Do you like ER or ICU better?

Zookeeper3 · Dec 20, 2009

I've been lucky enough to do both and I love them both for different reasons.

ER- variety of diagnosis from a tooth ache to a full blown trauma cracking the chest in the bay. Fast paced, the shift is over before you know it. Security and the sheriff dept. is always present to handle volitile situations, I'm never the one that has to de-escalate alone. Can't stand a patient or family, no worries they are only there for worst case your whole shift, not a month. Learned what tests were ordered for ruling out everything as well as how to prep the patients. Learned what really needed addressing and how to prioritize.

ICU- short of a code, I have complete controll of everything that needs to get done, in what order and on my own terms (usually), I have two to three patients max. Generally I can sit and relax several times through a shift. I see patients through some life challenging diagnosis and it's incredible to see them recovering due to my efforts. It's amazing to be a part of someones death and doing everything possible for them/family. Have more time to teach and educate. Love the adrenaline because no matter how sick the patient gets, they're not going anywhere, I've got to deal with it.

bad er- never ever stopping, after two knee surgeries I could never do that pace again. I get sick of the abuse of the medicaid/medicare system. People faking, taxi voucher demands, complaints about waiting, the drama!

bad icu- family, family family, coding a 100 year old, not allowing people to die-let alone with dignity{see family coment}, paperwork not patients is stressed more and more.

Cyan8181 · Dec 20, 2009

Great explanation Zoo. I've thought about these two areas myself so nice to see the advantages and disadvantages of both. Thanks for the post.

PMFB-RN, RN · Dec 20, 2009

ICU for me. In my hospital the ICU nurses are part of the code and trauma team. When a level 1 or 2 trauma comes in it is the ICU nurse who does everything. The ER nurse records vital signs and runs to get things. We also recover open heart surgery cases, take trauma admits, neuro surg cases and gen surg cases that go bad. We are allowed lots of autonomy with standing orders and protocals for nearly everything. We don't have doctors actually in the untit except for in the morning when they round. The rest of the time they are on call, sometimes at home so the RNs must deal with anything that comes up. That's part of the reason so many from our ICU get acceped to CRNA school. Got a kid with an infected ear? Call the ER nurse. Got a guy who drove his car into a concrete wall? Call the ICU nurse.

We also respond to all codes in the medical center and one of our RNs are one fouth of the rapid responce team (nursing sup, RT, MICU RN & SICU RN). Most of the PICCs are placed by ICU nurses as well.

I_LOVE_TRAUMA, RN · Dec 20, 2009

Are we being punked? I mean do you seriously think that there is a nurse on this planet that believes that your hospital accepts level 1&2 trauma pts. & that your ICU nurses stabalize/save them while the ER nurses are only permitted to do tech tasks such as VS and fetching supplies. Seriously?!? I mean do you not know that the holiday coming up is Christmas...not April Fools.I work with some brilliant ICU nurses, but most of them would agree with me when I say that I would rather have my 3 year old niece in the trauma bay with me for the initial stabilization than a whole group of our ICU nurses-not their area of expertise!And also, how can you be a level 1 trauma center if you do not have specialty docs in house 24/7?? Or do your super-duper ICU nurses really know everything, and don't need any stupid neurosurgeon giving tham advice?Please... maybe you should try to get someone in the student nurse forum to buy this crap...they maybe don't understand how things work...but I don't know.And at my real level 1 place-we have a PICC team, and to be part of it all you need to do is be an RN and take an 8 hour class, no GOD-like ICU experience required.But hey ER nurses, maybe its true! Maybe everyone is finally fiquring out that ICU nurses are all we need and can do everything...maybe we should all be very careful or they will discover that ER nurses have just been skating by thus far on the ICU nurses coat tails.Sorry for the rant-man I need sleep-which reminds me, ANY ICU experience will get you into CRNA school-not just YOUR ICU extrodinaire- & the reason you need ICU experience before CRNA school is so that you'll have lots of experience taking care of sedated, paralyzed, intubated patients-ER nurses prefer to interact with their patients (ok most of them). Sorry mom-(MIL is a CRNA)Best laugh I've had in weeks though, almost made apple juice come out my nose!Lol-thanks!

