ED Admissions

perkizme · Jan 11, 2009

I'm in level 1 trauma and teaching hosp. ED calls report and then transports to us (all the way up on 7th floor). I couldnt imagine having to leave my other critically ill pt to go get the other... :banghead: 2 ED RNs bring up the pt along with RT if on a vent- Esp for an ICU admit I would think you would want 2 ACLS certified practitioners transporting up tothe ICU- no offense to the tech...

I can't tell you the # of times ED has said they'll be right up and then it takes another 15-30min before I see them because something else was done downstairs. Happened to me yesterday when I had an arrest come in and I thought he was on his way but didnt show up until 45-60min later bec cardiology came to see him and did a bedside echo and repeat ekg. You never know what could hold you up and you probably have another pt waiting on you upstairs. Its nice to be able to get report over the phone and then set up your room accordingly and get ready for them to roll in. IMO :nuke:

nrsang97, BSN, RN · Jan 11, 2009

I'm in level 1 trauma and teaching hosp. ED calls report and then transports to us (all the way up on 7th floor). I couldnt imagine having to leave my other critically ill pt to go get the other... 2 ED RNs bring up the pt along with RT if on a vent- Esp for an ICU admit I would think you would want 2 ACLS certified practitioners transporting up tothe ICU- no offense to the tech...
I can't tell you the # of times ED has said they'll be right up and then it takes another 15-30min before I see them because something else was done downstairs. Happened to me yesterday when I had an arrest come in and I thought he was on his way but didnt show up until 45-60min later bec cardiology came to see him and did a bedside echo and repeat ekg. You never know what could hold you up and you probably have another pt waiting on you upstairs. Its nice to be able to get report over the phone and then set up your room accordingly and get ready for them to roll in. IMO :nuke:

OH good I am not the only ICU nurse that feels this way. Check out this thread in the emergency nursing section for my opinions. Glad to know I have some friends on this. :wink2:

TraumaNurseRN · Jan 12, 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. :twocents:

stressgal, RN · Jan 12, 2009

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.

TraumaNurseRN · Jan 12, 2009

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!

TraumaNurseRN · Jan 12, 2009

worth the read

++++++++++++++++++++++++++++++++++++

guest editorial

acep news

september 2006

by david f. baehren, m.d.

for a generation or two, we have lamented the loss of role models in society.

as parents and individuals, we naturally seek out others we would like to emulate. sadly, a serious search through the popular culture leaves us empty-handed and empty-hearted. thanks to a long list of legal and moral shenanigans, many entertainers, politicians, and athletes long since abdicated this momentous position of responsibility.

we usually look afar for heroes and role models, and in doing so overlook a group of professionals who live and work in our midst: nurses.

and not just any kind of nurse: the emergency nurse. there are plenty of people involved in emergency care, and no emergency department could function without all of these people working as a team. but it is the emergency nurse who shoulders the weight of patient care. without these modern-day heroes, individually and collectively we would be in quite a pinch.

this unique breed of men and women are the lock stitch in the fabric of our health care safety net. their job is a physical, emotional, and intellectual challenge.

who helped the paramedics lift the last 300-pound patient who came in?

who took the verbal lashing from the curmudgeon giving admitting orders over the phone?

who came to tell you that the guy you ordered the nitro drip for is taking viagra?

the emergency nurse has the thankless job of sitting in triage while both the long and the short buses unload at once. with limited information, they usually send the patient in the right direction while having to fend off some narcissistic clown with a zit on his butt. they absorb the penetrating stares from weary lobby dwellers and channel all that negative energy to some secret place they only tell you about when you go to triage school.

other kinds of nurses serve key roles in health care and attend to their patients admirably. however, few function under the gun like emergency nurses do.

it is the emergency nurse who cares for the critical heart failure patient until the intensive care unit is "ready" to accept the patient. the productivity of the emergency nurse expands gracefully to accommodate the endless flow of patients while the rest of the hospital "can't take report." many of our patients arrive "unwashed." it is the emergency nurse who delivers them "washed and folded." to prepare for admission a patient with a hip fracture who lay in stool for a day requires an immense amount of care--and caring.

few nurses outside of the emergency department deal with patients who are as cantankerous, uncooperative, and violent. these nurses must deal with patients who are in their worst physical and emotional state. we all know it is a stressful time for patients and family, and we all know who the wheelbarrow is that the shovel dumps into.

for the most part, the nurses expect some of this and carry on in good humor. there are times, however, when the patience of a saint is required.

in fact, i believe that when emergency nurses go to heaven, they get in the fast lane, flash their hospital id, and get the thumbs-up at the gate. they earn this privilege after being sworn at, demeaned, spit on, threatened, and sometimes kicked, choked, grabbed, or slugged. after this, they go on to the next patient as if they had just stopped to smell a gardenia for a moment.

great strength of character is required for sustained work in our field. the emergency department is a loud, chaotic, and stressful environment. to hold up under these conditions is no small feat. to care for the deathly ill, comfort suffering children, and give solace to those who grieve their dead takes discipline, stamina, and tenderness. to sit with and console the family of a teenager who just died in an accident takes the strength of 10 men.

every day emergency nurses do what we are all called to do but find so arduous in practice. that is: to love our neighbors as ourselves.

they care for those whom society renders invisible. emergency nurses do what the man who changed the world 2,000 years ago did. they look squarely in the eye and hold the hand of those most couldn't bear to touch. they wash stinky feet, clean excrement, and smell breath that would give most people nightmares.

and they do it with grace.

so, here's to the emergency nurse. shake the hand of a hero before your next shift.

dr. baehren lives in ottawa hills, ohio, and practices emergency medicine. he is the author of "roads to hilton head island." he welcomes your feedback at [email protected].

sugar plum · Jan 13, 2009

It is the policy of my small hospital for a ED Rn and tech to bring the patient to the AICU. We do go down in pinches. I believe that a physician and RN or two RN's bring the unstable patient to the unit. I would not want to be the one in the elevator for the crash!!!!

APNgonnabe · Jan 14, 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.

NCTraumaNurse · May 4, 2009

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!

I am now an ED nurse (two years now) who was an ICU nurse for many years, so I will speak to this from my perspective. As an ED RN, I do have four patients total, but it is VERY rare that I have even two "critical" pts. The ESI system doesn't always reflect the morbidity of the pt, usually just the amount of resources that pt will utilize. They did talk about that system (ICU nurses collecting their own pts) where I work (Duke), but even the ED nurses thought it was not the best idea. If we have an ICU pt, it is usually in our Resus area, where the ratio is 2:1, and if the nurse needs someone to take the pt, there is almost always someone who can do it... It is rare that ALL of the ED pts. are truly "sick", there are many, many of them who don't even need to be there, but occupy the beds nonetheless. We have "Admissions Nurses" (to an extent, the hours are sad for us night shifters) who can accompany a pt to any of the units, and this helps out a lot.... Just my two cents...

Larry77, RN · May 7, 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!

NeosynephRN · May 7, 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!

We do?? Yeah and I usually leave that patient that just coded on the floor while I go finish my lunch and my daily dose of shopping on ebay...they can handle the vent and 3 pressors while I take care of my business right....:icon_roll