Should Emergency Nursing be part of the Critical Care Nursing Specialty on this site?

I've also noted you say that a majority of the pts "I see aren't critical." Well, we all work in different EDs and I rarely see a pt who isn't critical. Yeah, when I am triage, I see a lot of the "unsick" but when in the back most of my pts are very critical. The unsick get fast tracked. A new grad started last week and on her first day out of orientation she had 5 rooms: 1 NH pt in severe resp distress and unknown code status (lucky she was DNR because she did go) , 1 GSW to abd that just rolled in hypotensive and with abd distention, 1 Spanish only speaking woman in active labor, head crowning and "WE DON'T DO OB AT MY HOSPITAL!" , and an ICU hold boarding in the ED pending room assignment, and she was unable to recall her last pt's chief complaint. She told me all this the next day and I hugged her and told her to just laugh because it is just that asinine. I mean honestly, she didn't stand a chance in those circumstances. She did have 1 other nurse who was able to help but everyone else had their own sick pts. That's typical of my ED. Maybe it's not considered "critical" for some reason, but it is some kind of specialty! She even came back to work the next day. I was so proud!

I say, until we start doing Swan's, and shooting cardiac outputs, and titrating fluids to the CWP and/or balloon pumps or managing ventricular shunt drainage for more than a couple of hours, it is not "Critical Care".

At times the acuity can elevate to critical care levels for a while, but it doesn't remain there.

Oh, and if you ARE doing all the above in your ER, you need to be very careful of your practice of nursing, cause you probably don't get the required inservicing or continuing education/competency training to do the above.....

ER (actually ED) is it's own niche I believe, it is a mix of:
(1) Primary care
(2) Acute care
(3) L/D-OB/GYN
(4) Peri-op
(5) Psych
(6) Peds
(7) Trauma
(8) Some Critical Care.

If you look at the CEN (Certified Emergency Nurse) core competencies, they don't even go into central lines and such. Pretty much the only critical care there is vents and ACLS type critical care. I reference the Emergency Nursing Core Curriculum because if you were to write a job description and competencies, something like that would be your guide.

ER is it's own specialty. With GPU and ICU mixed in.

What I like about picking up shifts in the ICU is that I have a whopping TWO patients to care for, TWO. In the ER, I'll have up to 5 at a time. Our admit percentage is 72% so we see a lot of sick patients. And as far as "clinic patients" they go through fast track, so we don't have the luxury of treating those folks in the main ER.

One night last week in the E.R. I had a subarachnoid vented pt awaiting an ICU bed, another ICU pt who was on Levo along with a faulty pacemaker/Difib, a telemetry pt (3 previous MI's) who was on Cardene as well as an insulin drip who must drink prune juice and mag citrate by the gallon it seemed, and a Lower GI bleed admitted to the floor who's was getting 2units of blood all at the same time. Everyone's on the call light (except for the vented pt of course) for various things, have to change sheets because they are soiled (We don't have the luxury of rectal tubes like we have in the ICU.), MD calling to give verbal orders, pain meds, etc...

And the entire time I couldn't help to think how if I was only in the ICU, I'd have two of them. Half of these people I had to work up, start lines, get labs, intubate, throw in NG tubes, foleys, etc. We don't have all the work done for us like I do in the ICU, we initiate everything, we even stabilize them before going to the unit, all is needed then is to maintain. Luckily for me we were completely saturated up stairs with zero beds available in the house so I took care of all FOUR patients the entire 12hours of the shift. But that's life in a busy E.R., I guess those critical patients I take care in the ICU magically become "critical" when they get on the unit because E.R. nursing doesn't involve critical care.

I do find it odd we have lots of ER nurses who pickup shifts in ICU, yet the ICU nurses "looking to make a change" never last long in the E.R. They typically make comments about the "workload" and "their feet hurting from standing" in the ED. I guess they must be bored from the slow pace and overabundance of clinic patients we see down there.

Does the organization of a internet bulletin board really matter in the long run?

I was an ED nurse that maintained CCRN status. It doesn't matter a hill of beans to me where the "Emergency Nursing" thread is...just as long as there IS one!

Turning the argument around...We (as a whole) complain about people abusing the ED for primary care needs, pregnancy tests, and narcotic fixes. Can we really say we're "Emergency" nurses, when a good portion of our patients aren't true emergencies?

Go ahead...I'm wearing my bunker gear for the flames!

The fact that we manage the care of pts who are so acutely sick that they need and eventually will have the above interventions mentioned, and despite the fact that I don't have the benefit of having these specialized devices activated yet, that aid in pt care via accurate and sophisticated monitoring equipment and aid in myocardial tissue to pump, etc, etc, etc confirms in my mind that I do treat critical pts, necessitating that my nursing be called critical and "specialized."

Also, at my hospital a central line isn't such a big deal that it is placed and managed only in the ICU. Some of your other examples are bogus because they would only be placed after or during a special procedure and not done at the bedside. This means they are done out of the ED and the pt wouldn't return to the ED for the ED nurse to manage, making it irrelevant to her practice and therefore her supplemental education.

Have you seriously never boarded multiple ICU pts at the same time in the ED over the course of days? A nurse, is a nurse, is a nurse....


And one more time, my ER triages many not-sick-non-emergent-pts but that doesn't mean that they are ever in any of my beds. My pts are always SICK!

Actually ED should be in its own spot, neither critical care nor nursing specialty. We deserve our own section as we are all so obviously one of a kind.

Maybe Critical Care shouldn't have it's own special spot under specialties. After all, they are just another specialty with the rest of us. Click on specialty tab and the list comes up with ICU, CCU or whatever CU's you want under the same as the rest of the specialties.
Maybe the real question is, Why are they more special than the other specialties?

I think a lot of hairs are being split for no reason.