Do you like ER or ICU better?

Larry77, RN · Dec 20, 2009

I've worked in quite a few ED's as agency and have never seen one where the ICU nurse runs a trauma. We have an ICU nurse come down for our level 1 trauma's and they document on the packet then leave when the patient goes to surgery or is transfered. To PMFB-RN--I'm sure your account may have been accurate in the hospital you were working but is not the standard in the nation.

To the OP, I'm sorry that this thread has become what it has but as you can see there is a lot of passion for our jobs in both departments.

I always say if you want to be in the trenches and be able to take care of anything that walks in the door then go for the ED. If you want a more controlled environment and like to tinker with machines and study labs go for the ICU. If you would like to be involved in trauma do not go into ICU (unless you want to take care of the patients after surgery)...Truama is not run by the ICU nurses in most hospitals around the country otherwise EMS would go directly to the ICU...the ED nurses are the trauma nurses!

I would never work ICU myself because I like to be thin/fit...lol

IzzyTheRN08 · Dec 20, 2009

Ahhh. I love this topic and I often wonder to myself, which do I/did I enjoy better?

I am currently working in a Pediatric ICU, a job that I decided to take after working in the ER and PEDS ER while I was a student (doing my externship). I loved the peds ER, and I figured that if I did indeed want to go w/ peds as a career, I wanted to know as much as I possibly could (drips, PALS, trauma, etc). To clarify, the ER that I worked in did not have a very large Peds ER and did not have a lot of the resources that bigger hospitals around us w/ bigger pediatric depts did. Anyways, some days I LOVE being an ICU nurse, and other days I find myself really missing the ER. Both are fast paced and intense. In both depts I see almost everything from GI issues to neuro to cardiac... I love the skill set that comes along with being an ICU nurse in the fact that we tend to be more skilled w/ vasoactive drip titrations and other drips, along with ECMO, ventilators, etc. I miss the ER in the sense that I didn't always see the same patient's day after day...I liked the fast turn-around. I am happy to say that I will be returning to the ER prn while I continue to work full time in the PICU. I think both units have helped develop my critical thinking skills as a nurse...

So I can't really say which I like better, but I like that I have both ER and ICU under my belt!... :specs:

AlleeBooRN · Dec 20, 2009

I like them both....especially if you have been on the unit for days. In the ER you can send the patients away for a change instead of the receiving end. You never know what your getting in the ER!!!

ThrowEdNurse, BSN, RN · Dec 21, 2009

1) I love "I LOVE TRAUMA". Ahahahha! You are hysterical.....and always hit the nail on the head.

2) PMFB-RN, you are hysterical too, just in a different way. ICU nurses working in the ER,hahahahhaha!!!!! Let me guess, on a day when there are a lot of traumas, the ER nurses are working in ICU? I wonder how they manage given that apparently at your hospital the only tubed pts are in the ICU. You are so cute!

3) For the OP, you'll work it out. Just a couple of shifts in the wrong dept and you'll know it. When it's right, it's right, just go with your gut.

PMFB-RN, RN · Dec 21, 2009

To PMFB-RN--I'm sure your account may have been accurate in the hospital you were working but is not the standard in the nation.

*** I have worked at two level I trauma centers on the west coast and one level two here in the midwest. In two of those hospitals the SICU RNs responded to the level I & II traumas and served as the primary RN. However I did not claim it was the standard for the nation. Here is an excerpt directly from our trauma policies:

"A. Adult Level I Activation

Trauma patients' meeting Level I criteria require the presence of a Trauma Surgeon, Anesthesia, staff from the Emergency Department, Critical Care RN, Respiratory Therapy, Laboratory, Pharmacy, Radiology, Spirtiual Service, and the Nursing Supervisor . The Criteria are based on both mechanism and physiological criteria and will include:"

ThrowEdNurse, BSN, RN · Dec 21, 2009

Ooooh, I get it! It's like when the floor calls a code blue and an ICU and ER nurse go up. We are only a level 3 trauma center but when we do have traumas coming in our hosital sends out pages, "trauma alert ER, trauma alert ER." It puts the OR on notice, alerts radiology, respiratory, etc. One of the things it does is send down an ICU nurse who does NOTHING! Yes, the almighty ICU nurse stands in the corner and gets in the way, that's it. Maybe the perspective from the corner is different though....

