Q and A

ER v. ICU Nursing: A Friend’s Question

One of my favorite co-workers and nursing school friends from Madison, Wisconsin, and I have lost touch a bit. I travel nursed (and she visited me!) and then moved to Milwaukee. She moved to the Twin Cities. We finally saw each other after 4 years (4 years!) recently!

Just wanted to share a question she sent me a while back. Too, this feels especially apt as I’m in yet another semester of school! 😉

Hello long lost friend! How are you!? Still loving the ED? I was actually hoping to hear your thoughts on working there.  I’m currently in the ICU. It has been a long road, and I’ve been hurting my back. I’m thinking of making a couple of changes. 1 – I’ve always wanted to get back to the ED since my clinical nursing school, and I have been told that it is a bit less taxing than the ICU. Just wondering your thoughts on the physical demands and that setting. 2 – Applying to grad school for a DNP program so I don’t end up in chronic pain or requiring those futile back surgeries down the road.

– Nursing school friend and old co-worker

It is so good to hear from you! I hope you are loving the Twin Cities.  😀

I’m in full-time graduate school (9 credits a semester) and work part-time hours, 0.625 FTE, so 50 hours every two weeks. I tend to pick up extra or sign up for on call hours, so it usually ends up being about 30 hours a week. For my organization, the minimum FTE for full-time benefits is 0.6, which is why I work that much. From my understanding in Minnesota, it’s 0.4. At least that’s what my friend who got her DNP in midwifery from the University of Minnesota worked and said when we got lunch about a year ago.

As for the physicality of the job, I think of all the turning and moving we did on our old unit in Madison, Wisconsin, and my back hurts thinking about it! Patients are lucky if they get a pillow in the ED. Honestly. There’s some moving involved with getting people into and out of wheelchairs and some cleaning up, but usually, people can move or be convinced to move.

However, back injuries are a problem for the radiology technicians and EMS providers. They do a lot of pulling and heavy lifting. ED techs do as well. For me personally, the patient stays on the cot for the majority of the stay, and I help with maybe a boost or two the entire shift. I do a lot of ICU transfers, but the carts are really easy to push, and there’s more of an arm workout.

Traumas are the exception, but there’s so many people in the trauma bay during an acute medical emergency or trauma that it’s not hard to find a hand. I definitely think I do much less heavy lifting and turning than I used to. Too, I’ve started doing yoga at least once a week, and that’s helped my back out as well.

I personally adore the ED. I love the pace. I love the variability in patients. I love knowing a little bit about a lot of disease processes. I love the interaction with all my staff from ED techs to attending consults. I love it, and I’ll likely stay in it until I graduate. I would even consider Urgent Care or ED as an NP too!

I think it’s help me be a lot more creative and flexible too. I’m less worked up about getting new patients because I always get new patients. It’s really opened my mind up about good quality care outpatient and inpatient. ED care is its own beast that’s quite difficult to explain, but I just cannot speak highly enough about it.

Some people say it’s less critical thinking, but usually that’s nurses who came from the ICU and haven’t been trauma trained yet. Too, I’m now trained in triage, and that’s a lot of critical thinking. I essentially figure out what the worst diagnosis could be and often get to cherrypick the tests we run for them (or ask for the ones I want) while they’re waiting. I think that area has been really helpful in honing my critical thinking and assessment skills for my future practice.

I’m enjoying my DNP program, but I don’t know if it’s for everyone. I’m finding there’s a lot of good Masters and post-Masters options. I’m glad I picked the DNP though because I think just as nursing is pushing for everyone to have a Bachelor’s, I think the same will be true of DNPs for NPs one day. I barely want to go back to school now. Me going back when I’m 50 sounds terrible.

So far, it’s a lot of the classes we considered fluff in undergrad. I appreciate them a bit more now and can see how they’re useful longterm. A lot of the educators and such in my department have only their bachelor’s, and some people work at the access center and do triage there. I think unless you want to commit to whatever career, there’s still a lot of movement and opportunity available where you are, though.

And really, the differences of ER and ICU nursing can be boiled down to this hilarious video:

 

(And as an update on her, she’s applying to CRNA school!)

Does that answer your question? Anything else you want to know? 😀

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