Choosing a Nursing Specialty, ED vs ICU

One of the greatest draws to nursing as a career is the flexibility. I love the fact that I could simply decide that the ICU is getting old and switch jobs with little to no stress. This being said, choosing a nursing specialty out of school is stressful. This is especially true if you have plans on pursuing further education within nursing such as NP and CRNA school. Hopefully, this post will help you decide which specialty is best for you.

Before I get into it, I want to note that I love both the ED and the ICU. I currently work full time in the ICU for reasons I will detail later. However, both of these specialties have their own benefits and drawbacks. I wouldn’t look at this as a competition of which specialty is better, but rather which specialty provides a work environment that I wish to experience.

Working in the emergency department is a rush. Obviously there are different levels of acuity which lead to different work experiences. Everyone recommends getting a job in a level 1 trauma center in order to “see some shit,” however I disagree. Level 2’s are where it’s at. Level 2 trauma centers provide almost all of the same services as level 1’s with less resources. For new nurses, this is a great learning opportunity. In my experience, level 1 trauma centers do receive some gnarly patients, however, there are usually so many residents and attending physicians that nurses may only get to watch instead of do. At level 2 trauma centers, the patients are still sick, however, there are more opportunities for nurses to participate in the actual care of the patient.

Something else to consider about working in the ED is the percentage of patients who are actually sick. Let’s say that you work in an ED that sees 200 patients per-day. If we play the numbers liberally and say that 10% of patients who visit the ED every day require life or death care, that means only 20 patients provide classic ED experience. This means that there are 180 patients who are visiting the ED for PCP like complaints such as STD testing, medication refills, and the common cold/flu. I’ve seen parents bring their kids to the ED for a physical for sports as no other office would take their Medicare. This can be frustrating, but these are the consequences of a poorly functioning medical system.

While the Emergency department is quick and dirty, the ICU is meticulous and methodical. You will know everything there is to know about your patients. While the ED may get vitals every 15 minutes, you will constantly monitor your patients with incredibly complex technology. If you enjoy spending your entire shift with the same one or two patients, then the ICU is for you.

The actual care you provide in the ICU is also very different than the emergency department. The ICU is about keeping very sick patients alive and hopefully heal them. Sometimes, keeping your patient alive is the only thing that you can do, as their disease process is far too complex or advanced to heal. However, I would say that there is a fair amount of excitement in the ICU as well as the ED.

I love working in the ICU. I enjoy the complexity of my patients and I enjoy having them over multiple days and sometimes weeks to months. Like any job, it does sometimes get old. However whenever I feel particularly burnt or “over it” something happens at work and I am immediately drawn back in.

I don’t think that the ICU is better than the ED or vice-versa. The skill sets needed for each specialty are different and the patients you meet and treat are also different. Ultimatley, both are stellar options and offer great options for career growth and the coveted ability to work on any unit after working there.