Do you like ER or ICU better?

Specialties Emergency

Published

I am just wondering if there are any nurses out there that have worked in both the ER and the ICU? If so which did you like better and why? I have never worked in the ER but i have worked in a general ICU and a CVICU and enjoyed both. I will be starting a critical care program soon and will have the opportunity to to choose to go back to working in an ICU setting or the ER. I've always thought that I would like the ER but since I have never worked in that area I am nervous.

Specializes in Trauma/ED.

We keep hearing about how things are where "PMFB-RN" works but to everyone else, just know that this is not how it is in most hospitals in the country...listen to everyone else on this thread not "PMFB-RN" when you want to know what it's actually like. Unless you are going to work with PMFB-RN where only ICU nurses know their head from a hole in the ground :-)

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Specializes in ICU, CVICU, Surgical, LTAC.

I didn't post this thread to turn it into a war between ICU and ED nurses. I have worked as an ICU nurse so I am well aware of their duties and responsibilities, as well as thier talents and mishaps. I have always been interested in ED nursing. I was simply looking for a comparison from nurses that have worked in both specialties. Im sure that different hospitals across the country utilize their ICU and ED nurses differently.

For anyone else that reads this thread I apoligize that this is what has become of it. I truly hope that I can get some more positve feedback and if anyone wants to post their experiences whether they be positive or negative, hopefully we can refrain from disrespecting other nursing specialties to make ourselves look better. I personally would never want to work with any nurse, be it in ICU or ED that has the "better than thou complex." I appreciate all feedback, but hopefully if anyone has anything negative to say it will be about their own specialty. No offense to anyone who has posted thus far. I am just hoping to turn this thread in a more positive direction....if that is at all possible.

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Specializes in Emergency & Trauma/Adult ICU.
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.

This just doesn't add up. On the one hand, it sounds like a tertiary care hospital which accepts patients from throughout a larger region who require a higher level of care ... therefore would be a TRAUMA CENTER with ED staff capable of handling whatever comes in off the helipad. If this hospital has figured out a formula for the magic required to have a unit bed available for all transferred patients so that they ALL bypass the ED ... then someone is missing the boat if they haven't marketed that magic in a bottle.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

This just doesn't add up. On the one hand, it sounds like a tertiary care hospital which accepts patients from throughout a larger region who require a higher level of care

*** Yes, of course it sounds like that because that is exactly what we are.

... therefore would be a TRAUMA CENTER

*** Yes we are a trauma center.

with ED staff capable of handling whatever comes in off the helipad.

*** This is very simple. Substitute one of the ER nurses on the trauma team with an ICU nurse. That's it. Nothing weird or magical about it. We can and do handle anything that comes off the helipad.

If this hospital has figured out a formula for the magic required to have a unit bed available for all transferred patients so that they ALL bypass the ED ... then someone is missing the boat if they haven't marketed that magic in a bottle.

*** What a weird thing to say, and of course an conclusion unsupported by anything I have said. We do not bypass the ED. Our trauma bays are in the ED. CT is between the ED and the OR & ICU. Helipad to trauma bay to CT (usually) to OR (if needed) to ICU. Very, very simple and normal. When there is a trauma activation whichever ICU nurse that is carrying the beeper gets beeped and reports to the trauma bay with the rest of the trauma team.

It's just like in a trauma center it's not the ED physician that handles traumas but a trauma surgeon. In our ED, and at least some others, it's not the ED nurses who are on the trauma team, it's the trauma nurses, the ICU nurses from the surgical trauma ICU. We have all the expected certifications like ACLS, PALS, TNCC or ATCN. Those are the required ones, some have more. All of our flight nurses are former ICU RN, not ED nurses. ED nurses at our hospital are not eligible to apply for the transport jobs with our service.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
We keep hearing about how things are where "PMFB-RN" works but to everyone else, just know that this is not how it is in most hospitals in the country...listen to everyone else on this thread not "PMFB-RN" when you want to know what it's actually like. Unless you are going to work with PMFB-RN where only ICU nurses know their head from a hole in the ground :-)

*** Wow, you guys are sensitive.

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Specializes in Emergency.
*** Wow, you guys are sensitive.

Yeah, it's because we've got all this advanced training and education yet stand in the corner while the critical care nurse takes care of the emergency room patients for us. We're funny like that. Come to think of it, why does your hospital employ RNs in the ED? If what you say is true, why not save a buck and operate the ER on the backs of LPNs and ERTs?

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Specializes in CVICU, ER.

You say we are sensitive, but you are the one who put top of the line Trauma/ED nurses, the best of the best, in this little box and try to make the rest of the world believe that our skills are no more than taking vitals and fetching blankets so you big bad ICU heros can come in and save the day. It is comical to anyone who is an actual nurse, esp an ED nurse. I think what ppl are trying to get you to understand is that you are part of a vast minority, or possibly an only... Don't know where you're from, I am imagining ummm Alaska or somewhere remote, but in the rest of the civilized world, there are standards of care that have to be followed. You're hospital doesn't value ED nurses evidently the rest of the world does. Don't get me wrong, our ICU nurses are valuable for what they actually do-1:1, but most have never even walked through the ED. They are truly 2 different worlds. We have a policy that protects our dept. In our hospital, no nurse, not even the unit nurses, can float to our dept during their down times without a basic preceptor orientation. They are simply not qualified. Sure, they may have the acronyms, but they don't have a clue how quick things move down there. Most do not think it's worth it so they take their cost containment and go home. It comforts me knowing that when I do have a trauma come in, I will be with a qualified staff who actually experience crisis on a daily basis rather than someone who may have had been only maintaining a vent for the past month.

