ED Admissions

NCTraumaNurse · May 8, 2009

I'd rather ICU stay out of my dept...you stay in your corner and we'll stay in ours except to transfer of course. My fear would be for the ED length of stay to increase because the ICU nurse wants to implement an admit med or intervention that could be done up in ICU.
You guys up in ICU get to take your lunch, give your meds, finish your bedbaths etc before we can even think about bringing the patient up and then you have the nerve to complain when we think we are ready to bring them and something comes up to delay transfer...sheesh...must be nice! Try telling an ambulance you have to take lunch before you can take their patient...lol!

Having been in both positions, (ED and ICU) I found that I often missed lunch in the ICU and I often miss lunch in the ED. It is interesting how one area thinks another "has it made".... I used to tell my co-workers that we would need to "walk a mile in their shoes" before knowing how easy their job is.... That should mean that the nursing home RNs would have the easiest job on the planet, right, don't their patients just "sit there"? (I do NOT feel that way, I imagine that to be among the most difficult nursing positions out there, I couldn't do it, and I am so glad that there are people who can!).... Each area of nursing has it's own difficulties, and I hope that someday we can all appreciate what the other one does. Kinda like the day shift vs. night shift thing, each one thinks the other has it easier.... Peace!

chare · May 8, 2009

At my ED we are trying to implement a new policy where the ICU nurse comes to the ED to transport their patients to floor and recieve bedside report. Our tech aids in transport. I am currious to the process at your hospital for getting patients to the ICU

For the most part, in every ED I have worked in, it was the ED Nurse's responsibility to transport the patient to the ICU. In my last ED, the only exception was for patients going to CT before going to the ICU. The ICU nurse would bring the bed to CT and receive the patient there. However, this was for patient convenience and to better facilitate patient transfer, not for nursing convenience.

I too cannot imagine leaving the ICU, and any patient I have to transport a patient up to the unit. At my facility it is a combination of RN and medics that bring the patient to the unit.

Yes, I see your point....please see mine. I do not like leaving my 3 ESI/2 patient(s) to transport a now stable patient to ICU, but it's part of our protocol and we do it. It can get quite scarey sometimes....Luckily you speak of only one patient whereas, I have 3 or more.....We all work hard don't we. ....my new saying is....come on down to the front door of the hospital.....It's the ER!

Not all patients in the ICU are high acuity patients requiring constant nursing care. Just as every patient in the ICU is not a high acuity patient, not all patients in the ED (even those classified ESI 2) are high acuity patients. If one of your patient's requires transport off unit for a procedure someone is going to cover your patients while you are gone. Transferring a patient to the ICU or going to the ED to retrieve a patient is no different. Again, it's just a matter of the two nurses talking to each other to see who is best able to facilitate the transfer.

I'd rather ICU stay out of my dept...you stay in your corner and we'll stay in ours except to transfer of course. My fear would be for the ED length of stay to increase because the ICU nurse wants to implement an admit med or intervention that could be done up in ICU.

If I come to the ED to transfer a patient, I am not going to implement any ICU medications or interventions, I can do this much better in ICU where I know where everything I need is located. If the patient has an airway and can be ventilated, and their circulatory status is relatively stable, I'm out of there.

You guys up in ICU get to take your lunch, give your meds, finish your bedbaths etc before we can even think about bringing the patient up and then you have the nerve to complain when we think we are ready to bring them and something comes up to delay transfer...sheesh...must be nice! Try telling an ambulance you have to take lunch before you can take their patient...lol!

When the room is clean and ready, I am going to call you for report. My expectation is when we hang up the phone, you are on the way. I can give meds and whatever else I have to do for my other patient after I receive the patient from you and get them situated. I would appreciate a call from you if you are not immediately on the way so I can take care of my other patient.

We all work hard to provide the best care possible for our patients. It's easy to see that in our unit, but sometimes not so easy to see or believe about the other units. Unfortunately many ICU nurses have never worked ED, and many ED nurses have never worked ICU. As a result we often lack appreciation for what these nurses do.

