Can't Decide Between ICU and ED

  1. Dear Nurse Beth,

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

    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)
    How will I ever know if I'm making the right decision?


    Dear Undecided,

    Congrats- You have two really good offers.

    Read Am I Cut Out to be an ED nurse?


    Typically ED nurses and ICU nurses are not cut from the same cloth but I'm gathering that you would be a good fit in either ICU or ED. You like to research (ICU) but thrive in chaos (ED). It isn't so much that there's a wrong decision to be had here, they both could be right decisions. You will be marketable either way.

    The trick, if possible, is to find the answer within yourself - the answer lies below the uncertainty and anxiety.

    Here are a couple of strategies to draw out your decision:

    Coin Flip Method:
    Heads= ED
    Tails= ICU/SDU

    Flip a coin and see what you call out loud before it lands. The key is to not think or plan your answer ahead of the toss.

    If that doesn't work, pay attention to the signs- for example, did one manager call you back before the other?

    Another method- project yourself 10 yrs ahead. Do you regret never working ED? Or ICU?
    Finally, realize that the beauty of nursing is that you can work in many different specialties during your career. The decision you make today is not permanent.


    Best wishes,


    Nurse Beth


    Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!
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    About Nurse Beth, MSN, RN

    Joined: Mar '07; Posts: 1,538; Likes: 4,553
    Nursing Professional Development Specialist; from CA , US
    Specialty: Med Surg, Tele, ICU, Ortho


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