ER vs ICU, how did we get there? - page 3

Ok... In my hospital the lines have been drawn. I don't like them...the lines I mean. Somewhere along the way the ED has become the enemy of the ICU and I am not sure how that happened. So I... Read More

  1. by   huggietoes
    Well said Pamela g c, my thoughts exactly. I am ER nurse but I also live by the Golden Rule. I have also worked in the units and on floors as a float, therefore, walking a mile in other's shoes, so to speak. I understand the unit's frustrations but they have to understand it is no cakewalk in the ER. And how about some appreciation for diluting the drunks before they get to floors, or the fact that we contend with many other beligerent patients that are not even admitted. It has been my experience at least at my facility, that ICU nurses are the Grand Pubbahs of the hospital, they very rarely get floated even if overstaffed and the supervisors generally tend to take their side. How about a little respect for us that are working on the 'front line' of healthcare. "Dorks" I think not!"
  2. by   Dinith88
    Apologies are in order..i have to clarify the dork thing. I was speaking about a few er nurses i know personally..not all of them.

    And i'm not anti-er nurse either. I suppose the point i was trying to make is that er nurses have alot more (all of it?) control over when report is called. It seems that most of the friction i've experienced w/our er nurses is when we ask them to wait just a few minutes as we're busy (for whatever reasons). The responses we/i SOMETIMES get (huffing and puffing and accusastions and occaisional reporting) are worthy of 'dorkhood'...straight out of 'dorkville'...and as a matter of fact i refuse to apologize for calling these dorks out for what they are....dorks dorks dorks.

  3. by   veetach
    Quote from Medic946RN
    Us ER Nurses are crafty little devils!


    The other day i get this pt who comes in being bagged by EMS. Doc tubes him, goes on a vent etc. Now I have tried to learn to what the ICU likes in their patients and get it all done for them. So I get the Doc to put in a triple lumen subclavian central line, the pt get's a foley, all labs and cultures done, he's on three drips the doc wants another, and puts in a femoral line for rapid fluids,pt's blood glucose was above 1200, he was also septic. We get his BP up to 66/40 which was great since had no bp earlier. I'm told there is a "ready bed" for him in ICU. I call up and give the report. ICU nurse tells me "Oh you have to get that BP up to 100 before we can take him." Naively I ask why that matters. "Oh it's dangerous for him to have the low bp up here." I reply, "No more dangerous than it is for him down here." And I think and maybe less dangerous because his primary nurse will have only one other pt in the ICU instread of three others down in the ED. And since I do both Critical Care Transport and EMS, I'm of the philosphy that some BP is better than none and 66/40 is respectable when you're in shock.
    So I explain to her that we are flowing fluids and have a norepi drip running and the doctor has offered to accompany the patient to the floor to ensure his safety. She replies "He's too unstable." So I say. " Where do you think unstable people go? If he was stable he could go to PCU or med/surg."

    She finally accepted the patient, but I really get a pain from these people. They look down on us in the ED because we don't grasp all the nuances of critical care (supposedly), but when we punt to them for help we get a thousand reasons why the pt is too unhealthy to come up. I mean if they are the "best care" in the hospital, isn't that where the pt is going to have the best rate of survival? I just don't get it. If you're so proud to be a critical care nurse, shouldn't you want to take care of a critical patient? Or is it all about low pt to nurse ratios?

    Medic946, you are awesome! I like your style. Thanks for making me smile and for letting me know I am not the only one with problems like this. :hatparty: I wholeheartedly agree with your opinion. :hatparty:
  4. by   veetach
    Quote from Dinith88
    Apologies are in order..i have to clarify the dork thing. I was speaking about a few er nurses i know personally..not all of them.

    And i'm not anti-er nurse either. I suppose the point i was trying to make is that er nurses have alot more (all of it?) control over when report is called. It seems that most of the friction i've experienced w/our er nurses is when we ask them to wait just a few minutes as we're busy (for whatever reasons). The responses we/i SOMETIMES get (huffing and puffing and accusastions and occaisional reporting) are worthy of 'dorkhood'...straight out of 'dorkville'...and as a matter of fact i refuse to apologize for calling these dorks out for what they are....dorks dorks dorks.

