ER or ICU

TazziRN, RN · Jan 20, 2008

ER! ER! ER! ER! ER!

Did I say ER?

ER can be boring but the thing about it is that you never, literally NEVER, know what is going to come through the door. You do not always get a warning because the worst stuff very often comes in by private car rather than ambulance or helicopter. It can be crazy busy but you get daily variety, rather than caring for the same two pts all shift for several shifts in a row.

I did say ER, right?

Sue Damones · Jan 20, 2008

ICU! ICU! ICU!

In ICU, you will commonly get the worst patients who come through the ER (as long as they make it that far) but don't get all the nonsense ER complaints (like hangnails- haha)! In ICU, you will get a chance to sharpen all your best skills (not saying you can't in ER) and will get to be able to see how a patient does over a few days (sometimes weeks). It is nice to see how patient's progress (or don't), and you learn a lot about long term effects of interventions. So, check out ICU! ICU!

Did I say ICU?

(haha I just have to say- When I grauduated, I wanted to go to ER so badly. But... they weren't allowing new grads to start in the ER at the hospital I wanted to work at, so they offered a position in ICU and I took it. Now I'm a little biased, but trust me, I SOOO would love to still go to ER at some point!) :) :up:

labcat01, BSN, RN · Jan 20, 2008

Tazzi and Sue....ya'll crack me up!!!

bill4745, RN · Jan 20, 2008

My first 10 years was ICU. I finally realized I was bored to death-turn q2h, write all vital signs and I/O every hour, hang a dozen IVs each shift, draw bloods from any patient with a central line at 0500, do one bed and bath on night shift, 24 hour chart check, etc.

My last 4 years have been ER, and I wish I had switched 13 years ago. There is no routine-things can go from calm to total chaos in 5 minutes. You will honestly learn something new every day. You never know what is coming down the road next. You learn to think and act on your own, before the doctor sees the patient-it's your decision to draw labs, start saline, EKG, etc. I've never had such a great relationship with co-workers as I have in the ER-I'm not sue what the difference is, but we all seem closer that when I was in ICU.

Christie RN2006 · Jan 20, 2008

I am also a fan of the ICU, but I wouldn't mind switching to the ER someday! The ER and ICU are very different.

In the ER, they focus more on the short term. They stabilize (well sometimes) the patients and then they send them to the floor/unit. In the ER they also have to deal with a lot of crap such as drug seekers, and people coming in for things that they don't need to. Our ER does not deal with a lot of things such as A-lines, drips, etc. They will occasionally start a drip, but our ER nurses don't really know how to titrate them for the long term. One time they had to start an A-line in the ER and one of our nurses had to go down there and assist with inserting it and then monitor it. In the ER, they see a lot of different things. You never know what is going to come through the door next. One major plus to the ER is that if you get a really awful patient (combative, rude, etc), you know they won't be in the ER long (hopefully!).

The ICU is generally focused on the long term. You deal with a lot of drips, lines, and vents. You receive the worst patients that come through the doors of the ER. In my ICU, we have patients driven and flown in from other hospitals if they have things that those hospitals can't handle. ICU nurses also deal with a lot of crap at times. Attempted suicides, psych, overdose, prison inmates, brain injuries, etc all can become combative and/or just give you a major headache. In the ICU you will get to see patients come in at their worst, but you also have the unique opportunity to see that patient make a full recovery, but sadly you will also lose patients too.

There are definitely good and bad sides to both the ICU and ER. Would it be possible for you to do a shift in each area to see what you think? Be prepared to take classes and do lots of studying for whichever job you choose. Good luck!

nici1978 · Jan 20, 2008

hey thanks for your input, i think it is a good idea to work one day in ER or ICU

maybe i can find out what to do

nici

TazziRN, RN · Jan 20, 2008

Tazzi and Sue....ya'll crack me up!!!

That's muh job!

TazziRN, RN · Jan 20, 2008

Point to ponder.........Sue is pushing the ICU but she admits she wants ER...........hmmm...........

theatredork · Jan 20, 2008

I recently started my first nursing job in a Burn ICU, even though I had offers for both the ER and ICU. I worked in the ER in the past as a nursing assistant, and miss it horribly, but I also really enjoy the experience I'm getting in the ICU; the drips, vents, critical patients, assorted central lines, etc. I think I'll eventually get back to the ER, but for right now I couldn't be happier in an ICU.

I've two schools of thought about the ER, that if you want ER, go right into the ER if you can, but I've also heard that you should get ICU experience before working in an ER. I kind of took the latter route because it made more sense to me. Yeah, I had experience in the ER, but it made more sense to learn to care for critically ill patients in a more controlled environment than the ER offers.

TazziRN, RN · Jan 21, 2008

I recently started my first nursing job in a Burn ICU, even though I had offers for both the ER and ICU. I worked in the ER in the past as a nursing assistant, and miss it horribly, but I also really enjoy the experience I'm getting in the ICU; the drips, vents, critical patients, assorted central lines, etc. I think I'll eventually get back to the ER, but for right now I couldn't be happier in an ICU.
I've two schools of thought about the ER, that if you want ER, go right into the ER if you can, but I've also heard that you should get ICU experience before working in an ER. I kind of took the latter route because it made more sense to me. Yeah, I had experience in the ER, but it made more sense to learn to care for critically ill patients in a more controlled environment than the ER offers.

Nici, please note the part in the above post that I bolded.........

Bones, seriously, what you say about ICU experience first makes sense on paper, but in reality I don't know that it really contributes, except for the critical pts that are kept in the ER because of awaiting beds or a transfer. When I started out one of my classmates went into the ICU. Our two managers decided to have all new grads be oriented to the other unit. I was scared to death in the unit because of all the machines, I was used to dealing with the PATIENT. My classmate was a basket case because she was afraid something would come in the door in pieces and she would be expected to put it back together by herself. I realize it's different now, but back then ICU nurses rarely saw the stuff I did, because by the time they got the pt he had been put back together and, in an ICU nurse's words, "needed to be maintained until he was healed." I could deal with an evolving MI with my eyes closed, I hung so many thrombolytics that I caught a mistake made by the pharmacy. Once they left the ER, however, I had no clue what was done after that thrombolytic was in. Totally different world.

theatredork · Jan 21, 2008

I definitely understand what you're saying, and I completely agree. The ER definitely does everything they can to stabilize the patient before shipping them off to the ICU.

A lot of my very limited experience in the ICU has been with patients directly admitted to the ICU from other hospitals, bypassing the ER.

The ICU and ER are both totally different, but equally complex worlds of nursing. I don't think one is better than the other. It's really just personal preference.

I will say that I enjoy going out for drinks with the ER staff. They definitely know how to have fun! :cheers: