ICU gets differential and not ER??

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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.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

In that case, pretty much every floor has an accordian door.

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Specializes in Oncology/Haemetology/HIV.

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.

And Med/Surg Nurses don't have the hoops to run through?

As a Oncology nurse any many places, I have to do 16 hours of chemo courses at least every two year and in some cases every year. As an OCN, I have to 100 hours of Onco classes every 4 years, plus 1000 hours of demonstrable onco "care" hours in 18 monthes prior to recertification. In at least two assignments in the past year, I have been on onco or Med/Surg floors that required electrolyte protocols/continuous renal replacement therapy. Many hospitals are requiring MS nurses to master ACLS, do and read EKGs, take patients on insulin/cardizem/dopamine/nitro drips. All without "compromising" their generous allotment of 5-10 patients. And since two of our patients ports have been destroyed by incorrect accessing by ER/ICU professionals, we get the joy of dropping everything to rush to the ER or ICU to access ports or administer chemo in any EVERY area of the hospital. We get to frequently transplant stem cells/monitor transplants of bone marrow, administer high risk for anaphylaxis chemo. We also have to pay for our onco/chemo classes in many places. We also have to deal with an increased risk of resistant disease and development of resistant cancers due to our continual exposure to chemo and hazardous chemicals.

Virtually every ortho(also, Med/surg) unit that I know have your epideral drips, complicated equipment and other issues that they must be inserviced on. And their patient load rarily if ever dips below 5-8 per nurse.

There are few if any departments of the hospital that do not have a great deal of extra requirements specific to it's expertise. The few that don't burden their staffs with wretchedly heavy patient loads, and lousy staffing.

Sorry but your argument does not hold water.

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Specializes in Critical Care, ER.
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:)

Our SICU is required to transfer pts out to accomodate newbie super sick pts as well.

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Our SICU is required to transfer pts out to accomodate newbie super sick pts as well.

Exactly (we don't transfer out unfortunately, we just keep taking over other parts of the hospital with our patients). This is why I hate the nursing pi$$ing contest that ensues when nurses in one specialty are given an automatic differential. Differentials for credentials are fine with me, but for just doing your job is silly IMO.

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Sorry but your argument does not hold water.

The matter is not up for debate. Nowhere did I state that our differential policy should be followed by all institutions. To the contrary I specifically pointed out that I was speaking strictly about my own facility. If you have any doubts about that fact, you need only look at your own post, the very first quoted sentence.

In our facility, we were able to demonstate that we did, in fact, have many more mandated competencies than other areas. Additionally, by the time all of those competencies were achieved the hospital had invested a great deal of money in that nurse and further, the nurse became more marketable; under such circumstances it makes good economic sense, I think, to offer incentives for fully credentialed nurses to stay.

Now unfortunately if your facility makes you pay for mandated continuing education courses, it will be difficult to argue on the investment angle. Similarly, if they engage in psychotic practices like expecting floor nurses to initiate and maintain patients receiving CRRT, I would expect that it would be extremely difficult to demonstrate that your ICUs have many more competencies than other areas to achieve and maintain.

In summary, I don't necessarily believe that all ICU nurses should receive differentials while all ER nurses or whoever else receives none. All nurses work very hard. And besides ICU patients in some facilities would end up on the floor in others. On the other hand, if WHICHEVER unit can demonstrate that their facility requires many more competencies than is the norm in that facility, I believe that they should be compensated accordingly.

As to the greater number of patients per nurse outside of the ICU: On occasion I hear these rumblings from nurses floated into the unit. They are assigned patients ready to go out because they are not credentialed so they think we have it made. I always invite them to apply for a transfer if they think we have such a great deal going on. Most decline the offer. For those who accept some make it and some don't but the commonality is...they learn WHY it is that we have just 2 patients.

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Specializes in ER.
Our SICU is required to transfer pts out to accomodate newbie super sick pts as well.

Just curious though...do any of your patients have to sit in the hallway the entire time they are getting cared for? Mine do...

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Our hospital counts ED as a critical care area. After all, we have to take the time to learn to manage and insert A-lines, presep caths, take regular dysrhythmia courses, ACLS and PALS( most ICU, CCU, SICU, etc only takes ACLS), and we titrate drips, etc.

