Frustrating... ED is Not Critical Care

[bgxyrnf, MSN, RN]

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?

[Lunah, MSN, 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.

[~Mi Vida Loca~RN, ASN, RN]

Funny, FB reminded me I just posted about this exact thing 2 years ago.

[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....]

[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".

[luvRN1987]

Sorry you get that comment because some CRNA schools accept ED as their ICU experience.

[OlivetheRN, ADN, BSN, RN]

Sorry you get that comment because some CRNA schools accept ED as their ICU experience.

I have yet to come across one

[Jedrnurse, BSN, RN]

...be curious to see if opinions would change with a few float shifts to the ED. (Or not.)

[calivianya, BSN, RN]

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.

[Lunah, MSN, RN]

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.

[NuGuyNurse2b]

I am howling at the "Level None" moniker. I'm going to be using that in my daily vocabulary HAHAHAHAHA

[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.