Apologizing for my prima donna ICU coworkers.

[NickiLaughs]

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.

[emtb2rn, BSN, RN, EMT-B]

I want to play...

Having worked both sides (3 years ER and now 1 year ICU) it is very different. That being said, when a patient is dumped on me by the ER nurse (which I worked with) with a single IV with dopamine and dobutamine flowing...I get ******. ER doc admits a patient on a vent without sedation ordered? Chest pain without morphine/NTG orders? I work night shift and we dont have 24/7 docs on the floor. The ER does. Did they bother to try and get a 2nd line? I dont expect everything from the ER...I'll take 2 good lines, a full report, and someone that is still alive. ER nurses are trained for critical care. They should know how to take care of these patients. They have a doctor beside them if they need something. I dont in the ICU. I have to call a Dr in the middle of the night and hope they call me back.

To the person complaining about juggling one critical patient, a couple of unhappy families, etc... I dont feel for you. Sorry but I dont. There are times we get tripled with critical patients. I'll take a couple whiney families because their kid hasnt seen a doctor any day. ER nurses should wander up to ICU and work for a day. It is completely different. Sure we dont have crying kids...we have 6 pumps going, a vent and chest tubes, hourly vitals, etc. ICU nurses are trained for ICU. Im guessing very few of you work in an ER where you will juggle more than one critical patient. Working in a medium sized ER in for 3 years, a typical nurse day is a belly pain, kid needing stitches, broken arm, etc... It aint all drama like on the tv show. When things go bad in the ER, I know first hand they go bad. In my facility, the ICU will come down to help the ER with critical patients until transferred up. THis often leaves ICU nurses tripled with critical patients.

The key is to have mutual respect between departments... a little common courtesy and common sense goes a long way. I know the idea behind the ER is get them in and get them out, but dont crap on your fellow coworkers.

OK, I bolded a few items above.

So, you imply you were an ER RN for 3 years and then moved to the ICU. According to your prior posts, you were a ER tech for 3 years. While I respect our techs tremendously and they are an integral part of the team, as a tech you didn't truly understand what the ER RN's were doing.

If you did actually understand what an ER RN does, you'd know that managing other pt's alongside a unit pt is difficult. Can't ignore those other pt's while doing q5minute bps on that hypotensive's dopamine drip trying to titrate to compatible with life. That broken arm? going to the OR. Line, lab, pain meds, antibiotics, teaching. That kid needing stitches? needs to be held down. Oh wait, it's a facial lac. Now we're doing conscious sedation. 1:1 But hang on, gotta check the bp on that ICU pt first.

And another thing. Your description of "typical nurse day". Really, that's what you think? Shows you don't know what you don't know.

Regarding your complaint about coming down to the ER to help with critical pts. Your choice or your managers? If it's your choice, you have nothing to whine about. If it's your manager, then your manager seems think you can handle 3:1.

Respect is a 2 way street. That's how it becomes mutual.

[Hagabel]

I agree with the last poster re previous bolded points.

A criticial pt in the ED deserves/needs immediate care 1:1, not a nurse who is split between 3 other pts. I have done ICU for 11 years and ED for 9 and so have seen both sides also. If you do triple up in ICU (which is not ideal at all) your pts are likely to 'stable', a critical pt in the ED is never stable.

If my ICU pt has an airway, a heartbeat (preferably a BP>90-95) and an IV (preferably 2) then I am happy. Yes, if they are intubated they need an NG or OGT but the foley with the temp probe...if you are lucky, not essential in the ED most of the time!

So I think everybody needs to relax and appreciate what the other unit does. One thing to ask though of the ICU nurses:

Please don't complain when I call to give you report cos you have not taken lunch, you are busy etc...our pts come into the ED 24 HRS a day..we suck it up and deal with it!!!!

[BelgianRN]

@ Hagabel.

I hope you didn't take grievance to my Foley with thermometer comment. I wrote that post only to highlight how much I appreciate the ER and their help.

So to clarify this I don't mind at all if there is no Foley in the patient. If they're busy they're busy it is non essential I agree there. But when they want to help us out by putting one in then I prefer it if they use the one that's standard practice in the ICU and one we kinda need whenever we mechanically cool our patients.

[Footballnut]

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.

Brainkandy, Our older nurses in the ICU are quite seasoned and ready to help transition the pt from ED as much as possible. I really appreciate them. The ICU nurses that give me the most trouble are the newest ones that are not quite secure yet and don't have enough experience to see both sides of the coin. Imagine giving report to a young ICU nurse who has a bias against older nurses and ED nurses.

There are a lot of age related comments in this thread. I just try to remember that nurses in each stage of growth in their practice have something unique to contribute and I look for it. I hope to learn from everyone, regardless of their age.

[pcud4qrn]

Hi guys

I am an anesthesiologist for 36 yrs..worked with all kinds nurses.

I love most, if not all of the nurses I worked with. You guys make me look goood!

As for the central lines: in the OR , I take what I can get because I don't know what the circumstances are. Getting upset about not having a CL does no good... could be the pt's coags are not good..remember , critically ill patients may have a DIC ,heart patient's may be on Coumadin,Plavix or whatever. I don't want to manage a bleeding neck. I know,we can now do them under ultra-sound guidance...but still. Or,there was no time or no one to do it.

