Frustrating... ED is Not Critical Care - page 4

I've been an ED nurse for 7 years, working at four different hospitals from a tiny, rural, critical-access hospital (as I call it, Level None) through a regional academic medical center (peds and... Read More

  1. by   ILUVERNSG
    Great post!
  2. by   Kaybee1983
    National University accepts trauma ED experience on a case by case basis. It is the mech vent experience they are looking for.
  3. by   2mint
    Quote from KindaBack
    I've been an ED nurse for 7 years....
    We are not Critical Care nurses.
    OP, take your typical sepsis alert patients for example: you draw labs and blood culture and start Abx infusions, then admit the patient. Same with your RSI patients: after intubation and starting drips, you admit the patient. Same with copd/chf exacerbation, Stroke, etc.
    As ER nurses, we stabilize/start initial TX, then dispo.

    This is how my ED works:
    Level 1 Trauma center: a main ER, a fastrack, and a Trauma bay
    I will speak for the main ER

    1. Pts come in, we put them on the monitor, draw labs, send them to diagnostics.
    2. Run IVF and/or medicate for pain, give appropriate meds in the meantime, as warranted.
    3. Labs/diagnostic results will dictate further interventions and appropriate dispo (d/c, admit, or transfer to observation)

    Steps 1-3 happen in an avg of 90 minutes.

    As ER nurses, we receive 'Emergency Nursing' training, which entails BLS/ACLS stuffs: Primary survey (ABCDE) and Secondary survey (H&P). After a year or so, ER nurses will receive additional training in Trauma to work in Trauma bay.

    I'm an ER nurse, I don't do Q2H repositioning or strict I&O (or even I&O for that matter), therefore I'm not a critical care nurse....I kid, I kid...but lots of truth to it, though.
  4. by   Wuzzie
    Quote from 2mint
    We are not Critical Care nurses.
    OP, take your typical sepsis alert patients for example: you draw labs and blood culture and start Abx infusions, then admit the patient. Same with your RSI patients: after intubation and starting drips, you admit the patient. Same with copd/chf exacerbation, Stroke, etc.
    As ER nurses, we stabilize/start initial TX, then dispo.

    This is how my ED works:
    Level 1 Trauma center: a main ER, a fastrack, and a Trauma bay
    I will speak for the main ER

    1. Pts come in, we put them on the monitor, draw labs, send them to diagnostics.
    2. Run IVF and/or medicate for pain, give appropriate meds in the meantime, as warranted.
    3. Labs/diagnostic results will dictate further interventions and appropriate dispo (d/c, admit, or transfer to observation)

    Steps 1-3 happen in an avg of 90 minutes.

    As ER nurses, we receive 'Emergency Nursing' training, which entails BLS/ACLS stuffs: Primary survey (ABCDE) and Secondary survey (H&P). After a year or so, ER nurses will receive additional training in Trauma to work in Trauma bay.

    I'm an ER nurse, I don't do Q2H repositioning or strict I&O (or even I&O for that matter), therefore I'm not a critical care nurse....I kid, I kid...but lots of truth to it, though.
    Salient points 2mint but what about those ICU patients that are boarded in the ED until a room is available? Sometimes for days. This happens very frequently in institutions large and small all over the country. No CC nurses get floated to care for the patient so it's on the ED nurses. Now granted they won't be running CVVHD but not all CC nurses do it either. Multiple drips-check. Ventilated patients-check. Invasive monitoring-check. Multiple meds-check. Q2 hour turns-check. I'm not sure we can say absolutely but it seems to me that ED nursing moves along a continuum that does indeed include critical care. But the bigger question is why does it matter?

    I wanted to add I've been a CC nurse, an ED nurse and a flight nurse. They're all awesome!! Just rock at what you are and don't worry about critics (they're everywhere). If someone puts you down throw them some shade and relax in your own supreme coolness!
    Last edit by Wuzzie on Aug 20 : Reason: Had another point to make.
  5. by   canoehead
    As an ER nurse I only feel competent in titrating drips up, not weaning down. I have seen a Swan, and could run the various numbers, but I don't have much of a clue what they mean. That gentle persistent encouragement over months to push patients just a little more, get a little better, and stay optimistic, that's frigging amazing, ICU nurses are the bomb. I always feel like I don't know how much I'm missing in patient care, like a new grad, when I have an ICU patient. There's a difference between being competent to deal with a vent or art line, and being an expert. I'm just competent.
  6. by   2mint
    Quote from Wuzzie
    ....why does it matter?
    ...I've been a CC nurse, an ED nurse and a flight nurse.
    My level 1 trauma training hospital pays CC bonus, we ER nurses did not get CC bonus pay, so we know that we are not CC nurses. But we argued for and finally got ER bonus pay just a few years ago.

