Do you like ER or ICU better?

[LeLeeFNP]

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.

[rwright15]

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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!

I was thinking the same thing when the EMS report came in, but when they transferred him onto our stretcher and I rolled him over I was like $#!*. SBP = 49 and 2 prior MIs... Even bigger $#!*.. Immediate transfer to trauma room with all available ED nurses! It was a thousand something gallon, one of the huge ones. I don't know aquariums, but imagine it had to be huge to do this kind of damage. He'd gotten up from a deep sleep and stumbled somehow back first into the aquarium. The pt nor family had no clue how bad he was. He was worried about the fish flopping on the floor and had to gather them all up while ems was on the way. His diaphragm was cut, had a huge pneumo and multiple small and large glass piecies throughout his thoracic/abd cavities. He went straight to emergency surgery. I haven't heard whether he survived or not. What a great way to end a mundane day! This is why I :heartbeat the ED.

[LeLeeFNP]

I have a question for you ED nurses. Are certain nurses in the ED specifically trained for the traumas? Because it seems like in some hospitals the trauma area is kind of seperate from the ED. Also what types of certifications do you have besides Pals, ACLS, EKG and BLS? Like isn't there some type of certified trauma nurse or something? Sorry if these sound like stupid questions but I have no idea how it works in the ED that is why i am so anxious to do my ED rotation.

[PMFB-RN, RN]

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

*** Yep, that is exactly what happens. The ER nurses are already there of course. The codes, unlike traumas are run by ER physicians (when available, which is most of the time). Our trauma surgeons have no roll in codes unless they happen in the ICU. ER nurses do not respond to codes as part of the code team but will take part if an ER nurses is the primary nurse for the coding patient in the ER. Our code team director is one of the ER physicians. He set it up that way.

Lots of hospitals have similar set ups for codes. For example some hospitals use SOS team nurses who respond to all the codes rather than the nurses of whatever unit the code is in, including ER.

However there is not the urgency to get to the code when it is in the ER, we know the nurses there will have the situation well in hand.

[rwright15]

However there is not the urgency to get to the code when it is in the ER, we know the nurses there will have the situation well in hand.

I'm confused.... You said earlier that the ER nurses in your hospital only took vitals, fetched supplies, and stood in the corner watching the ICU nurses work their magic. :bowingpur How can they possibly have "the situation well in hand"?

[PMFB-RN, RN]

Oops, pushed send twice.

[PMFB-RN, RN]

I'm confused.... You said earlier that the ER nurses in your hospital only took vitals, fetched supplies, and stood in the corner watching the ICU nurses work their magic. :bowingpur How can they possibly have "the situation well in hand"?

*** (chuckle) Of course I never said that. There seems to be a lot of reading into what I have written rather than reading what was actually written. ER nurses do all sorts of things like all ER nurses. You may have confused my comments about the roll of the ER nurse in a trauma activation with things I didn't say about their roll as ER nurses. They will have things well in hand cause they are freaking awesome nurses. And they don't take vitals in trauma activations. ICU nurses do and the ER nurse records them (usually).

[LilgirlRN, ADN, RN]

I suppose it'll always be this way. ER nurses think we're great and ICU nurses think they hung the moon. I think the original question was which do you like better, Icu or ER. The person posting this didn't see this coming, I'm sure.

The ICU nurses where I work, well they work in ICU. ER nurses work in the ER. We do all the trauma care for any patient that might need it. It's a small hospital but we have a great group of people working TOGETHER!

I've worked both places. I prefer ER because of the greater variety of patients that we see. Plus, we try not to keep them long.

In the ER if you're tired of doing truma, you just ask the charge nurse to assign you to different rooms. In ICU you don't get to make that choice. You could even ask if you can do fast track the next day, can't do that in the ICU.

The pace in the ER is fast. In ICU it's controlled. You have set visiting hours. Set times to draw blood etc. In the ER it's chaotic, so if you don't perform well under stress, you may want to chose somewhere else to work.

In the ER sometimes it gets slower, you may even be empty at some point. I've never seen that happen in an ICU setting.

The ER is the red-headed step child of the hospital. We're chronic money losers because so many come to see us and never pay their bill. The ER is abused by patients left and right. We get NO respect. But if you want to work with a bunch of crazy people who in a split second can go from laughing to running en masse to save a patient, tehn by all means come work with us!

[LeLeeFNP]

i noticed that in the ICUs i've worked in there can be a lack of team work at times. a lot of finger pointing and "the previous nurse didn't do this or that." is this an issue in the ED as well? it would seem like there would be less of this because how often would you even have to turn your patients over to the next shift? it would seem to me since things are turning over so rapidly that there would be less time for this type of pettiness? Am i right or wrong. another issue i have is I am HORRIBLE at starting IVs. Is this something that the co-workers and docs would be patient with me on? I know i would get my normal training and preceptor and all that, but i'd just be so afraid that i may fall short of everyone's expectations of me.

