stress in er and icu

BinkieRN, BSN, RN · Sep 12, 2008

They each have stresses of their own. Having worked M/S and having been pulled to ICU and ER I can say I felt far less stress in the ICU because I had only 2 patients and didn't have to deal with the family members except for 15 minutes at a time. ER can be frantic or it can be dull. It comes and goes. If you can work M/S you can work on any unit. Best of Luck :nurse:

Advanced Practice Columnist / Guide · Sep 12, 2008

I've worked in a staff nurse capacity in all three settings. Like the previous poster said, there's stresses in each of those areas but the kind of stress you get into may be different in each one. I found Med-Surg to be very stressful because of the number of patients you have and the organizational skill you have to develop to juggle your time between admissions, discharges, meds, IV starts, rounds/physician orders, and family member questions.

ER was crazy! but there's always other staff members willing to help so it lightens the load. I also found having an ER attending or resident close by a plus because any medical concerns you have can be immediately addressed by medical personnel instead of you having to page someone who will arrive many minutes later while you struggle with keeping the patient stabilized. I also loved the variety of cases you see in the ER. One thing you hone well as an ER nurse is your triage skills. You will need to be savvy about knowing which patients need immediate attention and which ones can wait.

To, me ICU is my best fit. It allows you to focus on one or two patients and be really thorough about what is going on with them. You have the closest you can get to complete control of what happens in your shift and you can easily prioritize what needs to be done first. There is also immediate access to medical help from residents and intensivists should that need occur. Generally, you have some time to talk to family members and you can limit their presence in the room by enforcing the ICU visiting hours, something that is harder to do on a regular floor. However, you do discuss dire events and unhappy developments with families and that can be a bummer sometimes.

You should self examine what kind of patient care you like best. I think that if you have developed good coping skills in a Med/Surg floor there is no shame in wanting to stay in that setting. Med/Surg nurses with lots of good experience are invaluable in the hospital setting.

vivere · Sep 12, 2008

Working on Med Surg is a great background for working in ICU. You get a great education and learn how to manage your priorities on the floor. I had nine months of Med Surg prior to going to ICU, many years ago. It really should be a prerequisite for the unit, but now with the nursing shortage there are new grads going into ICU, which is not always a great idea. In ICU, with two patients, you are totally responsible for your patient, and it is often intense, but it is very gratifying. You have to love learning new things, and love your patient as though he or she was your own family member. It can often be very stressful, but you do have to learn how to manage your stress by taking care of YOURSELF. Proper diet, exercise, sleep, spiritual life....If you are interested, I would definitely look towards it as a goal. Remember, you never stop learning, and respect yourself first, and respect your patients. :specs:

neurorn6 · Sep 12, 2008

Med/Surg is a great learning base for new grads. You learn to priorize, you learn how to deal with "docs" and you learn how to deal with families. I worked med/surg before moving on to ICU and the ER. I feel that for new grads it really helps you develop your "nurse's gut". Working med/surg you learn to trust that feeling you get when you look at your patient and just know something isn't right.

If you work at smaller hospital where you don't have residents or hospitalists available it really comes in handy.

If you get the opportunity to float to other "intensive" areas take it. It's a great learning opportunity. Don't be afraid to take classes like TNCC or PALS.

I like to call the ER "controlled chaos" on it's good days. ICU, well you just never know. It can be controlled or just chaotic. Good luck with whatever you decide

Dinith88 · Sep 12, 2008

They each have stresses of their own. Having worked M/S and having been pulled to ICU and ER I can say I felt far less stress in the ICU because I had only 2 patients and didn't have to deal with the family members except for 15 minutes at a time. ER can be frantic or it can be dull. It comes and goes. If you can work M/S you can work on any unit. Best of Luck

M/S nurses (withoutvtele experience of any type?!?) who get pulled arent assigned 'hard' or 'critical' patients (in plain english) so this isnt a good guage of true ICU stress. Also, you wont be getting ERs' critical patients that come in or are rushed in off the rig...So... 'floats' from areas other than these are really not knee deep in it...and may be a little off on their observations.

In my experience, (as has been said a bazillion times on a bazliion posts/threads) any area or unit can get CRAZY...though usually different brands of crazy.

ER's can become swamped and crazy over-busy with too many patients of everything-you-can-imagine under the sun...with the occaisional dying people mixed in...loud and chaotic and tempers and...

ICUs (again is this cliche?) nurses have the luxury of being in a more 'controlled environment'...but are always caring for the sickest of the sickest patients...and are responsible for handling a ton of fancy machines that you wont find outside of icu (and cannot be given to 'floats' or 'pulled' nurses as its out of their scope)...and are always the front-man for families in crisis... many times SEVERE crisis. (15 minutes q 2hrs is old-school and not the norm)...loud and chaotic and tempers and...

so...is ER or ICU more stressful or chaotic than the other? or more chaotic than a busy M/S or tele unit??? probably not. BUT...as a novice to ICU or ER you will doubtless feel overwhelmed at first...but...people adjust...and can actually grow to love these specialty areas :loveya:

Iam46yearsold · Sep 12, 2008

Personally I would encounter more stress working med surg or even any floor period. I am and have been an ER nurse too long. Putting me on the floor would stress me out.