Who transfers the patient should not be graven in stone. Personally I think that the ED nurse is probably the best person to transport the patient the majority of the time. However, as I mentioned earlier, this doesn't mean that as the ICU nurse I should never be expected to help with the patient transfer. All it takes is a little communication between the nurses, and never forgetting what's best for the patient. :twocents:

C-DIFF PHIL RN · May 8, 2009

the only time we would leave the unit to come get a er patient is if you have no pt's assigned to you and your assistance is not needed at that time and if a super major trauma (plane crash) has just been called. the attending er nurse and a er tech brings the pt to the unit. they would have a very hard time trying to start a policy like that at my hospital and at the part time position i have in their unit i think the unit director would have a stroke if they tried to implement that.

nobody comes to our unit to get patients that we transfer out. we have to push them out ourselves. heck...the way i see it is if you want them out of your unit then you find a way to get them where they need to go.

RN Joe 86 · May 10, 2009

Hmmm, that's interesting to hear. I can understand the benefits of recieving report from a nurse in-person. However, leaving your own unit to recieve another patient makes little sense to me since you will likely have other acute patients to tend to. I work at a Level 1 Trauma hosp. and we recieve all ED admits by an ACLS RN (Maybe 2 if needed) and ED tech. Respiratory meets us in the unit room, programming and setting up the vent. Honestly, I've never seen any of the nurses complain about NOT recieving report face to face with the ED nurse.

cardiacRN2006, ADN, RN · May 10, 2009

I do not like leaving my 3 ESI/2 patient(s) to transport a now stable patient to ICU,

Lol, I missed the part where they are 'now stable'. Usually, it takes me hours to make the pt stable....

dorie43rn · May 16, 2009

Our staff in the ICU would laugh that suggestion of an ICU nurse coming to the ER to get the patient. The ER tried a thing with us that they use for the floors. Send a SAR, then bring the patient to the floor. NOT! The ER has to call report to us, then wait till we tell them we are ready. I cross train in the ER, and I know they are busy most times, but with a 4 p

dorie43rn · May 16, 2009

Our staff in the ICU would laugh that suggestion of an ICU nurse coming to the ER to get the patient. The ER tried a thing with us that they use for the floors. Send a SAR, then bring the patient to the floor. NOT! The ER has to call report to us, then wait till we tell them we are ready. I cross train in the ER, and I know they are busy most times, but with a 4 patient load, THEY can have someone watch their patient while the nurse and tech bring them up one floor to the ICU. We already have to take our patients on road trips, go on codes and rrt's and are downstaffed to minimal nurses, no aides and no clerks, ARE YOU KIDDING??? Do the ICU nurses a big favor, and throw you suggestions right out the window.

Dinith88 · May 16, 2009

I was invited to check out the responses to "ED admissions" by nrsang97 who recently visited the ER nursing site and voiced her opinion about a new policy her hospital instituted..... (having the ICU nurses come to get their patient from the ED). I must say, I thought there would have been much more discussion on this issue on this CCN site other than 2 responses before me. nrsang97 made it sound like there was actual debate and conversation going on. Frankly, she was rude and insulting on the ER thread. I got the impression she needed the ole 3 vacation days with a mimosa in hand somewhere on the shoreline.
I see now....there really isn't a debate.....
I think we all work hard, and in general overworked....I think it's a managment issue myself and feel it wrong that there now seems to be a ERRN vs ICURN issue here.
I know from my own experience.....I'm never afforded the luxury of an empty room less that 3 minutes, the amount of time it takes for me to wipe the bed down, and prepare for my waiting EMS stroke/MI/MVC/Resp Fail/Full Arrest....etc.....let alone the bogus drug seeker, the drunk the police brought in, the hang nail from triage....constipated for 2 weeks (ick...manual dissempaction in my future) lady partsl bleed, omg and the list goes on. ...sometimes not even 3 minutes.
She was actually quite rude and insulting....
We all work hard......we all deserve a break....and as I said in the ER nursing forum....It shouldn't be ER vs ICU RN....it's managment who doesn't care. If she is forced to be in charge, take a load, and pick up patients for admission or other transport.....it's not the ERs fault....it's the hospitals management.