I_LOVE_TRAUMA, RN · Dec 20, 2009

To the OP, I think Zookeeper3's response was very good. I work in both areas, but really love ER. You stated that you worked in an ICU an liked it, maybe during your program you could ask to shadow in the ER...but I wouldn't do just one shift...or you will never get the full effect.I can tell you that it has been my experience over the years that ER nurses generally hate the ICU and vice versa (usually takes way different personalities), but that is just what I have seen. I have also seen some nurses that have made a switch (either way) and have loved it. I only work in the ICU for 2 reasons-1. they always needs help and I am need money, and 2. I am in ACNP school and think that both areas are contributing to my education. There are many other critical care avenues to choose from though...like air and ground transport etc... but ultimately you just will just have to try both areas out and decide which is a better fit for you.Good luck in whatever you decide and keep us updated on your progress...I love to see new nurses who are interested in critical care areas!

LLLLiiiFFEsaveer · Dec 20, 2009

In my hospital the ICU nurses are part of the code and trauma team. When a level 1 or 2 trauma comes in it is the ICU nurse who does everything. The ER nurse records vital signs and runs to get things. Got a kid with an infected ear? Call the ER nurse. Got a guy who drove his car into a concrete wall? Call the ICU nurse.

Curiosity has gotten the better of me. Would you be willing to tell us something? Is it The University of Wisconsin Hospital, or is it Froedtert Hospital that you are employed? The only other Level 1 in Wisconsin is a Pediatric Hospital/Trauma Center. I am very curious. (edited: nevermind, I now see that you never said it was a Level 1 facility. At first, I thought you did)

You and your kid with an ear infection comment was way out of line, and you should be ashamed! To belittle another nurses specialty in such a way is most definitely asking for trouble. I believe you to be well aware of this fact... Stop that. I don't like it! ( Such behavior only makes you look immature )

To the OP,

Emergency is an Animal! If you have the curiosity, I say go on into the pit and check it out for yourself. It sounds like you would bring alot of knowledge, skills, and valued experiences to an Emergency Department. Don't be too nervous about Emergency. The ED is an environment very rich in teamwork.

Plus, most ED's have a seperate Ambulatory Emergency Care area designated for such things as ear ache's, if it gets too hot on the main... j/k

PMFB-RN, RN · Dec 20, 2009

Are we being punked? I mean do you seriously think that there is a nurse on this planet that believes that your hospital accepts level 1&2 trauma pts. & that your ICU nurses stabalize/save

*** When I say "everything" I am referring to nursing duties, not practicing medicine. I am sorry if it wasn't clear. I had thought that since this was a nursing forum that would be so obvious as to not need mentioning.

them while the ER nurses are only permitted to do tech tasks such as VS and fetching supplies. Seriously?!?

*** It's not that they aren't "permitted", it's just their job. The ICU nurses are the trauma nurses.

I work with some brilliant ICU nurses, but most of them would agree with me when I say that I would rather have my 3 year old niece in the trauma bay with me for the initial stabilization than a whole group of our ICU nurses-not their area of expertise!

*** First I don't doubt for a second that you are a skilled trauma nurse. Second it IS our area of expertise. Maybe not in every hospital but in ours, where the ICU nurses receive training in trauma it is our job. I know that in some hospitals it's the ER nurse who responds to and cares for traumas. I know because my other (part time)job is being an ER nurse in just such a facility.

And also, how can you be a level 1 trauma center if you do not have specialty docs in house 24/7??

*** We are a level II, our neuro surgeon is on call. We do get level I traumas on a regular basis.

Or do your super-duper ICU nurses really know everything, and don't need any stupid neurosurgeon giving tham advice?

*** Well I didn't claim we where practicing medicine. The ICU nurses at my hospital don't know everything, but we are well enough trained to take care of any traumas that roll in to the trauma bays.

Please... maybe you should try to get someone in the student nurse forum to buy this crap...they maybe don't understand how things work...but I don't know.

*** What I said is true and not crap. Your leaping to the conclusion that when I said "everything", in reference to nurses, that I was indicating that the nurses where practicing medicine in unwarranted.

And at my real level 1 place-we have a PICC team, and to be part of it all you need to do is be an RN and take an 8 hour class, no GOD-like ICU experience required.

*** Us too. It happens that the PICC nurses that do the most PICCs in our facility happen to work in the ICU. Did I state that ICU experience was a requirement for PICC nurses?

But hey ER nurses, maybe its true! Maybe everyone is finally fiquring out that ICU nurses are all we need and can do everything.

*** Hmm, I guess we will have to agree to disagree on that one.

..maybe we should all be very careful or they will discover that ER nurses have just been skating by thus far on the ICU nurses coat tails.Sorry for the rant-man I need sleep-which reminds me, ANY ICU experience will get you into CRNA school-not just YOUR ICU extrodinaire-

*** Did I indicate otherwise? It just happens that a lot of our nurses get accepted each year. I also know that at some of the schools closest to this area look very favorable on RNs from our unit.

