ICU vs ED

CCU BSN RN · Dec 29, 2016

Critical care is for smart, meticulous people who like their ducks in a row, every box checked, every IV labeled and detangled. They provide excellent care on a lot of fronts. They can code you, then go do some mouth care for 20 minutes for VAP prevention.

Emergency Department is for the smart, but not so meticulous adrenaline junkie. For those who never want to be bored, and DGAF if things are tangled or not dressed up pretty, as long as everything works and the patient is alive and comfortable. ED is to treat life-threatening illnesses and then triage to the floor, not to address every little thing.

Sorry to those who will take offense to the generalizing. Obviously not every single ICU/ED nurse fits the stereotypes

OllieW, DNP, PhD, NP · Dec 30, 2016

ICU is more fun and you can be all OCD for your 1-2 patients. ED is sorta like Med/surg part 2.

Guest374845 · Dec 31, 2016

I agree with CCU, and I would add that there's a bit of comfort to be had in a "routine" at times in the ICU. Just like how not everyday in the ED is a shitstorm trauma codefest, not every day in the ICU is a blood-pressure chasing crashfest. Some days you can drink your coffee while charting your total cares and doing your q1s and q2s for your vented, sedated, ill but stagnant (or sometimes improving) patient. And some post-op patients are often 'routine' in that they are being gently progressed through a post-op recovery algorithm with low likelihood of badness... low because of your meticulous care and attention to detail.

And Ollie is just plain wrong. A level I ED can be bigger than some small hospitals and you take all comers, of all ages, at all times, and start from scratch, whether they're full of crap, sick, dying, or already dead. Some days are BS, and some days you're holding all of his ICU patients for hours or days on end, keeping their lines freshly tangled.

ThatBigGuy · Jan 1, 2017

Both are different, both are the same. We will all disagree to what extent each is.

Make a couple calls and in-person visits, see if you can get a meeting with a unit manager or director. Dress professionally, and wear your student badge. Ask if you can shadow a nurse for a few hours before you need to choose your internship location.

This is the only way you can decide for yourself.

akulahawkRN, ADN, RN, EMT-P · Jan 1, 2017

I think the best clinical placement for you truly will depend upon what YOU need to learn from it. That's kind of the point when selecting a clinical assignment when you're still a student. Look not only what you're good at, but also what areas you're weak. Sure the ED can be a great place to learn but so can the ICU. It all depends upon what you need.

Basically the ED Nurse has to have a wide base of knowledge that's not (usually) hugely in-depth because your job isn't really to cure the patient, it's triage. Your job is to figure out relatively rapidly where the patient needs to go (home, admit, transfer, or morgue). Yes, sometimes the ED is pretty much a den of semi-controlled chaos with an occasional moment when it all gets thrown in a blender and you just don't stop.

ICU is more like Med/Surg with but you get to really know the patient. If there's chaos in the ICU, something is seriously wrong. Everything is untangled, labeled, everything has its place, use, and there's a rhythm to things. You usually have only one or two patients and that's it. The ICU nurse is basically an expert in the care of the kind of patient they get in their ICU.

Lev, MSN, RN, NP · Jan 1, 2017

ICU is more fun and you can be all OCD for your 1-2 patients. ED is sorta like Med/surg part 2.

Don't agree with you on the med-surg part 2 part. Yes I have dubbed fast track "med-surg on steroids" on certain days but the main ED is a whole other ballgame and type of nursing.

William2 · Jan 3, 2017

Shadow in both if you can for a few days to see if you like either. The next problem your going to run into is location. Your mileage is going to vary based on city and hospital size. Level 1 trauma your going to have an opportunity to see a lot more in either field vs a smaller level 2 with a pop of

I am a junkie for heart pounding adrenaline and stress. The turn off about ER for me is how "routine" it can be too but in an annoying way more than ICU routine is annoying to me. Shortness of breath, mysterious abdominal pain, and jail clearance are the top 10 if not top 5 complaints seen on a daily basis here. Suppose I move it could be a different world. But I'm not moving. So for me its hard to have that same level of compassion when your 10th jail clearance admission comes in and its yours. Or grandma is "short of breath" while reading the newspaper on room air in the waiting room sent by the LTC nurse who panicked and had family up their ass. I lose my patience for that.

ICU I have a lot more control. It starts with locked doors haha.

CCU BSN RN · Jan 4, 2017

True, I forgot to mention that probably 80% of people visiting the ER are not having a life threatening illness or injury, whereas in the ICU they've mostly been pre-screened well though that they're actually sick. We've created a healthcare system where the ED treats colds, stubbed toes, minor MVCs, kids with fevers, abdominal pain after eating McDonald's, and 'found drunk in the street', 'did too much PCP', etc. I could do ED if I didn't have to deal with any of the above, but dealing with America's finest like that would burn me out in a week.

William2 · Jan 5, 2017

True, I forgot to mention that probably 80% of people visiting the ER are not having a life threatening illness or injury, whereas in the ICU they've mostly been pre-screened well though that they're actually sick. We've created a healthcare system where the ED treats colds, stubbed toes, minor MVCs, kids with fevers, abdominal pain after eating McDonald's, and 'found drunk in the street', 'did too much PCP', etc. I could do ED if I didn't have to deal with any of the above, but dealing with America's finest like that would burn me out in a week.

Agreed.

JellyDonut · Jan 10, 2017

I have worked both in the past and personally I prefer ICU over ED. ED is lots of belly pain and whiny people who should be seeing their PCP rather than clogging up the ED. However, it is fun when a real trauma or arrest rolls in the door. I always loved a good septic patient or an OD. It made the day go faster. However, there are way too many pain med seekers and you just lose patients for those over time.

amzyRN · Jan 10, 2017

Critical care is for smart, meticulous people who like their ducks in a row, every box checked, every IV labeled and detangled. They provide excellent care on a lot of fronts. They can code you, then go do some mouth care for 20 minutes for VAP prevention.
Emergency Department is for the smart, but not so meticulous adrenaline junkie. For those who never want to be bored, and DGAF if things are tangled or not dressed up pretty, as long as everything works and the patient is alive and comfortable. ED is to treat life-threatening illnesses and then triage to the floor, not to address every little thing.
Sorry to those who will take offense to the generalizing. Obviously not every single ICU/ED nurse fits the stereotypes

I agree with this. Very astute observations. I want to add that in the ED, we start the workup, we place the tubes and lines and initiate most of the care. The other units be it ICU or med/surg/tele or where ever continue care. Other units are where the healing takes place, EDs are for stabilization and transferring out. We initiate care and begin work ups, little or nothing is known when we start. That makes the ED unpredictable and the priorities are changing constantly.

I would love to learn more about ICU and I think that is more of an in-depth study of pathophysiology and human response. Some day I would love to be able to work in both ICU and the ED. I think one downfall for me in ICU would be that I would become attached to patients families and it would be more difficult to detach from sad situations. It would be hard to take work home with me all the time and over time it might be too much.

So I think a combo of short and sweet in the ED and thorough and detailed in ICU would be awesome.

OP, to answer your question (sorry I digressed a bit), I think you should start in ICU first. I kinda wish I would have done that. I was a floor nurse first, have done med/surg and cardiac step down (light ICU) and in retrospect I wish I would have gone to ICU before ED. That way you will get to go to the Resus/trauma rooms better prepared.