Apologizing for my prima donna ICU coworkers.

[NickiLaughs, ADN, BSN, RN]

It's been getting on my nerves lately. Our ER is supposed to be the second busiest ER in all of Southern California. I've also floated to ERs at other hospitals and I know the chaos that ensues.

I recently had a coworker complaining about how the patients never come up with central lines when they are septic. Seriously? How do you expect the ER nurse to do that when she's got to get Blood/Urine cultures, put in IV lines, get ABT stat going on this patient, and probably start a pressor quickly so she can get em up to us? While managing at least 3 other patients?

I always thought it was our job to take the mess and "organize it" including getting the lines in. I'm not saying we aren't busy, but I'm just saying that it seems if the nurse wanted the patient perfect before coming to her, well, she's not going to have much left to do, and eventually her job is not going to exist.

It's something that's been happening more lately with the complaining. I try to stick up for you guys, because it's a ridiculous complaint.

Or that they want the patient stable before the patient arrives. LOL, isn't that the point of ICU, to stabilize them? Ok, vent done. I think I need to get out of ICU.

[CrufflerJJ, BSN, RN, EMT-P]

It would also be nice if the ER staff could drop in an A-Line, take the pt for their VQ or bleeding scan, and do a complete bowel prep before bringing the pt to ICU.

-Just kidding- :rotfl:

[sapphire18]

Agreed. If the pt is down there forever then ya, they should have stuff done. But in my mind the ER supports them throughout their stay there, however long that may be, and the ICU has the job of stabilizing them further. I don't mind doing that stuff. I LIKE doing that stuff. The problem at our hospital is that the pt stays down in the ER wayy longer than they should. Meh.

[brainkandy87]

I've worked the floor and ER, so I have seen both sides of it. I just think nurses who've never worked ER have a hard time grasping the concept of ER nursing. It seems like the older nurses in particular are more hard to deal with, as a.) they're usually burnt out anyway and b.) they'll always find something erroneous to complain about.

[brainkandy87]

And I don't mean to offend any older nurses, this is just what I've noticed as a young nurse. So no hate, please. :)

[VICEDRN, BSN, RN]

I don't care how long they are in the ER. No one reduced my patient assignment and gave me just your septic/trauma/post code/drug overdose to deal with as my only patient. I simply do not have time to do the myriad of care that many ICU nurses expect the ER nurses to do and I often wonder what particular activities they think they should do if I am going to complete the entire MAR and every other thing.

I am sooooooooooo sick of being asked to place additional accesses, obtain a central line (ask the intensivist), transport the patient for some other scan, draw more blood, hang more whatever that isn't life saving, implement replacement protocols and complete admissions databases. Our facility's policy is that I must complete STAT orders from the ER doc, and no one else. A recent study of throughput problems in our ER revealed that the major cause of delay? In patient docs putting STAT orders in the ER that they wanted done before the patient went upstairs. Its ridiculous! My ratio is 4:1, yours is 2:1 and ICU level care is your job, not mine!!

Also ridiculous, as OP noted, requests to stabilize the patient prior to transfer: HELLO, if they were FREAKING stable they would go to step down or floor.

I recently spent an hour in CT scan with a patient because trauma doc had ordered it after bed assigned. In total, the patient spent an extra FIVE HOURS in the ER due to additional orders from ICU team MDs and the ICU nurse still wanted more stuff done.

Personally, I think we should implement the TNCC protocol and make them sit downstairs with their intubated sedated ICU patients until they go up. They just ARENT ER patients once that tube is placed and they ahve a rhythm.

[NickiLaughs, ADN, BSN, RN]

Thanks Viced....they just don't get it. I wish we were in the same "unit group" and could float between the two like my last hospital, it gave you a more realistic perception of each department.

Not all my coworkers agree with this concept, but there is definitely a few.

