ICU or ER Nurses: Which is a Better Fit for You?

Nurses complete a massive number of duties at hospitals and other healthcare facilities. Few do as much as ICU or ER nurses. For these nurses, every shift has high stakes, as the patients under their care face life-threatening injuries and illnesses.

ICU and ER nurses have different duties and workloads. Any nurse applying for jobs should carefully weigh the differences before accepting a job offer. These fast-paced jobs have similar levels of risk and reward.

However, the chaos of emergency rooms can be overwhelming for some nurses. On the other hand, the emotional strain of ICU nursing can be draining and cause nurses to burn out.

Different Stages of Care

An ER nurse’s job is to help assess and provide initial treatment for patients who are seeking emergency care. This means dealing with an unknown diagnosis, and in some cases, an unknown or poorly understood set of symptoms.

An ER nurse must be able to determine which patients need care most urgently, even if their diagnosis is still unclear.

In the ICU, nurses will generally be dealing with patients whose diagnoses are known. Or who at least have a clear set of symptoms and a treatment plan that has been determined by a doctor.

An ICU nurse must provide ongoing care for patients with serious conditions who may be unable to be discharged for the foreseeable future.

Primary Duties

Since patients may be unconscious or unable to articulate their symptoms clearly, an ER nurse must be a detective and get the right tests done to assist doctors in making a diagnosis.

An ER nurse must be comfortable administering emergency care for gunshot victims and other trauma patients.

An ICU nurse monitors vital signs, medications, documentation, and other ongoing tasks for patients in the ICU, and provides additional care as needed.

Nurses must be able to react quickly to monitor alarms and more subtle changes in vital signs. Communication with the patient’s family members and other nurses is also critical, especially at the beginning and end of every shift.

Patient Load

A busy Level 1 Trauma Center can see upwards of 100 patients in a single shift, and ER nurses may be responsible for multiple patients at any given time.

During a hectic shift, an ER nurse may deal with a total of 40 patients and may struggle to find time to eat or go to the restroom. Patients can be of any age and may be suffering from any illness or injury imaginable. 

An ICU nurse will typically be assigned to two patients who need close monitoring and ongoing care. While this workload sounds light, the amount of detail involved in patient care is much higher.

New patients must sometimes be transferred in and out of other departments. ICU departments also tend to specialize in a specific type of care, such as cardio or pediatric care.

Communication with Team Members

An ER nurse will be dealing with multiple unknowns while assessing a patient, and quick communication is key.

Patients may describe their symptoms in vague terms, so there may be guesswork involved when a nurse relays this information to doctors.

However, ER nurses still must follow established protocols and checklists to help streamline communication with their team.

ICU nurse teams typically have structured time at the beginning and end of each shift to update each other on a patient’s status. These meetings are highly detailed and almost always deal with a known diagnosis and treatment plan. Numbers play a much more important role than subjective descriptions in this job.

Emotional Labor

ER nurses see a range of horrific injuries and must be prepared to deal with the trauma of them. They also will sometimes interact with patients’ family members, which adds another layer of intensity to their job. Although the patients themselves are strangers, the pain of treating a suffering patient is incredibly hard. Especially if that treatment ends up being unsuccessful.

ICU nurses will sometimes have to deal with the loss of a patient with whom they have built a relationship. The grief process can be intense, especially if they had been caring for that patient for months or longer.

A patient and their family members may also celebrate birthdays and holidays during their time in ICU, and nurses must facilitate that to the best of their abilities.

Type A vs. Type B

Although ICU and ER nurses deal with similar levels of stress, they are probably best summarized by their personality differences.

ICU nurses must be very detail-oriented and carefully monitor every aspect of a patient’s health to help them recover fully. ER nurses must also be careful and detail-oriented. But can enjoy the challenge of meeting the immediate needs of an ever-changing group of patients.

The best job option for you will depend on your tolerance for disorganization and fast-paced work environments.

ICU and ER wards both need the best nurses they can get. Update your resume and plunge into one of these exciting fields as soon as possible. You will likely find this line of work to be worth the effort. It can be incredibly rewarding and life-changing.