4 Major Differences Between ICU and Emergency Nurses

Alright, let’s talk about the pretty obvious differences between Emergency Room (ER) nurses and Intensive Care Unit (ICU) nurses. If the photos above elicit a small chuckle or smirk, then you know exactly what I’m talking about. Let’s start with the basics…

What is an ER Nurse?

Emergency Room nurses are licensed Registered Nurses that treat patients coming through hospital emergency departments. They can be of any age or background and they come in for a variety of reasons – trauma, injury, and acute-onset symptoms. 

What Does an ER Nurse Do?

From heart attack to stroke to gunshot wounds, motor vehicle accidents, or just fractured bones, ER nurses see it all.

ER nurses learn to quickly triage patients based on immediate observation and acute assessment skills, then treat symptoms in order of life-threatening priority.

They may immediately start CPR to reverse cardiopulmonary arrest or start slamming blood products for a hemorrhaging patient or work to quickly discover underlying medical conditions that are less apparent. 

More specific ER nurse duties include, 

• Administering blood products, medications, and vaccinations 
• Assisting in the care of traumas, cardiac arrests, strokes, sexual assaults, and conscious sedation
• Cleaning and dressing wounds
• Conducting cardiopulmonary resuscitation, rescue breathing, or bag-valve-mask ventilation
• Discharging medically stable patients
• Educating patients, families, and caregivers about their disease and treatment plan
• Performing tracheotomies and intubations
• Placing Intravenous lines
• Responding to emergency situations throughout the hospital
• Setting broken bones
• Stabilizing trauma patients
• Treating critical injuries, allergic reactions, and trauma
• Triaging patients upon arrival to the emergency room

What is an Emergency Room Nurse Called?

Emergency Room nurses are called a number of different names including ER Nurse, Trauma Nurse and Critical Care Nurses. 

What Makes a Good Emergency Nurse?

Most of the patients they see are experiencing emergency, life-threatening situations, so ER nurses have to 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, so you need to be able to think fast and react well under pressure!

What is an ICU Nurse?

On the other end of the spectrum, Intensive Care Unit (ICU) nurses treat patients who require the highest acuity of care in a very structured and controlled setting, the Intensive Care Unit.

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.

Without ICU nurses, healthcare systems would be unable to accept trauma patients, end-of-life patients, and others that require highly specialized care. These nurses are specially trained and often cannot be replaced unless an individual has similar training and credentials.

What Does an ICU Nurse Do?

They care for the most fragile of patients who hang on to life by a thread. Most patients in the ICU are intubated, ventilated, and on life-sustaining medication drips at the very least.

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Nurses need to be able to preemptively recognize signs of decompensation and act swiftly on them. 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. 

More specifically, ICU nurses perform a variety of tasks and have numerous job responsibilities. These will vary depending on the healthcare system but generally, ICU nurses perform the following specific duties:

• Collaborate with health care professions to provide holistic care to patients.
• Educate patients and their families on diagnosis, medications, and other information
• Cleaning and bandaging patient wounds
• Tracking life support equipment
• Immediately respond to changes in the patient’s condition.
• Evaluating vital signs such
• Administering medications
• Acting as a patient’s advocate
• Provide comfort and prevent suffering
• Infusing blood products and monitoring patients for reaction
• Caring for the patient’s body immediately after death
• Identifying patient’s needs according to their age and level of consciousness and creating a care plan to meet them
• Complete paperwork prior to transferring or discharging a patient
• Respond to medical emergencies on the unit
• Supporting a compassionate and therapeutic environment for critically ill patients

What Makes a Good ICU Nurse?

ICU nurses need to be able to work quickly, efficiently, independently, and meticulously. Furthermore, they need to be efficient, patient and dedicated. 

Differences Between ICU Nurses and ER Nurses

So, let’s poke fun at some nurse personality differences…

1. Work Style

ER nurses thrive in chaos. ICU nurses detest 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, depending on who walks in the door, and these nurses run around like lives depend on it…and they do.

ICU Nurses on the other hand, typically operate like well-oiled machines and 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)

I have never met an ICU Nurse who wasn’t meticulously organized and borderline OCD, in the best way possible. These 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 nurse’s paper “brain,” don’t be surprised if they don’t carry one. Everything they need to know is up top.  

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3. Goals of care

In an ER, you never know who walks through that door next. ER nursing is the very big picture. You assess, identify the major problem, treat the major problem, and get the patient back out the door onto another appropriate floor because there are many others waiting for that bed. Prioritize, stabilize, 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’s system as interconnected and treat it 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

ER nurses are adaptable, calm, and collected during emergencies, quick-acting, big-picture thinkers, adrenaline seekers, loves organized chaos, and their report is something like “the patient is alive.”

