU:

-I'm an adrenaline junkie (I was a 911 operator for four years).. I worry taking care of the same patients for months at a time may get stale for me.

-I don't know if after 20 years I'm going to find myself bored with the same routine every hour with every patient.

ER nursing -

-ADRENALINE, you NEVER know what a day will bring.

-The joy of treating different patients, for something as simple as stitches, to as difficult as a trauma coming in and having a working code.

-I love the emergency situation - working at 911 I LOVED getting legitimate calls for help, I've delivered babies over the phone, I gave wound care instructions for stabbing/gunshot victims, I helped keep people alive until paramedics took over, every day I left work feeling accomplished.

The downside-

-The ER nurses at the hospital I work at are very catty (there is a HIGH turnover rate).

-People use the ER for their lack of a PCP (I've sent ambulances for people wanting STD checks - and in our state we can't refuse transportation), etc.

From what I've read on here there are some nurses that were cross-trained that did both areas of medicine. I don't believe our hospital does anything like that (I've asked a few nurse managers and they all said they weren't aware of any nurse that goes between both fields). Personally I think that would be the best of both worlds if it were possible to do both.

I may or may not stay in the area after graduation... does there seem to be a greater need elsewhere for ER or ICU nurses? Did anyone else go through this debate with themselves? What did you choose and were you happy with it?

[CCRNCMC11]

I can relate to your post a lot because I have a similar background. I was an EMT in nursing school and an adrenaline junkie so I always thought I would work the ER and even wanted to work on a flight team. As a new grad I worked full time ICU and per diem ER. The things I loved about emergency medicine I soon grew to hate. For example, just like you mentioned in your post, the ER I worked at had a lot of people that used it as a PCP, drug addicts, etc etc. That's ultimately why I stayed with the ICU side, and I've been happy with it ever since. I love the critical thinking that goes with it and advanced knowledge of patho, vasoactive gtts, vents, invasive monitoring, codes, and all the good stuff. Plus, there is a high level of comaraderie in the ICU because you have to be a team player. In your post some of the negatives you posted about choosing ICU over ER is totally false. You will not take care of the same patients for months on end nor will you have the same type of patient everyday. Sure occasionally you will have the long term acute care types that linger around, but from what I've seen, everyday brings a new challenge. I work in CVICU now and everyday is something new. Sure the surgeries may be similar and the protocols may be similar, but every patient is different. I used to work CCU, and these units (along with MICU) have a very diverse patient population. I cared for anything from trauma to MI's to codes to therapeutic hypothermia protocols. Everyday was something new and exciting. There is even oportunity to work on a code team, which is like the adrenaline junkie's dream. Anyways, I'm sure you can find good and bad in both settings, this is just my experience. If you have any questions feel free to ask.

[bagface]

Thank you so much for replying CCRN!! I appreciate your input greatly!!!

Do you still have a desire to do flight nursing? And has it fulfilled your love of adrenaline to work in the ICU/CCU/CVICU?

I may save your name just in case I have any more questions if that would be alright?

Thank you again for everything :)

[CCRNCMC11]

No problem! Feel free to ask anything!

I do still get the itch to do flight nursing but I wouldn't want to make a career out of it. I'm heading in the crna route now. I would still love to be in an ambulance too. In some places critical care nurses do some ground transport too.

And being in the icu definitely fulfills my need for adrenaline! Like I said, I used to work the code team and would respond to and lead any code blue (no pulse, CPR in progress) in the whole hospital. Plus, in a busy icu the patients have multiple drips, ventilators, balloon pumps, swan ganz catheters, you name it. And I like the level of knowledge that goes in to it. You need that for both Er and icu but in the icu I feel like there's more time to develop that, whereas in the Er it's get them stable and get them to the icu. Or treat em and street em.