Education 101: ER vs. ICU

[1EmergencyRN]

Help! I went straight into the ER from nursing school. I had battled between my choice to go into an ICU or the ER, but leaned towards ER the whole time. During nursing school I found a lot of criticism for looking at both as options. "It's either one or the other and they're both very different!" was commonly heard when I was in clinicals. I did my senior practicum in an ICU, mainly because I had not been exposed to it much and knew it would help solidify my choice. Sure enough, as much as I enjoyed the experience, I also confirmed for myself that I am an emergency nurse, no doubt about it. Now, fast forward a year and a half. I am an ER nurse, love my job. Here's what I don't understand though, why do so many ER nurses hate ICU nurses and vice versa?? Every time I've transported to the ICU, I've either been yelled at (it's happened several times!) or I have had a cold shoulder given to me. Only 1 time have I had a smiling face. Now, you may wonder maybe something is lacking in my practice? Well, I wondered that too, but I've asked and asked for feedback, not only from the ICU nurses, but from my peers as well. The responses have been baffling, as no one really seems to say anything solid, just continue to rant, rave and complain about the other. And you know what? I don't get it! Yes, I see that our jobs are totally different, but why can we not just respect our differences and do our job without grumbling? What is it that makes these two specialties dislike each other on such a large scale? Is this type of rivalry common between these two specialties in other hospitals as well? Help me understand, and more importantly, educate me to know what I can do better to make those ICU nurses happy! I want to be a team player and would love to not be viewed as "the evil ER nurse who put an 18 gauge in an ac" (hey, we had to do a CT angio, so I had no choice on the ac placement!) whenever I transport!

[Lunah, MSN, RN]

A lot of our ED nurses are former ICU nurses (and nurse managers, too), so they have been great in teaching me about a LOT of things that the ED doesn't necessarily do. For the most part, our ICU nurses are great -- I'm in a freestanding ED, so every now and then I have to ride with transport over to the ICU with my patient if they have something going that the medic can't monitor, like a TPA infusion, or if a critical care medic isn't available and the patient is on BiPAP or vented. Every time I've had to go to the ICU, they have been VERY nice and welcoming! After I call VoiceCare and they call me back, I'll admit that I cringe for a second while going to the phone because ICU nurses do have "that" reputation, but nine times out of 10, they have no questions and they're only calling to let me know they're ready for the patient. Once or twice I've even been told "great report." Ha ha! That has taught me to assume that ICU nurses are total ... well, you know. Then again, I've also been told by some of our former ICU nurses that I would do well in ICU because I'm a little ... um, detail oriented. All in all, I have great respect for both areas.

[Dinith88]

I feel superior to ICU nurses, but that may not count since I feel superior a lot of the time. QUOTE]

????

[LilgirlRN, ADN, RN]

Did CCU for 2.5 years then moved to the ER. Here's what I can tell you. In the unit the nurse has the luxury (most of the time) of only having 1-2 patients to take care of. In the ER I may have 2 patients just as sick as the ones in the unit but I have 3 other patients too. Then there's the I can't take report right now, the ER will just have to call back. This one really chaps my a$$! Does someone call me and tell me that their loved one is having a heart attack? NO, they just show the he!! up! I have to be ready for anything that walks or rides through the door. And yes, sometimes I do NOT know much about the patient even though he was supposed to be mine because one of my other 4 patients coded! Meanwhile in ICU, the tubed, knocked out paralyzed with drugs patient gets turned q 2 hours and suctioned every 4. He has a central line for you to draw his 4 am labs from. He has a foley to be emptied but hey the tech can do that. All of his meds go down his NG tube. He's on the monitor with q 15 min BP, PO2 and HR but it's all automated and will even tell you if the patient is in trouble.

Meanwhile in the ER... I go to the waiting room to get a patient's family member and a young mother grabs me as her toddler is vomiting and having a seizure. I'm full and have nowhere to put this kid. I take him and throw him face down over my arm so he doesn't aspirate and just run with him and find a doctor. We ask another patient to vacate his bed and go to work on the quivering patient with about 2 square feet of body surface area. His mom is crying hysterically, the unit clerk calls the chaplain to handle mom. Throughout all the chaos there is some control. We who have been doing this for years have learned our place and pace in the dance.

[Dinith88]

... In the unit the nurse has the luxury of only having 1-2 patients to take care of....Then there's the I can't take report right now ... I have to be ready for anything that walks or rides through the door. ... sometimes I do NOT know much about the patient ...my other 4 patients coded!

...in ICU, the ... patient it's all automated and will even tell you if the patient is in trouble.

Meanwhile in the ER... young mother grabs me ...toddler having a seizure...Throughout all the chaos there is some control. We who have been doing this for years have learned our place and pace in the dance.

I'm kicking myself because i keep looking at this thread! But because i was personally insulted my curiosity gets the best of me...but wow...your post is a perfect example of what i was talking about. I cut it to highlight my point...