I am wondering if this battle between ICU and ER nurses is common in a lot of hospitals. I have never seen such animosity in my entire life. To be honest it sort of freaks me out. If ED nurses hate ICU nurses so much and vice versa, I'd almost be afraid that people in the ED wouldn't like me just because I worked in the ICU.

[PMFB-RN, RN]

Am i right or wrong. another issue i have is I am HORRIBLE at starting IVs. Is this something that the co-workers and docs would be patient with me on?

*** I would think so as long as you let them know and ask for their help and teaching.

I know i would get my normal training and preceptor and all that, but i'd just be so afraid that i may fall short of everyone's expectations of me.

*** I suggest you just be very honest about your level of experince and skill and ask for help and thank those who go out of their way to help and teach you. If you are dedicated and willing to learn I am sure you will have no problem at all.

I am wondering if this battle between ICU and ER nurses is common in a lot of hospitals.

*** I doubt it as I have never noticed or observed any level of anomosity between the two units in any hospital I have ever worked at.

I have never seen such animosity in my entire life.

*** Me either.

If ED nurses hate ICU nurses so much and vice versa, I'd almost be afraid that people in the ED wouldn't like me just because I worked in the ICU.

*** They don't hate each other in the real world (of course there will some disfuctional units who are exceptions). I certainly having nothing but respect for nurses, like ICU and ER, who choose the most difficult and (at times) stressful fields. Where I work and at other places I have worked nurses from ICU and ER get along great and are one big team. Both units are "closed" (in lots of hospitals anyway) meaning nurses in those units do not have to float, but there is a lot of floating between the two, by nurse choice, where I work and at lots of other hospitals.

We have some nurses who work half time in each unit.

[Altra, BSN, RN]

I have a question for you ED nurses. Are certain nurses in the ED specifically trained for the traumas? Because it seems like in some hospitals the trauma area is kind of seperate from the ED. Also what types of certifications do you have besides Pals, ACLS, EKG and BLS? Like isn't there some type of certified trauma nurse or something? Sorry if these sound like stupid questions but I have no idea how it works in the ED that is why i am so anxious to do my ED rotation.

All ED nurses get trained for trauma, if that hospital is a trauma center. Many large trauma centers with good new nurse orientation programs will assign an orientee some amount of time in the trauma bay with a preceptor for the experience, but then do not assign that new nurse to the trauma bay until they've been off orientation and on their own for 6 months to 1 year. Your mileage may vary depending on the philosophy and the staffing *needs* of your individual hospital.

Having worked in the ICU you are probably familiar with the CCRN certification. Its emergency nursing equivalent is the CEN. http://www.ena.org/bcen/exams/Purpose/Pages/default.aspx TNCC is the trauma nursing core didactic & skill course which may be part of your orientation if you work at a trauma center. ACLS, PALS, and a cardiac rhythm interpretation course are also typically part of your orientation.

i noticed that in the ICUs i've worked in there can be a lack of team work at times. a lot of finger pointing and "the previous nurse didn't do this or that." is this an issue in the ED as well? it would seem like there would be less of this because how often would you even have to turn your patients over to the next shift? it would seem to me since things are turning over so rapidly that there would be less time for this type of pettiness?

Your perception is correct, in my experience. Not until I started working in the ICU did I experience the let's-dump-on-the-previous-nurse mentality. In the ED multiple shifts overlap at multiple times, and patients come & go constantly - other than at 7am, "shift change" is almost meaningless for the department as a whole.

[LeLeeFNP]

Altra, thank you so much for answering my questions. Do you have to have so many hours of working in the ED before you are qualified to take the CEN? As much as I love the ICU the whole lack of team work aspect of it and the culture that comes with it (at least where i've worked) really breaks my heart. that in itself makes me lean more toward choosing to work in the ED.

PMFB-RN, I appreciate your comments as well and i feel much better things now. I guess you are right in that people are much more likely to be rude on a discussion board than in real life.

Anyway I am starting my critical care residency in two weeks and will let you know what unit I end up on. I will be doing 6 weeks of rotating in various critical care units and the ED before I select a unit to work on. I am very excited and anxious all at the same time. Thanks again for all your feedback!

[indreams84]

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 disagree....I worked in a CCU as a student nurse intern and we had a former ER nurse that was always on TOP of the code situations. Not to detract from ICU at all, as I intend on going back once I get my 1 year experience as a brand new ER GN :) but I wanted to be able control emergency situations like that ER nurse could, as she had been well-versed in it!