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Experienced nurses, can you explain the differences between ER and ICU nursing for aspiring nurses considering which path to take?

September 16th, 2022

There is a vast difference between an ER Nurse and an ICU Nurse. Both a critical care but that is where the similarities end. ER nursing is immediate treatment. Someone who is bleeding, can't breath, drug overdoses etc would go to the ER. Usually you have up to 4 patients at a time and the goal is to "treat and street" them quickly. You treat their immediate problem and then you discharge. Assisting you are the resp therapist, discharge planners and CNAs. ICU nursing is continued treatment for critical care. You will have 1-2 patients for which you are responsible for. If they are intubated in the ER, you continue with care until they are extubated. If they are still in acute resp distress, you will intubate them. You also have patients with chronic illnesses such as heart failure who are in acute distress. There are no CNAs to assist but resp therapy does come in and maintain the vent and do treatments but they are not always there as compared to the ED. I enjoyed both critical care areas but I think I like ICU more but that may have been due to the culture of each unit. Good luck

August 10th, 2021

ER is fast and dirty with many patients turning over and ICU is slower and meticulous with a higher level of care.

October 2nd, 2022

There are some really good answers in here but what I can tell you is when the icu has no beds you are the icu in the er along with continuing to be the er.

August 29th, 2021

The ER environment is a faster paced setting. Emergency rooms are now becoming the first stop for suicidal, intoxicated, jail clearances, behavioral health, depression, and elderly dementia, alzheimers, and aggression placement cases. It is not an appropriate environment for these populations, but it is increasingly occurring. This takes away from the true emergency practice we went into ED nursing to provide. It is an amazing learning environment encompassing ortho, neuro, OB, trauma, cardiac, peds and so forth. I saw in a review that it is "dirty". Keep in mind your patients are coming in from accidents, lakes, outdoor events, homeless situations, hoarding situations and so forth - so no- they are not always clean and fresh smelling, however I would certainly expect the work environment to be clean and well maintained. Effective and engaged security is also something to watch for in an ED setting.
The ICU environment is completely different. You have the sickest of the sick. You may learn open heart surgery strategies, balloon pumps, SLED, ICP monitoring, art-line management, ventilator management and so forth. Your patients frequently are not awake and interactive, which appeals to some. At times these can be longer term patients and severely detoxing patient populations are increasing, which is a negative to some. With the current Pandemic, there is a considerable amount of burn-out occurring in this work group due to the high level of care these patients require and staffing shortages.

August 25th, 2021

ER - treat problem but be able to assess quickly if there is another problem that may have initially caused the visit. You need to be able to multi-task multiple patients, discharge and admit quickly. Need a good knowledge base for those critical care patients that arrive in sepsis, new onset cva, respiratory and/or cardiac arrest. Those patients can remain in ER for long periods of time currently and you need to be able to manage their care if admin is unable to pull ICU to help out. New ER nurses need to take ACLS, PALS, NRP NIHS and TNCC so they have a good knowledge base for treatment. Knowing national patient care guidelines for sepsis, STEMI, Stroke and wound management. Be able to assess for APS or CPS referrals as we are mandated reporters.
ICU - At least a year of telemetry experience before entering this area. Hospitals have internship programs for new nurses in some areas. It should be a 3-6 month program. Preparation is key. A critical care course such as those that prepare for CCRN go over all body systems and care of those patients is invaluable to help you manage in this high stress environment. Nurses need to be able to manage multi system failure. Obtaining knowledge on ventilators, critical care drips, chest tubes, drains, wound care, post surgical care are necessary to successfully treat these patients. Knowledge of management of family members is also helpful.

October 16th, 2022

Depends on what someone is looking for.

ER you see the patients as they initially come in. Ideal staffing for ER is 3:1 but can range from 1:1-5:1 depending on the acuity of the patients and volume coming in. ER your aim to fix what is a real emergency and refer out anything else. It’s fast paced with a high patient turnover. In a large ER don’t be surprised to see between 10-20 patients in one shift. Sometimes more, sometimes less. Depending on location, approximately 80% of your patients really don’t need to be there, 15% should be in the ER and 5% REALLY need to be there. In the ED you’l get an intro into vents and titration of things like paralytics, sedatives and vasoactive drips, the ICU will make those meds second nature, and then some.

ICU has a lot of crossover of skills but it is a much slower pace, although the volume of work remains about the same. ICU is where you’ll learn a lot of meds and various devices such as vents, balloon pumps, impellas, CRRT, EVDs, etc. You’ll learn a lot about how electrolytes act within the body, fluid shifts, pressure gradients, etc. You can have the typical 2:1 patient load or, if the patient acuity is high enough, you may have 2 nurses managing one patient. In the ICU, ALL of your patients need to be there.

Having worked both, I feel less challenged overall in the ED however I do love a good trauma center.

August 17th, 2021

ER is reactive and ICU is proactive both in a good way but very different worlds. ED turns multiple pts around several times a shift. ICU you take care of pt long term over days or weeks sometimes.