[OCNRN63, RN]

I've worked the floor and ER, so I have seen both sides of it. I just think nurses who've never worked ER have a hard time grasping the concept of ER nursing. It seems like the older nurses in particular are more hard to deal with, as a.) they're usually burnt out anyway and b.) they'll always find something erroneous to complain about.

Thanks for making sweeping generalizations about older nurses. I'm sure you won't mind my complaints about slacker younger nurses who spend their time texting or on FB instead of working.

[BelgianRN]

Ah the ER and the ICU it is like little brother and big brother or vice versa. Sometimes perhaps more like sisters when they start pulling hairs. I love "fighting" with the ER nurses in our hospital over these things. As an ICU nurse I have but three expectations when a patient comes into my ICU:

• Two peripheral IV's that are patent and one big enough for an emergency.
  
• A foley with a temperature probe so I don't have to redo placing the foley.
  
• A general idea of what's wrong with mister/miss X.
  

Only time I ever raged at the ER nurses was when they were bringing a patient with something that could vaguely be described as a "pulse" with two IV's that weren't patent and they walked out of the ICU as mr X went into Vfib. I wasn't all smiles at them then.

But since then they've come to my aid so many times I've forgiven them for that. The time my patient needed a sternotomy in the cathlab, the 9 yo that kept coding on the CT table, the woman that was bleeding out during angiography. Basically the times when I was all alone with my patient and I needed help the ER came up and helped because there was no staffing in the ICU for that. In return we come down when the ICU is full and they need to start HFOV on a lungtransplant patient in ARDS, need an urgent ECLS, need someone to babysit one of their criticals because they are flooded by other things.

In the end I like to think we work together towards a common goal, providing good and qualitative care. And some fighting, hair pulling and name calling comes with that but in the end we are still family :)

P.S. in my hospital the young nurses tend to text all day while we have an older nurse that is on facebook nearly 24/7 ^^

[hiddencatRN, BSN, RN]

I am sooooooooooo sick of being asked to place additional accesses, obtain a central line (ask the intensivist), transport the patient for some other scan, draw more blood, hang more whatever that isn't life saving, implement replacement protocols and complete admissions databases. Our facility's policy is that I must complete STAT orders from the ER doc, and no one else. A recent study of throughput problems in our ER revealed that the major cause of delay? In patient docs putting STAT orders in the ER that they wanted done before the patient went upstairs. Its ridiculous! My ratio is 4:1, yours is 2:1 and ICU level care is your job, not mine!!

Yeah, we have problems with floor doctors dictating to our docs to place stat orders as well. They've been tightening up on it and now they're only supposed to do that if it's TRULY a stat issue but sometimes a lot of minor things that can wait still slip through.

[ANurseDivided]

Well I just left the ICU after 9 years and my coworkers and I would often complain about this very thing. It wasn't until I had an opportunity to speak with an ER nurse that I fully grasped the concept of what their role is. The ER nurse is supposed to stabilize the situation so that the patient is able to move onto the next part of his/her field trip through the hospital. I had coworkers complain about "big" things which are "little" things to an ER nurse in the grand scheme of things.

I do feel, however, if a patient has been in the ER nurse's care for a substanial amount of time, certain things can be done--such as placing a line or sending them to the department for a critical test rather waiting for the ICU nurse to do it. As we all know, time is off the essence with some of these patients.

I think that it would be great if time permitted, ER and ICU nurses had a chance to switch position for a day or maybe for half a shift to truly grasp the concept of what the other expects...until then, I feel that it is always going to be us versus them so to speak.

[suanna]

If you watch the TV medical shows, ERs accurately diagnose, treat, perform complex surgery, recover the patient and educate the family, patient and community all in 4 minutes. I think you aren't holding your ER to a high enough standard.

As for the ER where I work- I would rather they did as little as necessary to get my patient to me alive. I have more years of experience and more resources on hand to manage the patient. I don't want to have to deal with a pneumothorax because a central line was placed in hurried conditions by less skilled providers in less sterile conditions. I have enough to deal with in solving the problems the patient came in with, not adding to they with problems we (the hospital) caused.