ICU or Emergency

[Momochi]

Hi all,

I recently received job offers for both ICU and Emergency in different hospitals. I've worked in both before, and I like both, for different reasons. However, I can only accept one job offer.

With the assumption that the job offers are equal, the hospitals are comparable, and commute time similar, which job offer would you say yes to? And why? 

[Okami_CCRN, BSN, RN]

I would always choose the controlled chaos of the ICU over the uncontrolled chaos of the ED. 

I enjoy the patient care of ICU, and following patients through their critical illness. 

[aqualady_21, BSN, RN]

This is a difficult question... not sure which unit you are coming from but I think it depends on your personality and the type of work environment you desire. I worked in a trauma/psych ER for about 2 years as a new grad, and I can tell you it was 2 of the hardest years of my life/career but I knew the experience gained would be invaluable to my nursing career. It sounds like you are not a new grad, but are looking to gain more experience - as Okami noted, both places are chaotic in their own way. 

ER can be very fast paced, stressful, and humbling - you must be able to depend on your team of nurses, doctors, and techs to help you out when one of your patient's is crashing and your other patient is running down the hall naked. The ER can also be a "holding" place for patients awaiting placement at facilities, jail, etc. Your priorities are constantly shifting throughout the day as you get higher/lower acuity patients, and you'll take care of a huge variety of people with all different types of personalities and complaints (and also lots of frequent fliers who just want a sandwich), as well as deal with psychosocial and ethical issues. You may also take care of admitted ICU patients awaiting a bed assignment, so in that sense, in the ER you will get experience in both areas.  Typically, ER nurses have more relaxed personalities, as they adjust to the constantly changing environment during any given shift  and dealing with difficult patients/families. Also, our ED did not have a separate pediatric ED, so we got experience in caring for all ages - infants, toddlers, teens, etc. 

ICU is much more of a controlled environment, and the nurses are typically doing total care for each of their patients, (our ICU does have a few techs on the unit) while you'll likely depend on your fellow nurses for things like bathing, turning, etc. In my experience, ICU nurses tend to be extremely OCD, meticulous, and protective over their patients (as they should be). Obviously, most of the patients you'll care for will be extremely critical or near the end of life, on multiple drips, CRRT/dialysis, ventilators, multiple codes during a shift, etc. Not sure if patient interaction is a factor in your decision, but I've heard many ICU nurses say they prefer their patient's intubated/sedated so they can complete all of their tasks without protest by the patient (no judgement here, it's just their preference).

Personally, as stressful as the ER was, I can't ever picture myself working in the ICU full time seeing patient's hooked up to so many machines, drips, monitors - I think it would definitely affect my mental health. BUT, I can imagine how exciting it is for an ICU nurse to see their critical patients improve and be extubated and sometimes come back from the brink of death. Experience in either unit will be great for your career and resume - that being said, it may be easier to try ER first and then transition to ICU later on if desired, as going from the controlled chaos of the ICU to the uncontrolled chaos of the ER may be more of a shock. Hope this helps a bit... good luck!

 

[DavidFR, BSN, MSN, RN]

Neither. I don't wish to sound harsh but I kind of get the feeling, rightly or wrongly, that given that you know both specialities already, if you really wanted one or the other you'd know the answer yourself. Or are you just looking for the comfort zone of a speciality you already know? It isn't as if you're considering the unknown, in which case I'd see your question as being perfectly valid. 

One could always argue that you've done both, so why not be adventurous, expand your horizons and move on to something new?

[Corey Narry, MSN, RN, NP]

I would shadow the nurses...

do they seem happy in the unit they work at?

is the staff turn over rate problematic?

does the unit leadership team seem supportive?

is it a Level 1 trauma center?

is the ICU a mixed Med-Surg or specialized?

I would have a lot of considerations but you really did not give much info

[JKL33]

I would think most people will answer this based on their own personality and that isn't going to help you. You need to know your strengths and preferences and decide accordingly.

I'm  a bigger picture person and probably could not be compelled to remotely care about some of the minutiae that make ICU people tick. It's important stuff and they are good at what they do. I would not be good at it. I worked in the ED for a long time and enjoyed the very short patient relationships and the work of sorting and stabilizing and moving on.

I remember one time when giving ED report to the floor I was asked where the patient's IV was and the specifics of it. I said something along the lines, "It's probably an 18g in the left AC 'cause that's what I do about 90% of the time." If that answer is perfectly acceptable to you, work in the ED. If that answer makes you recoil in horror, work in ICU. 😂

[EmergentAnesthetics]

Having done both, it is entirely dependent on what you're looking for career wise. I started in the ED as a new graduate and enjoyed it 80% of the time. It definitely can become routine but that's when additional certifications come in handy. Once you become comfortable it's time to either leave or seek additional knowledge or skills. I went to the CCU after being in the ED for 4 years. Receiving the patient from the ED was full circle for me and enjoyed experiencing the other side. Agreed, the ED personality and CCU personality are night and day.

What I enjoyed about the CCU was the ability to improve my critical thinking skills and confidence. Playing with the different devices and actually see patients improve from the depth of their sickness to eventually being discharged. However, the amount of comfort care patients was a reality check for me.

As an ED trained nurse, I hated the documentation and the mundane tasks (labeling IVs, detangling a mess from the previous shift, the plethora of paperwork for every single thing being done, did I already say charting every move?), taking care of the same patient weeks on end. Sometimes it wasn't as hands on as I was in the ED. Placing IVs, dropping NG tubes, foleys, etc etc so I got bored. I also enjoyed the quick patient turnover in the ED.

If I could do it all over again I definitely would start in the ED because it made me a much better and adaptable ICU nurse. If I had to choose one over the other, I'd chose ED time and time again.

[Mamma_mia1]

I've worked in the ICU for 10 years and work in the ED sometimes (I moved to CC float pool). It's very different to work in the ED if you're used to the ICU where everything is labeled, controlled, and you know your patient from top to bottom and inside out. In the ED it's very chaotic and the nurses don't really know what's going on with the patient due to constant changes in flow. In my perspective, the ICU is a controlled chaos and the ED is just the wild west, LOL.