ER to ICU is my plan backwards or not?

interleukin · Mar 30, 2009

Generally, better ICU to ED. But optimally, floor, ICU, ED.

Still, anyone can succeed in any order.

But knowing what you don't know should always be your guide.

jpRN84, BSN, RN · Mar 30, 2009

I think whatever you wanna do, and wherever you want to start should be your goal. I've known nurses who started in the ER and nurses who started in the ICU and nurses who started on a med-surg or tele unit. The options in nursing are endless, that's the beauty of it. Follow your heart, and go where that is. You will do great especially if you are in an area your heart is in. Good Luck to you!

Medic09, BSN, RN, EMT-P · Mar 30, 2009

Either way works, but the more complex medical management is something you'll learn in ICU. Having said that, we continuously have ICU patients who we manage for hours, even the whole shift in the ED. There are times I wish my ICU skills were better (like, every other shift!). I'd say start with what interests you now. Both are pretty intense places, and if you stay put for a while you'll learn a lot.

nola04 · Mar 30, 2009

Thanks for all of your replies.

gonzo1, ASN, RN · Mar 30, 2009

I'm an ER nurse who consistantly wishes I had the ICU skills esp with drips, etc. That said nursing is becoming more complex all the time and sooner or later we all specialize even though you won't hear people say that.

A labor/delivery nurse would be lost in dialysis, and vice/versa.

Whenever you go to a different unit you will be starting all over again.

Of course starting IVs, foleys etc never change, but a lot else does.

In the ER you will see everything and all age groups. In the ICU your going to see a lesser range of stuff because so much goes home from the ER.

In the ICU you will have longer exposure to different disease processes and see more of a progression towards wellness or death.

In the ER you treat and then don't always know what happens in the end after the pt leaves you.

You spend less time with your pts in the ER, which is sometimes a bonus.

If you work in the ER you have to be able to be a calming influence to people on what is often the worse day of their life. You have to be able to quickly change directions from MI to stroke to COPD as you may have 4 or more pts and each one has something else wrong.

Listen to other nurses, friends and family and then listen to your heart and know that whatever choice you make isn't wrong, and will be a great learning experience

oceanfloor · Apr 14, 2009

i'm "in the same boat" (or as least a very similar boat). ER pays more and is closer to home...but i'm just wondering if taking the ICU will give be a better framework/foundation (nevertheless, about 10-20% of ED patients are critically ill...so if one is moving from ICU to ER, there'll still be many aspects of emergency care to learn. gonzo1 puts it well. essentially no matter what, "if you move to a different unit you will be starting all over again.")

grad nurse orientation is likely the most extensive orientation we'll ever get. i've seen several hospitals who provide a more thorough orientation for experienced RN's without ER or ICU experience (but these seem few and far between)

also another important factor (as you mention), what if we do ER and then decide to progress to ICU? i've been getting the impression that moving from ICU to ER (whether clinically easier than moving from ER to ICU or not) is more common and thus possibly more accepted and recognized by hr/recruiters/managers. i know a couple people who recently moved from ICU to ER after a couple years experience in ICU. however i personally don't know any who have gone from ER to ICU...is ER to ICU just the road less traveled, or do those with ICU experience have an easier time landing an ER job (than those with ER have landing ICU)?

also, right now (at least in my state) it seems like every new grad is attempting to get an ICU position and those who don't are planning on applying to one after they put in a year or so. overall, we'll there (or are there currently) more ER openings than ICU openings for RN's (relative to applicants)

i see you mention ER to step-down to ICU. have you been told ER to ICU is difficult or do just feel you'd prefer this route?

question for users: stereotypically, who will get the ICU job? someone with step-down experience or someone with ER experience?.....this question is ridiculous because all other factors regarding the individual are laid to waste, but still any opinions?

all in all i agree with you. the decision is difficult. given the state of the economy people are picky with who they hire. while i want to enjoy my first experience as an RN, i also want to take the position that will give me the option to explore other areas/units should i choose to do so in the future.

if only we had the option of cross-training (however even if we did, this may be a little much to ask of ourselves).

nola04 · Apr 14, 2009

I was just thinking to move from ER to step down or tele may give me the opportunity to prove that I can handle ICU patients. I have ICU experience as an extern but not sure that after my two years of ED experience will this be valid. I have heard nurses moving from Step down and Tele to ED and to ICU so I just thought that if I could not move from ED to ICU because this is the road less traveled or just not talked about. I figured that having ED experience should qualify me for at least Step down or Tele which may open the door to ICU in the future because I was thinking about asking to be on Tele and then perhaps going to ICU but I did not want to take the chance of not having an opportunity in ED. The way the economy is I just decided to just stay with ED because RN will always be needed since most ED's are short staffed. I also decided that if I started in this particular ICU and since its really not a "true" ICU with many drips, vents, and trachs then I probably would be wasting my time so hopefully the ED will be ok and I will have an interesting story to tell when I do get my ICU interview in 2-3 years. I think I will use this to stand out in future ICU interviews hopefully this will allow them to remember me apart from the other applicants. :specs:

robinzkj · Apr 14, 2009

I was an ER tech during nursing school. I thought I knew so much about ER but that was the only department I ever worked in. When I graduated I got a job in ICU. I learned so much in ICU about vented patients, about drips, titrating drips, drawing ABG's, IV antibiotics, art lines, cvps, taking orders from doctors on critical patients and I learned real quick what do look for and what to do when my patient is going bad. I think that my ICU experience taught me so much more than I would have learned starting out in ER, things that now benefit me in the ER. I really didn't want to go to ICU because of my ER history but I'm glad I did. It was a surgical ICU, we saw everything. With my new job in the ER I also had to cross train to their ICU which is tiny and a piece of cake compared to the one I came from. I felt great! I did 9mos in the ICU before I moved to ER. I was just itching for ER, it feels more like home to me.

good luck in your career!