Education 101: ER vs. ICU

PostOpPrincess, BSN, RN · Dec 12, 2009

I've said it before and I will say it again. It is about never having stepped in the other one's shoes.

I have done both, so I understand EXACTLY how it is for each "side." The thing is, there are NO sides. Only one--that particular patient going to the ER and then ending up in the ICU.

ICU doesn't understand what ER is for...and the ER doesn't understand that just because the patient doesn't have a room in the ICU yet, standards of care still need to be continued. ICU doesn't understand that the ER never closes and they could coming and coming and coming and coming..and buffing and puffing the patient is JUST NOT A PRIORITY.

It's the same with the FLOOR vs. the ICU..the FLOOR versus the ER...

In the end, we are all in it together. It is about communicating and discussing a practical plan of care to benefit not only the patient, but the entire team as well.

IT CAN BE DONE.

You just have to change the attitude a little bit....

1EmergencyRN · Dec 12, 2009

Well, yes, I guess that's exactly my point though, I already believe all of what you've said, but how do I go about promoting it? I want to find a way to make it so that the smile I give gets a smile back. I keep giving and giving and hope that at some point it will rub off... sigh....

ONCRN84 · Dec 12, 2009

I work in an ICU and have worked on the floor as well... but never in the ER. I always try to smile at the transporting RN and thank them. What I do hate is getting a report that consists of "I don't know much, I just took over the patient." I know that it happens with change of shift, but take 30 seconds to read what the ER course has been, maybe a little history of the present complaint. Even if I get a crappy report, I still thank them and try to be halfway nice because I know they're slammed.

I also got a patient not too long ago with a spinal cord injury and was supposed to be started on the solumedrol protocol... that needs to be initiated within a certain time frame from injury... order written at 4pm, i got the patient at 9pm, and the bolus or drip hadn't been started. THAT is NOT ok. I called the ordering doctor to let her know because she was under the impression it was started in the ER and she was livid.

My point is, I'm trying really hard to be nice and play fair, but if you get an order for a STAT protocol, please either do it or send the patient over ASAP so I can do it. Some things can be put off, but other things really need to be done ASAP.

Emergency RN · Dec 12, 2009

Like JoPACURN stated, the differences is in not knowing what the other side does. This is why it's always best to give report to someone who has worked the other side, because they inherently understand the differences in arena focus. Not that one is more important than the other, but rather, that the patient's needs evolves from emergent medical diagnosis, rapid treatment, selection of nursing priorities, and immediate stabilization in the ED; to the fine tuning of differential medical diagnoses, continued treatment, and consolidation and refinement of nursing care in the ICU.

IMHO, I believe that ALL emergency and intensive care RN's should routinely work the other areas because in the long run, it actually makes you a much better RN. One begins to see and understand that one's own iron clad rules, are perhaps not so iron clad after all.

Otessa, BSN, RN · Dec 12, 2009

I worked in a Critical Care Float pool for several years and was finally able to see things from several different point of views-sometimes was able to enlighten others (ever so gently, though). The end point for ER is to get them stable enough to go to the ICU and ICU gets them and wonders why there is still glass in their hair-as an example. I remember being in ICU and wondering why ER didn't do more or start a certain med and then working in the ER with traumas and other things being flown at you , you just want to the semi-stable ones out of there so you can get to the ones that are not.

otessa

mcknis · Dec 12, 2009

As a brand new ER nurse coming from the floor with over 3 years of experience, I can say that I now see the other side to the story. Having not worked in someone's shoes gives certain individuals the thinking they can rattle off anything they want to say no matter feelings or facts. The floor is convinced that the ER can hold the patient for a few extra minutes, but the fact is no one ever knows what is coming through the door next or how many codes/traumas may be occuring without the floors knowledge. As a floor nurse, I was always upset when we would get an admission at change of shift, but it truly is a comfort knowing that another nurse, medic/aide, and a physician has already seen this patient, that they must already be fairly stable. For as long as there will be different areas of nursing/work, there will continue to be differences in the workforces.

Ruby Vee, BSN · Dec 12, 2009

i've been an icu nurse since 1983, and a floor nurse before that. i've never worked in the er. i've never walked in the shoes of an er nurse. but hopefully i have some understanding of the stresses involved. i read allnurses.com, after all! i don't think it's an "er vs. icu" thing as much as it is a "my territory vs. your territory" sort of thing. some people, nurses included, can only make themselves feel good by putting others down. hence the "why does it take so long to get an icu bed?" vs. "why is there still glass in her hair?" conundrum. i've gotten along with the er and, worse than that, the or for years by recognizing that their issues aren't my issues.

some of my best friends work in the er. the or, now . . . .

kfarinato · Dec 12, 2009

I work in an OR and everyone in the hospital hates us. Its ok, I accept it. When I go to a floor or any other department I am polite and smile at them, and do what I went to do. I am friendly with people in every department from housekeeping all the way up. There is no point in being that miserable person from _______ (fill in the blank) department.

phoenixfire · Dec 12, 2009

Ok, maybe I am looking at this with inexperienced eyes, but having worked in both places (as a tech), I have heard from both sides. I know that when I am in ICU, and we recieve a trauma patient, the nurses tend to be ***** because the patient is a mess... I mean blood and dirt still on them, etc. In my mind, this gives me (the new grad) an opportunity to do a really awesome assessment. I bathe them, note any wounds, scratchs, scrapes, etc that were not in report, assess pulses, look for bruising, broken bones... etc. In the ER, I know that the primary goal is to stabilize the patient... not necessarily make them pretty. I'm just about to start in the ICU, but having done several rotations in the ER, and been floated there plenty, I know that I will not be one of those catty nurses that complains about the patient they just got... blah blah blah...

Perhaps you could arrange a meeting of some sort between the departments. What you need, what they need, etc. It would probably help if you also told the other side what they do well.

Larry77, RN · Dec 12, 2009

Hmm...I've never hated on the OR...now the ICU and the floors I've hated on for years :-)

I think if we all respect each other and look at the situation from the other's perspective we can all get along...that said, we are like cats and dogs, we will bark and hiss at each other but with effort, we can still live in the same house...

meadow85 · Dec 13, 2009

I respect ICU nurses, but I have had bad experiences with our Emerg. Receiving poor reports, transferring unstable patients to the floor, getting upset when we can't take all 5 patients at once etc. I think our first priority should be the patient and to work together for the sake of our patient.