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Specializes in CVICU, ER.
I didn't post this thread to turn it into a war between ICU and ED nurses. I have worked as an ICU nurse so I am well aware of their duties and responsibilities, as well as thier talents and mishaps. I have always been interested in ED nursing. I was simply looking for a comparison from nurses that have worked in both specialties. Im sure that different hospitals across the country utilize their ICU and ED nurses differently.

For anyone else that reads this thread I apoligize that this is what has become of it. I truly hope that I can get some more positve feedback and if anyone wants to post their experiences whether they be positive or negative, hopefully we can refrain from disrespecting other nursing specialties to make ourselves look better. I personally would never want to work with any nurse, be it in ICU or ED that has the "better than thou complex." I appreciate all feedback, but hopefully if anyone has anything negative to say it will be about their own specialty. No offense to anyone who has posted thus far. I am just hoping to turn this thread in a more positive direction....if that is at all possible.

Angel, I know you didn't intend to turn this into a brawl, but let me tell you something about ED nurses. We are very passionate about what we do. I am sure a lot of nurses feel the same, but someone can't sit back and make it sound like we are a bunch of scared nurses afraid to get our hands dirty and not expect a backlash. It is infuriating. I worked in CVICU with post op cardiothoracic pts. IMO-- necessary, but boring. Unless one crashed, it was very quiet in the unit, and the lights went out at a certain time.... May not be like that in all hospitals, but in mine it was. I respect those nurses greatly, they are very necessary. I respect all nurses, esp the ones who work in hospice or the WOCN. Def not my forte. In return, I would appreciate a little respect from other nurses and not be looked at as the second rate gutter rat that a pt must settle with since her kid only has an earache. That's not the case at all.

Fast-forward to the real world ED, where we have so much autonomy and are actually respected by our doctors. The MD/Nurse squabble that everyone talks about doesn't happen all too often unless it's conflict in treatment, then the nurse will document everything. There are many shifts that you will not get a lunch. I worked for 9 hours last night before getting to void. You will see all patients. Yes, the ones with the earache, and the one who fell into the aquarium, is bleeding out and now has a sbp of 49. Rarely is there a dull moment. Things change so quickly. I had a pt come to fast track last night who'd been triaged as a possible bronchitis/pneumonia. My gut was telling me it was worse, clinically he looked terrible, so I ran a troponin.:yeah: Came back super elevated!! Everything changed in that second. Instead of calling for his CXR (he did get one, just not right then), us ED nurses, including the triage nurse, had him prepped for emergency PCI before cardiology could ever get there. We didn't accomplish that by standing in a corner. When finished, we both went back to fast track and triage. It is hard and stressful, but it is fun. Sad at times. Same emotions for many areas of nursing, but the pt who comes to you in the ED during their emergency, if you are good to them and they know you care and genuinely want them to get better, will never forget you. I love it and although I often find myself saying, "what am I doing here, there has to be something less stressful", I don't think I could give it up for anything else. At least not right now. You should just try to go in on one of your off days and orient with someone so you can form your own opinion. You need to be there after all the dr offices are closed so you can get a feel of what it's really like.

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Specializes in ICU, CVICU, Surgical, LTAC.

rwright15,

I appreciate you sharing this with me and there is definately nothing wrong with being passionate about what you do. It sounds like you are a great ER nurse. All of that sounds really exciting to me. I just don't know if I could switch gears like that and go into an environment that is so different than ICU. There are crazy things that happen in the ICU as well, but still a very well controlled environment and 90% of the time routine. I don't know if I could handle and keep up with things changing so rapidly and not knowing what i am in for from minute to minute. As exciting as it sounds, I just don't know if i'm cut out for it. I will take your advice though and form my own opinion once I observe for myself. Thanks again for sharing your experience.

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While I have done both, I prefer ER nursing. Always something new and different.

I think people who prefer to have control over a situation generally prefer ICU.

Both areas require a trenemdous amount of skill and passion to do well. I have friends who have done ER and those that have done ICU for decades.Both still love their jobs.

Find what you love and do it well. Thats the beauty of nursing.:heartbeat:heartbeat

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Specializes in Emergency/Trauma/Critical Care Nursing.
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.

umm... so let's see if i understood this correctly... when a patient codes in the EMERGENCY dept, an ICU nurse comes to the code??? wow.. actually i have no response for that, i'm speechless :uhoh3:

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Specializes in Emergency/Trauma/Critical Care Nursing.

"You will see all patients. Yes, the ones with the earache, and the one who fell into the aquarium, is bleeding out and now has a sbp of 49. Rarely is there a dull moment."

HAHA maybe it's because I've only had 4hrs of sleep but someone falling into an aquarium cracks me up! How did they manage that? i'm assuming this was quite a large aquarium lol, if it was like a 10gallon fish tank that makes me laugh even harder haha, oh my i need some sleep! :yeah:

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