ICU gets differential and not ER??

fergus51 · May 15, 2005

This is why I hate differentials for specialty areas alone. No nurse in the hospital has an easy job. Med-surg nurses aren't working any less than ICU or ER nurses. Unfortunately many hospitals just don't consider ER as "critical care" since it's such a mix.

bluesky, BSN, RN · May 15, 2005

That is completely unfair. ALL nurses work hard and if one group gets a special bonus, we ALL should. Sometimes I think they do that to further divide and conquer us.

tridil2000, MSN, RN · May 15, 2005

I work in an inner city ER. There are commonly waits over 2 hours long. We have see many critical heart patients as well as GSW's and everything else in between. We consistently work short staffed and can manage as many as 6-7 patients per nurse. The question being, why am I not getting paid a "critical care differential" like the ICU nurses make? I understand they have a stresfful job as well..key words being AS WELL. I see typically 10-20 NEW pts per shift. 60% of wich are critical. And I see them congruently. Not 1-2 pts but 5, 6, sometimes 7. I think as ER nurses we deserve the extra pay.

i am a cc, float. i do both er and icu/ccu. and i have no problem saying outright that i work my *** of in the er. i think i sit maybe 30 minutes all 8 hours there. in the units, i can usually sit about 2 hours of the shift. (not all at one time of course...)

Dixielee, BSN, RN · May 15, 2005

I am lucky to sit 15 minutes to chart in our ER. Most of my charting is done standing up at the counter. We routinely hold ICU patients for 24 hours or longer, have codes or near codes come thru the door, intubate, titrate drips, accompany head injuries to CT scan, administer thrombolitics for CVA's and MI's, care for OD's, perform conscious sedation, etc. What is not critical about that? I agree if anyone is to receive a specialty differential, then all should. I think all of us have our ups and downs and we all deserve more than we get.

James Huffman · May 15, 2005

Hospitals pay specialty area differentials because they feel they have to, in order to get nurses to work in those locations. It's not a matter of "fairness," of what nurses "deserve," or a matter of "dividing" nurses. It's pure economics.

Jim Huffman, RN

rstewart · May 15, 2005

Our hospital pays a differential to fully "credentialed" critical care nurses but not emergency department nurses. I believe in our case it's fair and reasonable.

We have a general critical care unit only so we do pretty much everything including heart surgery recovery. This means we must complete (and in many cases check off annually) on many equipment and procedure compentencies that other areas do not.

The annual checklist required before yearly evals became quite long after many years of adding duties and not subtracting anything. It became a tangible piece of support for a differential. So in our case it's not that our work is harder or the acuity is higher that justifies a differential.......it's the fact that the powers that be run us through so many hoops both initially and annually when compared with other areas in our facility.

Now the need for all the "hoops" is another topic. Why, for example, as a certified critical care nurse and ACLS instructor of 15 years I must still take the code blue team credentialing tests (written test, mock code demonstration, crash cart item location timed test etc.) every year I don't know. Can you imagine if physicians had to demonstrate competency annually on every area of their practice, every machine they touch etc....? Funny how Jacho requires it of us but not them.

I don't believe that any one area is harder to work in and therefore deserves a special differential. But I do think that extra "pay for hoops" is justifiable.

Finally, there is truth to the economics argument as well. For years we pointed out the extra stuff required of us and were told "You chose to work in that area and that's just part of it." We were also literally given the "If you all don't like it there's the door" verbiage as well by the VP of Nursing. As you might expect, many took her advice and we were short nurses who could fully function, couldn't keep the ones we had and couldn't recruit new ones fast enough. Not long after her departure the differential came into effect.

MAGIK GIRL · May 15, 2005

i think we deserve extra pay and a combat bonus!

it irks me that er nursing is not put into the critical care category. how many time has your icu unit been "capped due to staffing" (like the er can say we don't have enough nurses and close the unit :rotfl: ) and we have had to keep that mi, cva, trauma, etc in the er, take care or it, and take more pts?

just a pet peeve. just give us or props! some money would be really nice! :balloons:

Dixielee, BSN, RN · May 15, 2005

i think we deserve extra pay and a combat bonus!
it irks me that er nursing is not put into the critical care category. how many time has your icu unit been "capped due to staffing" (like the er can say we don't have enough nurses and close the unit :rotfl: ) and we have had to keep that mi, cva, trauma, etc in the er, take care or it, and take more pts?
just a pet peeve. just give us or props! some money would be really nice! :balloons:

The ER is the only department in the hospital with an ever expanding accordian type door. We can not close it. We can make people wait, we can line them up and down the hall, but we can never get "full" and close. Even if you can go on ambulance divert for a short while, you have no control over walk ins. We must make do with the staffing we have for an ever increasing number of patients.

