You’re confident in your decision to become a nurse. With your caring personality and ability to keep calm in any situation, you know that this is the right next step for your career. What’s less clear is the nursing work environment that will be the best fit for your skills and characteristics.
Not all hospital nursing positions are the same. You think you’ve narrowed your options down to working in an emergency room (ER) nurses or an intensive care unit (ICU)—but now you’re stumped. So what exactly is the difference between nursing in the ER or the ICU?
ER vs. ICU: The basic breakdown
Both ER and ICU nurses are concerned with tending to patients who are experiencing urgent, severe, or even life-threatening medical conditions. However, there are some key differences in how these two hospital units function. In a sense, the emergency room and the intensive care unit are two of the most different areas of the hospital.
What does an ER nurse do?
ER nurses treat patients coming through hospital emergency departments for a variety of reasons – trauma, injury, and acute-onset symptoms. They treat patients of all ages and backgrounds. Most patients are experiencing emergency, life-threatening situations, and ER nurses must be quick to recognize those acute problems and be able to resolve or stabilize them immediately upon arrival. The job is fast-paced, full of adrenaline rushes, and completely unpredictable shift-to-shift.
This job is all about focused assessments, stabilizing the patients, and sending them where they need to be. Also, effective communication with providers while working elbow-to-elbow with them is paramount. Quickly identifying an issue and rapidly implementing a plan of care requires effective teamwork.
ER Nurse Responsibilities
ER Nurses have a long list of responsibilities. As varied as this job is, these are the main responsibilities:
- Triage – assess and decide which patients will be seen first and in which order
- Take vital signs and complete focused assessments
- Administer medications
- Emergent life-saving measures like assisting with rapid sequence intubations, cardiopulmonary resuscitation, and more
- Provide medical treatment
- Charting – take a full history of patients so the physicians can diagnose them easier and accurately.
- Educate patients and family members – help them understand the importance of the doctor’s orders and repercussions of not following them.
- Communicate with providers, colleagues, and patients
- Transfer – getting patients safely admitted to a nursing unit for further care and evaluation
What does an ICU nurse do?
On the alternate end of the spectrum, ICU nurses treat patients who require the highest acuity of care in a very structured and controlled setting. In order to treat the most critical patients in the most thorough manner, critical care nurses use their specialized skills and extensive knowledge of disease pathology to provide interventions that sustain life. They are advocates for their patients and work closely with the intensive care team to treat their patients. The environment is structured, high acuity, and multifaceted.
In addition to that, this nurse is also responsible for communicating with providers and other healthcare team members, as well as families about their loved one and the patient themselves. In fact, communication with everyone can be trying and difficult. An ICU nurse explains complex medical conditions to laypeople, many of whom have little experience or previous understanding of healthcare.
ICU Nurse Responsibilities
The responsibilities of an ICU nurse include:
- Monitor the patient’s condition, which becomes very complex as patients become more unstable
- Oversee and provide care to the patient
- Communicate with the patient and family and provide support them
- Assess the patient’s and their response to treatment, suggesting changes as necessary
- Use high-tech equipment to provide quality care for the patient
- Stay educated on the latest evidence
- Document appropriately
Watch the following video to know about ER vs ICU Nurse
Poking fun at some nurse personality difference
ER nurses thrive in chaos. ICU nurses attest to chaos. When it comes to the work environment, the two specialties can seem like opposite worlds.
ER Nurses have personalities that work best amid a storm of disorganization. It’s very hard to stress out an ER nurse. Because of the chaotic flow, ER nurses rely massively on teamwork and intuition. Ratios can be tough to manage and depends on who walks in the door, and these nurses run around as lives depend on it, and they do.
On the other hand, an ICU typically operates like a well-oiled machine and ICU nurses wouldn’t have it any other way. ICU nurses appreciate shifts that are structured, organized, and allow them to perform their work without hiccups
2. Organization (or lack thereof)
ICU nurses know their stuff. Checklists of exactly which medications are due and highlighted grids of which are compatible together, which drips to titrate and when exact intake and output of fluids to the milliliters of blood taken for lab draws, etc. It’s hard to catch an ICU nurse off-guard with a question about their patients’ care.
ER nurses operate entirely differently, and for good reason. They don’t have the time or luxury to be detail-oriented. They only have the time to assess, react, and move on. So if you want to look at an ER nurses’ paper “brain”, don’t be surprised if they don’t carry one. Everything they need to know is up top
3. Goals of care
In an ER, you never know who walks through that door next. ER nursing is a very big picture. You assess, identify the major problem, treat the major problem, and get the patient back out the door on to another appropriate floor because there are many others waiting for that bed. Prioritize, stabilize, and move out. You only have time for reactivity and responsiveness.
In the ICU, you can instead proactively think and act. ICU nurses have to look at everybody system as interconnected and treat as such. Something that affects your neurological functioning, affects your GI system, affects your liver, your kidneys, etc. ICU nurses are planning for long-term goals for patients and often watch patients progress from critical illness to health again. The goal is not in-and-out, it’s long-term wellness. ICU nurses are very involved with patients and families, building rapport, and providing education. ER nurses often don’t have the time for much interaction with patients and families beyond life-saving measures
4. Personality types
Adaptable, calm, and collected during emergencies, quick-acting, big-picture thinkers, adrenaline seekers, love organized chaos, and their report is something like “the patient is alive.”
Meticulous, organized, planners, love the detailed level of care, and they can simultaneously orchestrate 10 pumps, 6 drips, 4 beeps, and 1 crashing patient without blinking an eye.
Fast-Paced and Critical Nursing
Both ER nurses and ICU nurses work in stressful environments that will tax them and require quick-thinking, problem-solving, assessment, and nursing skills.
Although ICU and ER nurses alike are superheroes. They are incredibly smart, quick-thinking, and save lives every single day.
So if you are now thinking about entering the world of nursing or just have finished taking up the board exams, you might want to consider one of the two types of nurses mentioned above. Of course, you have to make sure you are very well fit and capable when placed in such an environment.
“The character of the Nurses is as important as the knowledge she possesses. – Carolyn Javis”
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