What is the difference between ICU and Urgent Care and ER?

kateee · Mar 19, 2016

Right now I'm a tech in an emergency department, we also have an urgent care section which gets mostly our ortho and cold/flu things that are not life threatening. So urgent is much easier than the ER. In the ER we get any sort of emergency, heart attacks lacerations etc. icu is a lot different because those are patients that are admitted to stay there because they need critical care. As a nurse you only have about two patients at a time, in the ER you have around 5. I love working in the ER though because you never know what you'll get and you're always learning something!

xmilkncookiesx, RN · Mar 19, 2016

Right now I'm a tech in an emergency department, we also have an urgent care section which gets mostly our ortho and cold/flu things that are not life threatening. So urgent is much easier than the ER. In the ER we get any sort of emergency, heart attacks lacerations etc. icu is a lot different because those are patients that are admitted to stay there because they need critical care. As a nurse you only have about two patients at a time, in the ER you have around 5. I love working in the ER though because you never know what you'll get and you're always learning something!

I was told by a aesthetic nurse that once you graduate and go into the real world as a nurse, you completely feel like you were taught nothing-although you do know the basics.

Several nurses told me that actually!

So in that case, if I was working in the ER and I wasn't sure what to do for a patient in an emergency because I honestly do not know what to do .. What happens? Do they have you just step back and watch or? That's why I am afraid of working in the ER and having someone die on my watch because my lack of knowledge in that situation...

Here.I.Stand, BSN, RN · Mar 19, 2016

So in that case, if I was working in the ER and I wasn't sure what to do for a patient in an emergency because I honestly do not know what to do .. What happens? Do they have you just step back and watch or?

I'm short on time at the moment, but I really think you need to go through your rotations to even have a clue where you might want to work. I will say that in the ED and ICU both...remember how I told you how in school or on the floor, you call for help and initiate BLS? In these environments you do need to be ready to respond more fully. Now as a new RN in one of these depts, you will take ACLS to learn the protocols, and you'll learn the equipment and so forth; and you'll get help from fellow unit RNs. But still, you need to be confident that you won't freeze.

But again, you'll get an idea of how the different depts run as you go through school.

nursej22, MSN, RN · Mar 19, 2016

Employers understand that newly graduated nurses need longer orientation than an experienced nurse. Also, highly specialized units such as ED and ICU usually have a longer orientation period than med/surg or long term care. They don't want people dying on your watch any more than you do.

You will rotate through many settings through your school, so give yourself some time before your choose your spot. Some love the adrenaline rush of ED, others the technology of ICU, and I hear many students that they only want to do mother/baby. I personally loved cardiac telemetry, I think because of seeing patients actually getting better between the time of admission and discharge.

elppaym, BSN, MSN, RN, APRN · Mar 19, 2016

Good advice, and I agree use your time in school to get a better understanding of what each area does etc. When your doing your rotations/clinicals ask questions. When your studying certain topics in school (OB, Critical care, etc.), make a note of which areas you find yourself more interested in come back here and browse the specialties threads.

Good luck!

Penelope_Pitstop, BSN, RN · Mar 20, 2016

As a rule, I believe that two years of MedSurg is best; however, ED or ICU with a proper orientation (meaning at least six months) is a possiblity for new grads.

As for urgent care, I wouldn't recommend it for a new grad.

You will see what you like and don't like as you progress through school. And please keep an open mind. Ten years ago I was completing my last clinical rotations and was going to be in NICU, NICU only.

Now I work psych after years of medsurg and critical care.

TheCommuter, BSN, RN · Mar 20, 2016

Moved to Critical Care forum for more replies.

drejoy77 · Mar 20, 2016

Start off at an inner city community clinic.You will be able to build on your resources and interact with many different providers.

Pheebz777, BSN, RN · Mar 21, 2016

I work all areas. I have more ICU / CVICU experience than E.R. experience though. To answer your top 3 questions:

What is the difference?

ICU is more thorough. You take every aspect of the patient into consideration

E.R. is more of stabilizing patients within the first 10-15 minutes. You don't worry about decubitus ulcers or hygiene, etc. Depending on your hospitals' Trauma rating, you'll get what you're hospital is accredited for.

URGENT CARE E.R. is like the little brother of the E.R. EMS will not direct severe traumas, strokes, MI's, etc. to this E.R., you have the occasional exception of a family bringing in patient with a GCS of 3 needing full resuscitation and intubation. But you basically get simple cases on a regular basis.

What is your job in these departments?

ICU - you gain more knowledge and understanding of disease processes, pathophysiology, hemodynamics, and you really get familiar with many drip protocols (heparin,tridil,cardene,insulin, DKA,labetolol etc) and sedation protocols. Most of the time, you call the shots!

E.R. - You get really good at managing your triage skills, time management, multi-tasking, assisting with central lines, chest tubes, code blues, needle decompressions, splinting/casting (orthoglass), assisting with lacerations, etc. Almost all the time, the Docs call the shots!

URGENT CARE - Almost the same as the E.R. but you do not see many critical patients on a daily basis.

What is the most difficult to work in?

I would say a full fledged E.R. would be the most difficult area for a new grad to start. Followed by the ICU, then the Urgent Care.

I would recommend starting in ICU, you will learn a lot. Then if you want to transition to an E.R. setting, the learning curve will not be so steep. Having a background in ICU critical care will boost your experience in the E.R. You become more thorough in your primary and secondary assessments. Your terminology will be more precise, however the only downfall for an E.R. nurse coming from an ICU setting is the temptation to be a little "too thorough". This only wastes time and backs you up.

In the E.R. "Treat, then Street!" or "Medicate then evacuate!" are simple but important reminders to how to approach your "simple" cases.

bgxyrnf, MSN, RN · Mar 21, 2016

Whatever you decide to do, go for that right out of the gate. I am not a proponent of the "everyone should start on med-surg" mentality because you don't learn to be an ED nurse on the floor, you learn it in the ED.

allyk47 · Mar 21, 2016

Urgent Care: Basically any issue a patient or their parent feels can't wait until they can get a doctor's appointment.

ER: Patient/parent either feel this is an emergency or just that it can't wait for the pcp (see above). Also serves as a place to admit and stabilize those in true emergency situations.

ICU: The place where the actual emergent patients go if not stable enough to be admitted to a regular floor.

In a nutshell, that is.

ICU is going to be your highest acuity.

I believe ER definitely has its acute and fast paced moments each day. But in the little experience I have with that environment (few months of clinicals I did there in school plus being there as a patient)....a large percentage of ER patients are just "I have this illness and need an ABT script" or "my elbow feel funny" patients who don't have insurance and treat the ER as their pcp.