ICU vs ER

  1. 0
    I know this discussion has been presented many times by many different levels of student nurses to RNs to APNs. I would like to give a more detailed background about myself in hopes of a more detailed response

    I am an Accelerated BSN student who is about to go into my 10 week residency which is the culmination of my program. I am trying to decide between the ED and the ICU for the residency as well as for future employment as an RN. I have been at a level one trauma, county hospital for my clinicals. I was in the ICU (one floor for all patients) for 10 weeks. I was only in the ED for 1 12 hour day. The hospital I will be at for both (hopefully) is a level one trauma center. I LOVE working in trauma...I know that for sure. So here are what I my thoughts on both:

    ED
    - Amazing. Teamwork. These people tag team like no other.
    - Constant movement
    - Every patient is like a mini mystery
    - Get them stable and move on
    - Have MDs and Pharmacists working with you at all times
    - Adrenaline rush with trauma's
    - Broad knowledge of many degrees of care and stabilization
    - Quick gratification from treatment given

    ICU
    - Critical thinking is a must...which is what I like
    - Sometimes the patient to nurse ratio is nice, other days I get a little antsy
    - More interaction with the patient and the family
    - From what I have experienced, it is the culmination of nursing skill and knowledge
    - Sometimes I feel like I am a housekeeper to tend to someone for weeks with no improvement
    - Get to take care of the sickest of the sick
    - Deep knowledge of patho and treatments
    - Autonomy due to MDs not being there 24/7
    - Possibility of being on code and/or rapid response team in future (dream of mine)

    I went into nursing school with the idea of wanting to be an ICU nurse, but that changed when I went to the ED for my 1 rotation. It was a mild day, but it was the best clinical day I have had. My clinical instructor, family and nursing school friends see me in the ICU. I am torn!

    TL;DR - ED or ICU for new grad?!?
    Last edit by kevsgirl1 on Mar 25, '13
  2. 2,667 Visits
    Find Similar Topics
  3. 5 Comments so far...

  4. 4
    I always thought throughout nursing school that I'd be an ER nurse. It didn't work out that way due to decisions I made. I'm now an ICU nurse. So when the opportunity came up to cross-train for ER, I took it because I didn't want to have regrets over the decisions I'd made. Now I moonlight in ER. I'm always glad to come back to my ICU world after working a crazy ER shift. To answer your question though...no one can answer that but you. They are different units that have different functions. You should also think about this though, if you do ICU, you can be quickly cross-trained to ER. If you do ER first, you have to go through new grad orientation to work ICU.
    anewsns, HouTx, ObtundedRN, and 1 other like this.
  5. 1
    A couple of your points can vary by facility. Some hospitals have residents or ACNP/PA's that are there for the ICU pts at night. My hospital does have someone in house covering the ICU 24/7

    Also, you noticed staffing for ICU isn't always great. Well that problem in the ER can be compounded when all the rooms are full, the waiting room is packed, and ambulances keep rolling in. Unlike the ICU, we can't turn away a pt just because all of our beds are full.

    Also, at my hospital ICU nurses respond to inpatient codes, and ER nurses respond to outpatient codes. So us ER nurses are on a rapid response team at some hospitals

    I work ER and I love it, but that doesn't mean it is right for you. Something else to think about is do you want to be a jack of all trades and know a little about everything (ie peds, ICU, woman's health) in ER or would you rather hone in your knowledge on one area, such as a trauma ICU
    GrnTea likes this.
  6. 0
    Sorry, no mandate from me either. Reminds me of a friend who went to Harvard and Stanford, Cambridge and the Bay Area-- he loved both, missed the other whichever one he was in (went back and forth for grad schools, post-docs, and consulting), and was always pleased to go back to wherever he wasn't.

    I was a new grad who went direct to critical care, absolutely loved it for all the reasons you describe, and floated to ER prn, which was fine c me because it was sort of like a nifty spice you like a lot but don't want to have at every dish, every meal. As an ICU nurse I also got to go on critical care transport runs with residents, which was a lot like ER without the team backup and gave me some verrrrry interesting variety seeing other hospitals (there's no place like home, there's no place like home...)

    You'll have a great time whatever you decide. It sounds as if you are like my friend, so you should start in ICU and cross-train, and then go back and forth as opportunities permit. Good luck and let us know how it goes!
  7. 2
    As a new grad, I went straight into ICU. I've never had any doubts that its what I wanted.

    I worked in EMS for 3 years prior to being a nurse. Working EMS, I already know exactly what comes through the ED. The appealing side of the ED is that you don't have to neccessarily be with the same aggrevating patient for your entire shift. But it also doesn't mean you won't deal with several jerks throughout your shift. My EMS experience told me that I know how many of the people come through for absolute BS, which that sort of thing leaves me banging my head against a wall. For me personally, I probably would've burnt out very easily in the ED. Another appealing thing about the ED is that there are many things you don't have to worry about. You might get your patient's food, but you're not worring with meal carts and trays, at least not as much. You're not worried about if they've been bathed unless they need a clean up. You're not as worried about turning them and doing mouth care every 2 hours, etc. And your documentation is a little more streamlined and focused.

    I work in a medical ICU at a level 1 trauma teaching hospital. I see all sorts of really complex patients, and of course we always get overflow from other ICUs. So I still get plenty of trauma patients etc. And in all honesty, I only find trauma patients to be fun out in the field or in the ED. I hate trauma patients once they've made it upstairs, but that's beside the point. I always have two ICU teams available to me, always sitting on the unit unless they're off the unit to see someone in the ED or a patient crumping on the floor. We have a huge amount of trust between our docs and nurses, which gives us a lot of autonomy, and they listen to our suggestions and take our concerns seriously. I feel like there is a lot more to learn in the ICU. I like to just have my 2 patients (or sometimes 1:1). Downside to that is that sometimes I hate having to be responsible for EVERY human need of those 2 patients... lol. Sometimes it sucks to have a patient who can't turn themselves or anything, and so they're sitting in poop, thristy because they're NPO, and need to be turned, but they have to wait a few minutes because you're trying to keep your other patient alive.

    Anyways, I think I went on a tangent. I have a really good friend who is an ED nurse. We get together and talk shop often. We share stories and discuss what we like and dislike about our specialty and how it compares to the other. She loves the ED, and I love the ICU. I will say though, she has said that working in the ED has made her feel like she has lost some skills, and often get disconnected from hospital policies and procedures since they don't really apply in the ED.

    Its really all a matter of personal style.
    Kiro686 and prnqday like this.
  8. 0
    I did both and disliked both. I think you made a beautiful list of pros for each specialty. My advice is to go with the one that offers you a job. Apply at both and see what happens. Remember, you are not married to either nursing job. You can always transfer to another area down the line.


Top