Frustrating... ED is Not Critical Care

  1. I've been an ED nurse for 7 years, working at four different hospitals from a tiny, rural, critical-access hospital (as I call it, Level None) through a regional academic medical center (peds and adult Level One). I've also worked in the critical-care float pool at the Level 1. Whether it be from CRNA programs or from ICU nurses in the smaller facilities, I get a bit tired of the offhand presumption that ED nurses are not critical care nurses.

    While I will admit that that assessment does hold true in many circumstances, there are EDs where the nurses get substantial experience with some of the most critical patients.

    Think about those times when the ICUs are full and you are boarding critical patients for hours. I've boarded critical burn patients, unstable trauma patients, critically ill medical patients on multiple drips, post-ROSC patients, as well as patients deemed too unstable for transport to one of the units or needing to hold in the ED for completion of various diagnostics or procedures.

    How 'bout a shout out to and from the ED nurses who would absolutely raise their hands to self-identify as critical care nurses?
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  3. by   Pixie.RN
    Absolutely agree! And without the benefit of knowing a diagnosis right off the bat. I mean, some things are obvious, but ... certainly not everything.
  4. by   ~Mi Vida Loca~RN
    Funny, FB reminded me I just posted about this exact thing 2 years ago.
  5. by   JKL33
    Agree with your assessment of all the various situations and settings in which we provide critical care.

    Honestly, though, I almost couldn't care less what others think of the ED RN role...I love it. We come in darn handy in a lot of situations from 'you'll be fine' to 'minor crisis' all the way up to 'someone will die without my/our help' .

    And hey, at least my "primary assessment" doesn't start with "check coccyx"!! [Okay, not knocking it, I understand why but....]
    Last edit by JKL33 on Jun 11, '17
  6. by   offlabel
    They're not the same things. There are elements in common, but are ICU nurses emergency nurses? Their patients arrest sometimes and they get direct admits that are unstable that require emergency care. But why does that matter? Does the label validate the job? Sounds as if being an emergency nurse is somehow "less" instead of "other".
  7. by   luvRN1987
    Sorry you get that comment because some CRNA schools accept ED as their ICU experience.
  8. by   OlivetheRN
    Quote from luvRN1987
    Sorry you get that comment because some CRNA schools accept ED as their ICU experience.
    I have yet to come across one
  9. by   Jedrnurse curious to see if opinions would change with a few float shifts to the ED. (Or not.)
  10. by   calivianya
    Our ED nurses are absolutely critical care nurses.

    My unit (MICU) stays full all the time. It's daily that there are vents on pressors being boarded down in the ED... and a single ED nurse might be watching four unstable vents down there. They have a way worse time than we do, and get none of the credit.
  11. by   Pixie.RN
    Quote from OlivetheRN
    I have yet to come across one
    I think some CRNA programs state that as long as a nurse can demonstrate critical care experience (invasive monitoring, vents, critical care pharm/drips, etc.), that is acceptable. The US Army Graduate Program in Anesthesia Nursing (through Northeastern University) is one such program that has the "critical care" stipulation. I know people who have gone through USAGPAN from working in stepdown units.
  12. by   NuGuyNurse2b
    I am howling at the "Level None" moniker. I'm going to be using that in my daily vocabulary HAHAHAHAHA
  13. by   offlabel
    Boarding critical patients in the ER does not make the RN taking care of them a critical care nurse. It means they are doing critical care. If every single nurse on the shift was qualified and able to take care of critical care patients, that would be one thing. But that isn't the case on every shift with every nurse. Taking care of critical patients in the ER is skimming the tree tops and it is part of emergency nursing, but it isn't critical care. It would be like saying the ER physician and the intensivist or pulmonologist are interchangeable and they're just not. But they're not supposed to be and that isn't a problem.
  14. by   ~Mi Vida Loca~RN
    So question for my fellow ER nurses, how would you guys feel about an integrated ER. They are starting to pop up more and more. One of my best friends was doing his residency in EM/IM and then fellowed in Critical Care. At the time that was the only pathway they really had up and coming and now some places are starting to offer EM/CC.

    Anyway I have learned a ton from him and it completely changed my way of thinking in my patient care even in the ER. As a lot of you know in the ER even when we have a critical patient come in, it often doesn't change our Ratios. The problem with this is when in the ICU the nurses typically have a ratio of 1-2 with these same patients, well a little more stable than when we get them regardless of what some might want to say.

    So in the new integrated ER concepts the ER nurses would be cross trained in ICU and EM. There would be doctors staffed as well that specialize in both. If the nurse works the zone with these patient types their ratios would be reflected for that. The idea is not to hold patients longer in the ER. But more to provide safe and good care for those patients that will have to board in the ER while waiting for an ICU bed. Once a bed is available the intensivest and ICU RN would take over care. My friend was asked to come be a part of one of these ED's when he finished his fellowship and he was trying to convince me to do it as well.

    For me personally, as long as the ratios reflected the higher acuity, I would be all for it. Not only is it safer and things aren't getting missed in the holdover, I have always wanted to cross train in the ICU for the knowledge aspect of it, however had no desire to leave the ER. Would still rather have my ICU patients for a handful of hours and move along to the next. Obviously the ICU nurses would not need to cross train in the ER unless they wanted to switch roles.

    Anyway I was curious what others thought about this.

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