CCU vs ER

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I received an offer for both and I like both for different reasons. Would you choose cardiac ICU or ER and why? 

 

Just wanted to come to say I LOVE all of these answers! Super great. I've only worked in the ED and I don't regret my choice at all. From what I've heard from others, it's so much easier to transition from ED to ICU if you want later on. You get experience in EVERYTHING in the ED so I feel like it's a better choice (overall, but especially if you're not sure about what you want yet) and gives you so many more options in the future. 100% recommend starting in the ED. But I'm totally not biased at all 😜

Side note I did have a fellow nursing student start in the cardiac ICU and she got burnt out really fast because those patients are heavy, emotionally and medically.

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floydnightingale said:

You mean the ones who ask about popliteal pulses? And then follow it with "are you a nurse?" It's not just the ICU, thinking now about calling report to the woman's hospital and she asked me which side the ectopic was on. 

In my experience ICU nurse don't transition well to the ER, they can't focus on the emergent problem, and ER nurses who move to ICU always ask for their old jobs back.

No dog in the ICU v. ER nurse fight, but why is asking which side the ectopic on a problem?

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offlabel said:

...why is asking which side the ectopic on a problem?

Setting aside the fact that I don't have the time or interest to read ultrasound reports, if a physician tells me there's an ectopic that's good enough for me, what exactly would YOU do as a nurse if the ectopic was on one side vs the other? I'll wait for your reply.

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Specializes in Nurse Anesthesiology Student.
FiremedicMike said:

Or the ones who want to go through every lab/imaging result during report.  Dude you can look at the same chart I am looking at, I told you about the major issues, you can compare their calcium and phosphorus on your own.

 

When I got off orientation in the CCU, the ED called up for report and I legit only asked 3 questions: patient's orientation status, location of PIVs, and current medication/gtt rates... it took less than 30 seconds. My pod mate turned to me and said "that's it?" in which I replied, yup...I knew I was getting this patient the last 2 hours so I wrote down everything I wanted to know.

Nursing would be so much better if everyone would get off their high horse and just focus on the patient instead of having a pi$$ing contest.

^^^ main reason why I am a firm believer ED nurses should work a month long in the ICU, and nurses in the ICU should work a month long in the ED.

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floydnightingale said:

Setting aside the fact that I don't have the time or interest to read ultrasound reports, if a physician tells me there's an ectopic that's good enough for me, what exactly would YOU do as a nurse if the ectopic was on one side vs the other? I'll wait for your reply.

Weird...getting a toxic vibe...anyway, just for starters, as pain is one of the symptoms of this problem, if pain develops on the contralateral side of the ectopic, that could be a relevant exam finding. Secondly, laterality for a surgical consent needs to be accurate and the nurse is responsible for confirming that for liability reasons and wrong site surgery avoidance. So, there's two reasons. Hope the wait wasn't too long...

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offlabel said:

Weird...getting a toxic vibe...anyway, just for starters, as pain is one of the symptoms of this problem, if pain develops on the contralateral side of the ectopic, that could be a relevant exam finding. Secondly, laterality for a surgical consent needs to be accurate and the nurse is responsible for confirming that for liability reasons and wrong site surgery avoidance. So, there's two reasons. Hope the wait wasn't too long...

I can see how it's nice to know for the next nurse's assessment and have no problem with that. 


For the consent, yeah it's nice to know but ultimately the surgeon is legally responsible for consenting the patient for the correct procedure. Legally speaking they obtain the consent, not us.  What we are doing is not obtaining consent but having the patient sign a form that should state nothing other than the exact consented procedure that the physician states they have discussed with the patient (and already obtained consent for). Neither here nor there, but I believe that the entire process start to finish should be completed by the proceduralist because it IS important and at some point *some* degree of heresay is involved as soon as anyone else becomes involved. I have gone round and round on this years ago when OR would become UNGLUED if we didn't have the form signed in advance down in the ED....with the assurance that the physician would talk to the patient upstairs. Which was a huge no from me. 
 

The nurse's role has been debated here before with merits on various sides. Regardless, if I were of the mindset that part of my responsibility is ensuring that the physician has correctly consented the patient, I DEFINITELY would not then base my fact-checking on what side another nurse told me. If we say our job is to make sure all facts are correct that would involve checking the u/s report. [And then we still wouldn't know WHAT words, including side, the physician said to the patient unless we witnessed the whole entire thing.]
 

