HELP! New Grad> Two offers on the table: ER & ICU

[amandammarie]

So, I graduated in May 2011, passed my boards shortly after, and have been looking for a job in the New Orleans area ever since(6 months!). Within this last week, I was offered TWO jobs. One in a level one trauma center ER in a public hospital, and the other in the MSICU in the same hospital. Pay for both is the exact same, as well as shifts. My question is: Is one better to start off in than the other? I had my ER rotation at this ER, and actually liked it...but I know nursing students don't get to experience the real deal...I saw more trauma than most humans ever will. It excited me to think that one day, I could potentially be in that trauma room helping save a life...although I am getting more nervous by the moment just thinking about starting my RN career period much less the trauma room! (Please tell me this is normal!) I know you save lives in ICU as well, but its a completely different atmosphere. I don't want to make the wrong decision here, if there is one! Any advice?? Thanks in advance!

[awheat]

These are two totally different mindsets and patient care issues...ER seems to be about the skill and the procedure - the pt is either "treated and streeted" or sent to the floors/ICU. In the ICU you meet all the needs of the pt (and their family/friends) - often there is not an aide to help you (with bathing, turning, changing, pericare, feeding etc). Are you a fly-by-the-seat-of-your-pants personality or a quick-and-steady-wins-the-race?

[Spoiled1, MSN, RN]

Go to the ICU.

[Saharadan]

I have done both. Often at the same time at the same hospital. Depending on the size of the hospital :ER:ICU your roles and responsibilities can differ dramatically. In general, Large teaching hospitals are bogged down by procedure and “scope of practice” issues. In small rural hospitals a lot of acts are delegated and many “standing orders and protocols” are in place to address smaller staff. When I'm preceptoring, if a student is particularly strong, I suggest that they start their careers either in the ER or ICU or both as to not atrophy all of that fresh knowledge or to become “ghettoized”. The ICU will challenge you not only physically, but also conceptually; you will need to know exactly what is going on with your patient(s) on all levels. You will need to be alert to subtle changes. In the ER the challenges are different, no less demanding, just different. Time management is always a nurse’s concern, but if you get a heavy load in the ER it can be physically exhausting. I personally enjoy both, as I like the intellectual challenges of the ICU as well as the high-energy demands of the ER. Both are exciting in their own way. Both are invaluable additions to a resume. If your schedule allows: do both.

[AZMOMO2]

Can you ask to job shadow for 1 day on each unit? That would give you the best idea about where YOU want to be and how YOU think you would like it. Nursing is so independently about personal preference that it'd be hard to tell you exactly where you would want to work.

Congrats tho!!

[Esme12, ASN, BSN, RN]

I have done both and I have loved both. They are very different energies. The ED is a rapid fire, high energy, unpredictable adrenaline frenzy. The patients will come and go quickly and you need to be able to regroup quickly. ICU is an intense focused, attention to minute detail, high stress, OCD environment and the patients stay longer. ED is a focused patient assessment centered on injury and ICU is a wholistic to toe assessment and detail.

I think they both have their adrenaline rushes but the ED is more chaotic and sustained unpredictable environment...very little control. The ICU while it can be unpredictable the surrounding is more controlled and the chaos is for shorter periods rather than the sustained energy that is prevalent in the ED.

It's a genuine personality like or dislike of chaos. Congrats on the jobs and I think wither one will be fine and you will learn lots.....after a year if it isn't your cup of tea transfer. I have loved them both but I must admit I'm more of the adrenaline junky.

Good luck!!