ICU nurses are meticulous, organized, planners, that love a detailed level of care, and they can simultaneously orchestrate 10 pumps, 6 drips, 4 beeps, and 1 crashing patient without blinking an eye. 

Although ICU and ER nurses alike are superheroes. They are incredibly smart, quick-thinking, and save lives every single day. Hats off!

How to Decide if the ICU or ER is for You?

Deciding between the ICU and the ER can be difficult. The nursing skills needed both in the ICU and ER are similar. Nurses need to be highly focused and driven. But ultimately, if you’re a high-energy person who’s able to think on your feet and remain calm in a crisis, ER nursing would be a better fit. The ICU lacks the urgency of the ER, but there is an immense amount of pressure because of the severity of the illnesses. 

ER versus ICU Nurse Salary

According to the U.S. Bureau of Labor Statistics (BLS), the median salary for a Registered Nurse in 2020 is $75,330 per year or $36.22 per hour, but conditions in your area may vary. Unfortunately, the BLS does not differentiate between different nursing specialties. 

Emergency Room Nurse Salary

Payscale.com reports an average annual salary of $71,118 per year or $32.03 per hour for Emergency Room Nurses. 

ERN Nurse Salary by Years of Experience

ER RNs can earn a higher annual salary with increased years of experience. Based on reported salaries, the following years of service can earn, 

• Less than 1 year of experience earn an average hourly salary of $27.00
• 1-4 years of experience earn an average hourly salary of $29.24
• 5-9 years of experience earns an average hourly salary of $32.88
• 10-19 years of experience earns an average hourly salary of $36.45
• 20+ years of experience earns an average hourly salary of $39.00

Highest Paying States for ER Nurses

Currently, the states that pay the highest salaries for ER Nurses according to Payscale.com are as follows:

• Los Angeles, California - $95,813
• New York, New York - $83,369
• Houston, Texas - $80,000
• Phoenix, Arizona - $70,481

ICU Nurse Salary

ICU nurses can earn a similar salary to ER nurses. According to Payscale.com, reports an average annual salary of $70,548 per year or $32.35 per hour for ICU Nurses. 

ICU Nurse Salary by Years of Experience

ICU RNs can also earn a higher annual salary with increased years of experience. Based on reported salaries, the following years of service can earn, 

• Less than 1 year of experience earn an average hourly salary of $27.31
• 1-4 years of experience earn an average hourly salary of $30.09
• 5-9 years of experience earns an average hourly salary of $33.86
• 10-19 years of experience earns an average hourly salary of $38.51
• 20+ years of experience earns an average hourly salary of $41.18

Highest Paying States for ICU Nurses

Currently, the states that pay the highest salaries for ICU Nurses according to Payscale.com are as follows:

• Chicago, Illinois - $85,000
• New York, New York - $75,497
• Los Angeles, California - $70,986
• Atlanta, Georgia - $65,500

Education Requirements: ICU vs ER

The educational requirements and steps to become an ICU nurse or an ER nurse are the same

Step 1: Become a Registered Nurse

To become an ICU nurse, you must first become a registered nurse (RN). You can either graduate with a BSN or an ADN from an accredited nursing program. 

Step 2: Pass the NCLEX-RN

Become a Registered Nurse by passing the NCLEX examination.

Step 2: Gain Experience

It is possible to become an ICU nurse or an ER nurse directly out of nursing school; however, don’t be surprised if some positions will require prior bedside nursing experience. This might include at least two to three years of medical surgical nursing. 

Furthermore, an ER may expect their nurses to have an additional two years of bedside ICU experience. If that is the case - it may take 4 to 5 years before landing a job in an ER. 

Step 3: Obtain Certification

ICU and ER nurses can earn advanced certification in the respected fields after earning the required amount of experience. While certification may not be required it is highly encouraged and can lead to salary increase as well as additional benefits. 

The most popular certification for ICU nurses is the Certification for Adult Critical Care Nurses (CCRN) awarded by the American Association of Critical-Care Nurses.

To be eligible to sit for the CCRN exam, nurses must meet the following criteria:

• Practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill pediatric patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application

OR 

• Practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct care of acutely/critically ill pediatric patients, with 144 of those hours accrued in the most recent year preceding application

ICU and ER Nurse Similarities

While the ICU might be slightly slower than an ER at times, a lot of nurses would argue that they are both very intense and require expert critical thinking skills. Both settings can see specific patients that have a variety of different illnesses and both care for patients with life-threatening diseases.