ER vs. ICU in Military

[joepro7]

Hi everyone, I've been trying to get as much information as I can lately about joining the military as a nurse. I already posted a thread about becoming an army nurse but was informed by my peers and also a healthcare professional recruiter that 2 years of experience are required to be commissioned in the army at this time (I am a new grad), so my sights have turned to the air force and navy for the time being. My question now though is how is work life as an ER nurse in the military. I apologize if I sound ignorant but I'm confused on this issue. From the sounds of it, most hospitals (not all) in the military do not have a high patient acuity. And it is to my understanding that military hospitals only serve people in the military and their families (which are all fairly healthy) so it sounds like to me there would not be a lot of "action" in a military hospital ER. I recently chose an ER job over a CVICU job and I am starting to worry that might of hurt my chances to being commissioned in any of the branches because ICU nurses seem to be the most sought after specialty but the ER is really my calling (as far as I know now, I'm young and have a lot of experiences ahead of me). Any info on this or military nursing in general would be greatly appreciated and utilized.

[littleluvbugnavy]

I'm an ER Navy nurse. Yes, some of our acuity is lower than the civilian side, but remember we also take care of retirees

[Lunah, MSN, RN]

The ED is the ED is the ED. We do have many lower acuity patients in our military ED, but remember: while soldiers/active duty tend to be healthy, spouses and retirees are a whole other matter! Heck, we have a retiree with an LVAD in our area. Lol. We see a lot of surgical stuff - more ectopic pregnancies than normal because the military likes to reproduce, a lot of appys and gall bladders. A-fib, SVT, CAD, PEs, spontaneous pneumos, v tach, codes, suicides, overdoses, CHF, asthma, and even STEMIs. Our soldiers like to work themselves out into rhabdo and mess up their kidneys, and the electrolyte imbalances around the time for height/weight and the semiannual PT tests are fun. We get a lot of heat casualties as well, especially when the National Guard units from colder areas roll into town for training. Then your usual assortment of sprains/fractures/stupid human tricks, not to mention a LOT of peds with a huge variety of acuity.

Quite honestly, our inpatient units see lower acuity because our ER ships out the sickest to the civilian facilities nearby, usually the Level 1. Now I also work at that Level 1 ED, and that is something that you might consider - moonlighting at a local trauma center. You will likely need permission from your chain of command (I did for the Army), and the military takes precedence - I have had to call out from the Level 1 to work in my Army ED. But it is a great way to keep your skills up!

[Dranger]

To be honest the military ICUs I have been around were generally lower acuity even though they are equipped to handle lots of sick patients. Yes there are retirees but in my experience of working at civilian hospitals around military bases it seems like we got a lot of "Tricare for Life" patients which makes me wonder what the census at the military hospital was.

[jfratian, DNP, RN, CRNA]

Quite honestly, moonlighting is really a must for most military nurses: ICU and ER especially. You might see the occasional sick patient, but even small civilian community hospitals often see sicker patients than all but the largest military hospitals (SAMMC, NMC-SAN Diego, and WRMCC really).

The ER might get first contact with a sick patient, but a patient in nearly any environment can go bad; the ER doesn't have exclusivity on the 'unexpected.' The bottom line is the number of ESI 4 or 5 patients in our ER is probably 3/4 of the load or more. Most patients at military hospitals aren't that sick. You really have to hope for deployments is if you want sick.

Go with the specialty that fits you best. No matter what specialty you pick, I think moonlighting is a good idea.

[Camwill, ASN, BSN, MSN, DNP, LPN, APRN, NP]

I was wondering what a typical day or week of work is like...I mean do you work 12 hour shifts...is it 5 days a week...

[jfratian, DNP, RN, CRNA]

If you're ER, ICU, or any inpatient unit, you're likely to work 14 12-hour shifts every month (3-4 per week). Every local commander can alter that as needed, because # of shifts per person per month isn't something prescribed at high level. Additional duties (infection control, scheduling, etc) take additional time.