Education 101: ER vs. ICU

PostOpPrincess, BSN, RN · Dec 13, 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.

I hear your frustration. I often felt this way. Occasionally, I still do. I learned to deal with this by realizing that other nurses--people/fellow colleagues--are not MOTIVATED TO HURT the patient. NOT on purpose. We are not geared that way--that's something I embrace otherwise I'd have a million ethical dilemmas!

I think these types of situation require more education. I often go to the root of the issue by asking the nurse/nurses/about the care of the patient. More often then not, they didn't know to do it because they either "forgot" (distracted from other chaos in the unit) or honestly didn't know. I communicate with the nurse, learn their names, and the next time I know that type of patient is coming from that nurse--I've already established a bond (a good one, mind you--fighting or arguing with a colleague over who is the better nurse is just below me and my colleague. I don't go there) we talk about our last experience and really, it always seems to work out.

I have friends in ALL areas of the hospitals and when I give report, they know me well enough to NEVER give me a hard time.

If there is something I couldn't do--I tell them why and to please follow up. They are understanding. They are good people. Who have bad days at times....they are still good people in the long run....

It's about respect and communicating respect.

It's not that hard, really.

mwboswell · Dec 13, 2009

The way to understand this is to step back and look at ourselves as ED folks.

Think about how we perceive EMS bringing in more "work" for us...

We can either find a way to manage that rapid, unnanounced, untreated patient and work them into our workload or we can choose to get upset, miffed, abrasive, angry and sometimes downright rude to the EMS folks.

As our work environment is so crazy at times often we perceive EMS as the "bad" guy because they bring us more "work" to do.

Now take this and apply it to the ICU and re-phrase most everything I said above in light of the ED bringing more "work" to the ICU team....

Thats' my personal take on it; someone is always making more "work" for someone else, and if that someone else isn't prepared to deal with it efficiently, then it builds stress and tension.

"You gotta cross the anger bridge, come back to the friendship shore." ~Cal Naughton Jr.

fiveofpeep · Dec 13, 2009

I did my preceptorship in the PACU and it reminded me of the ER.

Both PACU nurses and ER nurses get slack for crappy report, but then I saw how you get a pt back without a history and the md and the nurse have no idea what they found intraoperatively and the patients never stop coming so you cant just sit down and look everything up. You can only discover what you need to know for safety and thats about it. Sometimes you dont even know that.

silentRN · Dec 13, 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.

I totally agree with you! I used to be a floor nurse, and now I work in the Surgical-Trauma ICU, and have just emailed my manager if I could cross train in the ER so I could pick up some extra shifts there.

Working on the floor really makes me appreciate being able to work in the Trauma ICU. I actually really like my job and I look forward to going to work now. Before, when I worked on the floor, I would always ALWAYS dread coming into work, but now I love coming in. I'm constantly learning. There are some things that I did on the floor that I can carry over to the ICU like working with transplants. I used to get a lot of transplant patients up on the floor along with stable trauma patients (kind of a weird combination), and in the ICU I don't see to many but I can carry over that knowledge of what needs to be done for those patients. And I used to change out a lot of wound Vacs on the floor, but for some reason, in the ICU the doc changes the wound vac, and alot of the ICU nurses never have changed one.

The only ED experience I had was when I did my preceptorship as a SR in college in the ED. I just have a feeling tho if I do cross train in the ER I'll only see the pain med seekers or the stomach pain issues, and that just really doesn't interest me. I'm a little skeptical.

Sometimes I feel like a mechanic trying to fine tune a car. HA!

PostOpPrincess, BSN, RN · Dec 13, 2009

I did my preceptorship in the PACU and it reminded me of the ER.
Both PACU nurses and ER nurses get slack for crappy report, but then I saw how you get a pt back without a history and the md and the nurse have no idea what they found intraoperatively and the patients never stop coming so you cant just sit down and look everything up. You can only discover what you need to know for safety and thats about it. Sometimes you dont even know that.

You are soooo correct. I hear a lot of frustrated sighs everytime I give report. But I don't let it bother me. I can't. The OR doesn't stop.

PostOpPrincess, BSN, RN · Dec 13, 2009

The way to understand this is to step back and look at ourselves as ED folks.
Think about how we perceive EMS bringing in more "work" for us...
We can either find a way to manage that rapid, unnanounced, untreated patient and work them into our workload or we can choose to get upset, miffed, abrasive, angry and sometimes downright rude to the EMS folks.
As our work environment is so crazy at times often we perceive EMS as the "bad" guy because they bring us more "work" to do.
Now take this and apply it to the ICU and re-phrase most everything I said above in light of the ED bringing more "work" to the ICU team....
Thats' my personal take on it; someone is always making more "work" for someone else, and if that someone else isn't prepared to deal with it efficiently, then it builds stress and tension.
"You gotta cross the anger bridge, come back to the friendship shore." ~Cal Naughton Jr.

