Standby: VENTING

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Why is it that there is a large percentage of ICU nurses who think that ED nurses are unable to correctly monitor cardiac gtts and vent settings in the ER?

Here is a little background r/t my venting. I have been monitoring the CRNA board and reading how ICU is really needed to prepare yourself for CRNA school.

I know for a fact that When I take my patient up to ICU who is vented and on multiple drips and who I have been monitoring for the last 6 hours waiting for an ICU bed to be opened is alive because I know what I am doing (run-on sentance). When a patient arrives intubated with CPR in progress I know I don't quickly say, "not here, take them directly to ICU!" because Boy Howdy, we may have to start a cardiac drip and set up a vent.

Granted this is mostly in JEST! Most ICU nurses and Most ED nurses really appreciate what the other does and the skill required to perform both in the ICU and ED. I just had had enough of a few postings. Forgive my flippant remarks they are not to be taken seriously.

I think your venting is right on the mark. When I was interested in CRNA school I noticed that they only wanted ICU experience prior to admission. I have ICU experience before I started ER and though it is like comparing apples to oranges, ER is much like critical care. You do get more experience in the ICU in using vasopressors and the like, but in ER, I all too frequently use many drugs to induce conscious sedation. Maybe CRNA schools should not negate all ER experience, but, if that's what they require...

I think it's mostly because of the amoun of experience you get in ICU rather than ED. In ED you have to deal with a much bigger variety of things each day. I did a few months in one, and not once saw a vented patient, nor did they do concious sedation. That was left for other departments.

Specializes in LTC,Hospice/palliative care,acute care.
Originally posted by FlyingED

Why is it that there is a large percentage of ICU nurses who think that ED nurses are unable to correctly monitor cardiac gtts and vent settings in the ER?

Same reason there are acute care nurses that feel that LTC nurses are incompetent.....Many nurses have no understanding of the challenges that nurses face in other specialties an d often feel that their own must be the most difficult and they must be the most knowledgeable and work the hardest... Maybe they have low self esteem and this thinking re-enforces their self -worth?
Specializes in Emergency Room/corrections.

I have worked in the ICU and CCU, and I have no answer for this question whatsoever. We have ICU/CCU nurses who question everything we do in the ED on a routine basis.

These are the same nurses who call for help when they have a patient go into cardiac arrest!!

Maybe its the mindset, the ICU/CCU mindset is so totally different from ours in the ER. They have the luxury of being able to take each case and virtually get to know the patient and their family intimately. We do not have that luxury, we stablize or attempt to and then transport them to their perspective bed... and someone else takes their place.

When I worked ICU/CCU, I also had the luxury of having only 2 patients, now I could have as many as 8, depending on their acuity. (and sometimes more)

good question, hard to answer. I would love to hear what nurses currently working in those units would have to say.

Hello,

I just wanted to say that I know an ER nurse who got accepted into CRNA School without ICU experience. I personally have never worked ICU. However, the school he applied at was impressed with the drips we did in the ER, the conscious sedations, of course the codes, vents, and IV skills. They reccommened he take a critical care course that focused on swann cathether measurements. But, felt the rest of the skills were there to build on.

Y2KRN

Specializes in Emergency/Critical Care Transport.
Originally posted by cyberkat

I think it's mostly because of the amoun of experience you get in ICU rather than ED. In ED you have to deal with a much bigger variety of things each day. I did a few months in one, and not once saw a vented patient, nor did they do concious sedation. That was left for other departments.

I'm not knocking you cyberkat but in my ED we do it all the time, conscious sedation, cardiac drips, vents and we're just a lil ol community hospital. Yesterday we had four people on mulitple cardiac drips and one vented pt that we had to hold because ICU was full. Just another day in the Magic Kingdom.

The only thing that yanks my chain is when I bring the pt up to ICU and the ICU nurses act like I'm ruining their day. You know they have a 2pt to 1 RN ratio which means the person who is getting my pt previously only had one. Meanwhile down in the ED I had the vented pt with propofol, mag, insulin etc running AND 3-4 other pts to attend to. I've done a couple of ICU rotations, do Critical Care Transports and yeah the pt's can get hairy at times, but when we bring them up they're clean, nicely packaged, IV's including central lines if necessary are inplace, they're vented, sedated, all wrapped up in nice bow and the ICU folks act like I did this on purpose just to make their life miserable. Gimme a stinkin' break.