    I know I am doubling back here as far as posting goes, but I HAD to reply to this. Let me see if I get this right, Dinith. ER nurses have "a lot or all of the control "over when report is called? Do you have any idea what it is like to have 4-6 critical patients all going bad at the same time, and only ONE of those with orders for admission? I am sure you dont because if you work in a unit like our ICU or CCU you only have TWO patients at a time, whereas in our ED we have from 5-8!! Anyway, it could be possible that I need to call report immediately (forgive me if it is at shift change, but my paitients do not always choose to become ill or injured AFTER the unit nurses have taken their report), anyway I may need to call report because there is a patient even more unstable that needs this bed. For this I wont apologize, this is just the way the cookie crumbles.

    As for the dork comment, I know a lot of ICU/CCU nurses who fall under this category too. However, I have respect for them and do not resort to labels.

    My advice to you..... dont criticize too much, there might just come the day when an ER nurse will save your butt. think about it.
    Last edit by veetach on Feb 29, '04
  5. by   Dinith88
    Hey Veetach,

    Dork dork dork dork....



    An er nurse may someday save my butt?? Hmm. Well, hopefully they'll call report stat so that i'd get to a floor right away.

    Look, i didn't post here to start a flame-athon, i was responding to this provocative 'icu vs er' thread and I put in my 2 cents. It's ashame that you or anyone else here feels threatened or insulted by the statements i made. I'll just leave it at that.

    I don't really have time to respond to your "i have 7 bazillion crashing patients and you wouldnt know anything about that because you're in icu" comment. It's really begging to be flamed.

    BTW, if you're the only person caring for 4-6 critically ill and crashing patients, your er is way understaffed...and dangerous. Ah well...at least there're doc's at your hip making the calls....we don't most of the time...but you wouldnt know anything about that because you work er. (didnt that sound a little asinine(sp?) )

    (PS, i work with some icu nurses i would call dorks..so your absolutely right about that)...
  6. by   fergus51
    Wow.... I am a total outsider in this (work maternal-child), but I had to take a look! I have worked at some hospitals that had a lot of ER-unit conflicts.... The place that solved it the best cross trained nurses to ER and ICU and instituted strict guidelines for dumping patients.
  7. by   Calfax
    As much fun as it has been to read all the posts full of whining that "My job is harder than your job......" I have to point out that, yo, it's a job....and no matter what you do.....work sucks. Whether you're wiping ass in the ICU or getting puked on in the ER...all things considered, I'd rather be doing something else than going to work.
    Now, before I hear people sputtering in their non-fat latte's...I'm a dedicated nurse who works hard.....and I'd work hard no matter if I work with the trolls in the basement or the bats in the belfry.
    I hear no suggestions on how to make things better. I don't mind working hard, but I hate hard work....and if I can work smarter, then dammit I will. So how to lessen the amount of effort it takes to get a pt out of the ER.
    An enterprising resident at our facility came up with some MS Word templates for admission orders.....discovered that the process went much faster if he wrote his orders at the bedside while doing his H&P. And because everyone could read them...he got more sleep. Soon all the residents were using them. All the nurses could read the orders. Feel the joy.
    By innovating just a little bit, we could all save each other a lot of grief. What if we sent report out over pagers? You can do it with Outlook. What if we all got nextel phones? What if we got rid of all the frikkin paperwork...and the ICU nurses could just pull up the ER stuff on their computers?
    What if we had a sit-down.....ironed out rules for admits, carved them in stone so that both units knew them and abided by them?
    What if we went to work, knowing that the harder we worked, the more we got paid? What if we could bill pt's directly for our services?

    What if we could build a giant tube system with a bed in it? Put the patient in there.....press the button and....fwoop! Sucked away straight to the ICU! With a little midget nurse watch the monitor, en route. While not practical or politically correct.....be fun, tho. :hatparty:

    Cheers.
  8. by   TraumaQueen
    I like the tube system idea the most!

    I work in the SICU, and a lot of times the ED nurses are actually calling report from CT, MRI, Angio..... so, even if it's shift change, it's not like they can hang onto the patient in CT, and there's no reason for them to take them back to the ED......

    In our ED, the nurses all work different shifts, 1-1, 3-3.... so their shift change may not be the same as yours, and they likely aren't even thinking about it being 7pm.

