Let me pick your brains :) ICU/ED

[TammyTho]

Hello all, I need to make sure my heads on straight and I'm not missing any aspects of this so I came here :).

Little background, 42 mom, grandmother, have owned businesses, managed companies and now that my kids are out doing their thing, I have finally gone back to school and graduated with my nursing degree. I have been working as a tech on a med/surg floor throughout nursing school and while my manager has offered me a position, I know that is not where I want to be as a nurse, it's just not me. I have also been a float tech and worked in the ICU where I am amazed at the acuity and knowledge base there is to soak in and an ED tech and love the hustle and bustle and unknown of the ED.

I have been offered two different positions in the last two weeks, both full time midnights, different hospitals - one in a level 2 ED where I haven't worked but have heard amazing things about the manager and staff, they have offered extensive ED internship/training and one in a step down/ICU overflow floor with a manager I know and respect (and who loves my work) who has also offered extensive ECCO training as well as additional orientation time in the ICU so I can eventually pick up shifts there.

This is where my brain waffles and I need your assistance. Part of me wants to take the ED opportunity, to soak in the crazy and either thoroughly enjoy it and know I've found my place or at least get it out of my system. I enjoy being busy, the unknown, the traumas that come in and the team work of the ED. The other part of me wants to take the stepdown/ICU overflow position to be part of the long term care, take excellent care of those who need it most (and their families), soak in the details of the different disease processes and continue to expand my knowledge base. I enjoy researching the details of what is happening with my patients, the whys, the hows, the what ifs. I honestly love the idea of both of these decisions and don't know how to decide. Right now (at this moment as my mind changes moment to moment) I am leaning hard toward the ICU as I believe that if it ends up to not be my place it would be an extremely marketable skill to have in the search for where I belong while the ED may not give me the same marketability if I find that isn't my place.

Thoughts? (other than start med/surg first because I'm not doing that :))

A million thanks in advance!

[Triddin]

They both sound like great opportunities honestly

[CharleeFoxtrot, BSN, RN]

Take the ICU position. ED will always be there but the opportunity to learn your craft in a step down with a manager you know...priceless in my book. Perfect resume material IMO.

[Here.I.Stand, BSN, RN]

I'm leaning toward the stepdown position. As a new grad you are still honing your assessment skills, critical thinking, and "big picture" thinking. In the ED you would be doing a lot of focused assessments and asap disposition (admit/discharge.) Plus yes trauma is cool... but a lot of pts come for non-emergencies too.

In inpatient, you will be providing more holistic care to the same patients for hours to days. I personally feel like it's easier to go from inpatient to ED mindset than vice versa -- especially one who has never worked as an RN before.

[PeakRN]

I think you should decide what you want more in the long term, the ED or the ICU.

In general I believe that the ICU will offer you a better launching point to most other units. ICU/Stepdown will teach you critical thinking and how to care for 1-3 patients. It sounds like you don't have a huge interest in med/surg so I'm not sure if setting yourself up for other units would necessarily be a priority. You will certainly have more sick patients more of the time. The ICU tends to involve managing more life-sustaining medications and devices (CRRT, balloon pumps, impellas, ECMO, vents, A-lines, multiple inotropes/pressors, et cetera).

The ED will teach you how to think on your feet, and multitask for 4+ patients (although only for the next few minutes...maybe hours at most). You will generally have less sick patients, but when a sick one comes in you may be the first person in the room and have to initiate their management before there is any medical plan of care. The ED does more procedures/interventions (more IVs, more emergent/unplanned intubations, all kinds of trauma toys). The ED tends to be a launching point for fewer units, but unlike ICU you will see more OB and certainly peds if that interests you.

While the ED has a very different mindset than other units, it doesn't mean you can't go inpatient later. It also doesn't mean that coming down from the ICU is easy, a fair number of nurses struggle with not knowing every detail about patients and end up transferring back. If you have an interest in advanced practice the ED will probably help you more with FNP, PNP-AC/PC, or AGNP-PC; the ICU would help more with CRNA and AGNP-AC.

My last thought would be to ask if either hospital consider their ED RNs to be critical care nurses, if so it would probably be a lot easier to transition from one unit to another compared to those who form a more concrete barrier between the ED and the Units.

[ICU-BSN]

I would pick the step-down/ICU spot. But then again, if my user name didn't clue you in, I may be a bit biased towards ICU...

Step-down experience will open pretty much any door you want moving forward. ED and ICU are very different worlds....I've seen several excellent ED nurses try to come to ICU and not make it. (And I am positive I couldn't not make it in an ED...)

As someone else said, yes the traumas and codes and critical cases in the ED are exciting. But there's a whole lot of other stuff that comes in that's not so exciting. Also...those traumas and codes and critical cases...when they leave the ED, they go to the ICU....