Yes...but...ICU nurses are still cooler than ER nurses.

Dinith88 · May 16, 2009

Lol, I missed the part where they are 'now stable'. Usually, it takes me hours to make the pt stable....

Thats cute and comes from a misunderstanding of critical-illness. I think, though, the OP is speaking of certain situations when the patient is in fact stable but being sent to ICU anyway.

Regardless...ICU patients are the sickest in the hospital...no matter what the busy-as-all-get-out ER nurses think...and pulling ICU nurses to transport is pulling them away from other critically sick patients and is bad practice. But...i dont see any harm in a not-busy ICU nurse goin down to help a very-busy ER nurse with transport. Or...if the patient is very unstable and likely to code in transit i can understand wanting ICU help.

The problem (in my mind) arises when the ICU nurse is in 'busy' mode attending to another critically sick patient and is then expected to transport...which is why instituting a 'policy' that dictates ICU ALWAYS transports ER patients would be a bad policy.

labcat01, BSN, RN · May 16, 2009

Yes...but...ICU nurses are still cooler than ER nurses.

LOL!!!

I don't get what the issue is- the ER nurse calls report and if they get delayed what's the BFD? It's better for the ER nurses to bring the patients to ICU. In the ER at my hospital, the nurses usually have 4-5 patients of their own and most everyone is running to the traumas and codes- the nurses are ALL OVER THE PLACE.

If I had to leave the ICU to come get my patient and then have to search all over to find the nurse and get report, I'd be pretty ticked. You know the saying "if it's not broke don't fix it"? Our current system isn't perfect but it's good enough!

criticalHP, MSN, RN · May 21, 2009

Let me play devils advocate...
If we went down to the ED we'd have better control of when the pt comes up. If we are the one getting the admit hopefully your charge assigned you a pt that wasn't terribly ill. Plus maybe there will not be so much frustration between units.

I like Devil's Advocate too, but tonight I'm sticking with my ICU buds. As a charge I can't make asignments based on what may come through the ED doors. I have open beds (hopefully) and a nurse that may get one fairly stable patient and the admit. But, ICU being what it is, these patients are critically ill and things can change in a hurry. Out of an 18 bed ICU I may have one empty bed- that's 9 nurses, one with an easy patient and admit potential. Meanwhile tthe other 8 are busy with their 2 critically ill, or semi-stable, trying to wean drips, wean vents, and get orders out so I can fill the bed with another pt- probably someone twice as busy as the first.

Now with that said I'll address the original issue of ICU rn transfering pt from ED to ICU. It is often in our facility that MDs (esp cardiologists, surgeons, GI) will try to slip in a consult before pt leaves the ED. Having our ICU RN wait for this would place the second pt in jeapardy by not having his primary RN on the unit. Further, the strain on staff covering the missing RN would be great, as he/she is now caring for 3 critically ill (multiple gtts, vent) pts for an unspecified amount of time. It's not to say this won't work in your facility, but you'd be hard pressed to find an ICU RN that would be glad to do this-and likewise it is understandable that ED RN's see the benefit in it from their point of view. What we actually do in our hospital is use an RN and a tech trained in BLS to transport from ED to ICU. They are called the Swat team, and do not take assignements. They are the extra RN hands when you need and RN-this works well, and we have a happy ,peachy relationship between our ED and our ICU's-really. These extra RN's also help out in other areas such as cath lab, interventional radiology-because these are, again, areas where a tech may not be enough if the pt is THAAT critical. :argue: =:heartbeat