ICU vs ER Nurse: Decoding the Critical Differences in High-Stakes Environments

by | Aug 13, 2019 | Critical Care | 1 comment

Both ICU (Intensive Care Unit) nurses and ER (Emergency Room) nurses work fast-paced jobs that require them to think quickly and treat patients with very serious diagnoses.

ICU vs. ER Nurse: Decoding the Critical Differences in High Stakes Enviornment

ICU vs ER Nurse – Major Differences

While the two have a few similarities, there are many more differences. Before you read more about each job, let’s look at their most apparent differences.


The ER Nurse ➡️ Stabilize the patient, identify the problem, and get the patient where they need to go. The patient could go home, to a different facility, or a unit in the hospital.

The ICU Nurse ➡️ Continuously care for critically ill patients until they are appropriate to transfer out of the ICU.

Patient Load

An ER nurse might see 8 – 40 people on a single shift. However, an ICU nurse will typically only oversee 1-3 patients per shift (if there are no transfers/admissions).


ER Nurses must follow many standard algorithms and protocols for patients who walk through the door. These include things like chest pain, sepsis, abdominal pain, stroke, etc.

While an ICU nurse has protocols to follow, there are not nearly as many.

Types of Patients

While critically injured or sick people arrive at the ER, that isn’t all that come in. Emergency Room nurses experience various acuity levels – from minor injuries to life-threatening ones. An ICU nurse only manages critical patients.

These are the significant differences between ICU nurses and ER nurses. Now that you understand their differences, how do you decide where to work?

Let’s look at each one individually and discover what they do and their regular responsibilities.

What Does An ICU Nurse Do?

An ICU nurse has specific roles and responsibilities during each shift. I explained this job in detail in my “What Do ICU Nurses Do?” post. It’s an in-depth look at a typical shift for this job, from beginning to end.

To summarize, a critical care nurse works in the Intensive Care Unit (also called the Critical Care Unit). This nurse provides nursing care to critically ill patients. They are responsible for direct bedside care, monitoring, and responding to changes in condition.

In addition, this nurse is also responsible for communicating with providers and other healthcare team members, as well as with families, about their loved ones and the patients themselves.

Communication with everyone can be difficult. An ICU nurse explains complex medical conditions to laypeople, who often have little healthcare experience or previous understanding.

ICU Nurse Responsibilities

Let’s cover the most common responsibilities of an ICU nurse. These include:

  • Monitor the patient’s condition, which becomes very complex as patients become more unstable
  • Oversee and provide care to the patient
  • Administer medications, which often includes managing and titrating drips, and evaluating the response
  • Perform procedures
  • Communicate with the patient and family and provide support to them
  • Assess the patient’s and their response to treatment, suggesting changes as necessary
  • Use high-tech equipment to provide quality care for the patient
  • Stay educated on the latest evidence
  • Document appropriately

Also, ICU nurses typically specifically care for one patient population. This could mean all adults (a general ICU), neuro patients (neuro ICU), patients recovering from organ transplants (transplant ICU), cardiac issues (cardiac ICU or coronary care unit), pediatrics (pediatric intensive care or PICU), and more.

Check out my ICU nurse master post here!

What Does an ER Nurse Do?

We have a comprehensive blog post that outlines a typical shift in the emergency department if you would like a plethora of details. Check that out here.

Their responsibilities encompass a wide spectrum of patient care. ER nurses manage a diverse array of cases – from individuals with minor ailments like colds or headaches to those facing life-threatening emergencies. Their role involves conducting focused patient assessments, administering medications, assisting with lab work and other diagnostics, and collaborating closely with physicians to develop and implement treatment plans.

A notable aspect of an ER nurse’s job is the sheer unpredictability and variety of cases they handle in a single shift. They must be prepared for any scenario, as there is no way to anticipate who will come through the door next. This environment demands medical expertise and the ability to manage multiple patients efficiently and effectively. The ER setting is dynamic and often high-pressure, requiring nurses to be quick on their feet and meticulous in their care.

ER Nurse Responsibilities

ER Nurses have a long list of responsibilities. As varied as this job is, these are the main responsibilities:

  • Triage – assess and decide which patients will be seen first and in which order
    • Important note ➡️ Triage is a skill that is for advanced ER nurses. New ER nurses will not be responsible for triage.
  • Take vital signs and complete focused assessments
  • Administer medications
  • Emergent life-saving measures like assisting with rapid sequence intubations, cardiopulmonary resuscitation, and more
  • Educate patients and family members – help them understand the importance of the treatment plan
  • Discharge – send patients on their way after they are treated as appropriate
  • Communicate with providers, colleagues, and patients
  • Transfer – getting patients safely admitted to a nursing unit for further care and evaluation

One of the biggest differences between ICU vs ER nurse is the patient population.

Unless the hospital you work at has a specific emergency department for kids, most ER nurses must be able to care for patients of all ages (from birth to geriatrics), while ICU nurses have a more specific patient population under their care.

ICU vs ER Nurse: Final Thoughts

If you’re trying to decide which unit would be best for you, here are major considerations:

The ICU nurse will provide highly detailed care on fewer patients who will all have a similar level of complexity and similar chief complaints. An adult ICU nurse isn’t going to take care of a 10 year-old, or a patient in active labor. Pneumonia, sepsis, ARDS, gastrointestinal bleeds, and kidney failure are all common ICU diagnoses.

You may care for the same patient(s) for many shifts in a row. This playing the long game, as you are not constantly trying to get people discharged or admitted. While ICU nursing is intense and patients are very sick, it is more predictable and controlled than an ER setting.

The ER nurse will care for MANY types of patients. There is much more unpredictability, which some people really enjoy. You may have 4 “easy” patients and then a major trauma roll through the door. You may care for kids, elderly, infants, or people with serious mental health needs, interesting cases, and more. The care for these patients will be a matter of hours, not days. The ER is more of a short game.

I hope this helped you in your quest to learn more about ICU vs ER nurse! Did you have trouble picking one? What are your challenges and questions? Share them in the comments!

ICU vs ER Nurse – More Resources

Picture of Kati Kleber, founder of FRESHRN

Hi, I’m Kati.

Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

Connect with her on YouTube, Pinterest, TikTok, Instagram, and Facebook, and sign-up for her free email newsletter for new nurses.

1 Comment

  1. Katie

    I’m applying for a rural ED new grad position tomorrow and it’s literally the speciality that scares me the most. Yet, I entered this field to GROW and LEARN! What better way to do it than to challenge yourself right out of the gate. It won’t be the only position I apply to but I’d certainly be happy to get it.



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