We are required to attend an annual skills day that includes defib operation, especially the portables because our ED sends the code teams, not the ICU. We have to attend the same skills fair as the ICU does.

We better know that stuff because after all, when ICU doesn't have enough beds we have to keep the patients with us, sometimes for up to 2 days. And, as a poster said, we can have 4 or 5 patients at the same time. Yep, we're critical care.

Our ICU calls codes overhead and we always send a team to help.

Of course none of us on any unit gets a differential either.

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Specializes in Oncology/Haemetology/HIV.
They are assigned patients ready to go out because they are not credentialed so they think we have it made. I always invite them to apply for a transfer if they think we have such a great deal going on. Most decline the offer. For those who accept some make it and some don't but the commonality is...they learn WHY it is that we have just 2 patients.

And I have seen many ICU nurses crash and burn in Med/Surg.

If one does not like the fact that they do not make a differential for what they perceive is more work than, they can transfer out....whining about the situation just divides nurses against one another. If as an ICU nurse, one feels that life would be easier and you are not getting paid for your credentials, feel free to transfer to MedSurg.

But as my local hospitals are staffed up on ICU and are extremely wanting in the MS staffing, nurses have proven with their freedom of choice where they find it more advantagous to work. And no, the local hospitals do not offer ICU diffs.

I have worked both sides of the fence. I found ICU easier because of the decreased load....but then that is me. However, I like oncology more and have made my choice.

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Sorry but your argument does not hold water.

The matter is not up for debate. Nowhere did I state that our differential policy should be followed by all institutions. To the contrary I specifically pointed out that I was speaking strictly about my own facility. If you have any doubts about that fact, you need only look at your own post, the very first quoted sentence.

In our facility, we were able to demonstate that we did, in fact, have many more mandated competencies than other areas. Additionally, by the time all of those competencies were achieved the hospital had invested a great deal of money in that nurse and further, the nurse became more marketable; under such circumstances it makes good economic sense, I think, to offer incentives for fully credentialed nurses to stay.

Now unfortunately if your facility makes you pay for mandated continuing education courses, it will be difficult to argue on the investment angle. Similarly, if they engage in psychotic practices like expecting floor nurses to initiate and maintain patients receiving CRRT, I would expect that it would be extremely difficult to demonstrate that your ICUs have many more competencies than other areas to achieve and maintain.

In summary, I don't necessarily believe that all ICU nurses should receive differentials while all ER nurses or whoever else receives none. All nurses work very hard. And besides ICU patients in some facilities would end up on the floor in others. On the other hand, if WHICHEVER unit can demonstrate that their facility requires many more competencies than is the norm in that facility, I believe that they should be compensated accordingly.

As to the greater number of patients per nurse outside of the ICU: On occasion I hear these rumblings from nurses floated into the unit. They are assigned patients ready to go out because they are not credentialed so they think we have it made. I always invite them to apply for a transfer if they think we have such a great deal going on. Most decline the offer. For those who accept some make it and some don't but the commonality is...they learn WHY it is that we have just 2 patients.

well, no matter how you put it, the er is critical care (that was my point) along with other speciaties, and should get the same dif and props as critical care. this web site doesn't even catorgorize er as critical care. :)

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Just curious though...do any of your patients have to sit in the hallway the entire time they are getting cared for? Mine do...

and the closet, the quiet room, the multiple hallway beds.... heck, i even once admitted a chf'er from triage on a portable monitor and portable o2!

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Having worked both ER and ICU, I have to say that paying diff to ICU and not ED is certainly unfair. I also have to agree with the part of the argument that most all hospital nurses work very hard and each area has differing aspects of the job that are difficult or challenging.

That being said, how about those of you who work at facilities with a clinical ladder? Is that a more fair way of rewarding nurses for their knowledge base, experience and skills specific to their practice? I wouldn't know because my hospital doesn't pay critical care diff, nor do we have a clinical ladder.

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Specializes in Emergency.

Just to make a comment. How many are getting a diff but it just doesn't show up on one check as a line item. For all you know it may be included in you base pay. Just because you say your not getting one specificlly doesn't at all mean you don't get one. I have worked in health care long enough, and I can say all the hospitals I have worked none paid any kind of diff., but I made more than nurses on the floor with the same amount of nursing exp.

Rj

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