ICU VS. the ER?

jojotoo, RN · Dec 12, 2006

No, their care was always complicated, which is why they go to an intensive care unit.
Look at the names, folks. ERs provide emergency care. ICU provides intensive care.

So if their care was ALWAYS complicated, why is the ER easy and the ICU intense? (My original question to Joe)

Jen911 · Dec 12, 2006

Sheesh, this debate will continue for decades, just like the ER vs Floors debate. ER can be hard work, so can ICU....we just focus on different care of the patient. ER tries to stabilize the emergency at hand, then sends the patient to ICU where they can work to fix the problem safely. I've worked ER's for 6 years, and have no desire to work ICU - it scares me! LOL! Let me stabilize and get 'em to the people who can actually fix 'em!

JoeMacERRN · Dec 12, 2006

I was a paramedic for 5 yrs, an ICU nurse for 1 and an ER nurse for 20, so I feel I can comment on this subject.

Work one day taking care of a fresh post-op CABG pt, or a heart transplant pt, or do a day managing a multi-system trauma pt in a surgical ICU, and then do a day in a busy level one trauma center, and you'll see the level of intensity is not equal. It's a flash bang in an ER ,vs a steady stream of data, procedures, more data, treatment modalities, more data, blah, blah, blah.. that needs to be evaluated, and acted upon in an ICU. It's not even close.

RazorbackRN, BSN, RN · Dec 12, 2006

There are lots of ways to look at the topic. Here's one: ER nurses are like the house painter that slaps on most of the paint. The ICU nurse then comes along to do the trim. But seriously, ER nurses must have critical care skills (we, yes I am an ER nurse, have to take care of unstable patients). Also, the emergency nurse must care for everyone that comes through the door, the ICU nurse takes 1 to 3 patients and that's it. Also, emergency nurses don't know what's wrong with their patient. Other nurses have a diagnosis for their patients. I believe that emergency nursing is the most challenging and that's why I do it. If I get to feeling lazy, I will go back to the unit.

If you get to feeling lazy, you'll go back to the unit?

You know, being an ICU nurse, I could really take offense to your lack of knowledge. However, I have to just chalk it up to that...lack of knowledge.

If you have ever been an ICU nurse and you felt it wasn't challenging and/or was for lazy people, perhaps you weren't really doing the job like you needed to be. :nono:

I'm really glad that most people on this board are informed enough to know that each job has its own challenges and doesn't believe that one is greater or more important than another just because the label of the dept.

Knoodsen · Dec 12, 2006

So sorry to ruffle feathers. Never said I was better than anyone. I simply gave my thoughts on the difference and stated that I found the ED to be more challenging. Don't worry about competition from me; just take report. (Wish I could say that I had never seen a lazy nurse.)

Knoodsen · Dec 12, 2006

By the way, Razor, I wasn't implying that ICU folks are lazy. At all. Read my post again. I was talking about me. I'm getting old. There will come a day when I will not be able to handle the pace of a busy ED. Having worked ICU as well, there is no doubt in my mind that I will be able to finish out my career there. Again, I did not intend to offend (and cause offensive replies to be launched my way).

RazorbackRN, BSN, RN · Dec 12, 2006

By the way, Razor, I wasn't implying that ICU folks are lazy. At all. Read my post again. I was talking about me. I'm getting old. There will come a day when I will not be able to handle the pace of a busy ED. Having worked ICU as well, there is no doubt in my mind that I will be able to finish out my career there. Again, I did not intend to offend (and cause offensive replies to be launched my way).

Thanks for the clarification. No offense taken.:nuke:

BlueEyedRN · Dec 12, 2006

You know, it totally depends on the hopsital. In ours, the ICU nurses do everything. We get called down the ED for trauma codes all the time (Level 2 trauma). If is is really critical, the ED nurses usually step back and let the ICU nurses take over. If it isn't as critical, the ICU nurses step back. If ICU nurses are floated to the ER, they get the most serious patients. They get these patients out of the ER as soon as possible and get them to the unit or OR. Plus the ICU nurses get called to all the floor codes and rapid reponses and sometimes even to the other critical care units. I don't know why things are like this, but it works out good for a new grad like me to get awesome experience. However, other hospitals in the area (where I did clinicals), it was totally different. The ICU nurses would get called to floor codes, but that is all and it really was more relaxed there (as much as an ICU can be, hey?). Plus, the admissions from the ER were already stabilized as much as possible and all they had to do was hook them up to the central monitors. So the thing is, I could go on about how ER nurses don't work as hard as ICU nurses, but that is only true here.

coffeeaddict, LPN, LVN · Dec 12, 2006

ICU vrs ED

For me the big difference is the age of people I am taking care of. I dont treat kids, the concept of coding a baby gets to me, so I work the ICU. Also I like the fact that I can be a controle freak in the ICU. I can know the labs, history, I know most of our docs and they trust me, much better than floor nursing (have not been a ED nurse). The other thing about ED nurses is they have a MD right there. In ICU we rarely do, except after the code is called.

tiredfeetED · Dec 12, 2006

Title should say ICU or ED..VS. always makes it sound competitive.

Most of the post have some truth in them, ED usually stabilize the critical pts then move them to the unit. In a ED like mine the pts may stay a day in the ED so makes it tough monitoring and taking care of other pts that keep rotating through your other rooms. Not every pt in the ED is critical, some need simple lac repair, fractures need splinting, tons of IV starts of all ages. Truthfuly most of the ED visits are primary care issues.

Days in the ED can be great and others can be full of train wrecks!! What I love about the ED that everyone works well with each other Docs/techs/nurses.

Ohh and one other thing stay away from the triage window!!!

Larry77, RN · Dec 12, 2006

We get called down the ED for trauma codes all the time (Level 2 trauma). If is is really critical, the ED nurses usually step back and let the ICU nurses take over. It isn't as critical, the ICU nurses step back.

Yikes...If an ICU nurse came down to our dept. and tried to run a trauma code they would be asked to leave and written up. It is the ED nurses who have trauma training not ICU. I do not think it is right to go to a different dept. and "take over" patient care, we are there to assist--remember we are all on the same team.

In our hospital the ICU responds to a rapid-response because they are looking for ideas in altering care for the better and usually a transfer to the ICU. Also this is always assigned to an experienced ICU nurse (usually the charge), not a new grad. We have a peds rapid-response which ED nurses must respond to d/t our training in PALS and ENPC.

I also have had thoughts of transferring to the ICU some day when I want to run a little less often. In the ICU you have time to sit down and study lab trends and slow changes in your patients with the freedom to order new labs/images.

I always think of the ED as the "Jocks" and the ICU as the "Nerds". And the ED nurses are required to know something about everything and the ICU nurses can have more knowledge of a narrower base. I wouldn't argue with an ICU nurse about interpreting ABG's but they sure better not come and try and run my trauma :)

Victoriakem · Dec 12, 2006

ED is about rescue. Stabilize, assess & save lives. However, in my ED we hold so many ICU patients, because they are "just too busy upstairs" that we become ICU nurses. It's doable for a couple of hours, but having an ICU patient for hours & sometimes days on a stretcher is not good. IF an in-patient bed is available, we can put the ICU pt on one, but that's the exception. ED nurses have other patients to care for besides their 1 or 2 ICU patients too. It can make for an interesting & harrowing shift at times, trying to manage all this & whatever comes through the door.