I would NOT be bothered if a nurse asked me which side in report. Though the ED mindset is that the answer to that question doesn't change anything about the ultimate plan of care or disposition of the patient. It's a goat rodeo down there....nurse is told your patient has an ectopic, they're going to OR — which is a result that was probably called to the ED doc by Rads and isn't even dictated yet.  
 

Edited to add: ^ I'm not angry about anything! Just food for thought! 🙂
 

Lipoma said:

When I got off orientation in the CCU, the ED called up for report and I legit only asked 3 questions: patient's orientation status, location of PIVs, and current medication/gtt rates... It took less than 30 seconds. 


I like it! Though curious ED minds want to know: is the IV thing so people can know which side of the bed to have IV poles ready or ? wanting to know whether the location could become problematic or...something else? I could understand wanting to know type of access but the importance of the location of PIVs has always eluded me a bit   🙂

 

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JKL33 said:

I like it! Though curious ED minds want to know: is the IV thing so people can know which side of the bed to have IV poles ready or ? wanting to know whether the location could become problematic or...something else? I could understand wanting to know type of access but the importance of the location of PIVs has always eluded me a bit   🙂

 

Mostly out of habit because when I was in the ED it was automatically included during report ( B/L AC # etc) so it carried over into when I went to the ICU...however, asking the location also allows me to set up the room appropriately and also allows me to figure out if I need to remove it and place a new one if it's going to be in the way of a potential a-line or prolong vasoactive drug infusion etc. At my former facility, infusing vasoactives through the wrists or hand was a nono...but in the ED, any line that flushes is good enough!

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I have never consented a patient, maybe I witnessed one really don't remember but we aren't opening people up in the ED except for the very rare thoracotomy.

ED care is general, it's about keeping patients alive. When the place I worked started doing more complicated monitoring only common in an ICU a very experienced nurse wasn't hired by a competing facility because they "knew she was lying" when she said we were doing CVP monitoring, just like they didn't believe that people walked in or were pulled out of cars  with GSWs.  We stopped putting new hires through ICU orientation and created our own because we'd never see a grashong or other things more common upstairs. A coworker once summed it up when she concluded a report with "I'll take care of the ABCs and you can worry about the rest of the alphabet."

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JKL33 said:

I can see how it's nice to know for the next nurse's assessment and have no problem with that. 


For the consent, yeah it's nice to know but ultimately the surgeon is legally responsible for consenting the patient for the correct procedure. Legally speaking they obtain the consent, not us. 

 

The RN's use the consent for the operative time out and if there is a wrong site surgery, ie, they take out the wrong fallopian tube, the RN is on the hook too. 

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floydnightingale said:

I have never consented a patient, maybe I witnessed one really don't remember but we aren't opening people up in the ED except for the very rare thoracotomy.

ED care is general, it's about keeping patients alive. When the place I worked started doing more complicated monitoring only common in an ICU a very experienced nurse wasn't hired by a competing facility because they "knew she was lying" when she said we were doing CVP monitoring, just like they didn't believe that people walked in or were pulled out of cars  with GSWs.  We stopped putting new hires through ICU orientation and created our own because we'd never see a grashong or other things more common upstairs. A coworker once summed it up when she concluded a report with "I'll take care of the ABCs and you can worry about the rest of the alphabet."

Worked in an inner city level one trauma center and while frequent, the times when we were 'keeping people alive' was the minority of the time. The majority of the time we spent treating routine problems and getting the patient to the appropriate disposition for continued or higher care whether that was the ICU, OR or outpatient clinic. Doing that requires thoughtful consideration of the whole picture and not brushing off important details because we 'save lives'.

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Lipoma said:

Mostly out of habit because when I was in the ED it was automatically included during report ( B/L AC # etc) so it carried over into when I went to the ICU...however, asking the location also allows me to set up the room appropriately and also allows me to figure out if I need to remove it and place a new one if it's going to be in the way of a potential a-line or prolong vasoactive drug infusion etc. At my former facility, infusing vasoactives through the wrists or hand was a nono...but in the ED, any line that flushes is good enough!

I had an older charge nurse in the ER who had started an IV on one of my patients. When I asked him where (he forgot to chart it), he said hand/ac/etc but didn't specify left or right.  I asked which side, he said "the not wall side.”  I laughed out loud because it was one of the smaller rooms where the bed was pushed close to a wall and if they didn't have a good vein on their right arm, you had to not only move the bed but first the trash can and biohazard bin.  So when he said "not wall side" I instantly knew!  

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Emergent said:

The only downside is giving report to the obnoxious ICU nurses who think they are the be all and end all.

Heyyyy.... LOL

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