    My ED comprises Psych ED nurses, Observation nurses, Clinic nurses, Flight nurses, ER nurses, Trauma nurses, and MICN's.
    The last three are 'ER' nurses; all seven are 'ED' nurses.
  7. by   JKL33
    Quote from 2mint
    We are not Critical Care nurses.
    OP, take your typical sepsis alert patients for example: you draw labs and blood culture and start Abx infusions, then admit the patient. Same with your RSI patients: after intubation and starting drips, you admit the patient. Same with copd/chf exacerbation, Stroke, etc.
    As ER nurses, we stabilize/start initial TX, then dispo.

    This is how my ED works:
    Level 1 Trauma center: a main ER, a fastrack, and a Trauma bay
    I will speak for the main ER

    1. Pts come in, we put them on the monitor, draw labs, send them to diagnostics.
    2. Run IVF and/or medicate for pain, give appropriate meds in the meantime, as warranted.
    3. Labs/diagnostic results will dictate further interventions and appropriate dispo (d/c, admit, or transfer to observation)

    Steps 1-3 happen in an avg of 90 minutes.

    As ER nurses, we receive 'Emergency Nursing' training, which entails BLS/ACLS stuffs: Primary survey (ABCDE) and Secondary survey (H&P). After a year or so, ER nurses will receive additional training in Trauma to work in Trauma bay.

    I'm an ER nurse, I don't do Q2H repositioning or strict I&O (or even I&O for that matter), therefore I'm not a critical care nurse....I kid, I kid...but lots of truth to it, though.
    I won't argue whether or not we are "critical care" nurses, since I personally don't care.

    And I can't disagree with these written words ^.

    However, I do think words don't convey it; simply listing the scope of our "tasks" doesn't convey what we are really doing. For example, "giving appropriate medications" isn't just that. If it were, anyone who can fog a mirror could step up to an ED gurney and twist this one thing into that other thing and push a plunger full of whatever "appropriate" med the provider ordered. No matter if it is vasoactive or a paralytic or antiarrhythmic or x, y, z ED med.

    Generally-speaking, there's a reason or two that our medication policies, for example, are not the same as the policies on general units. And there is a reason or two (beyond just staffing ratios) that a number of the patients we care for in the ED are not appropriate for general floor admission.

    Listing our tasks tends to severely underestimate the assessment and re-assessment and critical-thinking portions of the ED RN role. In my years of observations, THAT part is what makes the difference between an excellent and mediocre (or even scary) ED nurse. It is where subtleties are recognized and differences are made. I can pick out people who are mostly-task-oriented fairly quickly.

    We do provide care to critically-ill and injured patients. It is different than CC Nursing. Each have their own place and thus their own merit.
  8. by   2mint
    Quote from 2mint
    W
    2. Run IVF and/or medicate for pain, give appropriate meds in the meantime, as warranted.
    Quote from JKL33
    ...For example, "giving appropriate medications" isn't just that.
    We're ER nurses; we know what we do.
    These three steps are just a down&dirty snapshot of what goes on in the ER for non-ER nurses.

    Based on your selective quotation of me, I agree with your objection.
    Based on my full quotation of me, I disagree with your objection.

    Here's why: your objection is that I am omitting the critical thinking aspects of our job.
    Look again at the full quotation, those subtle and somewhat sexy two words "as warranted" encode said critical thinking skills.

    E.g. This Pt is very tachycardic, let's give some meds to control the HR.
    Appropriate? Yes. Warranted? Let's see: the Pt is also very hypotensive. So, no, it's not warranted.
  9. by   JKL33
    Edit/nevermind. I didn't mean to offend. I don't understand what point you are making in the post that I inadvertently incorrectly referred to, and don't want to cause any further offense.
    Last edit by JKL33 on Aug 20

close