ER or ICU?

dewp_63 · Sep 26, 2001

I have recently moved to the ER after 10 years of ICU work. I just finally burned out... The major difference I see in ER work is the variety, as others have pointed out. I finally came to realize that there are only so many ways to take care of a vent (or CHF, or MI, or GI bleed), and that much of what you do in ICU is just fill in the blanks. I became most frustrated with hourly UOP and VS that have been stable and normal for days on end. The charting in ICU is usually voluminous - and no one ever even looks at what you have written/typed.

I sound bitter - BUT I feel that I could not function in the ER without the base I learned on the floors and ICU. My assessment skills were honed in the ICU's, as I could see a single patient (or two) over a longer period of time and compare assessments. In the ER, you see them for such a short time, and then they go home or go to the floor/unit/morgue. The assessment and problem solving skills I learned in the ICU makes it easier for me to anticipate the MD/PA's priorities, the patient needs and the ways to get the best outcomes in a timely manner.

so, I guess the bottom line is : go where your heart tells you. ER is fun, but you have little continuity of care (unless they're "repeat offenders" as we call them). ICU is a major challenge and you WILL learn!!! Good luck! :cool:

LilgirlRN, ADN, RN · Nov 16, 2001

Originally posted by 502Nurse
Hi!
I am a student nurse who is interested in working in critical care. I need to select a site for my senior preceptorship, and was wondering what the best setting for this would be - working in an ICU unit or in the ER. It seems the ER would give a much broader view of urgent care, yet the ICU is where I would like to work.

Any comments or suggestions are appreciated!

Thank you.

I was hired to work in CCU straight out of nursing school, back then we sorta doubled as ICU too when they were full. I now work in the ER and have for many years, but if it weren't for the experience I had working in and intensive care setting, I would not have been able to function in the ER back when I first joined the staff. I agree with many others who have said that you have time to learn the whyfors in ICU, things move much too quickly in the ED for you to learn things like how to take care of an entubated patient, hopefully they won't be in the ED for long after they are tubed.

As far as gaining experience is concerned, in a crisis situation, such as a code, stand back and watch what each member of the team does. When it is all over ask questions, don't ever be afraid to ask..the only stupid questions are the ones that are never asked. I am continually amazed at the lack of knowledge among some of my peers, people who have adequate experience (as in years of nursing), but just don't know things that I consider essential to being an ED nurse. Watch, gather your thoughts and ask as many questions as your preceptor will answer. If you are interested in any particular thing, seek out the nurse that is most qualified in that area of experise and spend time with him/her. ED nurses tend to fall into the "Jack of all trades" category, they know a little about a lot of things, some seem to excel in certain areas however.

I wish you great luck starting out in your career, the only other thing I would consider doing other than nursing would be medicine. I love what I do and as a result I am very good at it ( I should be, I've been doing it FOREVER!) You cannot beat nursing for commeraderie, and for new nurses, pay. It also pays to move around some, change hospitals, each time you move, you increase your pay, then chose the one you like the best and settle there. OK..I'm running off at the fingers here, good luck 502. Wendy

Granted Fal · May 8, 2005

I may be starting ER as a new grad and a comment in your reply piqued my interest: "I am continually amazed at the lack of knowledge among some of my peers, people who have adequate experience (as in years of nursing), but just don't know things that I consider essential to being an ED nurse..."

Not to hang you on a pole or anything, but I'm curious on what some examples of such things may be... especially since i don't want to be one of these kinds of nurses. I have a specialization in psych and detox nursing that i'm taking with me, but my fear is inadequate assessment skills, I didn't work critical care or EMS or all that... I was given the impression that these would develop especially with the increased volume of patients that you encounter. Any feedback would be appreciated.

Rod

I was hired to work in CCU straight out of nursing school, back then we sorta doubled as ICU too when they were full. I now work in the ER and have for many years, but if it weren't for the experience I had working in and intensive care setting, I would not have been able to function in the ER back when I first joined the staff. I agree with many others who have said that you have time to learn the whyfors in ICU, things move much too quickly in the ED for you to learn things like how to take care of an entubated patient, hopefully they won't be in the ED for long after they are tubed.
As far as gaining experience is concerned, in a crisis situation, such as a code, stand back and watch what each member of the team does. When it is all over ask questions, don't ever be afraid to ask..the only stupid questions are the ones that are never asked. I am continually amazed at the lack of knowledge among some of my peers, people who have adequate experience (as in years of nursing), but just don't know things that I consider essential to being an ED nurse. Watch, gather your thoughts and ask as many questions as your preceptor will answer. If you are interested in any particular thing, seek out the nurse that is most qualified in that area of experise and spend time with him/her. ED nurses tend to fall into the "Jack of all trades" category, they know a little about a lot of things, some seem to excel in certain areas however.
I wish you great luck starting out in your career, the only other thing I would consider doing other than nursing would be medicine. I love what I do and as a result I am very good at it ( I should be, I've been doing it FOREVER!) You cannot beat nursing for commeraderie, and for new nurses, pay. It also pays to move around some, change hospitals, each time you move, you increase your pay, then chose the one you like the best and settle there. OK..I'm running off at the fingers here, good luck 502. Wendy

askater11 · May 8, 2005

Wow interesting!!!

Sounds like not too many like the ICU. That's where I"m at now--though I sometimes float to other telemtry floors.