Major Differences Between ICU and Emergency Nurses

When a patient’s condition can suddenly worsen at any moment, facilities turn to one of two units: Emergency nursing or ICU nursing. These HCPs focus on timely and specialized expert care to these critically-conditioned patients, under pressure and time constraints. Both are high-in-demand positions that form the backbone of any good healthcare facility. While demanding, these professionals are compensated accordingly for their expertise. Though similar at first glance, there are numerous key differences you must consider before committing to either path.

Immediate Response vs Continuous Treatment

ER Nurses are trusted to assess patients quickly and accurately, in order to identify the best way to stabilize their condition while minimizing pain. Cases can range from hard falls, to gunshot wounds, to severe heart attacks and more. Certified Emergency Nurses (or CENs) must keep themselves on their toes, since anyone can be admitted to the ER at any given moment. Emergency room nurses also communicate and collaborate within a team, to isolate the issue and devise a care plan as quickly as possible. By the end, either the patient has either made a full recovery or they have stabilized enough to be transferred to another unit.

Conversely, ICU nurses provide more continuous treatment for the critically ill. Admissions are often booked in advance, and nurses are given time to operate. By crafting detailed care plans, they involve themselves in every step of the process. Bedside care is provided as they prescribe treatments and medication dosage. During this process, they have to monitor patient conditions and immediately respond to sudden changes.


ED nursing is a wide-encompassing role that covers a varied list of responsibilities, including:

  • Triaging cases (arranging patients in order of priority)
  • Setting broken bones
  • Applying stitches and sutures
  • Working with other ER nurses to stabilize patients
  • Administering IV drips and medications, with physician approval
  • Making and updating patient records

Even in a more controlled environment, ICU nurses have a similarly long and broad scope of main responsibilities:

  • Commencing treatment and monitoring doses
  • Handling patient records and transfer paperwork
  • Closely monitoring recovery progress and reporting condition changes
  • Updating family members in a comprehensive, understandable manner
  • Overseeing patient recovery by creating care plans

Work Environment

ICU and ER Nursing have very different workflows. CEN nurses are expected to thrive in a fast-paced, frenetic environment. In one shift, they typically handle 8-40 patients. Emergency room nurses must also triage as quickly and accurately as possible, to smoothen operations. Once their condition has been assessed, they must follow a quick, efficient and algorithmic protocol. These protocols cover problems such as chest pains, head injuries and more. It is a hectic work experience for nurses who want to work on their toes.

By comparison, ICU units are far more organized and deliberate. Their shifts are much more planned out and structured than an ER Nurse’s. They cannot proceed without input and orders from the ICU physicians. ICU nurses are also not as meticulous as certified emergency nurses in following protocol. They can take their time to assess and adapt. It also helps that they usually work with one to three patients per shift.


As per, ICU nurses have a higher median salary at $78,200, compared to the ED Nurse’s $68,113. Both also have smaller low-end salaries ($63,490 vs $56,379) and significantly larger high-end estimates ($91,191 vs $82,481). While the pay gap is not drastic on paper, keep in mind that education, additional certifications, years of experience and even your location will affect your pay no matter what.

Go Out There!

Whether you are an emergency nurse or an ICU nurse, you will have to learn to work in a stressful, time-sensitive environment. Your nursing abilities, communication skills and your quick thinking will be put to the limit. Yet in the end, you will be rewarded professionally and financially. The right path for you depends on your career priorities and preferences. Consider the key differences we have covered, and consult ICU and CEN nursing specialists who can provide you with both practical advice and perspective.