ER Nursing, Is it considered critical care?

Dinith88 · Aug 15, 2008

What is your problem? :

just getting your goat i suppose. sorry!

:argue:

GilaRRT · Aug 15, 2008

Again, I really think it is irrelevant what adjective you use to describe your role as an RN. Other than silly pride and some machismo, I simply cannot see why we are getting our little feeling hurt over two words?

MAISY, RN-ER, BSN, RN · Aug 15, 2008

Thus the reason why nurses will never be a strong voice....you don't see doctors arguing about who is more critical care saavy!

Anyway, I suppose if I had 1-2 patients I could handle 15 drips....yet, I had one active MI, one s/p cva, one syncope which turned out to be emergent internal bleed, and one ccu admit who I did q5, then q10, q15 vs, drip titration and fending off a million residents for a 13 hour shift! I agree, definately not just critical care....I CAN DO ANYTHING! SUPERNURSE:rolleyes:

Maisy

MassED, BSN, RN · Aug 16, 2008

Well, unless ICU/CCU is performing direct admits, patients start somewhere, perhaps in the ED?
Since these same patients are vented/(come in on vents), central line insertions, stabilized, and all care initiated/sometimes maintained(due to lack of unit beds)....I'll take a stab and say CRITICAL CARE.
I know when I have had up to 4 unit patients, all orders including hourly labs, 15 minute vitals, fs, and whatever else was expected to be done. Amazing that I can handle 4 huh? Am I saying that we are able to do the kind of intuitive, notice of slight changes in condition care that ICU provides-ABSOLUTELY NOT(with 4 patients)-however, being able to maintain stability, comfort and orders. It's a special balance that only a critical nurse can achieve.
As always,
JMHO
Maisy:heartbeat

:yeah: yup. ER is definitely critical care (and urgent care and non urgent, etc. There are many facets to the ER) - those critical patients that come in to us and are (relatively) stabilized and sent to the unit... that requires a level of critical care expertise. There's no other way to slice it.

MassED, BSN, RN · Aug 16, 2008

Maisy, what is the hostility against ER nursing?

whoooahhhhh there is much hostility out there for ER nurses. Do you work in a hospital? All you have to do is be around on a floor when an ER nurse calls to give report on a patient.... I don't know why, but in my experience there has always been this separation between ER and every other nurse.

MassED, BSN, RN · Aug 16, 2008

All I can say is read the threads dealing with ER and the floors. I have heard many disparaging remarks from nurses regarding the ER and its staff. It's really a shame, I try to make patient care seamless and easily continuous for the floor nurses....there just seems to be a hostility towards us. It's heard in the voices on the phones, its heard during report, its felt delivering patients with a drip.....there's just something unspoken, and unfortunately palpably felt.
It's a shame when former schoolmates feel the need to say to their workmates "oh, she's not like that'' I say "like what?" "you know, like the other ER nurses" NO I DON'T KNOW...I THINK MY COWORKERS ARE GREAT!
Anyway, you can't appreciate it until you feel it or face it. I just muddle through....I am determined that whatever issue is there, I don't let it color my relations with the floor.
JMO
Maisy
It is true. Before I took the plunge into the ER, where I was working on the floor, the nurses said "don't do it, the ER nurses think they're the best, they're mean" etc. It's true there are some pretty hardcore personalities sometimes, but you have to mean business and get things done so it might come across as harsh to others. I think once you've dealt with life or death decisions, then everything else is peanuts. It reshifts your priorities. If that attitude is conveyed to a floor nurse, then that can give a floor RN a negative impression of the ER. I can appreciate being on the floor and those challenges compared to working in an ER. Before a floor nurse accepts a stereotype of an ER nurse, they should walk an hour in our shoes.... there would be a much different dialogue occurring during patient reports with the ER nurses!!

MassED, BSN, RN · Aug 16, 2008

That's a tough one. Yes at time one can be taking care of a critically ill pt but many ER nurses have limited experience with the on going management of drips, vents, and invasive hemodynamics (unless they have worked in a ICU).
I speak from experience - as a new grad 20 yrs ago I went straight to ER and after a few years then transferred to ICU specifically to learn more about taking care of critically ill patients and to learn things like vents, swans, and multiple vasoactive drip management.
FYI - when one is applying to CRNA school they want to see critical care experience and ER does not count.

I can understand having ICU experience for CRNA school in regards to meds - such as you write, since working in an ER you don't have that time to pore into detail regarding drips and multiple meds and s/e, etc.

MassED, BSN, RN · Aug 16, 2008

and..what if a patient strolls in having contractions...(duties of OB nurse)...hallucinations (psych nurse)...headache or diahhrea(sp?) (office?)....are you not performing these duties as well?
Sounds like you're very concerned about others' perceptions... of course you take care of critically sick patients...but all the time? nope. In any given shift (in 95% of the USA's ER's) there is a very good chance you WONT be caring for a critical-care type patient.
And are you more of a critical-care nurse than the tele/IMCU nurse with 5 patients on 10 drips? (would 15 drips impress you more?) in addition to a crazy-needy patient with a nut-ball family?? Or the recovery-room nurse with two or three vented patients on 10(15?) drips?
You see, 'critical-care' nurses come is several varieties... but... critical-care 'specialists' dont work in ER (neither do pediatric specialists...or psych specialists, etc. ad nauseum)
ER specialists do.