So...my response to your post is this... You state that you're angry and your a$$ is chapped because the ICU nurse wont take report immediately. I suspect you find this with every other hospital unit...and it's not unique to the ICU...right? (if it's unique to the ICU @ your hospital then yours is unusual)....ummm..

At any rate, because this is the thing that chaps your rear...you go on to bash ICU nurses, their work, and paint them as lazy and have luxuries and calm/quiet and etc. that you cant possibly have because you're in the ER. (Do you see how this post makes it seem that your anger is an over-reaction or mis-guided or coming from someplace deeper? perhaps because of some strange 'complex'? I say 'inferiority complex' because of the tone of the arguments i keep hearing....like some broken record...And I'm NOT pegging this on all ER nurses...the confident/competent ones know they're good and dont need to insult other units/people to make themselves feel like it.)

Oh...and the only thing your posts needed at the end was that while your four patients were coding and you were running with the sick kid looking to throw him at a doctor during your ER dance...was theme music...to reinforce the 'importance'' of your job. Unfortunately for all of us, drama isn't unique to the ER.

And by the way...having the option to throw a sick patient at a doctor...is a luxury the majority of ICU nurses dont have. But i will bite my tongue...lest i seem to have a 'complex' :)

[I_LOVE_TRAUMA, RN]

Yeah can't believe I'm wasting my time here either-especially on the same old argument.

But I must say-I'm really just upset because I work and see things from both sides, and i hate when people who don't work ER/ICU act like they understand what happens there.

In my place (a level 1) the ER has 1 doc and 1 resident, in the ICU there is 1 doc and anywhere from 2-5 residents-24 hours a day-7 days a week-365 days a year(part of our trauma program). They come down and help in the ER if needed, but are usually sitting around fighting each other over who gets to do the next procedure. And when we bring up a new they all eagerly jump on the patient. Now having said that-we still have nurses ICU nurses who constantly give the ER nurses crap because little things aren't done, and the patient isn't packaged perfectly-it happens a lot, and it is not fair-all I'm saying. It is called continuity of care-we each have a job to do, you really can't expect us to do much more than we do.

I know that there are bad seeds both places-I just think that you should definitely walk a mile in the other persons shoes before you judge and say we have complexes. I think that by working in both places for 5 years now (almost 14 in ER, but in the ICU for the past 5 years at least 1 day a week), I can honestly give my interpretation, like some of the other posters, better than someone who has never done the others job. I also have my CEN and my CCRN.

I would very curious to see how you felt after you had worked in the ER for a while, like some of the other posters stated that they very surprised when they went to the other side-I think that you too might have a very big change of heart...

[Dinith88]

Yeah can't believe I'm wasting my time here either-especially on the same old argument.

But I must say-I'm really just upset because I work and see things from both sides, and i hate when people who don't work ER/ICU act like they understand what happens there.

In my place (a level 1) the ER has 1 doc and 1 resident, in the ICU there is 1 doc and anywhere from 2-5 residents-24 hours a day-7 days a week-365 days a year(part of our trauma program). They come down and help in the ER if needed, but are usually sitting around fighting each other over who gets to do the next procedure. And when we bring up a new they all eagerly jump on the patient. Now having said that-we still have nurses ICU nurses who constantly give the ER nurses crap because little things aren't done, and the patient isn't packaged perfectly-it happens a lot, and it is not fair-all I'm saying. It is called continuity of care-we each have a job to do, you really can't expect us to do much more than we do.

I know that there are bad seeds both places-I just think that you should definitely walk a mile in the other persons shoes before you judge and say we have complexes. I think that by working in both places for 5 years now (almost 14 in ER, but in the ICU for the past 5 years at least 1 day a week), I can honestly give my interpretation, like some of the other posters, better than someone who has never done the others job. I also have my CEN and my CCRN.

I would very curious to see how you felt after you had worked in the ER for a while, like some of the other posters stated that they very surprised when they went to the other side-I think that you too might have a very big change of heart...

You make fair points. And i agree.

[Larry77, RN]

K...I'll stir the pot a little more...lets get an average weight of all the ICU nurses and all the ED nurses and compare...now who works harder?

I think that some of the smartest nurses I've ever met were ICU nurses but they are LAZY as far as the physical aspects of nursing...just my opinion.

I should post this in the ICU nurses forum...oh that's right I respect their space and go as a visitor not a troll!

Thanks for keeping this website entertaining btw...love you "I love trauma"...you always crack me up :-)

[I_LOVE_TRAUMA, RN]

awww... thanks Larry, your sweet.My husband is always worried about me...ya know since I was born without that little filter thing on my tongue,lol. Just think we should have all learned how to do research before speaking while in school.And FYI-I'm 4'11" & 95lbs. soaking wet-not that I am in anyway condoning your ugly remarks-did make me lol though...I always enjoy your posts as well...

