ICU or ER

blondy2061h, MSN, RN · Aug 13, 2008

ER won't take new grads here.

nessajune21 · Aug 13, 2008

I think that only you can decide. Apply to both and follow your heart.

ER won't take new grads here.

She's not really a new grad. She has 3 years experience as an LPN.

blondy2061h, MSN, RN · Aug 13, 2008

She's not really a new grad. She has 3 years experience as an LPN.

Still, you need a year experience as an RN to get an ER position here.

HouTx, BSN, MSN, EdD · Aug 13, 2008

Good question - as a 'veteran' of both areas, I think that the primary difference is is the environment rather than the skills. Here is my :twocents: based on my own experience.

ED is episodic - at least it is supposed to be. You work with a patient to stabilize immediate needs & send them to another 'place'. Nowadays, ED frequently turns into a clinic because people have no primary care doc - or becomes an obs unit while waiting for beds in an inpatient area. I found EDs to have a very "macho" culture (for both male & female staff). The goal was to be tougher/quicker/more daring than anyone else. Down-time humor tends to be more ribald - more practical jokes & teasing behavior. Adrenalin rush is the name of the game. ED staff are usually very open to newbies - as long as you stand in the corner & don't get in their way!

ICU is more about providing high-level/very concentrated services - medical or nursing. The care is supposed to be time-limited and have a goal of moving the patient on to a lower level of care as they become more stable. The working environment is actually less 'team oriented' than the ED. ICU nurses work pretty independently - and are expected to ask for assistance when needed because there's no one keeping tabs on you. The (reality based) experienced nurse is all-knowing (multiple certifications), values acknowledgement of clinical expertise & appreciates the approval from physicians more than from co-workers. New staff are expected to hit the ground running and the culture may not be very receptive to newbies.

Metaphorically - action in the ED is like a basketball team... fast paced, everyone needs to know where everyone else is and what they are doing without prompting or stopping to re-group. ICU is more like baseball - everyone playing their own position, and interacting only when an event causes them to interact with another player.

Career-path wise, you will find many more ex-ICU nurses in mgmt positions. I think it's due to 2 reasons:

1. ICU nurses are usually very assertive & 'take charge' - more comfortable with leadership responsiblity and less concerned about whether co-workers like them

2. ED nurses tend to LOVE it - and don't want to change areas or move out of their direct care roles.

labcat01, BSN, RN · Aug 13, 2008

Wow rbezemek- that's probably the best description of the two that I've ever read. Nice work:yeah:!

MaryAnn_RN · Aug 13, 2008

I have not worked in ER as an RN, only as a student so don't feel qualified to comment on that.

ICU can be emotionally, intellectually and physically draining. However it is a fantastic place to work. To take a patient and give all care, to support the family through the worst of times, to know that you have made a difference, is just the best feeling in the world.

Perhaps I am lucky but our nursing team is just that...a team. We look out for and support each other.

clairebearrn · Aug 13, 2008

I am a new grad in the ER and have worked as a student in the ICU. I agree with the above posters. ICU nurses are more independent...ER nurses are more involved in teamwork and need to adapt to change quickly...

sissiesmama, ASN, RN · Aug 14, 2008

Still, you need a year experience as an RN to get an ER position here.

That's how it is here too. I was an LPN for 6 years before becoming an RN and they wanted a year of RN experience to get a job in ER or L and D.

But, as to your question about either ER or ICU, there are pros and cons to each. Like another poster said, follow your heart, what you think you really enjoy. We are ALWAYS holding ICU patients in the ER, quite a few on vents, lines, the usual. So, in that aspect, some of it can overlap. We have actually held ICU patients in our ER for days, get them extubated and then later, home. Crazy. Some of the nurses started anwsering the ER phones "EICU", but the suits put a stop to that as soon as they heard.

Just my take on it, I personally enjoy the spontaneity of your day or night, you never really know what may walk or roll in. Of course, a lot of clinic stuff tries to come in along with everything else. The first 12 hour shift I worked, we had 1 stabbing, 2 trauma codes from shootings, and a worker that fell over 40 feet that we stabilized before running up to the OR with him. We had a chest to crack in rooms 1 and 2 at the same time. The ER doc was crazy running!

Now, a lot of ICU nurses like it because you do have a little more constant, with the patients and their families.

I know this isn't much, but I hope it hepls just a little! Feel free to PM if you would like.

Anne, RNC

IVleaguenurse · Aug 14, 2008

Need Advice....I don't know which dept I would rather be in ER or Icu. I graduate in Dec and currently I work on a med/surg floor as a lpn and have been for 3yrs.I'm in the bridge program and I'll be taking critical care this semester as my last semester. I haven't worked in ER of ICU but I find them both interesting.I'll have clinicals in ICU but I think Im gonna try and do my precepting in ER. What is the major difference in nursing between the two....I mean as far a nursing skills...

I work in a SICU here in Florida and was the best thing I ever did, you learn a lot in a short time :up: