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

I've done both. The big difference is the ER is tasked with the job of painting the picture that will define the patient's journey and ICU provides the frame. ER gets the history, meds list and what got the patient to that department and then is tasked with finding a diagnosis and stabilizing the patient. ER patients aren't wrapped up pretty with a bow before they go upstairs. We do the best we can, but our charge nurses push to get those patients upstairs so we can get another patient, often before we even get back downstairs.
Once they get to ICU, the focus shifts to a plan of getting the patient to rehab or home.... in my case, probably at least once a week I was doing death care and participating in some hard conversations for the family. The reality is that not every ICU patient lives to be discharged. You also get well versed in handling organ donation. ICU is a lot of pumps, pressors, sedation and ventilators. ER is a lot more people whining about wait times and a lack of urgency when they want a cup of coffee or something. Lots more people complain about the ER than the ICU, but the ER gets a lot of people who SHOULD be going to their primary care doctor instead, so there's also that issue.

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

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.

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

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.

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.

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.

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.

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.

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

ICU is my bread and butter but I've crosstrained for ER and they are very different worlds. ER you see everything, from scrapes and bruises to literal guts hanging out and limbs blown off. You will have to manage these patients and be ready for more afterwards as there's going to be an endless supply of people walking into your ER. Your main goal is to triage, stabilize, and send them on their way be that to a unit or out the door; anything past that will be extra work that's not always necessary but will definitely help you when passing this patient along. You will be starting IVs, cleaning and dressing wounds, stopping bleeding, managing "difficult patients" (everywhere has em but ER see's all of em first), what I like to consider "battlefield medicine" essentially. In ICU it's a lot slower paced with bursts of activity followed by nothing (and depending on your facility it could be a whole lot of nothing all shift or fire and brimstone the entire time). ICU RNs are generally expected to respond to Codes around the hospital and this is usually decided at the start of shift who will be running rapids, generally it's a more experienced nurse and they MUST have their ACLS (other ICU nurses can accompany but in order to push meds someone needs to be ACLS). You will be managing vitals a lot of the time and titrating (setting your doses for medication) meds to achieve that desired effect. Doctors have parameters for you instead of hard set orders meaning you're given A LOT more leeway to make critical decisions than on other units even ER (ER cannot titrate any medications afaik, they must receive a new order from the doctor every time that make a dose change. obviously this doesn't always happen but it shows you what kinds of freedoms you're afforded). With this extra leeway comes a lot of extra responsibilities; in a split second you can kill your patient without even trying and it really is that easy. Turn your patient who's hemodynamically unstable? You might just code them... You really really really need to watch your patients' vitals and status like a hawk because their lives are literally in your hands. Remember, ICU is one of the last stops you can go, there really isn't another level of intensity we can escalate to above ICU; this is it, and people here are extremely sick sometimes. You MUST know every med you're giving because you're not only giving it, some of them you'll also be dosing them (within parameters).

TL;DR, ER focus a lot more on trauma, triage, take them to the floor. ICU can be slower but you're expected to know your patients and medications in and out or risk being chewed out or worse...

I’ve worked both and can say that which one you work largely depends on preference. ER is usually faster paced, more focused charting, and more unpredictable than ICU. Most of what you’ll deal with in an ER will be things you can see in an urgent care if I’m being honest. Most people struggle with the concept of what’s appropriate to come to the ER for and what’s not. ICU will almost always be critical patients. Very rarely did I have someone that wasn’t serious (which should be straightforward given the name of the unit). It requires extensive charting as well. I did feel that I learned more in the ICU than in the ER. If you plan on going to CRNA school, the. ICU would be the better choice. I would recommend trying both and seeing which one you like more.

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.

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.

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.

ER stabilizes ICU maintains critical usually unconscious patients with complicated treatments

Been a nurse for almost 30 years.... ED and ICU were my favorites. Basically, in a nutshell...
ER: Stabilize them and get them out (to floor, to home, to a different facility if higher level of care needed)
ICU: Keep them alive

I did both, depended on what my mood was.... quick turnaround or 12 hours with 1-2 patients :)

I've done mostly critical care with occasional float to ED. In my experience ED is focused on the system that brought them in and stabilizing for discharge or transfer to admission. I think they are both fast-paced but in very different ways. ED is more in and out. ICU is full body, and a focus on how all the systems are working together leading the patient to ICU admission. It is very fast-paced, but usually its due to rapidly changing patient status requiring frequent intervention.
ED nurses don't often get the opportunity to really form a relationship with the family. ICU relies on forming those relationships because their family knows them better than we ever well.

The ER mindset is “stabilize the pt and ship them out ASAP” (emergent reason for being seen only). Docs have no interest in “all the other ailments”. There is always a Dr. In the ER. RN only goes to off unit testing with Stroke or MI or unstable pt or to transport an ICU pt, otherwise techs help with all the rest…(well if you are staffed)🤪
The ICU mindset is “the entire patient” , every little detail…. Exact fluids in PO, IV and measure to all urine and BM, very detailed care. Manage and troubleshoot vents. Keep them sedated. Suction them and manage their ETT. Clean teeth/mouth on vent patients on a time schedule, pts must be turned minimum every 2 hours, feeding pts, cleaning and changing pts. Titrating gtts and knowing when to call your doc for changes. Monitor pt labs carefully, lung sounds, cardiac rhythm. On ICU pt catching subtle changes are important. The can go down fast. RN has to go with pt for all off the floor testing. And you also have high family needs in the ICU. The family is your responsibility as well. I started in ER for years ,got talked into ICUa. And there 10 years. I am now back in the ER and happy. ICU taught me so much! I will say it is so hard to not look deep into your pt issues after being in the ICU…. No one cares if its mot what their complaint was.

I used to work ICU and if short in the ED and the ICU well-staffed they would occasionally “float” the ICU nurse to ED. I hated it! Most of that is having your own system and routine, also all your patients are very ill in the ICU. In the ED people will come in for very minor problems or as severe asactively dying.

We had a saying that the ED is Organized Chaos and the ICU is Chaos Organized. ICU nurses are extremely organized and territorial with theirpatiwnts and resposibilities. ED nurses must be able to tolerate a lack of predictability and control over their environment.

My answer is short and sweet. ER is chaos. ICU is controlled chaos.

In my perspective ER nurses are trained for the what is emergent and life threating now scenario
we will start the workup for the ICU side and start the drip but the ICU maintains and adds to that.
For ICU prepare to know your drips and see the whole dynamic by then pts come from the ER usually with 2 IV lines and once in ICU central lines are placed, so now the patient can be managed more hemodynamically. When I get ICU pts in ER I get tunnel vision what is the main cause I have to address to keep this pt. alive is is sepsis vs trauma vs cardiac etc. I might not achieve full stabilization which could be a week or weeks long process that the ICU can offer, I recall giving report and the ICU nurse states that pt. is a train wreck I think exactly I am keeping them alive plus my other 4-5 pts as well so I did ABCDE can not get to letter H or I right now not gonna happen there coming up. So be prepared to have the same pt. for days weeks on end know you drips and endgames for the ICU As for the ER pt's come and get admitted once their on the ICU unit you erase them from the memory bank and move on to the pts in you pod that need you next.

As an experienced nurse in both, the only difference is at the ICU the patient is full continuous monitored.
In the ER you can received unexpected unknown situation to deal with. Monitoring starts on arrival if needed. To me, the trauma room is the same as when a pt is near crashing or coding in the ICU. Look for the cause, dx, treat, procedure/intervention and moved to ICU/other. In the ER your flow of patients change rapidly all illnesses to deal with. In the ICU they are there at least 48 hours.
ICU nurse will be an excellent ER nurse. Flexibility ( no all patients are priority 1 or 2)
The ER nurse to ICU needs to learn to assess pt every hour and keep 12 hours shift log of every monitor VS, ICP, B/P A-lines, CVP and tubes, drenajes etc in the EHR.

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!

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

I have experience in both.

ICU - you walk into a chaos, then it’s chaos, then it’s AAAAAAAAAA and more chaos, but sometimes you get a minute to organize your chaos and enjoy your little “Type A personality” moment, handing down less chaos in the end of the shift.

ER you walk into chaos and then AAAAAAAAAAAAAAAAAAAAAA and then your shift is over, you hand down your chaos to next shift so they can go AAAAAAAAAAAAAA.

That sums it up for me.

Bold print versus fine print.

Worked in both. The ED is the first stop and we get the patient with no tidy package - no labs, xrays, etc. We have to garner the information, chose the right tests for a diagnosis and then the patient moves to the next step for a plan of care and management ie, home, follow up or admission. ICU gets the patient with labs, xrays, initial medications and ready for the ICU to continue with a plan of care and magement. They are both critical care areas but the ED has a mix of very minor to life threatening. Time management and organization is different for both areas. Having worked and managed both areas I am a believer that it is better to start in a med surg area to learn time management and get a comfort level of taking care of patients. Critical care does not always allow time for real time questions and teaching depending on the situation or explanation of procedures which a general floor can. ICU is more structured and ED requires a lot of flexability. Many nurses have a preference. Interestingly enough nurses from other areas of the hospital have difficulty floating to the ED because it is so different and they usually are floated with things are the busiest. They often ask how we work there. Good luck on whichever area you choose

Well as an ICU nurse we are more involved with care. Critical and in dept. as ER rn we stabilize and ship or transfer. Don’t know the rest of the family story

I started out as a new grad working in a pediatric ER where I eventually met my husband who was a pediatric intern. He asked me to take a job in another hospital as he didn't want me to "hear" of any complaints about his work. so before we married , I switched jobs and moved to an Adult ICU in another local hospital. I LOVED both of those jobs and learned A LOT about adult critical care and pediatric emergencies. After a couple of years in the adult ICU, my husband filed for divorce. I realized I MISSED pediatric nursing and returned to our local Children's Hospital where I accepted a new job as a Heme/Oncology teaching nurse. I LOVED that job and stayed there for seven years. The only downfall was the 45 minute commute each way from where I had bought a home for my kids and I. Luckily , I found and accepted a job as a school nurse in the same district where I was living with our kids. I stayed in that job for 26 years. When I decided to retire, I discovered I had a GREAT retirement income from my job as a school nurse!
My Advice: Take the job that excites you the most!!!

I have worked in both and loved them both. The difference was explained to me by a very experienced ER nurse when I first went into that specialty: ICU is flowing music, sometimes faster, sometimes slower, but steady. ER is jazz with lots of syncopations. Depends on our personality. I would say if you want to do both (and I did), do the ICU first. You'll learn lots of critical care skills and be able to do them easily and automatically, something VERY important in ER where time is usually of the essence. Good luck.

ER NURSES HAVE A LOT OF EDUCATION TO BE ABLE TO TAKE CARE OF PATIENTS FROM BIRTH TO DEATH . THEY HAVE 6 to 1 ratio of PATIENTS sometimes up to 8. They multitask, work in a team approach, very fast paced, they rarely get a break to eat or relieve themselves and the stress level is high. They have trauma patients, cardiac arrest, drownings, . They have to hold admitted ICU patients until a bed up in ICU opens up and still has to maintain the rest of their other patients. They never get respected from any other departments and always have difficulty with getting the patient up to ICU because they have a sick patient they are attending to so the er suffers and no one backs the ER up. They do not work in concert with the other departments , they lack peripheral vision. Now a Critical Care nurse usually has a 2 to 1 ratio of patients and when .one patient goes bad there whole system stops to take care of one patient. They will not except an admission until they stabilize the sick patient. They have credentials that are the same as the er and the work load is less

As an ICU and ER nurse at two separate times in my career, I think I have a pretty good idea of how to answer this question.

Emergency room (ER) nursing and intensive care unit (ICU) nursing are two distinct specialties within the field of nursing, each requiring a unique set of skills and expertise.

ER nursing focuses on providing rapid and efficient care to patients who are experiencing acute medical issues or emergencies. ER nurses must be able to think quickly on their feet, prioritize care for multiple patients at once, and work well under pressure. They are often the first point of contact for patients in need of immediate medical attention, and must be able to assess and stabilize patients rapidly while working with a diverse patient population.

On the other hand, ICU nursing involves caring for patients who are critically ill or unstable, often requiring advanced life support measures and continuous monitoring. ICU nurses work closely with a multidisciplinary team of healthcare professionals to provide specialized care for patients with complex medical conditions. They must possess a deep understanding of critical care concepts, advanced patient assessment skills, and the ability to manage complex interventions and therapies.

While both ER and ICU nurses deal with highly acute patients, the key difference lies in the level of acuity and complexity of care. ER nurses focus on initial stabilization and rapid assessment, while ICU nurses provide ongoing specialized care to patients with severe, life-threatening conditions.

In summary, ER nursing is fast-paced and focused on triaging and stabilizing patients in need of immediate care, while ICU nursing requires a deep understanding of critical care concepts and the ability to manage complex medical conditions. Both specialties are essential in providing high-quality and comprehensive care to patients in need, and offer unique opportunities for nurses to make a meaningful impact in the lives of others.

I hope my answer helps. I tried to be fair with both ER and ICU nurses. :-)

Danwil Janz Reyes, RN-BSN, CLININST

When I moved from my position in Surgical ICU to ER I had a wise and wonderful preceptor who had also worked in both areas and told me the easiest way she knew to explain the difference would be to use music as an example. She said I could think of ICU as scored music, sometimes smooth and routine, sometimes with crescendos and dramatic interludes, but all with the same underlying regular score: (times for meds, times for calibrating lines, times for turning, suctioning, bathing, etc.) with occassional "accidental" notes (codes, near misses) here and there. She said to think of ER as improvisational jazz, highly symcopated and always changing. I found that useful, and hope you will also.

The simple answer is in the ER you treat the injuries and in the ICU you treat the whole person.

I think a simple answer is in the ER you are treating the injured parts and in the ICU you treat the whole peellerson

"I have experience in both settings. In the ICU, patients are under constant monitoring, with vital signs checked hourly. In the ER, you encounter unexpected patient arrivals, some of which may have life-threatening conditions. It's crucial to support the medical team in stabilizing patients and initiating monitoring swiftly. Situations can escalate rapidly, so familiarity with ACLS, PALS, NALS algorithms is essential to differentiate between emergent and non-emergent cases.

In both settings, physicians are available around the clock to provide support and guidance."

It's good to get the experience of talking care of the whole patient. ED is patch work then get rid of the them. If you don't mind chaos and like a adrenaline rush give it a shot. It depends on the type of person you are. I don't like ppl complaining about how much longer when they could have gone to the Urgent care up the street 3 weeks ago . For reference 40 years a nurse and done ICU OR Endo Ep etc and admin

Ear nurses often times hold the position of an ICU nurse. ER nurses like chaos I see you nurses don’t. I see you nurses typically like controlled situations and have a very hard time with the chaos of people coming in a different time getting discharged at different times, and all kinds of chaos is happening all around them ER nurses thrive on that differences in personality.

It's actually pretty easy. Innuendo ER we get the patients as stable as possible and ship them out. Or if they don't stabilize we make them comfortable. In the ICU that's is where our patients go! In the ICU nurses are more concerned with graphs and details. When I was a baby nurse it was all on paper in the ICU and frequently that would be a six or 8 page fanfolded chart for each patient for each day. I always liked the stabilize and move rather than the endless paperwork and hundreds of tubes!!

They are completely different. The Acute, critical ER patients are stabilized and sent to ICU for intensive, critical care. ER assesses and stabilizes, Intensive care assesses and monitors. The patients have more IV's and machines that need to be monitored in ICU and can be there for long term. They have to be assessed for sundowners syndrome (ICU psychosis) and are often in comas.

The patients can be in Coma's from head trauma in ER as well but as soon as they are stabilized enough to be moved, they are sent to Neuro ICU.

ER is different every day, ICU is same everyday with intensive monitoring and lots of IV meds

ER is stabilizing whatever the emergent health concern is. Generally cardiac, respiratory or acute pain. Once stable the
Patient
Is referred to a specialist for
Follow
Up treatment. I CU is patients that are either unstable or high risk for becoming unstable. Again, predominate emphasis on cardiac and respiratory systems. Frequently patients are in medically induced coma and ventilated to facilitate medical
Management. ICU patients will have intervention and care while remaining under the care of the I CU team, ie cardiac cath, ventalatory weaning, etc.

ER is critical chaotic care focused on stabilization with short duration of stay, ICU is critical organized care with a more extensive stay and the care is very comprehensive . If you’ve worked ER you can work ICU with some ‘adjustments’ and vice versa. Overall I’ve come to find it’s more of personalities than skill. I love the unknown thus ER works for me. Also most ER have more flexible schedules 7a7p, 11a11p, 1p1a, 3p3a, 7p7a

From my experience, I noted several differences. I worked my first 10 years in a CVICU with mainly open heart surgery post-op patients. It was very daunting at first, but an excellent partner/preceptor and an outstanding ICU orientation program for new RN grads made a huge impact. Of note, all of the 10 nurses in our cohort were experienced LVN/LPN s with IV skills. The hardest part for me was understanding the mechanical equipment, but that came with time. My assessment skills were very focused and I was a good problem solver. I was never afraid to ask for help when my patients needs exceeded my abilities. Attention to detail, a good work ethic and dedication are paramount to success. I worked ICU for 12 years, then I was ready for a change
I switched to Emergency Department nursing and again received a solid orientation. My ICU organizational skills and clinical skills were of great value in a general ED setting. Of note, cardiac patient problems were not the strongest area for many of my ED colleagues, so I felt strongly that I could contribute to this team. While ICU was more isolating, me with “my patients”- ED was all about the team. Many patients needed a great deal of help quickly and often required several nurses and other staff initially. We all worked together like a well-oiled machine. Most patients weren’t there with very
complex problems but they needed rapid, accurate assessment and treatment. My assessment skills broadened to include working with people of all ages and conditions. I always kept up with the specialty nursing journals and was active in the professional organizations, where I was exposed to different manners of treating patients. Always the focus must be on patient CARE. Most people didn’t want to be in the ED but they were looking to us for help. The goal of rapid and accurate assessment remained paramount. As we said “treat em and street em” in order to keep flow of patients (throughput) in the
Department. There were many frustrations always. Labs too slow, no open inpatient beds,
and always people upset by having to wait. With many patients to care for, multitasking is a real
talent.
Either choice of direction will be challenging if you’re open to learning. Don’t let the burned out staff color your judgment. With either specialty you can enjoy a fulfillIng career in nursing.

I agree with most of the answers here. There are also some personality traits that might make one department a more natural fit than the other. A lot of ER nurses I’ve worked with are adrenaline junkies with short attention spans (me in my 20’s). A lot of ICU nurses I’ve worked with are more detail oriented and prefer a more controlled environment.
Obviously, these are just stereotypes, but it might help to consider your general tendencies and preferences when making this decision.

Worked both areas. I did work longer in ER. Id say ICU is more challenging than ER. I worked as a travel nurse in icu during covid and it was stressful. You get 3 intubated pts and we’re always short of staffs. Knowledge wise, i learned a lot in ICU. We dont have doctors in ICU so assesments and monitoring was of great importance. I took this chance learn and develop my knowledge and skills. Sometimes, id not work for a couple of weeks just to read on icu meds(especially pressors and sedatives) and procedures(codes, chest tubes, arterial line etc). Honestly, not all ICU nurses are good either, especially for travellers. Ive seen icu nurses who boast their years experience but still dont know what theyre doing. Id say around 60% of icu nurses that ive met are above average and the rest are just there to get paid. Best thing ive learned in er is iv ultrasound. If the salary is the same, id definitely choose ER. If you want knowledge, go icu. There was an instance when i had travel assignments in er and icu at the same time(staffing worked with my scheds). I work in er because it is more lively and less stressful than icu.

I've done both. ER is emergent care, fast paced, keep the patient alive and patch them up enough to discharge or send to the floor. You are going to see death and accidents, poisoning, cuts and abrasions, early labor, etc. Depending on the size of your hospital you may do more treatment in the rural ER than a large hospital. The ICU is basically you against death. You try your best to keep a patient alive for your shift while they are trying to die. It is much more complicated as you have all kinds of drips, vents, tube feed, TPN, and it can get overwhelming. They don't call it Intensive for nothing. Both can be very rewarding.

You will a lot in ICU about diseases process, hemodynamic monitoring, swan , MTP and so on alot complex diseases , high risk medication and how dosing can affect certain betas and alphas . A lot beside procedures , codes , charting and it can be depressing. ER get them in and out faster pace and less bonding to patients . Both are great experiences and open doors to other specialists and higher education

I have been both though always preferred ER but made a civilian and military career of the ICU" Aric has a very nice detailed "ICU NURSE" answer.

The ED answer was always our job is to meet the new patient assess, then treat "em and street em. (that has changes with ED's having multiday patents)

and

the ICU patients had the same patina to which you did the same thing the same way every 2 hours until the patient got better or passed on.

These days the slog is difficult in each area

ER is chaos. ICU is controlled chaos.

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 ...no 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!!

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.

I have been a nurse for over 30 years and recommend that you go into the ICU because you will gain alot of knowledge that you won’t get in the emergency room! You will be the nurse in the ICU and have to be on alert for any emergency or complications! Of your patients and you will learn fast taking care of your patients! A few days to weeks ! Depending on their condition! In the emergency room you learn to react and act fast but you have all the doctors there to assist you not so much in the ICU where at night you will be working and may have problems with patients and will have to call a code and wait for the code blue team to come ! And will need to start CPR and be able to react on your own and with your other nurses in the ICU ! You will learn to be more confident and after working there for at Least two years ! Will have the experience you will carry with you to any other position! I started on a medical/surgical floor and had to learn !

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