"Trauma-surgical ICU vs. ER" Where to work?

WalkieTalkie, RN · Jan 28, 2009

I've worked in both settings, and here are some of the key differences:

ICU - patients are either there short or long-term. Many can be very annoying, especially when you are dealing with highly emotional and large families.

ER - patients usually there less than 24 hours (although I've seen some psych holds get stuck there for days). In any case, you will see a variety of frequent flyers, some with ridiculous expectations, and some who will make your life miserable.

ICU - you do EVERYTHING - paperwork, complete patient care, labs, meds, etc.

ER - "drip and ship" patient to whatever inpatient unit they will be going to. Paperwork is limited to the assessment, vital signs, etc, and any specific procedural documentation. Our ER also had phlebotomists and techs did most of the mundane things like toileting.

ICU - deal with a wide variety of doctors, students, ancillary providers, etc. Have to call people in the middle of the night to get orders if something is needed.

ER - mostly deal with ER docs and a few ancillary services. If your patient has a fever, you can walk over to the desk and ask for Tylenol and blood cultures. You will also see a lot of students.

ICU - usually have a 1 nurse to 2 patient ratio.

ER - Ratio depends on the acuity of your patients, the section you may be working in, and how busy the department is.

ICU - most patients need to be there and are actually sick.

ER - 75% of visits aren't emergent or even urgent. You will have to assist in a number of disgusting procedures such as pelvic exams for that bothersome 2 AM crotch rot.

ICU - patients are adults unless your facility is different.

ER - you will see patients of all ages.

As you can see, both have their advantages and disadvantages. See if you can shadow an ER nurse for a couple of days to help you make up your mind.