I believe the point of that poster was that there are aspects of critical care (just as there are aspects to the job of an ER nurse to be knowledgeable of OB, Peds, Geriatrics, trauma patients, etc.) As some previous poster wrote, it's a smattering of all things - but the important piece is to be able to care for that critical care patient, among all of the other junk, being that we have TNCC, PALS, ACLS, CEN, etc... the difference with the ER nurse is that speciality nurses in other areas (critical care, peds ICU, burn unit, psych) don't come and work in an ER and have other patients like we have. A peds ICU patient isn't going to come into the ER and work with a trauma patient or cardiac patient and feel a certain level of comfort or expertise. It's not an argument of us versus them, which is kindof what you're making it out to be. It's that we can address it all (including the crtical care aspect of the job) and keep rolling.

MassED, BSN, RN · Aug 16, 2008

But, what you neglected is that not any RN can be board eligible for the CCRN exam; therefore, I stand by my statement that ER nurse are critical care nurses because they are included in the eligibility requirements for taking the critical care nursing boards.

boo ya!

MassED, BSN, RN · Aug 16, 2008

Thus the reason why nurses will never be a strong voice....you don't see doctors arguing about who is more critical care saavy!
Anyway, I suppose if I had 1-2 patients I could handle 15 drips....yet, I had one active MI, one s/p cva, one syncope which turned out to be emergent internal bleed, and one ccu admit who I did q5, then q10, q15 vs, drip titration and fending off a million residents for a 13 hour shift! I agree, definately not just critical care....I CAN DO ANYTHING! SUPERNURSE:rolleyes:
Maisy

you know, it's the ICU nurse who would say this, not understanding the complexities of ER patients at any given time!! I'm with you, Maisy! Only other ER nurses would understand when the poop truly hits the fan and what we have to deal with at any point. ICU patients are given to them in a somewhat stabilized state from the ER.... so they have that going for them! So much for the ER supernurse! Thanks! :banghead:

MAISY, RN-ER, BSN, RN · Aug 16, 2008

whoooahhhhh there is much hostility out there for ER nurses. Do you work in a hospital? All you have to do is be around on a floor when an ER nurse calls to give report on a patient.... I don't know why, but in my experience there has always been this separation between ER and every other nurse.

Case in point,

ACT 1:

yesterday fellow nurse has ICU hold patient who is incontinent....THE ER WAS ROCKING! It was crazy, no breaks, call outs, short staff, I was in our regular medical and had 6 patients! My friend, brought her admit to ICU monitored, and with open diaper.....ICU nurse freaked out! Mind you, all orders complete...patient clean and on bed....Like some Joan Crawford nightmare (No wire hangers ever) "We don't use diapers ever, you all give crappy care!" WHAT! :eek: S replied perhaps if she had one patient with a technician she could change the bed 50 times daily, but was this nurse kidding? She wasn't..

Act 2:

S gets another emergent patient, junctional rhythm-vomiting/diarrhea-basically looks like St Peter's calling....as the multi doc brain trust musters about....patient prepped, drips everywhere, foley in, patient cleaned a million times, blah blah blah....bed opens in ICU as patient has a stable time-orders still being written....bed ready....GUESS WHO IS RECEIVING?...ICU nurse from first ACT! S brings monitored patient over, with residents and every imagineable implement for resus with her....the first thing ICU does is start screaming that the ALMOST COMPLETED ORDERS (THEY ARE STILL WRITING) have not been implemented! AGAIN, WHAT! :eek: Orders aren't even on the chart yet. This nut went on and on!

S is such a gentle, sweet nurse who busts her butt, I "strongly" encouraged her to report it. This is horizontal violance and unacceptable. I can't stand nurse who are that pushy....nursing is a 24 hour job...that's why we are here....that's why need to work together.

This is just two patients, it's not just ICU, it's everywhere....the thing that bothers me is that I am always pleasant on the phone, address everyone respectfully, and usually send my holds with a majority if not all orders implemented. I think a majority of my peers perform the same way. We all have work to do....I know I don't sit on my butt, but I think nurses who have never worked ER do!

I know, kind of off topic, but answering a question.

Maisy:wink2:

MAISY, RN-ER, BSN, RN · Aug 16, 2008

you know, it's the ICU nurse who would say this, not understanding the complexities of ER patients at any given time!! I'm with you, Maisy! Only other ER nurses would understand when the poop truly hits the fan and what we have to deal with at any point. ICU patients are given to them in a somewhat stabilized state from the ER.... so they have that going for them! So much for the ER supernurse! Thanks!

Okay, since we are both on a roll, I'll throw this out there......we deal with unknowns....patients who if they are talking are poor historians, if they aren't talking... A COMPLETE UNKNOWN. WE take the information however it is presented and paint the picture that will provide the base for every treatment, test, and patient placement that will be done until they are in a room assignment-after stabilization of course. ER is crazy, and we have to be fast! Our actions, or lack thereof, can make or break a patient.

Other areas of critical care, maintain and watch for those deadly changes that may lead to further complications. They continue on the course originally charted, or as the patients needs change...BUT THE MAP ORIGINATED IN THE ER. :rolleyes:

JMHO:redbeathe

Maisy