Er, Icu, Med Oncology Help!!!

[LolaRN]

Currently I work on medical oncology floor night shift 8-9 patients each staff. Very, very busy floor with dying patients, neutropenic patients, needing blood products, chemo etc. Then there are the brain injured pt, quads, bilat amps, with all kinds of sig medical problems. I have been offered a position in the ICU and at a nearby small town hospital ER. I cannot decide what to do. The pros of where I am: I know how to do the job, the manager is great, I like the people I work with, the hospital values its nurses. The cons- heavy patient load, lack of support from cna, a lot of repeat customers- no one ever really gets better, it is a ways from home. The pros of ICU- very sick but less number of patients, interesting and challenging work, same organization, good hours. Cons- a ways from home, the need to have a tough skin (told to me by the nurses themselves), the fact that I could do something to kill someone. Pros of ER- challenging, variety of work, a few blocks from my house, small family atmophere. Cons- seems disorganized- they have had trouble communicating info to me, may be boring-small town. Also important to know- I have turned down ICU once because I didn't feel ready. And, I have been offered the position at the ER once before but turned it down because I had already accepted my current position and felt obligated to remain where I was. What would all of you do? Please, please give some feedback. THANKS :)

[Katnip, RN]

Why did the ICU nurse tell you that you need a thick skin? Is it because of the patients, the doctor's attitude, the staff behavior, or just the nature of the job?

If they are referring to the nature of the job, you needed that thick skin to do what you're doing now, and you'll need it for emergency as well.

As far as which to choose, I can't really answer that. I've never worked in an ICU but I do know that things can go bad very quickly. It's a lower ratio, but the acuity of the patients can more than make up for it. You have to watch them constantly.

I do work in an emergency room and though we have a small 250 bed hospital, we saw 86,000 patients in the ER last year. In the ER you have to be prepared to be slammed, and slammed often. You never, ever know what's going to come through that door and you need to be able to deal with anything.

I might get flamed here, but though ICU has its chaotic moments, emergency tends to have many more of them. ICU is a much more controlled environment. Those things might have a stong bearing on your choice depending on your personality.

[traumaRUs, MSN, APRN]

I have worked ICU and ER and love the ER! It is a personal choice, but once you find your niche - you're hooked - no matter where it is. Good luck finding your place.