[LilgirlRN, ADN, RN]

No, I have no inferiority complex. Please remember I've been on both sides of this fence. Don't take what I wrote as an insult, it's just my version of the truth. When I worked in the unit we thought that ER nurses were lesser than. We knew it all, of course we were all young and didn't really know that much. We'd ask the ER nurses stupid stuff like what the patient's cardiac output was when they didn't fool with Swanz in the ER and we knew it! What I was trying to point out is how skewed the world of nursing can be.

This site actually makes me angry that they didn't put ER under critical care nursing cause we do it all the time. I worked with a nurse a few years ago who was trying to get in CRNA school. She said she needed some critical care experience. I said huh? You do critical care here all the time! Yeah, but they won't accept it unless it's experience in a critical care unit. Dumb, dumb, dumb!

I do love ER but sometimes I do wish for the days that I had two vented patients who were knocked out. I worked in the unit at night so no family to deal with. It was usually peaceful.

I'm not saying that ICU nurses are lazy or dumb. Everybody finds their own niche. To me the more (and I don't mean this in a bad way) anal nurses like critical care. You have a place on your flowsheet to chart every little thing. You can keep your area nice and neat cause you don't have 20 different patients in that same room everyday.

ER is for all of "those" nurses with ADD or ADHD. We go go go all the time. We're generalists. We gotta know something about everything! And if we actually run outta something to do, which is rare, then we help another nurse get her/his stuff done. I suppose the general outlook with us is that we can do anything even with a limited amount of staff. When the shift is over we can look at each other and be proud that we took care of all those patients and didn't lose a one! We think we ROCK! and we do!

And you're right, it's not just the ICU nurses that don't wanna come take report. The nurses on the floor have anywhere from 5-8 pt's a piece! I wouldn't want to take report either.

[Tonjia]

I also think it is a case of working in the shoes of the other department. As ER nurses we are accustomed to receiving traumatically injured, or medically unstable patients and doing everything in our power to make sure they take another breath. We do not have the luxury to establish a long term relationship with the patient and to learn about them like other areas do.

The element of rapid assessment and treatment is sometimes not fully understood by nurses who are able to take their time with the

patient and who are able to peruse the chart and compare lab results etc. It isnt a bad thing that they dont know where we are coming from, sometimes I feel the same way about them.

I think the key is to try to be a team player, no matter who is on the other end of the phone. In the big picture patient care is what is important!

[dan_dfc]

I'm all confused now. Was the original post asking for advice to help reduce the rivalry and animosity between ER and ICU or did it say "I'm bored, I'd sure like to see a shameless ******* contest with lots of petty bickering between ER and ICU nurses"?:argue:

I've been in ER for three years and started there right out of school, we had a lot of these same problems when I first started, but they have slowly gotten better. In my opinion, it all starts with you, someone has to take the first step. Forget about you past issues and start tommorow fresh. Acknowledge that the ICU nurses job is every bit as difficult as yours, although entirely different. Go an extra mile to help out the nurse who is going to be receiving your patient without killing yourself in the process, little things count! If your putting in a foley and know your patient is going to the unit, grab one with a urine meter so they can accurately measure output, go ahead and start a second IV even if they don't need it right this minute. If they're goin to ICU they probably will need it before the shift is over. If the patients pressure is 95/40 with a heart rate of 115 and septic ask your doc to write a prn order for a pressor so the ICU doesn't have to wake up the primary doc two hours later when their pressure bottoms out. I won't hold a pt in the ER for two hours after getting a room assignment as some nurses ask of me, but I do acknowledge that the ICU nurse is probably every bit as busy as I am, and have no problem giving them 10 or 15minutes to pee, prep their room, or whatever. It's going to take me a few minutes to bundle the patient up for transport anyway! Treat your patients and coworkers with dignity and respect regardless of whether or not they return it. Lead by example and encourage others to do the same. Over time those mean ol ICU nurses will realize that you are competent, caring, and playing on the same TEAM! Granted-some people are never going to change, they are bitter for reasons of their own, they work in every department in the hospital, smile at them, kill them with kindness and move on about your business. Three years ago bitterness between our departments was a given, just accepted and dealt with. Now many of us in the ER and ICU are friends and occaisionally go out for drinks after our shifts, there we laugh and joke together about the cranky, anal ICU nurse who has a gripe about everything we do in the ER, as well as the Idiot ER nurse who transported a pt with bilateral PE in a wheelchair on a nasal canula.

Anyway, that's my 2cents, :twocents:it aint' worth much but I figured I'd throw it out there anyway.

[Tonjia]

Kudos to you Dan! I think if we all stepped back and utilized your work ethic then the friction would most certainly be reduced.

I applaud your preceptors when you were trained to be an ER nurse, they did an amazing job.