Help Please!!

Published

At my ED we are trying to implement a new policy where the ICU nurse comes to the ED to transport their patients to floor and recieve bedside report. Our tech aids in transport. I am currious to the process at your hospital for getting patients to the ICU

Thanks In Advance

Ashley

Can't help but add my 2 cents. Change is hard for everyone and to top it all off, it has always seemed that nurses in specialty areas always seem the worse to budge and do things differently (myself included). We always seem to think our job is the hardest and we can't leave our pts. There are a few differences though between an ER and an ICU nurse. First, an ER nurse takes care of the same type of pts as an ICU nurse with the exception of ratio. An ICU nurse typically takes care of 2 total care pts. In the ER, we often have more than that and we are lucky if we get help because we are always run so short. An ICU nurse complaining to come an get one pt seems ridiculous, considering ER nurses transport their pts and like I said, often have more than 2 pts to take care of, not to mention when the ER nurse leaves for transport, there is almost always a brand new, sometimes critical pt placed in that room you previously emptied....while you are transporting!! That does not happen in the ICU.

And I def. won't go into the fact that most ICU nurses I know and have known, complain about being short staffed and life is unfair while on one of their many smoke breaks.:banghead:

Up Vote Up Vote ×
Specializes in Neuro ICU and Med Surg.

I never said my job was the hardest at all. All of us work hard and our jobs are complicated by short staffing, etc.

I did say that I am not going to leave my unit without enough staff to watch those existing patients we already have. I know ER is hard, and also not my specialty, so I know things are much different down there. I am not going to leave one nurse to watch 8 patients while half the staff is at CT or getting ready for CT or MRI, to go pick up a NEW paitent.

I am sorry you take offense to a ICU nurse saying that they wont leave their floor unsafe, but sorry no way no how.

I didn't generalize about most ER nurses, so please don't generalize about most ICU nurses.

Up Vote Up Vote ×
Specializes in ER.
ER staff brings the pt to the ICU after giving phone report. Questions asked at bedside.

I work the ICU and there is no way I am going to go down to the ER to get report and then bring the pt up. What is being said by the ICU staff in response to this new policy?

ER nurses have been transporting patients up to the ICU for years, why is it so appalling for you to go to the ER to get a patient?

ER nurses often have to leave their 6 other patients to bring you the ICU patient, usually with out having another person to really cover and watch the patients being left.

So is that safe?

Up Vote Up Vote ×
Specializes in Neuro ICU and Med Surg.
ER nurses have been transporting patients up to the ICU for years, why is it so appalling for you to go to the ER to get a patient?

ER nurses often have to leave their 6 other patients to bring you the ICU patient, usually with out having another person to really cover and watch the patients being left.

So is that safe?

Are you constantly with your stable patients? I didn't think so. I know you have 6 patients who you are only with for maybe a few hours, then you send them to the floor, ICU, or home, or other hospital. Sorry I am not fond of the idea that I have to go get the pt I am going to admit, while I have another critical patient. I travel enough without having to go to get my patient that I am going to admit. I think I am out of this discussion.

Up Vote Up Vote ×
Specializes in ED.

I currently work in two ER's. In the larger one (still small by most respects but pretty busy), the ICU comes for the patient on almost every admission to the unit. I call and give report on the phone first, then they ask questions as needed when they come and I help them take the patient up and briefly help settle the patient in bed before leaving (trying to get IV lines untangled, getting on their monitor and such). If they are busy with a rough patient or two, then I try to hold my patient as long as I can until we can safely get them up there.

In the other one, I work at a small VA hospital with 5 beds. The ER nurses take the patients to the floor no matter what unit they are going to and thankfully we have enough staff where that isn't a problem. Both ways seem to work for me, I guess it depends on the facility and how well their system is running.

Up Vote Up Vote ×

The bottom line is that nurses have to work together to provide the best, safest care for patients.

As I said before, our ICU comes and gets the patient .. but of course if they have a critical patient then I, as the ER nurse, is going to recognize that and make allowances by keeping the patient if I can.

And don't presume that if I have 6 patients that 1 or 2 of them cannot be critical, of course they can. And the ICU will recognize that, if I tell them, and make an effort to come and get a patient a bit sooner, all the while ensuring that patients in both departments are getting the best care that "we" can provide.

Some where along the line someone is going to have to give up the "control" and make sure the patient gets to ICU.

Up Vote Up Vote ×
Are you constantly with your stable patients? I didn't think so. I know you have 6 patients who you are only with for maybe a few hours, then you send them to the floor, ICU, or home, or other hospital. Sorry I am not fond of the idea that I have to go get the pt I am going to admit, while I have another critical patient. I travel enough without having to go to get my patient that I am going to admit. I think I am out of this discussion.

