Why are emergency nurses not considered critical care nurses?

[JessicRN]

Just an observation but why are emergency nurses not considered critical care nurses? Who deals with more critical patients? We work on the same patients although we take care of more critical patients at one time on many occassions. We do the many of the same procedures (internal pacemakes, arterial lines,burr holes). We give the many of the same drips (dopamine,neosynephrine). We have the same education need the same prerequsites (ACLS PALS, arrythmia interpretation). If you work in an ED that has Pediatrics dept then you need to know more because we are dealing with completly different group of patients with different needs. We monotor many of our patients on telemetry and have no telemetry nurse manning the central monitors. I also can't tell you how many times we have kept patients in the ED because "they were not stable enough to go to the ICU". We are not allowed to sent patients to the ICU with critical low vital signs until we stabalize them. We have to do most of the admission orders before we send them. (put in central lines, start drips,give all IV meds, if we start blood we keep them one hour after we start. We have to address all abnormal blood values).Many times we board ICU patients in the ED many times we recover patients from the OR because there is no PACU nurse afterhours. I love it when an ICU nurse is floated to us. Half the time we give them the most critical person then devide the rest between us because they are totally overwhelmed. I am not saying we are more special then ICU or PACU or NICU nurses but we should at least be considered one of them.

[Dinith88]

Funny thing I noticed about the poll I started is the specialty (majority) of those against putting Emergency Nursing into the critical care forum. Take a look for yourself and see if you feel the way I do.

And thank you Jessic RN for the inspiration to pose that question in a poll. Wonder why we threaten the 'other' critical care nurses so much? I've done the ICU thing and it was much easier work than what I do now; and, it laid the foundation to being able to handle the higher load of ICU patients I now have waiting to go to the floor so the ICU nurse can maintain no more than a 1:2 ratio. You would think they would appreciate our help in keeping their patient load down (giving them the time to attend to the aesthetics)---go figure:smackingf

You should put up a poll "Are ER nurses prediatric nurses?"

You see WAY more sick kids than critically sick patients (children or adults) on a daily basis.

But then you may be threatening the 'other' pediatric nurses.

You see where this is going?

And ICU work is 'much easier'? Whatever, dude. You SO did NOT do real ICU work if you think it's way easier than your current job...

ER nurses specialzie in knowing a little bit of everything...(including a little bit of critical care...a little peds, psych, etc)...and ICU nurses ONLY do critical care.

Another example would be that we should then place IMCU/Step-downs into the ICU forum...as they are all (for the most part) ACLS, take part in codes, and are seeing/interpreting telemetry on ALL of their patients...seems enough 'stuff' to be in the 'critical-care' forum. But...apparently they're not as concerned about their cyber-image on allnurses...

THIS THREAD SHOULD HAVE DIED A LONG TIME AGO...

(Or i should've stopped peaking in on it and all the insecure image-inefiority-complex-having people who are way cooler than the slow-paced lazy ICU nurses who have easy jobs... )

Phew.... i need some coffee i think...

[loricatus]

you should put up a poll "are er nurses prediatric nurses?"

you see way more sick kids than critically sick patients (children or adults) on a daily basis.

but then you may be threatening the 'other' pediatric nurses.

you see where this is going?

and icu work is 'much easier'? whatever, dude. you so did not do real icu work if you think it's way easier than your current job...

er nurses specialzie in knowing a little bit of everything...(including a little bit of critical care...a little peds, psych, etc)...and icu nurses only do critical care.

another example would be that we should then place imcu/step-downs into the icu forum...as they are all (for the most part) acls, take part in codes, and are seeing/interpreting telemetry on all of their patients...seems enough 'stuff' to be in the 'critical-care' forum. but...apparently they're not as concerned about their cyber-image on allnurses...

this thread should have died a long time ago...

(or i should've stopped peaking in on it and all the insecure image-inefiority-complex-having people who are way cooler than the slow-paced lazy icu nurses who have easy jobs... )

phew.... i need some coffee i think...

it certainly appears that the only traits more pronounced than your ignorance may be your vindictiveness or arrogance.

[teeituptom, BSN, RN]

how old and how often doesn this thread show up

[JessicRN]

You should put up a poll "Are ER nurses prediatric nurses?"

You see WAY more sick kids than critically sick patients (children or adults) on a daily basis.

