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!

[gcupid]

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.

Many of those issues listed can be credited to bed assigning/poor staffing/management/& lack of physician education regarding the resources available & skillset of nurses to each floor. ER nurses have no authority to what floor a patient is placed and by what time. There is a lot of pressure to get them patients moving. You must fight your battles wisely as a nurse. It is tiresome to keep preaching and fighting the same issues. I speak up once and Ive learned to do the best I can with what's presented unless I feel that the patient is going to die while en route...

I think it depends on the culture of the hospital but I've worked at multiple facilities as a floor nurse and I'd much rather an admit from the ED than an ICU transfer despite having less paperwork. I despise ICU transfers bc it always appeared that the acuity level was borderline between the floor and the icu and they just had to make available room for an even more unstable patient....

In addition to having borderline acuity level between the floor and icu, the patient/family members were extremely spoiled bc they become accustomed to a nurse with "only" 1-2 patients being directly over them. I give a speech to every icu transfer, this floor fosters more independence and that it may be challenging to get to you in a short of amount of time, if you have Any requests bundle them together so that I may make one trip to this room bc my time is divided between you & however many other patients.

[Larry77, RN]

Good comments "gcupid", but please nobody stir up this old thread--quite controversial for sure (fun though).

[NickiLaughs, ADN, BSN, RN]

I've done both, it's a lack of perspective I think. ICU nurses have more time for the little important details because that is their job, to know every important detail going on with that critically ill patient, that's why they have the lower ratio of patients. ER nurses do not have the time for the little details typically because they often have that ICU patient and 3 other patients. Their goal is to keep all the patients alive, and get the ICU patient up as quickly as possible to the nurse who will be able to focus on that patient more.

Neither is better, both are completely necessary. :)

[gcupid]

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.

What if patient #2 was an active STEMI with overdose, patient 3# a stroke protocol with TPA admin, Patient 4 a DKA patient that is Septic & requires drip titrating, patient #5 an AKA with active bleeding that's not your patient but the nurse ran off to lunch, & #6 an escalating aggressive psych patient that is not your patient but is the newbies who needs support bc the psych patient turned to a medical case bc of asthma exacerbation and is in a non symptomatic hypoglycemic episode.... All the while the charge nurse & nurse supervisor & pharmacist is helping out with the 3 new patients that came in back to back with in a 10-15 minute window who all needed intubation, art line setups, & whatever else....

What I mentioned above is a hard rare night but I make no excuses for that slip up. A call should have been made to float an icu nurse down to get the protocol started. But the ratios must remain intact in the icu, so no one can come, so u do the best that u can with the resources u have..... I blame the system for that child's negligence. And I wonder why the ER doctor did not follow up Nor admitting doctor before patient was sent to the floor?