Rstewart, do you think ICU is the only department to have to jump thru hoops? Does your hospital not require all RN's to attend annual "skills fairs" and recertify certain procedures? Every one I have been in does. Most are JCAHO requirements, not department requirements. Do you think ER RN's do not have to maintain ACLS, BLS, TNCC, etc. to do their jobs. We may not recover open heart patients, who are already ventilated, have drips adjusted, etc., but we save their lives so you can get them after their plumbing has been repaired.

I have no beef with ICU nurses, we need all areas covered. I have worked ICU and ER, and they are both tough jobs. Physically, I work much harder in the ER. ICU was tougher emotionally, because of the long term patients who were never going to get better. They are both intellectually challenging, and you are in error if you do not believe that ER nurses are up to the standards of the ICU nurses you mention.

Just don't try to convince us that you "deserve" more money because of the hoops you jump thru, cause I ain't buying that one!

rstewart · May 15, 2005

Rstewart, do you think ICU is the only department to have to jump thru hoops? Does your hospital not require all RN's to attend annual "skills fairs" and recertify certain procedures? Every one I have been in does. Most are JCAHO requirements, not department requirements. Do you think ER RN's do not have to maintain ACLS, BLS, TNCC, etc. to do their jobs. We may not recover open heart patients, who are already ventilated, have drips adjusted, etc., but we save their lives so you can get them after their plumbing has been repaired.

I have no beef with ICU nurses, we need all areas covered. I have worked ICU and ER, and they are both tough jobs. Physically, I work much harder in the ER. ICU was tougher emotionally, because of the long term patients who were never going to get better. They are both intellectually challenging, and you are in error if you do not believe that ER nurses are up to the standards of the ICU nurses you mention.

Just don't try to convince us that you "deserve" more money because of the hoops you jump thru, cause I ain't buying that one!

rstewart · May 15, 2005

Rstewart, do you think ICU is the only department to have to jump thru hoops? Does your hospital not require all RN's to attend annual "skills fairs" and recertify certain procedures? Every one I have been in does. Most are JCAHO requirements, not department requirements. Do you think ER RN's do not have to maintain ACLS, BLS, TNCC, etc. to do their jobs. We may not recover open heart patients, who are already ventilated, have drips adjusted, etc., but we save their lives so you can get them after their plumbing has been repaired.
I have no beef with ICU nurses, we need all areas covered. I have worked ICU and ER, and they are both tough jobs. Physically, I work much harder in the ER. ICU was tougher emotionally, because of the long term patients who were never going to get better. They are both intellectually challenging, and you are in error if you do not believe that ER nurses are up to the standards of the ICU nurses you mention.
Just don't try to convince us that you "deserve" more money because of the hoops you jump thru, cause I ain't buying that one!

I knew I was going to receive a reply such as this no matter how carefully worded my post.

I might point out that at no time did I state that the ICU is more intellectually or physically challenging than the ER. I don't believe that to be true. On the other hand your characterization of ICU nurses managing already ventilated, drips in place/not in need of titration patients is clearly off the mark.

And, of course, we have "skills fairs" to recertify certain procedures...but in my facility those are for all nurses, not the unit specific ones to which I referred.

I was speaking strictly about my present facility...where sheath pulling, act running, balloon pumping, continuous renal replacement therapy, code blue/code team, heart recovery, epidural pumps etc etc require additional training and skills beyond other units in general. This years "new flavor of the month" to fill our leisure time is the rapid response team. And in my opinion, these extra skills which take time and effort to master initially and in most cases recerted annually merits additional compensation.

fergus51 · May 15, 2005

The ER is the only department in the hospital with an ever expanding accordian type door. We can not close it.

Umm, that's not true where I have worked. L&D and NICU can't close their doors either. We can't tell women to hold the baby in and go to another hospital or make them deliver in the ER:chuckle So don't feel alone:)