Best experience before ER nursing?

TigraRN · Jan 24, 2018

Hi ChicagoRN3! Congratulations on your hard work and your two offers, you are off to a great start whichever one you choose. It seems you are already leaning more to the onco/tele floor, and as you have said, the benefits are greater, so I would probably go with that one as well if it were me. Are both of the offers the shift and the hours that you would like to work? What are the patient ratios there?

I started as a new grad in ER, so I cant' really tell which unit is easier to transition from. We do have a couple nurses who came to us from tele and ICU and they seem to have adjusted pretty well.

BassCatchingNurse · Jan 24, 2018

I started off in ICU and went to ER. My time in the ICU was extremely helpful. You will get to really study critically ill patients!! Ultimately, either would serve you well. Of course, both have differences that will be of value and a hindrance to ER nursing. When I went to the ER, I was well versed in critical care meds, dosages, mixtures, codes, critically ill patients, vents, etc; however, it was new to me to do focused assessments. I had to learn to focus on the emergency or what potentially could be the emergency, as oppose to head to toe assessments. Also, in the ER you get a LOT of patients that are not critically ill, if they are even ill at all!! I didn't see that in ICU. Your ICU experience will be valuable in the ER, but your oncology experience will as well. You will have cancer patients in the ER!!! Just some things to think about. My suggestion is...do what you are passionate about. It will make that first year or two a LOT more bearable, and you will get more out of it. You will get burned out quickly if you choose an area that you do not want to be in just to get some experience.

JKL33 · Jan 25, 2018

Since these will both provide useful experiences, I would look very closely at what supports are in place and what each facility's idea of a good orientation is. Also, do you know anything about either place, as far as nursing culture or the culture on the unit?

Kuriin, BSN, RN · Jan 25, 2018

You'll have more patients in medsurg/telemetry which would make it easier to deal with more patients in the ER. However, caring for high acuity patients in the MICU/ICU will aid you (more) in the long run in the ER when you have a critical patient.

PeakRN · Jan 27, 2018

The best place to start out if your ultimate goal is the ED is to start out in a well designed ED residency. The ED is like nothing else, and other units primarily teach you to work in that environment.

The ICU will give you experience with critically ill patients, which honestly is who I worry about in the ED. Most of our patients are not sick, however I honestly don't care that much if the mild gastro patient had to wait a few extra minutes because had to look up bentyl. I do care when new ED nurses don't understand the basics of giving TPA or starting pressors. You would still need to learn to manage a pod full of mostly non-sick to mildly sick patients. I also believe that the ICU provides the best launching point if you decide to go somewhere else in your career.

Oncology is a great learning experience, cancer and the treatments we give effect every body system. Patients can become critically sick very quickly after some of the infusions we give, however they would most likely be transferred to the ICU for management. The level of patient depends greatly on the oncology unit, I have seen some where they are mostly just managing chemo side effect to those that are actively managing septic neutropenic patients.

I would say that depending on how much you want to build relationships the ED might not be the best place for that. Our relationships are very fast and superficial, with the purposeful intent of identifying sick patients and stabilizing them. I'm not saying that ED nurses don't care about their patients, but real connect probably happens a lot more in other care environments.

Lev, MSN, RN, NP · Jan 28, 2018

Hi all,
I'm a new grad and currently have 2 offers on the table for my first job. My ultimate goal is to get into the ED after 1-2 years of experience elsewhere, and I'm wondering what everyone thinks would be the best route to go about that.
Offer 1- ICU in a small community teaching hospital. 14 beds, 1-2 patients on nights. The unit is attached to an IMCU and together they're the only intensive care units for the hospital.
Offer 2- oncology/medical telemetry unit in a very large health system teaching hospital. 36 beds. I would have 5-6 patients on nights. They've offered me higher pay than offer 1, and the benefits are also better. My current doctors are all a part of this hospital as well
I'm leaning towards offer 2 because one of my favorite parts of nursing is the direct patient care and conversation (and on this unit, I would be taking care of more patients than the ICU). However, my ultimate goal is to get into emergency nursing after a year or 2 of experience, so if the ICU job would help me out more than the onc position, I could pay my dues for a year or so. I know the ICU would provide me with valuable skills related to drips and vents, and the onc position would be a lot of IVs, chemo, and tele experience.
Thoughts?
Thank you!

I would go for the ICU job. You will have oncology patients in the ICU and all ICU patients are on telemetry.

I think offer two sounds good, but those ratios are high for a tele/onc floor. Oncology patients are often sick and can turn bad quickly.

If your aim is ED, ICU experience is invaluable even if the experience is from a small community ICU.

akulahawkRN, ADN, RN, EMT-P · Jan 28, 2018

I think I would tend to agree with some of the above posters. While either will give you a good starting point, the fact that you wish to do ED work down the road does make a difference. While the ONC/Tele floor will usually have your patients on tele, ALL of the ICU patients will be on tele and you'll actually be able to see what's going on immediately by looking at the monitor. My experience with patients on tele is that they're hooked up to a tele box and the patient is monitored from some distance away. The other thing with ICU patients is that they're usually very sick. You'll learn how to take care of those patients and you'll learn the basics of ventilator settings (even if you don't set them yourself) and you'll get good learning how to deal with various drips, often multiple drips going simultaneously. You'll get to really see what sick patients look like and once you know that, you'll be able to spot them easily.

One very good thing about the ICU is that everything has a rhythm, a purpose, a label, and is precisely ordered. If you have an OCD tendency to keep things tidy, you'll probably feel right at home there. The ED is more "squirrel" and keeping things moving all the time. Most of the time I don't label my IV lines because I only have one or two drips going. Most of the time I do focused exams. Most of the time I'm dealing with stuff that's got to be done right NOW because everything is done right NOW because if I don't, I'll get behind. If I get 5 or 10 minutes to "sit" I'm probably looking at labs, image reports, etc and catching up on my charting because I know that I'll be busy again in minutes.

Seriously, given the choices and where you want to end up (for now) I would suggest doing ICU. You'll probably get more out of that experience than you will doing the ONC/Tele job.

Forest2 · Jan 30, 2018

I think that the ICU will give you more exposure to the critically ill patients that you will encounter in the ED. On the other unit you may be so busy that you don't have time to learn the critical care stuff. Just a thought. I know I would go to ICU because I like to give more time to one patient than a little time to a bunch of them.

thoughtful21, BSN, RN · Jan 30, 2018

I would say that depending on how much you want to build relationships the ED might not be the best place for that. Our relationships are very fast and superficial, with the purposeful intent of identifying sick patients and stabilizing them. I'm not saying that ED nurses don't care about their patients, but real connect probably happens a lot more in other care environments.

I was thinking the same thing as PeakRN í ¾í´”... In your OP you said "I'm leaning towards offer 2 because one of my favorite parts of nursing is the direct patient care and conversation." In my experience in the ER, the nurses unfortunately don't really have much time to form relationships and have conversations with patients. We just have to stabilize them and send them home, or transfer them to another floor in the hospital as soon as possible. Don't take this the wrong way, but, are you sure that you would really like ER nursing? You don't have to respond - just a thought!

ICU doesn't offer very much patient interaction either, because patients are often ventilated and extremely sick. Looking at it from that angle, and considering other aspects that you mentioned in your post, you might not find much happiness and job satisfaction if you take offer 1. You listed a lot benefits for offer 2, and you seem excited about that opportunity. It might be perfect for you!