Babs0512 · Sep 13, 2008

Having worked both ICU and ER, for me, the ER was much more stressful.

In ICU, you have your one, two or three patients for your shift. In the ER, you never know what's coming through the door next, and you can have 20 patients or more come through your rooms in a shift. All in varying states of "distress".

It's rough having 4 rooms in the ER. One with an active MI, another with a pediatric resp distress, another with a simple laceration who LOVEs the bell ringing, and another with abdominal pain screaming and crying for Demerol! That's just the beginning of your day.

In the afternoon you get the CHF patient with O2 sats in the 70's, then a full arrest (while your in with the arrest, your hoping someone is watching your CHF since you gave the lasix. The abdominal pain is still there, ringing and ringing for more Demerol - she has had a CT and US and pelvic exam, can't find anything wrong - "why is it taking soooo long to get any help!!" abdominal pain whines!

Your arrest doesn't make it, so you now call the coroner and organ donation, and deal with the family (call the chaplain, makes it easier on you!), you CHF sats are now 88% and putting out good urine. The abdominal pain is refusing to be discharged because "you stupid people can't find anything wrong with me!", and your 4 y/o in the last room is having a febrile seizure!

You get the point, after eight years I left the ER. Had great fun the first 7 years, the last year, total burn out.

IMHO :twocents:

icyounurse, BSN, RN · Sep 13, 2008

M/S nurses (withoutvtele experience of any type?!?) who get pulled arent assigned 'hard' or 'critical' patients (in plain english) so this isnt a good guage of true ICU stress.
Thank you!! That is exactly what I was thinking. We are relieved to have the help when med surg nurses float in and we give them a really easy load most times. You wouldnt take a nurse who is not used to the unit and give them a crashing open and close necrotic from the abdomen down dead gut who is in their 50's and the family is hysterical at bedside or a 400 lb gastric bypass gone bad who is very unstable and on multiple gtts, both patients intubated and requiring alot of drugs and such.....that was my assignment last night.
Am not saying ICU vs Medsurg that one is more stressful than the other, having worked both, I just think its a different kind of stress:D
But sorry ICU can be be pretty stressful some nights for sure and just experiencing it as a float from med-surg is not an adequate representation most of the time.

icyounurse, BSN, RN · Sep 13, 2008

Also would like to agree with the poster who said ER was more stressful. I think it depends on the ER and the person,but mostly it would be true for me as well.

ER you have no idea what kind of day you are going to have and if you are going to have a bad shift in ICU you tend to know right of the bat alot of the time and can at least mentally prepare. ER is too much of an uncontrolled environment if you ask me. Actually since I have gotten fairly adjusted to ICU, I could not handle to work in the ER or Med-surg for that matter. I turn into an unorganized mess when you give me more than 3 patients....

marilynmom, LPN, NP · Sep 13, 2008

I graduated in May and have been working ft in an ICU for 4 months now. I have no other experience except I did work as a nurse extern in this ICU for a year. I LOVE the ICU!! IS it stressful? HECK YES! But it is also so much fun and I love that I know *everything* about my patients and even I, as a new nurse, can spot when something is going wrong. My skills base and assessment skills and intuition had to be built super fast over a very short period of time!

Our families (because I work in a peds ICU) are there 24/7 so I deal with families all day and night and some of them can wear you out man--but some are very helpful. In my ICU you don't know what is coming through the doors half the time with an admit either....we get direct admits all the time that bypass the ER, mediflighted right in, etc so it can be very chaotic, but a controlled chaos. I love it. You get used to it and it gets easier the more you do it. The first time my patient came rolling in coding I was scared sh*tless, now I know I have so much help around me I don't freak out.

If your interested in ICU or ER try them out! I can't imagine doing anything else.

gonzo1, ASN, RN · Sep 13, 2008

For me ER is the easiest place to work. Way less stressful than the floor. Your docstor is always nearby. Lots of great teamwork with the nurses. Techs that are usually in nursing or med school or part time paramedics etc. You only have your patients for a few hours, not days.

No doctors to call, no dinners to serve, no med passes.

And since more and more we are the local clinic, lots of patients who really aren't even sick.

ie: My stomach has been hurting for 6 months. (stop drinking, smoking and doing crac and you will feel better)

My baby has had a fever for one hour, what should I do (give him some tylenol he is teething)

What a joke

in the ER stupidity equals great job security and lots of overtime if you want it.