Help! ED or ICU? I cannot decide.

Nurses General Nursing

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I have job offers: OFFER #1 - ED, not a Level 1 Trauma Center, but the hospital does CABG and emergency dialysis, they also apparently get very busy, during my interview at 1300, the director said they had three code blues already that day. The other offer, OFFER #2 is not actually ICU, it is PCU at a Level 1 trauma hospital, nurse:patient ratio of 1:2 or 1:3 depending on pt acuity...this PCU gets step-down patients from 4 ICUS: surgical/trauma, med/surg, cardiac, and the other I cannot remember, maybe surgical and trauma are each their own? At the rural hospital where I currently work they would def be considered critically ill and be in our ICU.

The problem: I have a split personality and feel I would totally enjoy BOTH units. I have both job offers. I cannot decide which one to choose. I have 2 years telemetry med-surg exp. I dream of the fast-action crazy ER enviornment and it would be cool to learn about ER medicine and trauma, but also have been told by the people I met on the PCU unit that I would learn a ton of skills there too because they get all kinds of ICU patients. I also love it when I have a very ill patient that has to monitored very closely (and usually has to get sent over to ICU).

I know both jobs will be challenging. I don't want a ER vs ICU (or PCU) fight. I am seeking your reasons for why you work in ER or ICU or PCU and also if, say, way down the road I want to look back and say, "I did it all, seen it all, etc.," which one should I choose? And again, I have a very split personality - I like one-on-one, I also like crazy mad rush of patients.

ANY help would be greatly appreciated! Thank you!

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Specializes in public health.

What's your long and short term goals for your career? If you don't know, then I say flip a coin and pick either one. If you know what your goal is and still torn between two offers, I would ask if you have toured both units, do you like the teams, how do you get along with your potential coworkers? A job is a job but it's the people who make it interesting and challenging. The nature of ED and ICU is quite different, so if you know what you want I think it would be an easy choice. Good luck! Both opportunities sound amazing.

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Thank you so much! Flip a coin, lol, that is totally how I feel!!! The problem is I don't know my long-term goals yet :( but I do know I want to learn, learn, learn NOW. But the units both have so much to offer, like apples and oranges! Ahh!!! I seriously need a margarita. It's five o'clock somewhere!!! My hubby, like you, also advised to tour both. I toured the PCU and got a good feeling (yay!), but did not get a chance to tour the ED. I just read your post and contacted the ED director's recruiter and asked her to let me tour and meet some of the team members! She says she will arrange it!!! Thank you again so much. I do get really affected by the people around me and I think getting to meet my potential ED co-workers will really help me know if it feels like "home."

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Specializes in ICU.

Lol. I have times of split personality it seems. My breadwinner is ICU and I love it. Have been doing that for years. My fun job is ER and I do that per diem when I get tired n grouchy in iCU. Honestly there are good and bad to both. I prefer working both. Go with your gut and realize that you can always change it up later.

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Thank you so much for your thoughts!!! The people on PCU were so nice and happy, they made me eat a donut during my interview, they love it there, so that is great! But I have not met the ED team, just the ED director who was really grouchy! LOL! But I kinda liked her anyway! LOL! What is wrong with me???!!! She went ahead and bypassed the group interview and said she was going to just have her pp check my refs and do background check, like then and there on the spot, which I thought was so cool!! Like, "Wow, she must really like me to pass that by and go straight to background check, cool..." But now, I 'm kicking myself!!! The recruiter says she has tried to reach out to ask her to get me an opportunity to meet the team and tour the unit....still waiting for response....

Also, you are so funny that you do ER for fun when you get grouchy! Haha. I too thought, maybe I will take the PCU job then pick up ED shifts for change of pace. I get kind of bored on tele and this is why I crave ED as I have helped out down there a couple times! I think PCU should be really busy too but you are saying it is not the crazy chaotic rush right?? I have never floated to PCU or ICU.

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How much structure do you like?

I work ICU. There is a rhythm to the day. I know I will have one or two adult patients with ICU type problems. They come to me with a working diagnosis and a couple of IV lines. The day has an underlying structure of report, assessment, rounds, first meds, charting etc. It is similar to many inpatient departments only the patients get more monitoring. I work ICU because I like a certain level of predictability in my day. I am the kind of girl who always has a to-do list. I don't "hang loose" very well.

ED is a lot more random. You get all ages, all diagnoses, and all levels from faking it to barely alive. You might have a slow shift or a busy one. ED nurses learn to go with the flow and be open to changes of plan.

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Specializes in Med-Surg, Emergency, CEN.

ICU tends to be more for the nurses who have to know every detail of one or two patients to the milliliter.

Emergency is more about stabilize and send (home, floor, OR/cath lab, ICU). Huge amounts of variety as the above poster already mentioned.

If you're afraid of certain patient populations (babies, kids, GYN, detox, whatever) then go more towards the PCU.

Glad to hear that you are touring both. You'll have a much better idea of which way you might be leaning.

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Thank you so much for your thoughts!!! The people on PCU were so nice and happy, they made me eat a donut during my interview, they love it there, so that is great! But I have not met the ED team, just the ED director who was really grouchy! LOL! But I kinda liked her anyway! LOL! What is wrong with me???!!! She went ahead and bypassed the group interview and said she was going to just have her pp check my refs and do background check, like then and there on the spot, which I thought was so cool!! Like, "Wow, she must really like me to pass that by and go straight to background check, cool..." But now, I 'm kicking myself!!! The recruiter says she has tried to reach out to ask her to get me an opportunity to meet the team and tour the unit....still waiting for response....

Also, you are so funny that you do ER for fun when you get grouchy! Haha. I too thought, maybe I will take the PCU job then pick up ED shifts for change of pace. I get kind of bored on tele and this is why I crave ED as I have helped out down there a couple times! I think PCU should be really busy too but you are saying it is not the crazy chaotic rush right?? I have never floated to PCU or ICU.

Haha... either she really likes you or that unit is a hot mess and she's desperate. Tread carefully, OP

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