Just an interesting observation= on the MAIN page for the bulletin boards it lists Critical Care and ER is not in there but under "speciality". Guess everyone has thier own idea of what critial care is. If ER isn't one of them I don't know what is! Where does ICU think they get most of their patients from???

I don't doubt you do all those things, and probably do them often enough to get really, really good at it. I was just pointing out that a lot of hospitals don't do it that way, and that could be why schools require ICU experience? Maybe those schools just don't want to take the time to question ED nurses enough to find out just how much each individual does those drips, etc.

In our area most hospitals consider ED a critical care unit and nurses have to take the same critical care courses ICU nurses do.

Specializes in Neurology, Neurosurgerical & Trauma ICU.

Well, someone asked for an ICU nurse's reply, so here it is!

I have to say, for the most part, I do appreciate everything the ER nurse's do! I think they are very capable and I've rarely had a problem with the pt's they bring up to me! It's like everything else, when people have a problem with a few, they tend to think that the majority are that way.

My only complaint in MY hospital is this. First, let me say that I work in a large Level 1 trauma center and I work in a very specialized ICU. Now, when it comes time to get report, I sometimes feel like I have to pull teeth to get a "good" report out of them. And that I specifically have to ask for things that should be given automatically.

But to tell you the truth, other than that little gripe, I have to say that our ER nurses are very good at what they do!

Now OR nurses......well don't even get me started there! ;)

There's my 2 cents...thanks for listening!

I hope I can add something useful to this discussion, as a current SRNA who did SICU/CVRU/ER/CCL. Speaking from my personal experience, the experience I had that is proving to be the most beneficial to me now that I'm actually studying anesthesia is my unit experience. That is where I had the most ventilators and drips. But I think this goes much deeper than whether a nurse has simply cared for someone who is being ventilated and on some drips. Almost anyone can be taught those purely technical skills. The issues (at least I think for NA school) is a deeper understanding of these things. In my experience, I found that taking care of two ventilated patients in the unit and truly trying to understand what was going on was a better learning experience. Things such as relating changing your vent settings to changing ABG results, figuring out why your pt's peak pressures are going up, and why you have a horrible V/Q mismatch, are things usually only learned from experience in ICU's. And NA schools know this. Most hospitals don't have to hold ICU pt's in the ER, so therefore those nurses may start these things, but then transfer the patient. I understand and appreciate that there ARE some ER nurses who do have to hold these pt's, and therefore know more than some ICU nurses give them credit for. And yes, people do get in anesthesia school with only ER experience, if they can prove they do have the experience and critical thinking skills needed to succeed.

I would also like to make the following point about this whole argument regarding drips. ANYONE can start a drip. All that's needed is RN behind your name. And many nurses know to start dopa for low BP and nitro for high BP. That's great, and much more than some others know. Where I believe some resentment may come in is this: where a CVRU nurse, who is attuned in to tell when her post op cabg/mvr needs which of 7 drips titrated to decrease preload according to a wide variety of hemodynamic numbers from a swan, is told by an ER nurse that they know just as much about drips. That is offensive to some unit nurses, b/c they know that is simply not always the case. To you ER nurses who are that knowledgeable about the pharmacodynamics of vasopressors and inotropes from ER experience only, then I commend you. I'd love to see your ER, b/c it must be one amazing place.

So this is just my two cents.....

NCGIRL,

That was a wonderful explanation. You stated your opinion clearly without getting snotty and you made great points. NEUROICURN-very funny thank you both.

Now let's stir the pot a little more. We all know ICU nurses that have crossed over to the ED and vice versa. But, we also know ICU nurses that turn pale anytime anyone even mentions the words "float to the ED". For me, the ICU, with fresh hearts coming right from OR, scare the hell out of me. I remember watching a pair of ICU nurses working the drips on a unstable fresh heart. They were amazing, beyond me, by miles. So, don't get me wrong ICU nurses have "mad skills" but so do we, in a broader field.

Like I said in my first post, disrespect goes both ways and only from a very low percentage.

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