But then you may be threatening the 'other' pediatric nurses.

You see where this is going?

And ICU work is 'much easier'? Whatever, dude. You SO did NOT do real ICU work if you think it's way easier than your current job...

ER nurses specialzie in knowing a little bit of everything...(including a little bit of critical care...a little peds, psych, etc)...and ICU nurses ONLY do critical care.

Another example would be that we should then place IMCU/Step-downs into the ICU forum...as they are all (for the most part) ACLS, take part in codes, and are seeing/interpreting telemetry on ALL of their patients...seems enough 'stuff' to be in the 'critical-care' forum. But...apparently they're not as concerned about their cyber-image on allnurses...

THIS THREAD SHOULD HAVE DIED A LONG TIME AGO...

(Or i should've stopped peaking in on it and all the insecure image-inefiority-complex-having people who are way cooler than the slow-paced lazy ICU nurses who have easy jobs... )

Phew.... i need some coffee i think...

Ouch, I any given 12 hour shift, I deal with at least 2 critical patients five or six psych and 5 or six peds and 3 or four minor medical patients. ICU nurses deal with a maximum of 2 critical patients and nothing more. I do not do a little bit of everything. I DO A LOT OF EVERYTHING

[Yvette Acute ER RN]

Wow....alot of anger in here!

I still think the "critical" is defined by the patient, ER nurses and ICU nurses see critical patients, however the ICU nurse is spared the initial "dirty work" of the ER. Most times the foley is in, the lines are in, the blood is hung, the drips are up. I read one poster who stated that ER nurses leaves lines a mess and the patient a mess, whereas ICU nurses keep the lines organized and the patient neat and clean.....well, I could certainly do that on a 1:2 or 1:3 ratio. The mechanics are similar folks, the difference is in the delivery......:biere:

[granite109]

Ok, I had to join in. This critical care issue has been my albatross for years. I have not read every thread, as I do not have all day. I do have this to add. I have worked ED and trauma at the busiest trauma center in PA for 7 years. I am also a flight nurse for a major University center. Either you have it or you don't. You can take some nurses and put them anywhere and they rock. You can take some and they can only function in their given area. ED nurses are NOT intensive care nurses, but they ABSOLUTELY are critical care. Yes, it's a matter of semantics, but I would never profess to be involved in the details that the unit nurses are so intensely a part of.

I have worked the unit-shock trauma. Not cardiac, I admit. So are the burn nurses not critical care because they don't know IABP timing or the mechanics of a BiVAD? It all depends on your definition of critical care. Perhaps the term, "critical care" is antiquated and inadequate.

The hospital can't make the ED critical care because the ratios won't allow it. It's a matter of money and liability. Imagine a bad outcome and the attorney gets up and says to the defendant: "What is your ratio for a critical care area?" The defendant responds, "1:2". The lawyer then asks, "How many patients did your ER nurse have?" The answer: "11". If the ED is considered a critical care area, the hospital is in deep doo-doo. Yes, I have had 11 patients, on more than one occasion. I have had 5 unit patients to myself. A-line, CVP, S-G, ventric, the works. We have turned on side of the ED into an ICU. Don't tell me I am not critical care. I am not intensive care, as I don't do O2 panels in the ED or adjust IABP settings, etc (Vent settings, yes). BTW, many anesthesia schools accept ED in large tertiary and trauma centers as critical care. Oh, and when my patient on shock trauma was having an acute MI that I recongnized, my preceptor, a 23 year "critical care" veteran told me that, "We don't read EKGs on trauma." Mmmmph!!!

[teeituptom, BSN, RN]

I think this is all so amusing. ICU is ICU and ED is ED. We are separate entities. Its hard to make an ICU nurses work well in ED and taking me from ED and putting me in ICU would be amusing. I find amusement in so many sources.

[granite109]

I agree with you, that it is amusing and that I, too get carried away. However, in the institutions I work at, it is an issue due to critical care pay and job opporunity. ED has to do the exact same 6 month CC course and carry MORE certs, but gets no CC pay and is repeatedly told they are unqualified for numerous positions, such as CC float. A new grad can go CC float pool, but an ED nurse cannot even be hired. A few months orientation would do the trick! I absolutely agree that they are separate entities, but you know as well as I, that the ED has a bad rap!

PS-I still love every minute of it though!!!!!!!