For dialysis patient's,I try not to do CL's unless critical,per advice of my friend ,a vascular surgeon who does AV shunts..this is because we try to preserve those neck veins for future use...thrombosed veins from central lines that were not necessary ? ..not a good thing.

Hmm bad veins ? hard stick? get someone to do a PICC. Stay away from those neck veins if you can.

[Scarlette Wings]

where i have worked ed nurses and icu nurses floated between the two departments and it provided the best education for pt care and "walking a mile in my shoes" that you could imagine.

the only thing i think about as far as types of access lines or who puts them in is "is this access what the patient needs?" if the pt is septic and needs a butt-load of ivf asap and can get it via 2 large bore peripherals, great. if they need a central to get it with, then drop the line in. just meet the patients needs. don't avoid putting in a cvc if all the staff can get is a "barely-hanging-on 22 g."

the infection risk is usually higher if put in an ed filled with chaos... and the ed docs will place a femoral line 9 chances out of 10 if they put one in (which really increases the risk for infection).

as long as the pt is getting quality care in the best possible way i am okay with putting a line in the ed or the icu. once the staff get comfortable with helping drop cvc lines and keep all the equipment easily accessable it is much less time consuming than most people think and can actually become routine with an experienced care team.

[Footballnut]

Part of our staff float between ICU and ED. I worked with one of those nurses yesterday on a 2:1 pt in the ED that we were resuscitating and stabilizing. She took primary care and charting since she was taking the pt in ICU when we were done. I did multiple "hands on" things (including a CL and cooling), gave meds, checked all the orders and did the work of moving the pt's care along quickly. During the course of things I found poop. The other nurse and I discussed it (for 5 seconds) and she decided we were too busy and the pt was too unstable to deal with it at the time. We even took the pt to CT with his poop in place and she headed straight up to the ICU after that.

Now, I have to say, I would not dare to have left the poop on my own. It's just one of those things. But the ICU nurse was able to see the situation as it was and made a decision that may have been termed "sloppy ED nursing" by someone who wasn't there. Whatever we were doing it worked because the pt started to respond shortly after admission to ICU. I expect a good outcome in the long run, yay!

[SecondGenRN]

Last time I checked, I don't put in central lines personally. If the ER doc or intensivist wants to I'm more than happy to set up. HOWEVER, I will not take credit for a central line not being put in because the ER doc didnt have time and the intensivist saw the patient for only 5 minutes. Take it up with them.

[yiyayiya]

lol - just as well you dont work near me. I refuse to have a catheter or be intubated under any circumstances. Even have an AD to that effect so that it cant be done if I am incapacitated.

[NO50FRANNY]

I love our ICU, but sadly find myself defending them a great deal also. A few of our ED nurses jump at the opportunity to complain about beds not being ready and other obstructions which really are outside nurses' control. The issue is often that neither side has a good grasp of what goes on in each others' backyard. I try to look in my own backyard before I talk about anyone elses. I remember delivering a bloodbath (being resuscitated) to ICU once, and it was my first handover to ICU ever (terrified). The nurses were awesome, and I just checked some blood and let everyone get on with it, "don't worry about handover mate, we've got it, I'm sure you've got plenty to do downstairs". I think the fact that I was literally covered from head to toe in blood was enough of a handover. I can honestly say that I have never been on the receiving end of any outward unpleasantness, and I will usually apologise if there are things that we haven't had time to do. Acknowledgement is key. We needed to take a patient to ICU from cath lab with a balloon pump who was about 10 mins. away from crashing but the Cardiolgist wanted us to take him for a CT head on the way (he fell off his bike when he had his MI). The ICU registrar saved our bums, curtailed the politics and said to bring him up first- he crashed the second we transferred him onto his bed and thankfully not in the scanner, no one cared about his bowel motion. My last ward arrest I worked hand in hand with one of our ICU nurses- he made me feel so dirty! I told him this. We have had a few ICU nurses defect to ED and I always give them a hard time if their patients don't look perfect "you call yourself an ICU nurse!". A lot of them float down to us if they are overstaffed, I always introduce myself and give them a plastic apron to make them feel at home. We also have 3 month rotations between ICU and ED, like a swap. I think this system facilitates good team work and trust and addresses the backyard debate. It's like my least favourite game "kick the triage nurse". I'm not saying that either side is perfect but we seem to have a good thing going most of the time.

[Creamsoda, ASN, RN]

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:

I thought you were serious. I work both, mostly ICU, but I sympathise with ED. They are slammed. I hate working there, but I float there now and again for overtime. They work hard and do what they can. And yes I will agree, ICU nurses can be prima donnas. Most of them have never done a shift in ER so they dont "get" it. Maybe next time in ER, try to emphasize what you DID do.

Have you seen those you tube cartoons...

Its funny, kinda mean lol, but ER truely is busy, busy, busy. As long as the patient is semi- stable when they come up im happy. I usually have more time to do everything else that was not done and more than happy to. I wouldnt worry about it.