We used to get Life Flights (traumas) from other countries (paid our hospital for the care of their patients) direct, bypassing ER, through the ICU...untreated, etc.,

We just dealt.

We did our best and that was it. No questions, no harassment, just did our best.

I

Dinith88 · Dec 14, 2009

This post...and the bazillion other posts like it share common threads...and can kind-of shed light into the roots of this 'cross-unit animosity'....just read them....

First off, it's a generalization...specific to YOUR hospital...and the people YOU deal with....different levels of this garbage probably exists most everywhere...but to different and widely varying degrees.

When it comes down to it the 'classic' struggle between ER-ICU most often involves two (fairly common and sadly juvenile) personality-types.

1) The super-busy ER-nurse who sees a gazillion patients a day...half of them are sick...the other half are system abusers...she tries her hardest to keep things moving and doesnt have time to hold patients in the ED. During report/transport she catches flack from the condesending(sp?), anal-retentive ICU-nurse who is often-times rude and insulting. The 'hatred' she developes for the ICU nurses is based on her INFERIORITY COMPLEX....like it or not.

2) The super-busy (in a different but no less real way) ICU-nurse thinks she's being abused by the ED nurse who cant give her a few extra minutes to prepare the room and wrap-up some loose ends. She thinks the ER nurse is stupid because she hasnt all the answers the ICU nurse wants...and has a flippant attitude about what the ICU nurse feels is important. Her 'hatred' for ER nurses is based on her SUPERIORITY COMPLEX...like it or not.

Now THESE GENERALIZATIONS are just that...generalizations....but are none-the-less the steryotypical personality-types who rant about this stuff and have strong feelings (hatreds) for the other units' nurses.

I_LOVE_TRAUMA, RN · Dec 14, 2009

Really...an inferiority complex-huh? That is by far the most ignornant thing I have ever heard. It's very obvious that you work in ICU...

However being someone that works BOTH, I can ensure you that you will never meet an ER nurse that feels inferior to an ICU nurse...but I have seen it the other way around.

You have brought absolutely nothing to this thread, especially no thoughtful, respectful advice for this sincere new nurse...perhaps you should just stay in your nice controlled environment and bash ER nurses there,at least until you can bring some intelligent, evidence-based logic to the discussion...

And p.s... your post is the perfect example of GENERALIZATION

I am so glad my friends/coworkers in the ER/ICU do not have your mentality.

Dinith88 · Dec 16, 2009

Really...an inferiority complex-huh? That is by far the most ignornant thing I have ever heard. It's very obvious that you work in ICU...
However being someone that works BOTH, I can ensure you that you will never meet an ER nurse that feels inferior to an ICU nurse...but I have seen it the other way around.
You have brought absolutely nothing to this thread, especially no thoughtful, respectful advice for this sincere new nurse...perhaps you should just stay in your nice controlled environment and bash ER nurses there,at least until you can bring some intelligent, evidence-based logic to the discussion...
And p.s... your post is the perfect example of GENERALIZATION
I am so glad my friends/coworkers in the ER/ICU do not have your mentality.

Ouch! You wound me with your cyber-barbs!!

ignorant of me to point out generalizations?

Forgive me if you mistakenly assumed i meant ER nurses are inferior. That wasn't the point. Seriously. I am a firm believer you cant judge a nurse by the unit she works in. (re-read the previous sentence)

And although you call me ignorant (i would argue against that), it's funny that you want me to bring "evidenced based logic" into a post about my opinion....what?!? What?!?

Would it make you feel better if i said ER nurses are superior to ICU nurses?...because "you have seen it the other way around." (your words)? Really? Did you really say that?

I was kinda laughing when i read your post. You sound angry. And suspiciously like you have an inferiority complex...driving your anger...and comically like my generalizations...

