ER or ICU for the New Grad

lauralassie · Dec 31, 2006

I've worked critical care ER for almost 30 years now. I've seen new grads do well in both areas. I guess it would say it depends on what type of work you want to do. Both are challenging . Although I have found that in a good ICU (SICU,MICU etc.) you can gain experience in care that can benifit ER. I think there is less helpful aspects going from ER to ICU. ICU is a good place to learn hemodynamics,many types of equipment etc. Both are critical care but complete different aspects.

Trauma Columnist · Dec 31, 2006

lauralassie is so correct: both ICU and ER are critical care in one aspect, but their focus is very different: the ER is more the "treat and street" or "treat and admit" with the goal that the ER visit is as brief as possible. The ICU really does the "treating" in depth part.

I have worked both and personally, although I like the ICU, I love the ER.

nnurlaw · Dec 31, 2006

I am a 24 year veteran of the ICU. (open heart, level I trauma, medical,surgical, cardiac) We never used to train new grads in the ICU. (too much work, too much risk) It is a whole new world! Our hope is that our new grad ICU nurses will stay with us after we invest a great deal of time, money, and effort in training them. Attracting experienced nurses from their current ICU to 'our' ICU is difficult.

Any new grad that is interested in ICU should concentrate on pathophysiology and perhaps, take a critical care seminar or course. Look for a hospital that provides 3-6 month preceptorships for their new grads. Talk to current employees to find out how new grads are treated. It is a difficult proposition but not impossible. I have precepted 3 new grads in the past 14 months. All of them are doing quite well. It is an honor to train the next generation of ICU nurses!

Trauma Columnist · Dec 31, 2006

And working in a unit with nnurlaw would be wonderful - she's a gem! What a wonderful attitude.

CritterLover, BSN, RN · Dec 31, 2006

i've done both er and icu. i started out in the icu, and now no longer work icu but work in the er part time.

unless you absolutely know that er is for you, and that you don't want to do anything else, i would definatly recommend going to icu first.

the skills you learn in icu will be absolutely invaluable to you in the er. almost every shift i work in the er, one of my coworkes asks me for help with a vent or a drip. on the other hand, my er specific skills arn't really all that helpful to the icu people. i mean, really, how helpful is it to them to know which orders are standard for a pt with a cough? or what labs we automatically order on a pt with abd pain? or what dc instructions to give to that pt with a sutured lac?

further, a strong icu backgound will make you more comfortable with the crashing patients.

bottom line: go where your heart is. but if you are unsure, i highly recommend a year or two of icu before going to the er. you probably won't need those icu skills daily in the er, but when you do need them, you will be so glad they are second nature, rather than having to think about them.

Trauma Columnist · Dec 31, 2006

CritterLover - good points. I had a year of ICU under my belt when I went to the ER. It did help especially in the first year. However, I hones my assessment skills in the ER and that has strongly helped me as an APN. The ER gives you the ability to KNOW when someone who is alert and talking to you, is going to go down the tubes and quickly. It gives you the assessment skills to tell even before you listen to a child that they are in serious resp distress. I liked the variety in the ER. In the ICU, I simply got tired of all the heart patients. I like variety.

BTW in any setting, totally believe it when ANY patient says "I'm going to die."

Dinith88 · Dec 31, 2006

ICU first.

ICU skills are valuable in the ER. You'll be good at taking care of the very sick people if/when you go to ER. MOst ER 'skills' (like juggling patients), on the other hand, arent really necessary in the ICU. Some could even argue that nurses from step-downs/imcu/pcu would make a better adjustment coming to ICU than an ER nurse...as they'll have all the certs (acls, etc) and be more 'in-tune' with the environment/routine...whereas the ED nurse 'system' is very different.

But...just because you are ICU doesnt mean you'll have an easy go of it in the ER. YOu'll have to get used-to caring for lots and lots and lots of coughs, bellyaches, head-aches, whiny kids with freaked-out parents, idiot drunks, hypochondriacs(sp?), drug-seekers,etc. To put it simply, you can quickly become overwhelmed and burnt-out by the mass of office-types that file through...in addition you'll be expected to also care for the SICK people who come to you.

GrnHonu99, RN · Jan 1, 2007

New grad in a specialized ICU. Love it!!! Haven't regretted my decision at all. 4 months in.

GrnHonu99, RN · Jan 1, 2007

I am a 24 year veteran of the ICU. (open heart, level I trauma, medical,surgical, cardiac) We never used to train new grads in the ICU. (too much work, too much risk) It is a whole new world! Our hope is that our new grad ICU nurses will stay with us after we invest a great deal of time, money, and effort in training them. Attracting experienced nurses from their current ICU to 'our' ICU is difficult.
Any new grad that is interested in ICU should concentrate on pathophysiology and perhaps, take a critical care seminar or course. Look for a hospital that provides 3-6 month preceptorships for their new grads. Talk to current employees to find out how new grads are treated. It is a difficult proposition but not impossible. I have precepted 3 new grads in the past 14 months. All of them are doing quite well. It is an honor to train the next generation of ICU nurses!

I second that. As a new grad in the ICU I would also say, make sure you get an adequate orientation. I had 4 months and I really wouldnt have minded 5 months.