ER is fast and dirty with many patients turning over and ICU is slower and meticulous with a higher level of care.
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.
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.
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.
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.
E.R treat and street. IC U patients need Healthcare monitored closely.
E.R treat and street. ICU patientsare very sick need medical care closely monitored