August 20th, 2021

The ER method of treatment is much more geared towards treating the immediate problem. Take for example, septic shock. The goal is to stabilize the patient by maintaining their hemodynamics (BP and HR) through fluid, antibiotics, and pressers if needed.

The ICU takes a much more comprehensive, and dynamic approach to care. It’s not always about treating the immediate need but about the patient as a whole from all organ systems. The septic shock noted above may have impacted kidney function, so now you’re responsible for monitoring for an AKI. Long term presser use may result in ischemic limbs etc. Your process in the ICU is much more geared towards the treatment of all organ systems and long term recovery versus always prioritizing immediate need.

September 18th, 2022

So, I'm an ED/ICU nurse. I like both areas for different reasons. What other nurses are saying is true. ED is a treat and street mentality vs the slow and progressive care of the ICU. I think both areas offer different specialties and provide a very difficult learning curve to any inexperienced RN. If you want to decide which field is more appropriate for you, I would have you shadow new inexperienced nurses and ask them many many questions. Ask about preceptorships, support, education, and MDs. The answers to these questions could sway you more than anything else. Also, try to keep in mind what your next step will be. Are you wanting to stay at bedside, advance to NP, or be able to travel more.

August 14th, 2021

E.R treat and street. ICU patientsare very sick need medical care closely monitored

October 2nd, 2022

ER stabilizes ICU maintains critical usually unconscious patients with complicated treatments

October 5th, 2022

I worked in ICU for 6 yrs, then one day i was pulled to ER. Thus started an additional 30yr career. I discovered I was Bored stiff in ICU. more paperwork and number crunching. ER was energetic and always challenging. I hated being pulled to ICU, ER was my home.

September 29th, 2022

ER receive, briefly assess, triage treat, and then street.
ICU focuses on already identified major health problems and accompanying complications.
Though triage is a continuous process,that can continue even in the ICU.
I love the ER,though stressful

November 25th, 2022

What Shahreeza Ali — MSN wrote is exactly how I would have answered. I learned excellent physical assessment skills and learned about medications, protocols, etc. in ICU secondary to having 1:1 or 1:2 ratio. However after my ICU experience it was very easy to transition into the ED. I enjoyed ED better because of the quick turn around and not being stuck with the same patients for days on end. Great experiences in both units. ICU is more detailed while ED is stabilize patients than disposition to appropriate destination.

November 15th, 2022

In my opinion, an ER nurse’s main focus is in the now…dealing with emergencies or potential emergencies. They assess, stabilize/resuscitate, and move you on to being admitted or discharged. An ICU nurse focuses on the now while also looking for trends in vital signs, labs, responses to treatments. ICU nurses critically thinks about what they do in the present and how that looks 24, 48, 72 hrs down the road. ICU nurses pay close attention to subtle changes with their patients labs, ECG, appearance, breathing patterns, and overall assessments so that we they can ward off emergencies as much as possible.

November 14th, 2022

ALSO...TO CONSIDER....IS age of the people you will take care of..... in ER......ANY AGE CAN PRESENT. ICU/CCU.....MOST BABIES AND CHILDREN ARE TAKEN TO THE PED FLOOR quite quickly or a NICU DEPENDING ON AGE AND WHAT WAS GOING ON WITH THEM.and IT depends on what time of day or night..... LESS staff on in night,,,,, which is what I worked most all my years in nursing..... ITS MORE PAY .... BUT HARDER BECAUSE YOU DONT HAVE THE STAFF THAT DAYS HAS..... BUT you also learn faster because it may be just you and a DR. so they like to teach you what they want from you.. and how to handle things..... it maybe one second patients........when suddenly... two walk in.. one with chest pain and a woman in labor alllll ready to deliver.. you just barely have time to get them on the stretcher,,,!!!! you can call for help... but again .. it may just mean transferring chest pain person to ICU.... AND WOMAN TO OBS... IF YOU ARE LUCKY. yessssss nursing is a different kind of work...... BUT IM SO PROUD OF MY ALMOST 50 YRS IN IT!!!!! I RETIRED....AND NOW I WANT TO GO BACK.. I DONT THINK IM READY TO STOP YET!!

October 11th, 2022

I started in the ER and don’t regret at all. You are responsible to have your knowledge down on mostly all medical specialties. It’s a great foundation! You will learn to identify a sick patient from across the room and tell who is coming in for their FOS vomiting/and pain. Depending on the level of specialty ED you work at will be the type of exposure you get. Get yourself in a level 1 or 2 trauma center. I work at an everything receiving medical center, including regional burn center. It was great! In ICU you will focus on neonatal, pediatrics, or adult (with in a specialty). I can’t see myself doing routine nursing. Much rather walk into a room with traumatic arrest then into two already intubated patients. Best wishes!

September 16th, 2022

Completely different focus- ER nurse’s focus on the chief complaint - why are you in the ER. ICU nurses are focused on everything. Typically these pts require intensive treatment, could be septic, burned or some type of shock.

August 14th, 2021

E.R treat and street. IC U patients need Healthcare monitored closely.