& the reason you need ICU experience before CRNA school is so that you'll have lots of experience taking care of sedated, paralyzed, intubated patients

*** Well those are among the reasons.

-ER nurses prefer to interact with their patients (ok most of them).

*** I know, I am an ER nurse.

LLLLiiiFFEsaveer · Dec 20, 2009

I am an ER nurse.

Wow! I did not see that coming! I am truly kind of shocked that you are an Emergency Nurse. Hmm... I don't get it? Was it your intention to sound derogatory for a reason? You know many Emergency Nurses are reading this thread right? Whats up?

LG1137 · Dec 20, 2009

PMFB-RN has a listed specialty of burn ICU and SICU.

I_LOVE_TRAUMA, RN · Dec 20, 2009

I know that you meant nursing tasks, and not medical. I was just asking why it would be that your ER, a level 2 did you say, would train ICU nurses to do trauma nursing work? How do the ICU nurses leave their assignments to take care of the incomings-or is there a team of ICU nurses who just sit around and wait for traumas-doesn't seem very cost effective or productive.

So basically you have a level 2 ER ran by ICU nurses and an urgent care clinic ran by ER nurses? Please elaborate for us...

How can a level 2 ER accept level 1 trauma all the time..and they are treated by protocols and standing orders with an attending on-call?? Just very confused. Seems not very JACHO or even legally friendly. If you have a level 1 trauma patient-say a severe head injured patient-they are treated by ICU nurses until a neurosurgeon wakes up, and then evacuates the clot- how do you keep them alive for that long when usually seconds are all they have to get to the OR,even with an ER doc there? These are all legitimate questions that you have not answered.

I am also very perplexed that you are an ER nurse somewhere else, doesn't this allow you to see what ER nurses do? The OP was asking for advice from nurses who work or have worked both areas, and why they like a certain area better than the other. What you did was portray ICU nurses as a "trauma team" and ER nurses as clinic care providers-which is a totally inaccurate picture. OK-so you like ICU better-good for you-a lot of people do, but at the same time you gave a very inaccurate and very degrading portrayal of the role of the ER nurse-why?

I don't think that I leapt to any conclusions. I have just done this job for a looong time, and I am also an active member of the ENA. We are involved in evaluating and setting standards of what happens in ERs all across America, and the things that you mentioned are so far from what the current regulations and standards say that I am very blown away-I have actually never heard of anything being done even close to this. Taking care of trauma patients is a very difficult task, one that we are always trying to improve upon, and if this is working for your hospital, it would be wonderful if we all knew the process. And if you have nurses using standing orders to take care of level 1&2 trauma patients, then they are in fact practicing medicine-rules and regs would agree-if a trauma surgeon (not an ER doc) is not present coordinating care-then many rules are being broken...especially if a member of each specialty is not available in house at all times...not my rule, but none the less the way it is.

I must also say that I am a little concerned for my job. I do not want to work in a clinic! I do not want to find out that all of my trauma/ER certifications are crap, because trauma nurses are being phased out by ICU nurses-this is all new to me.

No, you did not say that a PICC must be inserted by an ICU nurse-but how you said it would lead someone who didn't know to come to this conclusion.

It's okay for you to like ICU better, it's great that you work in both areas-it's not okay to come here and not give an accurate picture of what each area does-especially doing it in the way you did-by making ICU nurses appear to be allowed to do everything and being highly skilled, while making it seem that ER nurses wipe noses and wipe the brows of the trauma/ICU nurses.

Maybe the OP did not post this on the ICU forum for a reason...maybe she wanted an accurate description of an ER nurse...not the crazy, degrading, portrayal that ICU nurses always seem to make...usually without ever walking one step in my shoes.

Altra, BSN, RN · Dec 20, 2009

In an effort to salvage the thread ...

OP, Zookeeper provided a good summation of some of the differences in the working atmosphere of the two specialties. They are each intense in different ways. In the ICU you're going to try to fix the whole patient, down to the smallest detail. In the ER you're going to deal with the big stuff or the primary reason the patient presented to the ER (or both :cool: ). In the ICU you'll spend 30 minutes in report talking about 1-2 patients in excrutiating detail. In the ER, report is sometimes, "patient found down, no response to Narcan."

I agree - try to shadow in both areas. Good luck to you! :)

PS - I'm not quite prepared to call PMFB-RN's post BS - maybe we're misunderstanding - but believe me when I say that most ICU nurses I have worked with, at large, academic, Level I hospitals ... would **** themselves if they had to deal with a bloody trauma fresh off of the medics' stretcher.