April 24, 2018

4 Major Differences Between ICU and Emergency Nurses

Nurse in scrubs with stethoscope in hospital crossing arms
Brittany Hamstra By: Brittany Hamstra

Meme showing organized wires and awry wiresMeme comparing ICU nurses 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…

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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 background. 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.

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 to 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.

The job is fast-paced, full of adrenaline rushes, and completely unpredictable shift-to-shift. 

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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.

ICU nurses work quickly, efficiently, independently, and meticulously. 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. 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. 

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

1. Work Flow

ER nurses thrive in chaos. ICU nurses attest chaos. When it comes to 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.

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)

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 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, 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

ER nurse

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 nurse

Meticulous, organized, planners, loves 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!

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