PMFB-RN, RN · Dec 21, 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?

*** They don't. It is not the ER who trains us. The reason given is that the ICU nurses are the most appropiately experienced and trained for the job.

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.

*** On each shift there is an ICU RN available to respond to codes / traumas, as well as a second ICU RN with one stable patient who can respond if a second ICU nurse is needed. Well that's the way it is supposed to be but is not alwasy achievable.

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...

*** Sure. We are not part of the ER. We don't "run" anything in the ER. We are part of the trauma responce team lead by a trauma surgeon. Those same surgeons are also the attendings in the SICU.

How can a level 2 ER accept level 1 trauma all the time.

*** Uh, that is normal and standard. Where else are they going to go? The difference between us and a level I is that we have a neuro surg PA in house and a neuro suregon on call 20 min away.

.and they are treated by protocols and standing orders with an attending on-call??

*** As is normal standing orders and protocals are used to treat things that come up like a patient suddenly going into A-fib, hypoglycemia, hypotension etc, etc. Obviously our ICU patients, like all patients everywhere, have treatment orders written for them by their physicians.

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?

*** The trauma team, led by a trauma suregon, cares for them. The ICU RN does everything nursing related except record. ER docs have no roll in traumas. We have a neuro surg PA in house who will see the patient, order scans, write orders so that when the neuro surgeon arrives (they have to be there in 20 min from the call) everything is ready to go to the OR if indicated.

These are all legitimate questions that you have not answered.

*** Well this is the first time you asked them.

I am also very perplexed that you are an ER nurse somewhere else, doesn't this allow you to see what ER nurses do?

*** Of course. I know well exactly what ER nurses do.

The OP was asking for advice from nurses who work or have worked both areas,

*** Yes and as just such a nurse I replied.

What you did was portray ICU nurses as a "trauma team"

*** We are the trauma team, at least here we are and at at least some other hospitals.

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?

*** You may have decided to take it as degrading.

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.

*** Like what? What did I say that is non regulation?

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

*** Standing orders and protocals are normal. Most places have some. Our ICU has a lot of them as we are not staffed by a physician actualy in the unit all the time. Of course a trauma surgeon (and usually one or two residents) are present in the trauma bays. You may have mistaken my comments about our standing orders and protocals I stated we had in the ICU for having been in the ER.

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.

*** You are talking about a trauma in the trauma bay in the ER. As I stated my comments R/T standing orders and protocals are in the ICU.

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.

*** Using ICU RNs for trauma may not be how they do it in your hospital, or even standard across the nation but that is how some hospitals do it. I have worked at two such hospitals. Our ICU RNs have all the required certifications. We also respond to peds traumas but so does the PICU RN and they are the primary RN with the ER RN again serving as the recorder and going to get things as they are needed. We also have a program called "Rescue One" wich is a streamlined program to get STEMIs from rural hospitals to our cath lab. When a rescue one is activated an RN from the CCU responds and is the primary RN with the ER RN serving as the recorder.

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-

*** I gave an accurate picture of how it is done here, a large level II, Magnet, teaching, tertiary care center.

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.

*** You may have decided to take it that way but it appears to me that you might be a little hyper sensitive.

Maybe the OP did not post this on the ICU forum for a reason...maybe she wanted an accurate description of an ER nurse...

*** I didn't see it in the ER section, I saw it when I clicked on "last 24 hours".

not the crazy, degrading, portrayal that ICU nurses always seem to make...usually without ever walking one step in my shoes.

*** When I worked at a level I trauma center on the west coast where the ICU nurses stayed in the ICU I chose to work in the ER. I worked there for 3 years. At another west coast level I center the ICU RNs where the trauma nurses, as there are here. In those two hospitals I worked in the ICU. As I mentioned I also work in a level III ER as an ER RN 24 hours a pay period.

