Critical Care Nursing vs Emergency Nurse

RNperdiem, RN · Jan 30, 2016

I work ICU. It's been 17 years in my unit and here is the reason I prefer it to ED.

ICU has an underlying structure the ED does not have. I like a little structure in my workday. I know at the beginning of the day that I will have 1 or 2 ICU patients. They will come up identified(usually), with a working diagnosis and a couple of good IV's. Assessment, meds, Q2 hr turns and doctors on rounds in the morning make a routine I like.

ED is more random. All ages, all conditions from mildly ill to almost dead, no patients or too many and everything in between. I suspect that a nurse who dislikes routine and can reshuffle priorities will thrive here.

Stress? I manage by working less than full time. At work, I make use of my charge nurse and the teamwork of my coworkers when things get tough. Repaying the favor for your coworkers when they have one of those days balances everything out.

Areas with a similar feel to ICU are often not available to nurses without ICU experience. Places like PACU, cath lab and procedural nursing seldom take new grads.

ED Nurse, RN · Jan 30, 2016

I've been an ER nurse for almost 8 yrs, took me several months to feel more confident. I love the random nature of the ED- in one room I'll have a 5 day old infant with a fever getting a septic work up (love the challenge of getting an IV in a newborn), another room is a 57 yo having a STEMI getting ready for emergent cath, in another room a female abd pain, and then you get a guy going bat **** crazy from the spice! OMG I love it! Then a crazy trauma comes in, what a rush! I deal with stress by staying organized, prioritizing, and playing practical jokes on my co-workers! Love to laugh in the few moments of downtime between sick pts, clears the mind!

I love the ED for the chaos- you have to! If you can't get in to the ED, do med surg/tele- it will give you a phenomenal foundation for treating the acute exacerbation of chronic illnesses- which is the majority of what you do.

The ER and how we do things is completely different than any other department in the hospital. We tend to be very type A people, love autonomy, and have a dark sense of humor. You need to be able to be a team player and roll with the tide in the ED. I wouldn't want to do anything else!

That Guy, BSN, RN, EMT-B · Jan 30, 2016

Well, do you want to be hated by everyone or only by some?

All4NursingRN · Jan 30, 2016

Hi!

I've worked ED/Trauma for 5 years, recently transferred to SICU (less than 6 mo ago) To be honest I'm starting to realize I'm much more suited for the ED, or perhaps because that's where I first started out. ED is high octane, fast, rapid assessment, stabilize and disposition. I loved that pace and energy. I also loved the independence of being an ED RN, the big focus on ''team'' (The nurses, docs, and techs really rely on each other heavily instead of top down flow of directives) Also in the ED I loved being able to initiate treatment (with protocol sets in place of course) without having to wait for the doc to direct me. I was expected to be a very proactive and intelligent member of the team and my input was valued a large portion of the time.

ICU is very structured which I like also, but I work in SICU and surgeons are very direct and leave little room for other opinions when they make up their mind ( at least the ones I work with lol) Although I've been up in ICU for almost 6 months I still run around the unit in ER pace and when a patient is decompensating I get a rush of adrenaline and go into high gear and instinctively start calling out orders (can't help it lol)

I don't want to say I'm getting bored, but I do miss the rush. Even though IMO ICU is way less stressful than ED, I'll always love ED.

.

ScrappytheCoco · Jan 30, 2016

3 years in the Emergency Department...I am confident but never comfortable...that's how you miss the little things and kill someone.

ED is awesome if you don't mind being the dumping ground/red headed stepchild of the hospital and have a thick skin for BS. Tons of cool stuff happening in the ED everyday.

Cannary22, BSN · Jan 30, 2016

Thanks everyone I value all your comments, it's very informative and makes my heart pound reading the comments, imagining myself in your guy's stories. I'm excited and somewhat scared, I've been out of hospital work since 2010 and I'm only coming back to the business now. I feel like I don't know anything anymore. I appreciate the inputs. Thank you all.

Cannary22, BSN · Jan 30, 2016

Well, do you want to be hated by everyone or only by some?

I don't want to be hated by anyone but i already expected that real world is not perfect.

**NickiLaughs, ADN, BSN, RN** · Jan 30, 2016

I've done both.

i worked ICU for three years, switched units a couple times before finally realizing that maybe it wasn't a unit issue but I was in the wrong department.

switched to trauma ER and loved it.

theres a rigidness with ICU, I've had the same pt on CRRT for weeks, I've had the same pt for months where report was: "Any changes?" "No"

what burnt me out and took me a long time to realize was these families. I tried to be realistic, but some need their hope in dire situations. I was supportive, but a few too many removing life support situations (all appropriate) I would just bring it home with me too much.

the perks of ICU:

routine

yiu will get really good at orgranizing all the IV lines, I never mastered it, but I labeled and still do. I just couldn't keep them that straight.

learning a lot of complicated skills, post op hearts, CRRT, vents, swanz, art lines, there are tons of cool things to learn. I had fun with all the fancy machines when I was doing it. But never forget there's a pt underneath all that. After a while it is easy to.

the best is seeing a really sick or you didn't think would make it, but hoped, get better and eventually go home

the downside of ICU:

you can have the same pt and family for months, it can be exhausting

theres a lot of death, I'm not sure if I worked in high acuity ICUs or what, but I felt as though half my pts died, I'm sure it was less, but I read somewhere that 30% of ICU pts have a fatal outcome because of how sick they are. Even so, you will experience a lot of it, and you have to be able to accept it not as failure, because the reality is sometimes you can't change the outcome regardless. I had a hard time with that.

ER, the good:

if you are very team oriented it is a great place, if it's a cohesive unite, you will see teamwork like no other

you get to see interesting stuff all the time

Lots of movement

lots of people

you will get really great at IVs, I was terrible in ICU lol

the bad:

you will never know as much about your pts as you want/need to. It's a very task driven job and hardly ever anytime to review the chart

it can be physically exhausting

there's really know way to know what you will like better. I'm fairly type A, I like lists and am very organized at home. I Always thought I'd be an ICU nurse, but working in the environments will give you a for sure answer.

Good luck OP. :)

Cannary22, BSN · Jan 30, 2016

Awesome advises and inputs everyone, I appreciate it a lot. I'll make sure to look back and read this thread once more before I make my decision and pursue what I really wanted to do. Thanks a lot.:)

Critical Care Nursing vs Emergency Nurse

As your only option , which area would you like to work?