I'm not certain what the answer is.

Many times, I have 3 high acuity patients and know their admissions are inevitable. We take our patients to the ICUs but the medics take our stepdown patients and the techs take regular admits up for us. If there isn't a trauma going on at the time, many times the Trauma nurse will cover my patients and do the initial assessment of the new patient brought back immediately from either triage or EMS to my room. I know ICU nurses are busy. ER nurses are busy as well.

What this really comes down to is your managements inability to provide a safe and effective transport protocol with adequate staffing. It's not the ICU nurses fault or the ER nurse...it's management and the big wigs who run the hospital's fault.

Up Vote Up Vote ×
Specializes in ER.
Are you constantly with your stable patients? I didn't think so. I know you have 6 patients who you are only with for maybe a few hours, then you send them to the floor, ICU, or home, or other hospital. Sorry I am not fond of the idea that I have to go get the pt I am going to admit, while I have another critical patient. I travel enough without having to go to get my patient that I am going to admit. I think I am out of this discussion.

In the ER my patients are not stable until after I have done all the work to get them that way. I usually have at least 2 of the 6 that are at least chest pains/abd pain/septic nursing home, etc. These require the full work up. So why should I leave those patients in order to transport the ICU pt to you? Meanwhile your other ICU patient may have been there a day or so. I am not saying you aren't busy and you shouldn't have to leave your patients but you should not think you or your work is so much more important than what the ER staff is doing and that was how your response came across.

Up Vote Up Vote ×
Specializes in ED/trauma.
ER staff brings the pt to the ICU after giving phone report. Questions asked at bedside.

I work the ICU and there is no way I am going to go down to the ER to get report and then bring the pt up. What is being said by the ICU staff in response to this new policy?

Just curious why you can't do that? I know you have a two-one ratio on the unit, but sometimes in my ER, we have an 5-one (or possibly higher) ratio of criticals?

Up Vote Up Vote ×
Specializes in ED/trauma.

Also our charge nurse for our level 1 ER also takes an assignment everynight, and the ER nurses must travel all night long too, where do you think your high acuity patients come from???

Up Vote Up Vote ×
Specializes in ED/trauma.
Are you constantly with your stable patients? I didn't think so. I know you have 6 patients who you are only with for maybe a few hours, then you send them to the floor, ICU, or home, or other hospital. Sorry I am not fond of the idea that I have to go get the pt I am going to admit, while I have another critical patient. I travel enough without having to go to get my patient that I am going to admit. I think I am out of this discussion.

Please don't run off now that you can not back up your comments. I work in a level one trauma ER (100-150 thousand visits a year) 4 12hour shifts per week, I also work at least one extra day in our ICU every week, I know it is different but, I just don't understand your logic. Our ER is always having trouble with staffing because you can not guesstimate how many will come through the door on any given day, so we are always short. However in the ICU we will not give a nurse 3 patients and if they are really high acuity patients(like prismo or something) it is 1:1 so ER holds them until the ICU can take them, and by then they are pretty much stabilized and packaged with a pretty bow- how do you think we can manage them any better when we have sicker pts. (who are not on a diprivan drip yet mind you?

I would also like to add that in my ICU things are always staffed so perfectly that I have never missed a lunch or a break, and the floor never suffered for it-it's going on three weeks now that I haven't had a break in the ER. Just curious-have you ever worked a shift in the ER, sorry if you answered that I may have missed it.

I think that you really should be more of a team player, and I am really glad that the nurses at my place are all working together for the benefit of the patient.

Up Vote Up Vote ×
Specializes in Neuro ICU and Med Surg.

Can't back them up? OK seriously have you ever worked the ICU? I sure have stated I never worked the ER and don't want to. I have missed so so many lunches and breaks it isn't even funny. WE all work hard. Team player? Who the hell is covering my patient while I am in the ER picking up my new pt. Hell I travel enough in a shift as it is with my patients. Did you read that response? No I bet you didn't! Good lord I didn't know taking a pt to the unit they are going to was such a big freaking deal for someone who works in the ER. While I am waiting for you to bring the pt, I am preparing the room, letting RT know you are coming if the pt is vented. Heck I have waited for about a hour after report is called because the doc decided to throw in a line. I can't be gone for a hour to go get my patient. Good lord. Yes I am done with the discussion. Follow what the other ICU nurses say in the ICU forums. I am not the only one with a problem. There have been times I have hardly left one of my patients rooms because the pt is so sick.

As I said before I am done with this discussion.

Up Vote Up Vote ×
+ Join the Discussion