Where I work now the ICU and ER staff get along great and each understands their rolls.

LeLeeFNP · Dec 21, 2009

thank you to all of you who have responded thus far. Especially those of you that have done both and shared your comparisons with me which is really what I was looking for. Because I started off as an ICU nurse I know the aspects of the job I like such as the autonomy, the critical thinking etc. I love titrating drips, hemodynamics, and being able to really get to know everything about my patients. However I also like the excitement of trauma, and although I know the ER would be various levels of acuity and problems, the fast pace of the ED really intrigues me. I am also contemplating going back to school for either CRNA or ACNP. One thing that I have noticed being a relatively newer nurse in the two ICU's I've worked in, many of the seasoned ICU nurses were very intimidating and didn't make me feel like that wanted me to suceed. In any of your experiences do you feel that this may be the came in the ER as well? Either way I think ER and ICU nurses rock and are the most intelligent of all the specialties. No matter what path I go down I will continue to have a great deal of respect for both.

intuition · Dec 21, 2009

I have found that in the E.R. I started out in right after graduation, the nurses really do want me to succeed. They are willing to help out in any way they can and will answer questions that are appropriate.

I_LOVE_TRAUMA, RN · Dec 21, 2009

I agree, ER and ICU nurses kick butt!! But to answer your question, I have found that unfortunately many 'experienced' nurses do love to make the newbies feel intimidated and try to make them think that they will not succeed. I have seen this a lot. I am constantly a preceptor to students, new nurses, or those like you who are changing specialties, and I try really hard to make them feel welcome and needed, but at the same time I also can be kinda of hard on them-but in a good way-because I want to make sure that I have them use their head (think critically) and learn how to spot things themselves. I want them to come out of the experience having learned how to handle problems themself.

My best advice to you...make sure that you accept nothing less than a great preceptor! If you feel that the one that you have is not teaching you, or that you are not having a very rewarding experience-kick them to the curb and get someone else. You have to realize that some nurses don't like to precept, and only do it because they have to. Find someone who shares your passion, has lots of experience, and wants to teach you! Remember, this is your only time to be shown the ropes, so find someone great to help you...and then become a sponge and absorb everything they say or show you.

If you decide to go the ER route...you will do fine...because although the ER is very different from the ICU...you already will be bringing a wealth of critical care knowledge with you.

Again good luck in whatever you decide, and keep us posted!

rwright15 · Jan 2, 2010

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!

Wow a BIG kudos to you!!! You took the words right out of my mouth. I work, not at a level 1, but much smaller hospital, and we also have a PICC team. The ICU nurses wouldn't have a clue where to start in my world. They can't even take a pt without looking over the report sheet first... Freakn plz. That was my experience trying to transfer a pt just this past tues night. The ED nurses are the ones who stabilize the pt before they can go to the unit. The ED nurses are the ones who can run a code when the MD just out of residency looks at you and says "I've never done this before".... Oh, and if your kid has an earache...... TAKE HIM TO THE FREAKN CLINIC, NOT THE ED...

PMFB-RN, RN · Jan 2, 2010

The ED nurses are the ones who stabilize the pt before they can go to the unit.

*** In our hospital it is the ICU nurses who do that. I don't think it makes any difference in patient care who does it so long as they are competent. Interestingly enough after this discussion I started asking around to find out why our hospital uses the ICU nurses as the trauma responders. I have been told it started at the request of the ED staff. We are a large hospital in a very small town. The hospital serves a huge geographic area but the ER only serves the small population of the local area, thus our ER is much smaller than you would expect to find in such a large hospital.

The ED nurses are the ones who can run a code when the MD just out of residency looks at you and says "I've never done this before"....

*** AT my main job it is the ICU RN who are on the code team and respond to all codes, including those in the ER, not the ER nurses. At my other (part time) job in the ER in a smaller hospital it is the ED nurses who attend codes in the ED and do the trauma stuff but they are getting those patients stabilized for transport, not admission.