ICU VS. the ER? - page 4
:idea: To ICU, and ER Nurses: Hi. I am curious to know the difference between ICU Nursing, and the ER. Do the Er people just treat people immediately, and iCU treat over the long-run ...or how... Read More
Dec 14, '06Where I live....nurses are not alot to do squat without consent / order from the docs. They are at the beck and call for the docs....it is bull....but how it has been here since the beinning of the hospital......There are usually 3-4 docs on a shift....and they do call all the shots. I live in a rural / country area.
Dec 15, '06Quote from MLOSI completely agree! I work in an very fast-paced ED where we are encouraged to be autonomous. My patients are usually completely worked up by the time an ED doctor sees them, and almost always medicated for pain, given their first dose antibiotics, etc. through my advocacy. My doctors have worked with me for years and trust my nursing judgement, and will sign off on my orders or take two seconds to discuss medicating a patient although they're still five down in the rack. Same goes for triage. We usually run two triage nurses with a tech, and we order labs, x-rays, meds, etc. from triage.
But this stuff about ICU nurses being more independent & making more independent decisions than ED nurses is killing me ... maybe in your community, non-teaching hospitals where there are no residents, just attendings who breeze in & out once or twice a day. But in my teaching, Level I hospital, the ICUs are just as overrun with hovering residents 24/7 as the ED ... often more so. Where I am, both environments are team environments.
If I didn't "make the decision" to do an EKG, start a line, draw appropriate labs, call respiratory, call CT or x-ray, administer appropriate meds for a fever, give ASA to the CP patient, have a thoracotomy tray ready, tell the doc the pt. has no gag reflex, etc. etc. ... I'd be looked at like I was stupid ... and rightfully so. Also ... we nurses have (generally) 3-5 patients ... the docs are juggling 8-10. They depend on us to assess a pt. & tell them "yes, the chief complaint entered by registration says chest pain, but what she's really got is bilateral, reproducible upper arm pain & some nausea. I've done an EKG & it's a sinus rhythm. No fall or injury to the extremities, so I did not order any x-rays." Or, "the cough in Room 5 is hypertensive, states he cannot remember when he last saw a doctor, & has a family hx of sudden cardiac death. Here's the EKG, I've sent off labs & put in the order for the CXR."
Sorry, but anyone who feels ED nurses are not independent do not understand the concept of triage. And also does not understand that triage is not just at the triage desk in the waiting room.
Then again, I'm a Type A, hyper eager beaver, and not all the nurses I work with do these things. It's kind of frustrating to be efficient and truly trying to help people as quickly as possible when some of your co-workers sit there like trained monkeys waiting on a doctor to tell them to collect a u/a on a female with belly pain!
The ICU and ED where I work mostly get along...we recognize that we're all overworked and underappreciated, and try to help each other out. In fact, at my facility, it's more a ED/ICU/Tele against the rest of the units situation... I realize that the ICU nurses are swamped, they are almost always at capacity. But they realize that due to that, we are almost always holding ICU patients, while also dealing with our own ED patients.
The only time I really see any problems arise is when the patient didn't get good care down in the ED. When you have an ICU hold, you HAVE to try and think like an ICU nurse and be detail oriented...that patient needs constant monitoring, reassessment, you have to make sure your labs, meds, etc. are done on time and interpreted and relayed to the MD if abnormal, and you have to chart all this concisely and usually on MUCH different paperwork than you're used to as an ER nurse. It's a personal source of pride for me to deliver a pt to the ICU and the level of care be up to par. But I've seen ICU patients go up NOT in a gown, or with no vitals charted for 3 hours, or no foley, or the q1hour neuro checks neglected, and if it makes me mad, I can't imagine what the ICU nurse must be feeling!