ICU v. ER

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Specializes in ICU, Cardiac Cath/EPS Labs.

ICU v. ER

I think this will be a very short-lived thread, because I think the answer may be simple...to put it briefly (for once ;-) ..... Is the ER just as bad as a med-surg floor?--i.e., so many patients dying that you can't focus?...I'm in ICU and LOVE it after having seen the numerous patient in med-surg floors that don't allow you to focus on care...ICU is great with two patients and their need for close nursing/monitoring, e.g., titrating drips, following lab values, counseling families, etc.....The reason I'm wondering: I'm interested in the different perspective of an ER nurse: You sometimes have NO IDEA what ails a patient, as the patient may be unconscious or not speak English, whereas in ICU, you know all that the ER has figured out for you before sending you the patient....I'm just eager for a DAY shift and would transfer to the ER to get it.....but is that precisely why ER is easier to get as a day shift, because it is NOT as desirable as med-surg?? Thanks so much!

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Specializes in Emergency Room; Acute Psychiatry.

I loved the ER. It's always something new and exciting with the exception of the regulars and the drug seekers. It gets busy, but it's a great feeling knowing that you've helped stabalize a critical patient. Then you can just hand them off and stabalize the next one. You have to be be mentally prepared for seeing the worst. You have to be compassionate yet somewhat emotionally detached. It's not easy, but it can be very fulfilling.

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Medical Surgical floors are much more stressful and require you to work much harder than ER IMHO. Once you get the hang of things, ER is actually a pretty nice area.

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Specializes in ER/EHR Trainer.
Medical Surgical floors are much more stressful and require you to work much harder than ER IMHO. Once you get the hang of things, ER is actually a pretty nice area.

I think that depends what is expected from you. When our patients are delivered to the floor, everything is done! I work hard every day in the ER, I think med-surg consists of more tasks-different stress and requirements. ER does all that ICU does and more, with more patients. I have had 4 unit patients with hourly blood draws, fs and insulin drips-and others running for concurrant dka. Then received a PE! No med surg I ever heard of...no unit I ever heard of. Worst day of my life!

Too hard to compare. Every area is what it is....you really need to shadow if you want an idea.

JM ER O

Maisy

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Specializes in ICU, Cardiac Cath/EPS Labs.
I think that depends what is expected from you. When our patients are delivered to the floor, everything is done! I work hard every day in the ER, I think med-surg consists of more tasks-different stress and requirements. ER does all that ICU does and more, with more patients. I have had 4 unit patients with hourly blood draws, fs and insulin drips-and others running for concurrant dka. Then received a PE! No med surg I ever heard of...no unit I ever heard of. Worst day of my life!

Too hard to compare. Every area is what it is....you really need to shadow if you want an idea.

JM ER O

Maisy

Thanks--you're right--shadowing is the best way to compare.

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Specializes in ER, Med/Surg.

I have worked both, and they are different. ERNurse03 has about put it in as simple terms as possible.

It depends on the facility you work in.

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Specializes in Cardiac, ER.

I think my ER job is waaaayyyy less stressful than the unit I left!! It's very fast, never a dull moment but we have staff,.se work great together,.we have staff,...ER is more c/o focused,.we have staff!!

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Specializes in ICU, Cardiac Cath/EPS Labs.

thanks for your thoughts...someone I spoke with at my hospital said she found ER had the RN running in too many different directions with too many patients and just trying to keep the patients alive (not a bad goal, of course, but one that focuses on basic interventions, e.g., is he hyperglycemic?, hurry and give him glucose)....versus ICU, where you really know the entire patient history and learn about ALL types of meds--not just crisis meds, but meds for chronic/maintenance, etc....

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Well look, for the most part, ICU patients are in pretty bad shape. ER patients on the other hand. Well, let's just say you have to know how to prioritize.

ER nursing is quite simple:

I have a problem and these are the ways I can deal with that problem.

1) I solve the problem and kick it to the curb.

2) I cannot solve the problem and send the problem to somebody else.

3) I cannot solve the problem and have to hold onto the problem; however, I still keep trying to send the problem to somebody else.

Working on the floor or ICU is different in that you cannot send the problem to somebody else but somebody else is always sending you their problem.

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Every floor has its demands and as mentioned shadowing at the hospital you are at is the best way to get a "feel for the flow". Some departments are managed better than other and some are staffed better than others which has a HUGE impact on job staisfaction. Some units have nurses that help each other and some don't.

As far as the ER turning problem pts over to the floor because they can't solve said problem ... never seen it happen. I have yet to see a patient that was known as unstable sent to a regular floor, this type pt is usually upgraded to an ICU bed so the patient can have optimal care provided. The house supervisor can reassign pts if they are told of impending problems. Do patients go bad on the floor? Of course, but I have yet in my 17 yrs of nursing seen anyone knowingly dump or pass off an unstable pt.

Toq

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Specializes in Emergency Room; Acute Psychiatry.
Well look, for the most part, ICU patients are in pretty bad shape. ER patients on the other hand. Well, let's just say you have to know how to prioritize.

ER nursing is quite simple:

I have a problem and these are the ways I can deal with that problem.

1) I solve the problem and kick it to the curb.

2) I cannot solve the problem and send the problem to somebody else.

3) I cannot solve the problem and have to hold onto the problem; however, I still keep trying to send the problem to somebody else.

I don't know what kind of ER you've worked in, but this is the typical mis-conception. You are right about one thing the patients are transferred out of the ER because once they are either treated and sent home or stabalized, the ER is not a place to hold patients because there is a continuous influx of patients of various acuities. However, I disagree with the first statement that "ER Nursing is quite simple."...please refer to my very first sentence.

The way I understand it is that you think ER patients are not in "pretty bad shape." Apparently you've never had a victim of a house fire who was pronounced dead at the scene and placed in a body bag. Then when the paramedic seen the bag move on the way to the morgue they turn around and roll the patient out of a body bag and onto your ER cot. You realize that the chared body of this living human who is actually not dead but in "pretty bad shape" is attempting to speak to you.

The rest of your "quite simple" 1,2,3 ER explanation sounds like it is spoken by someone who doesn't really know what happens in the ER.

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Hey, think what you will. ER nursing is like any other type of nursing, you work hard. However to say ER is harder than the floor or ICU, come on.

The concept of ER is still simple. Stabilize, move out, or move somewhere. I see floor nurses struggle with 8 or sometimes more patients all day long. Sick, demanding patients. Then, to deal with out of control paperwork all day long ontop of admits and discharges. It really burns me when people throw around ignorant remarks about floor nursing.

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