    Getting a patient right around shift change blows, but there's really nothing anyone can do about it. Patients don't time their illnesses around our shift changes.
  9. by   fab4fan
    ICU does not have the joy of walk-in's or people being "dropped off" (as in OD's being tossed onto the doorstep...driver barely slows down). There is more control over the numbers in ICU than the ED. If someone comes staggering in with a stab wound, you can't jolly well say, "Hold that thought. I need to call ICU with report on another pt before they get mad at me."

    A little understanding, please. I wouldn't want to be an ICU nurse for anything; it's a very demanding job. But we all need each other, and I do get a bit peeved at the superiority act.
  10. by   veetach
    Quote from Dinith88
    Hey Veetach,

    Dork dork dork dork....



    An er nurse may someday save my butt?? Hmm. Well, hopefully they'll call report stat so that i'd get to a floor right away.

    Look, i didn't post here to start a flame-athon, i was responding to this provocative 'icu vs er' thread and I put in my 2 cents. It's ashame that you or anyone else here feels threatened or insulted by the statements i made. I'll just leave it at that.

    I don't really have time to respond to your "i have 7 bazillion crashing patients and you wouldnt know anything about that because you're in icu" comment. It's really begging to be flamed.

    BTW, if you're the only person caring for 4-6 critically ill and crashing patients, your er is way understaffed...and dangerous. Ah well...at least there're doc's at your hip making the calls....we don't most of the time...but you wouldnt know anything about that because you work er. (didnt that sound a little asinine(sp?) )

    (PS, i work with some icu nurses i would call dorks..so your absolutely right about that)...
    I have edited this post. I am really sick and tired of fighting and flaming back and forth. Those of you who have the responses emailed to you already know what I originally said, but for those who are just seeing this reply for the first time, please dont ask. Bottom line, there will be dissention and competition as long as there are specialty units. It is obvious that ER and ICU/CCU nurses will never be able to work side by side. How sad, because the patients are the ones who really suffer.

    For those of you who work in ICU/CCU I just respectfully request that when you are getting an admission, please dont stall, it will only make the patient more uncomfortable because they will have to sit in the ED that much longer, it isnt good for them, they should our first priority.

    BTW assanine is spelled a-s-s-a-n-i-n-e.

    Oh yes, Calfax I love the tube idea.
    Last edit by veetach on Mar 1, '04
  11. by   RainbowSkye
    I've always considered the change of shift admission to be kind of like the Bemuda Triangle or a black hole of the hospital. In this day of 12 hour shifts it usually starts about 6am (or pm) and isn't completed until 7:30 or so. Woe be to the patient who has been in the ER for several hours already when the doc finally decides to admit him/her at 6 -they're pretty much guaranteed another 90 minutes on that ER stretcher. At least.

    And I can tell you that I'm often in a hurry to get an admitted patient to the floor because of pressure from the patient, family, significant other and, yes, the attending. (There's pretty much always another patient waiting for their bed, so it doesn't much matter to me.) All of these folks expect a bed to be immediately available when the doc gives the get-go. So I tell them the bed is "not quite ready".

    I do think there could be some answers, maybe. How about having someone assigned to new admissions during shift report (because shift report essentially lasts from the last rounds of the off-going nurse to the first rounds of the on-coming nurse)? I'm not an ICU nurse, but is there one free nurse who could start with the patient at these times? Is it necessary for the admission nurse be the one caring for the patient for the whole 12 hours? I really don't know; I work in an ER where we all kind of jump in together depending on what needs doing.

    Thanks. We're all in this together.
  12. by   RNin92
    Wow...when I asked the question that started this thread, I knew it would evoke some responses...but this ride has been QUITE eventful!!

    I know that ICU nurses work they tooshies off, too.
    I know that med/surg work them off as well.

    That is NOT the point.
    It simply cannot remain "my job is harder than your job" any more.
    There are pts.caught in the middle of this battle of wills...someone is going to die.

    While we are fighting about shift change (WHICH one exactly?) and who has to wipe more butts-a patient is getting minimal care at best.

    THAT is the issue.
  13. by   teeituptom
    Ahhh the dreaded Black hole
    swallows everything up
    but only the pts really suffer

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