Want to do trauma - should I pick ED or ICU?

commonsense · Oct 28, 2011

I am currently working on a tele unit, and I have about 1 year of RN experience. I have been wanting to be a trauma nurse since I started nursing school, and I originally saw myself working in the ED. Then during school, I decided that I wanted to work in ICU (still caring for trauma patients). Here's the situation now:
I just interviewed 2 days ago for a position in the CCU, which is not my 1st choice, as I want SICU (where the traumas end up, typically). However, I was willing to take CCU, to get my foot in the door of the ICU Dept. BUT, I had also applied for an ED position, not thinking I'd get a call. But, they called me and I interview tomorrow!
Both of these positions are in the hospital I currently work in, so I'd be transferring, not leaving the facility. I'm leaning towards taking the ED position, IF I am offered it, but if I do, and I change my mind, will an ED experienced nurse have a hard time getting a job in an ICU position 2-3 years down the line?
BTW, I work in a Level I trauma center, which is part of the reason I picked this hospital in the first place.
Any advice would be appreciated. Not sure if I'll get an offer from either dept, but if so, I'm torn about which one I'd rather have...

I'd try to do both if possible. Choose a primary department and try to get into the other department with PRN work. If you find out you like the PRN work that much better than the original choice then it would be easier to transfer departments in the same hospital than to switch hospitals all together. You'd probably be working more than 40 hrs. per week, but you're the one who has to weight the positives and negatives.

silentRN · Oct 28, 2011

I work at a level one trauma center in the Surgical-Trauma ICU, I would say if you want to work trauma off the back then pick the ICU, because if you're ED is like mine, then you'll be on a 2 year wait list to even get in the trauma bay behind everyone else who is waiting to work there.

silverbelle · Oct 28, 2011

I worked ED, trauma ICU and have ended up in CVICU...Not sure how your ED is set up...would you end up in the general ED with cp, sob and lacerations...then move over to their trauma area?? Off hand I would say go to the ICU..you will get a more educational experience..you will know why you are doing what you are doing..read xrays, abgs ect..then see step by step how they are treated and progress. No disrespect to the ED but when I have worked in ours we were so busy.."treat and street" and you don't get as deep an education as to the patho behind the treatment.. All your patients in the ICU are critical...not always so in the general ED...That being said if you work hard and do your best I think ED experience is always valuable and certainly won't hurt you! Good Luck...

imaginations · Oct 28, 2011

I'm not sure how EDs work where you are but here in Australia ED nurses rotate every shift through different parts of the department depending on their qualifications (e.g. one day they'll be out in triage, one day they'll be in 'acute' where the sick patients are seen, another day they'll be in sub-acute where you tend to get walking wounded, one day they'll be in resus where the traumas come through) so they do a bit of everything.

These are purely my thoughts but ED, to me, sees a lot of things that should be seen by a GP, does a lot of first aid and involves a lot of crowd control sometimes! You do need to have fantastic organisational skills (keeping track of patients who chop and change all the time, leave the department and so forth). In ICU you're generally guaranteed a critically ill patient! I'd go ICU over ED any day!

eCCU · Oct 28, 2011

Well.....if you are in level 1 no way you will be in the shock room immediately. So mostly will be dealing with minor issues for about 2yrs. Best if you start in ICU. You will have a chance to learn and understand pathology which will be needed in the shock room.

Good luck

kool-aide, RN · Oct 28, 2011

I would go for ICU first.

LaughingRN · Oct 28, 2011

Our ED also rotates shifts, so it is not true that you have to be here two years to work in trauma.

We also shuffle between triage, 4 levels of acuity, trauma team ect.

This starts on orientation (except triage which you have to have a significant time under your belt before you work there)

This would be a good question to ask at your interview :)

This is also a level 1 btw

turnforthenurse, MSN, NP · Oct 28, 2011

I would personally do ICU first. I have a friend who works in the SICU at a level 1 trauma center and her floor gets ALL of the traumas. She has seen some pretty bizarre things. Not sure how the ER works there, though. I would think in the ER they would want you to get the TNCC or whatever it is called (the trauma certification) and I know some hospitals have trauma teams.

If you decide to go to the ER, though, transferring to the ICU should not be a problem.

Dixielee, BSN, RN · Oct 28, 2011

I have worked both ICU and ED/trauma. ICU nurses are concerned about color and quantity of urine, ED nurses are just happy if you have some. There is a huge difference in how the two departments view the patients. ED is the first place to treat the patient (after EMS), so they may come in dirty, bloody, confused, unresponsive, or in cardiac arrest. They may or may not have any IV access and you may or may not know what the extent of the injuries are.

In the ED, the patient gets stabilized, cleaned up (to the best of our ability and the patient's status), IV's, first line meds given, airway controlled, labs, x-rays, CT scans, tubes, lines, blood etc. Once it is decided what plan of action is needed, i.e. surgery, special procedures or admission to trauma care, then the patient is shipped where the next stage of their treatment and recovery begins. The ED nurses job is then done! The patient may not look pretty when they arrive, but they are alive :)

In ICU, you already know the extent of the injuries and the patient essentially stabilized, although I know some are never really stable and won't be. So the ICU may see the patient through a long road of ventilation, healing and complications. The ICU is there to look at the bigger picture towards getting the patient home. I'm not saying that is all there is to it by any means, as I have been on both sides of the bed so to speak.

I think it boils down to what you want to do and personality. If you can't stand the thought of your patient without a perfectly white and tidy bed,or you want a patient who is clean and cooperative, if your IV lines must be perfectly labeled and hanging neatly from the IV pole, the ED is not for you. If you are OK with having the same patient week after week and sometimes month after month, ICU may be more appropriate, but if you want to treat and street (or send to another department), then ED may be your thing.

Most ED's with a trauma designation are also a regular ED so you get a little bit of everything. It is not always blood and guts, or exciting stories and glory. In fact it is mostly kids with sore throats, lacerations or broken bones, folks with back pain, dental pain and kidney stones, little old folks from nursing homes who have fallen and need their head sutured, or COPD patients who need help breathing, women who are suffering miscarriages, people wanting STD checks, or just seeking drugs. You will also see lots of chest pain, strokes, sepsis and other critically ill patients who are not trauma.

In the ER you have to know a little about everything but you don't have to be a master of it.

So look at the big picture and see where you think you might fit in. The best part about nursing is you can always change specialties and at some point most of us do.

See if you can shadow a nurse in both units for a day.

Good luck and I hope you have a long and rewarding nursing career whatever path you take.

VICEDRN, BSN, RN · Oct 28, 2011

I would go with ICU. I work in a Level I trauma ER. In the ER, you will spend the overwhelming majority of the time taking care of non-trauma cases. When you get trauma patients, they will likely be whisked away to surgery or ICU within the hour if not less. You will be left charting 5 minutes of care in the ER and wondering why you fought your way onto the trauma team.

Keep in mind that TNCC guidelines call for the presence of an ICU qualified nurse at the bedside of all trauma cases.

tathmrn · Oct 28, 2011

I have worked both. You will get more trauma experience in the ED probably. You will not get any in the CCU. They are totally different animals. CCU is clean, interesting and fun, but not trauma. SICU is good, esp if you like follow up and families, etc. Just my opinion.