MedSurg RN new nurse 1 year, ICU or ER?

akulahawkRN, ADN, RN, EMT-P · Mar 23, 2017

Disclaimer: I'm an ED nurse.

With your background, you should give the ICU a try and see how you like it. Then see if you can shadow in an ED and see how you like that. I would suggest the ICU is more like M/S but in much greater depth, frequency of assessments, and acuity of patients. The rhythm in most of these units is usually very subdued and quiet. The ED is basically barely controlled chaos where most of your patients will be low acuity, occasionally you'll have one or two that will be more serious and sometimes you'll have that one that's really a complex ICU patient that's holding in the ED because there's no room in the ICU yet. You should be able to get a "feel" for the rhythm of where you're at fairly quickly. You'll know where you'll be comfortable.

In the ICU you'll really get to know your patient. In the ED, you focus on the major problems and mostly gloss over the rest.

Another way to put is that in the ICU you'll be very focused on your one or two patients all shift. I the ED you'll be almost on roller skates going from patient to patient all shift. It's almost like OCD vs Squirrel! Pay very close attention to that aspect of things and feel where you'll be more comfortable. Do you like to focus or do you like to shift gears constantly?

Very personal choice, and only you can make that choice.

Either way you'll have a pretty steep learning curve. It won't be as bad as it could have been going directly to the ED or an ICU right out of school.

HarmlessDonut · Mar 23, 2017

This helped me a ton thank you! I feel like i'd be better suited to the ER, i'm the opposite of OCD and really think i'd love the excitement

llg, PhD, RN · Mar 23, 2017

How long until you finish your BSN? I work as a nurse educator in a hospital. I also teach an occasional online class in an RN-BSN program. I see many nurses in your position taking on too much at one time -- trying to go to school while also learning a new specialty, or moving to new city, etc. They often end up not doing a good job of anything. So they end up with a nice looking resume, but with a reputation for poor performance -- and they don't make as much progress in their careers as their energy expenditure would merit. Sometimes, when you go a little slower, you actually make more progress.

If you decide to switch specialties now, you might want to slow down your academic progress and take a minimal courseload until you are settled into it. Focus on getting solidly established in that new specialty without being distracted and exhausted by a lot of school demands.

Or, if you are not too far from graduation ... wait until you finish to make your career move. You still have a lot to learn in your med/surg job. People with only 1 year of experience can be competent, but not proficient/expert. Precept, be a Charge Nurse, participate in quality improvement work, etc. -- all of which will develop your leadership skills and prepare you to be a unit-level leader and highly contributing staff member. There are lots of ways for you to enrich your job for another year while you finish up with school.

I think any of your 3 options is reasonable: ICU, ED, or Stay on med/surg a little longer and develop advanced skills. All are OK. Pick the one that appeals to you most -- but try to avoid overloading yourself and squandering these opportunities to grow and develop professional skills beyond the beginner level.

Good luck with whatever you decide.

amzyRN · Mar 23, 2017

You'll need to eventually know some ICU nursing for the ED though. I almost wish I would have done ICU before ED, just to have more experience with ICU patients. When you have an intubated patients on multiple drips it's nice to be familiar with the nuances of managing that patient I think. I don't think I could stay in ICU because I would hate to have the same patient for that long.

Also, the workload in the ED is going to be heavier than any unit you'll work on.