[teeituptom, BSN, RN]

I agree with you, that it is amusing and that I, too get carried away. However, in the institutions I work at, it is an issue due to critical care pay and job opporunity. ED has to do the exact same 6 month CC course and carry MORE certs, but gets no CC pay and is repeatedly told they are unqualified for numerous positions, such as CC float. A new grad can go CC float pool, but an ED nurse cannot even be hired. A few months orientation would do the trick! I absolutely agree that they are separate entities, but you know as well as I, that the ED has a bad rap!

PS-I still love every minute of it though!!!!!!!

a 6 month course, wow. Never had that. I cant even imagine a 6 month CC course.

Much rather have a 6 month CCG course. much more interesting.

[loricatus]

I have worked the unit-shock trauma. Not cardiac, I admit. So are the burn nurses not critical care because they don't know IABP timing or the mechanics of a BiVAD? It all depends on your definition of critical care. Perhaps the term, "critical care" is antiquated and inadequate.

The hospital can't make the ED critical care because the ratios won't allow it. It's a matter of money and liability. Imagine a bad outcome and the attorney gets up and says to the defendant: "What is your ratio for a critical care area?" The defendant responds, "1:2". The lawyer then asks, "How many patients did your ER nurse have?" The answer: "11". If the ED is considered a critical care area, the hospital is in deep doo-doo. Yes, I have had 11 patients, on more than one occasion. I have had 5 unit patients to myself. A-line, CVP, S-G, ventric, the works. We have turned on side of the ED into an ICU. Don't tell me I am not critical care. I am not intensive care, as I don't do O2 panels in the ED or adjust IABP settings, etc (Vent settings, yes). BTW, many anesthesia schools accept ED in large tertiary and trauma centers as critical care. Oh, and when my patient on shock trauma was having an acute MI that I recongnized, my preceptor, a 23 year "critical care" veteran told me that, "We don't read EKGs on trauma." Mmmmph!!!

You bring up a very good point about why administration would avoid calling the ED nurse a critical care nurse. Yet, the actual patient load for an ED nurse can and should be considered unsafe when having to juggle more than what an ICU nurse is expected to handle (rather than just avoiding calling it the type of nursing it really is). Maybe a lawsuit lost on the grounds you cite would wake up administration to the unsafe conditions they impose on patients entering in through the ER. I have had IABP patients on hold for CICU beds to open up, A-line, swans, ICP monitoring, etc... while expecting to attend to other critical patients (no peds BTW). If it were not for my prior ICU training I could not imagine being able to deal with the type of patient mix I am expected to handle. I am pretty sure that the ENA had the critical care component in mind when they suggested that the maximum ratio be 1:4 for ED nurses-just that suggestion alone should be enough for a good lawyer to hang the hospital for a bad outcome in the ER on a critical patient who was attended to by an overloaded nurse.

[granite109]

This topic, while heated, brings up many important issues. In my experience, ENA has historically been realistic regarding ratios and considering the CC component.

On an academic note, it seems the term, 'critical care' is an umbrella term, and therein is the problem. Where I work, we have 9 ICUs. Medical, Surgical, Trauma, Neuro, Acute coronary, Open Heart, Burn, PICU and NICU. With the exception of MICU and SICU, each one is highly individualized. It's highly doubtful that a career NICU nurse can drain a ventric or perform interventions on a Licox reading of 18%, with a pyretic patient who has good sats and an increasing ICP. Conversely, you wouldn't see an Open Heart nurse touching a newborn! When specific skills are named, it excludes everything else.

The hospital setting has historically been territorial and competitive. Perhaps the issue here is the lack of teamwork and comaraderie among nurses. Each unit is its own unique place with its own unique skill set. Heck, different ERs have different skill sets. We are a pediatric trauma center, so we see a ton of sick kids. Our sister facility sees a ton of clinic kids. Each one is so unique.

It seems to me that CC is less based on specific technological skills, and more on critical thinking and a mindset. Of course, ICU nurses have a depth of knowledge about a specific area that the ER is precluded from due to volume and a diverse patient population. However, to state that it is not a critical or acute care area is ridiculous! It demeans the work that is done and the skills required to function well in a busy ER. No, not all ER nurses can handle those patients, they turf it to the ones that can. Not all unit nurses can handle their patients either. Either you have it or you don't, regardless of the unit title....and I shall extract myself from the floor of my soapbox!