ER New Grad- ICU holds in ER - Is this a normal situation in the ER? - page 3

by rlunay21 3,827 Views | 28 Comments

Hello Everyone, My employer plans on cross training me to be in ER, ICU, and Telemetry Units. My first stop is the ER. I finished 2 months of RN orientation and am currently on my own in the ER. This one particular busy day in... Read More


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    If you are smart please heed my advice. Please do a yr there and get the heck out. Please go back to school or find a easier job. That sounds unsafe. You are working like a dog. MD's should consult with each other. Crazy. If you are smart you will try to advance your degree or find something easier. Best of luck to you in the mad house.
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    Quote from prep8611
    Not that you don't have any idea but you don't have A lines, cvps, and hemodynamic monitoring systems so you shouldn't be expected to really understand whats going on. You guys get basic vital signs that shows you 5 values so how can you possibly take care of a patient who if in the icu we would be monitoring up to 10 values.
    I agree with Nurse onaMotercycle, lets not start a whole different fight. Its just you need to know that not all ERs are alike, in mine we do often have A lines, the CVP etc.; and we do titrate all sorts of drips. Just sayin'. Many of us also have critical care experience. We respect our ICU nurses! but if we wanted to be doing that all the time, we would't be in the ER.

    This is about the OP being given far more to do than reasonable or safe, rising to the task, doing a magnificent job, and getting yelled at for a missing lab draw.
    rlunay21 and Pixie.RN like this.
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    Welcome to the ER. It's a dumping ground. The flow of patient's never stop. Unless you've done it, you have idea. To answer another's post maybe a more seasoned nurse didn't take the patient because she had a couple of her own ICU holds.
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    Let me just say, IT GETS BETTER!! I am going on 6 months as a new grad without healtcare experience in a busy ER. We FREQUENTLY hold ICU patients in our ER because we don't have beds available. I'd say this... If you feel overwhelmed, tell your charge nurse. Ask her/him to review your charting/orders to make sure you have done as much as possible in the ER. In our ER we do STAT admission orders (Antibitoics, breathing txs, BP meds if needed, tests, labs, etc). I wouldn't worry too much. You are not expected to get all the admission stuff done! I'd say make sure the pt is stable, chart sedation and basic stuff that shows pt care is being provided. Make sure tests needed are ordered by ward clerk (EKG's, labs, wounds, cultures, influenza swabs, ua, etc). I would verbalize to admitting Doc things that need to be adressed like wound consults, etc. We don't acutally initiate these consults in our ER... Just remember, you are new and learning, and dont be expected to know EVERYTHING. I feel SO MUCH better after 6 months exp and it gets better each shift. I ALWAYS tell my charge if I feel overwhelmed or out of my scope of practice and ask them to review pt charting, nursing notes, and orders to make sure I have what is needed. I CHART THIS TOO. Sometimes you can only do what you can do... I remember going home one night after having an ICU pt and realizing I never had "orders" for the NGT I placed, never charted "sedation scale" (IE Ramsey, etc), BUT, I did an excellent job of charting pt status, vitals, sedation according to protocol, ER and admission orders, etc. I talked to my charge and was praised for such an excellent job. Just remember, you will get better with time! In the meantime, do what you need to protect your license and ask for help when needed! Hope you find the transition gets easier!
    NurseOnAMotorcycle likes this.
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    Quote from happyinillinois
    Welcome to the ER. It's a dumping ground. The flow of patient's never stop. Unless you've done it, you have idea. To answer another's post maybe a more seasoned nurse didn't take the patient because she had a couple of her own ICU holds.
    Unfortunately that was the case--all the other veteran nurses had their own pt load -- it was funny because i was just about to send my ICU pt to the unit--and then all of a sudden--BAM! we had to intubate another patient --and obviously that only open ICU bed (that was originally mine) had to go to the vented pt.!
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    Quote from JBudd
    I agree with Nurse onaMotercycle, lets not start a whole different fight. Its just you need to know that not all ERs are alike, in mine we do often have A lines, the CVP etc.; and we do titrate all sorts of drips. Just sayin'. Many of us also have critical care experience. We respect our ICU nurses! but if we wanted to be doing that all the time, we would't be in the ER.
    I agree- not all ER's are alike- in my hospital (if there is no other choice) --there are times we have to set up the hemodynamic monitors in the ER--I actually had to set up the CVP monitor down in the ER when I was a new grad and I thought it was pretty complicated! --Nonetheless, I do respect my ICU nurses and I ALWAYS reference to them whenever I have questions about my drips!
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    Quote from NJnewRN
    If you are smart please heed my advice. Please do a yr there and get the heck out. Please go back to school or find a easier job. That sounds unsafe. You are working like a dog. MD's should consult with each other. Crazy. If you are smart you will try to advance your degree or find something easier. Best of luck to you in the mad house.
    I agree that my Hospital doesn't have all the resources that we should have. We don't have a secretary to help deal with phone calls and help with paperwork - and our Charge Nurse functions as a triage nurse! So if we got a crazy number of people waiting to be triaged --it is hard to ask for help from the CN! There are plently of times where I had to triage my own patients! --thats just how the department does it :/ --but im glad to say that I am currently in school to pursue a higher degree! Sometimes juggling work as a new grad and dealing with school is so tiring - but i know it'll be worth it!
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    Quote from canoehead
    If I was your boss I'd congratulate you for making it through. There are a lot of systems issues I see in your post, and nursing can't be expected to pick up the slack for everyone. Docs need to make their own phone calls, the middle man just introduces errors, and they KNOW that. If they hold an ICU patient and you're still covering ER beds, then all the in depth ICU niceties aren't gonna happen. As a new grad, you're still learning about what is and acceptable load, and you did more than your share on this shift.
    Yes, I agree! Sometimes I feel like the MDs are treated like GODS and its so annoying! Sometimes I feel like saying to the MD "You got your own set of legs and arms--you can grab your own chart!" But i hold back cas Im still new HAHA
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    Unfortunately, my ED will sometimes hold ICU, TICU patients. And I hate it! It sounds like you tried to do your best and that y'all were slammed, the only good thing that my ed does is that when we have to hold the criticil pts we can close part of the ed that is set up as a major room and use those rooms to hold but we group all those pts together BUT its usually still only 1:4-5 and if your lucky you may have a tech. BUT the bad part of that is that you then occupy those major beds and the major assignments can then be quickly over filled and then you have the dreaded "hallway patients". Again, sounds like you were doing good trying to hang in there, and your going to make difficult decisions about what needs to be done first. Don't sweat the "telling of the charge/boss". You did what you could and your only one nurse


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