I_LOVE_TRAUMA, RN · Dec 16, 2009

This post...and the bazillion other posts like it share common threads...and can kind-of shed light into the roots of this 'cross-unit animosity'....just read them....
First off, it's a generalization...specific to YOUR hospital...and the people YOU deal with....different levels of this garbage probably exists most everywhere...but to different and widely varying degrees.
When it comes down to it the 'classic' struggle between ER-ICU most often involves two (fairly common and sadly juvenile) personality-types.
1) The super-busy ER-nurse who sees a gazillion patients a day...half of them are sick...the other half are system abusers...she tries her hardest to keep things moving and doesnt have time to hold patients in the ED. During report/transport she catches flack from the condesending(sp?), anal-retentive ICU-nurse who is often-times rude and insulting. The 'hatred' she developes for the ICU nurses is based on her INFERIORITY COMPLEX....like it or not.
2) The super-busy (in a different but no less real way) ICU-nurse thinks she's being abused by the ED nurse who cant give her a few extra minutes to prepare the room and wrap-up some loose ends. She thinks the ER nurse is stupid because she hasnt all the answers the ICU nurse wants...and has a flippant attitude about what the ICU nurse feels is important. Her 'hatred' for ER nurses is based on her SUPERIORITY COMPLEX...like it or not.
Now THESE GENERALIZATIONS are just that...generalizations....but are none-the-less the steryotypical personality-types who rant about this stuff and have strong feelings (hatreds) for the other units' nurses.

I used the terms, "Evidence based logic" because of what you said here- "The 'hatred' she developes for the ICU nurses is based on her INFERIORITY COMPLEX....like it or not" sounds like you have some great knowledge and must have done a lot of research on the subject since you appear to know all about the emotions of the ER nurse.

Like I said before- since you are an ICU nurse, who came on the ER nursing forum and insulted ER nurses-you must be wanting to cause trouble or are in fact ignorant. Can you at least explain what facts brought you to believe that ER nurses have an inferiority complex and ICU nurses have a superiority complex? I am truly curious to know. I have never heard anyone else generalize that the animosity that exsists between ER nurses and ICU nurses is related to this. Seriously, where did you get this from?

I can tell you that I have seen it the other way around, but I won't give any examples other than my own opinion-which in and of itself dispels your theory. I feel superior to ICU nurses, but that may not count since I feel superior a lot of the time. I can also honestly say that each and every time I pick up in the ICU-I am very bored, no matter what shift I am working. I find having 2(avg) patients, or 1 REALLY sick patient, or 3 sick patients (if very short), for the whole 12 hour shift to be VERY boring, and I work in a level 1 trauma center! You probably do not feel this way-just because we are different-and like different things. I am also curious to know, have you ever worked in the ER? If you have not, how can you generalize about it?

What about the rest of you ER nurses-did I over react, or did this poster appear to be trying to make them self feel better by making generalizations, drawing conclusions with no merit, knocking your specialty, and putting you down? Anyone else ever been told that ER nurses hate ICU nurses because we are inferior to them, how many of you felt inferior when you saved a life today?- Yeah, just so you know, you probably don't believe it, but every once in a while we save a life too...

midinphx, BSN · Dec 16, 2009

I did 9 years ER and now I've done ICU for 5 years. I hear remarks the ICU makes about the ER nurses. I can usually stick up for the ER nurse and redirect the ICU nurse about what she preceives. (ie: she didn't do anything about the low K!) But I tell them the nurse doesn't have the same focus.

ER nurse quickly fix and ship.

ICU nurses tweek.

Both should be proud of what we do. Neither really wants to do the job without the other doing his/hers.

Just try to be nice and not kill the messenger when giving/receiving reports.

NinaGirl · Dec 16, 2009

I also worked 4 yrs ICU (primarily SICU) then now 2 yrs ED.

I will take up for ICU in the ED on certain subjects like wanting a thorough report of the pt course in the ED. Also, it took me a good 1 yr to get over my ED coworkers bias against me because I had been an ICU nurse. And God forbid I should mention something that was done in the ICU environment (like using Amio instead of Cardizem as a 1st line drug for a-fib) without getting the eyerolls from ALL ED people (including docs).

On the other hand, at my current hospital (which is granted not a trauma center), the ICU will often refuse patients for 30 minutes after a bed is posted. When I worked SICU (at level 1 trauma center), I was called when the OR was ready and I had to accommodate them, no questions asked. Usually that meant get the room ready in 5 minutes or less. C'mon it's not that devastatingly hard to get the bed ready, Oxygen/vent available, the monitor leads on, an IV pump available and suction on the ready.

Another thing I have to give ED nurses credit for is that they can get frustrated by ICU nurses that float to the ED to work and sit on their patients subconsciously because all their training is about being thorough and responsible for the complete care of the patient whereas the ED nurse (as well described in previous posts) is motivated by getting the pt OUT so that sick pt in RME has a chance at a good room. After 2 yrs, I still do this just a little (in fact it came up on my eval).

Either way I'll tell you this. When non-medical people ask me what my experience is, I am so proud to claim to have worked in both the ED and the ICU. I have had the privilege of knowing some of the finest brightest nurses in BOTH areas!!! : )