I recently had an interesting conversation with my Chief Flight Nurse regarding who we ought to hire, and why.
The CFN is an NP who works in Neuro ICU. She has worked rotor wing and fixed wing flight jobs, and in house critical care nursing. She contended, and pretty well convinced me, that nowadays an ICU nurse is going to develop a lot more medical understanding and critical thinking than the average ER nurse. Especially if the ICU nurse works nights.
Today's ERs are full of patients who aren't all that sick, and don't have emergencies. We spend a lot of time just rushing to keep up with the amount of patients. As a result, the new ER nurse will have to look more for opportunities to learn and understand complicated patho-phys and how to make decisions and implement treatments. My shift today was a good example of that. Within a four hour block I had two drunks with rule-outs, a bug bite, two simple fractures, a cardiac rule-out who was stable before I got him, and new onset CHF. That last one could be an interesting and mildly challenging patient - but I didn't have that much time for him after the initial assessment. The busy ER environment doesn't allow much for taking advantage of the chance to get really involved in the patho-phys, differential Dx, and Tx decisions and modalities.
An ICU nurse is going to be seeing genuinely sick patients. There will be much more opportunity to hone knowledge and thinking skills. The nurse spends a lot more time with each patient. The ICU will confront you with educational and cognitive challenge; the ER might not give you the time to pursue similar learning.