Why Critical Care Experience Counts in the ER

“Hours of boredom punctuated by moments of sheer terror.”

That quote was posted in the hospital’s coronary care unit where I worked after graduating from nursing school, oh so many years ago. Later, when I moved to the ICU, I often thought the quote should be reversed: “Hours of terror punctuated by moments of sheer boredom!”

Either way, I have come to believe the best preparation for a career in emergency nursing is a strong background in critical care. I know not every ER nurse comes from that background, and I have seen great ER nurses who have never worked in critical care. However, there are good reasons for obtaining a solid critical care background if your long-term goal is a career in emergency nursing.

First, in a true emergency the ability to think quickly and on your feet has to be second nature. There is no time to look up drugs, to be uncertain or to have doubts about your ability to respond. Experience in a critical care unit gives you experience responding to many different types of emergencies.

Second, it is true there is a team of caregivers in the ER: The physician intubating; the respiratory therapist in charge of the ventilator/suctioning; various staff manning IV lines, medicating, drawing blood and scribing the code…. But once the code blue is done and the patient has a stable rhythm, the team moves on to other duties and you are now managing the care of the patient.

The patient is obviously going to be admitted to the ICU. But, what happens if the bed is not available, or there won’t be sufficient staff until the change of shift, or the intensivist and the neurosurgeon and whoever else is consulting on the patient decide they want to see the patient in the ER?

That critical care patient is now being boarded in the ER, and you are now functioning, for all intents and purposes, as a critical care nurse. That requires being familiar with ventilators and suctioning. It means assisting with the insertion and monitoring of central and arterial lines, and hanging/titrating multiple drips. It means initiating the plan of care as it would be initiated on the unit while the patient is still in the emergency department. Knowing what that plan of care entails, for a variety of different scenarios, allows an ER nurse to function as a competent critical care nurse when called to do so.

There have been numerous times I have been grateful for my critical care background, even today, after 22 years as an ER nurse. That experience has been invaluable to me, and if given the chance, I’d do it the same way all over again.