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 emergency nursing-ENPC, CATN, CEN.

This happened at our hospital as well. It was a tactic used to attract new nurses to our critical care area as there were staffing issues. The ED nurses met with the administration of the hospital and asked if we could be considered for the same differential if we could prove same type of care (mostly)

We in the ED wrote a comparative listing of what the CCU nurses were responsible for and compared to the ED nurse-

It was a side by side list- and at the end when we demonstrated that the ED nurse performed the same level of care as the CCU nurse-we added all the other ED responsibilities not found or performed by our CCU nurses- (ped emergencies, OB/GYN, trauma-environmental, etc). This counterracted any issues where the CCU staff performed skills not available in our ED (we don't SWAN in our ED). We also included the many days we were "holding" ICCU/CCU/telem/MS patients due to no beds available status and the policy that we in the ED had to provide the "same standard of practice" when caring for those patients as well.

We got the differential.

Similiar to :

ED CCU

ventilator ventilator

titrated critical care antiaarhythmics titrated critical care antiarrhythmics

cardiac monitor cardiac monitor

etc...

You all can get the drift. It took some time and investigation. The CCU actually helped us out (after all it didn't take away from their pay). We included all the mandatory education requirements, etc

But as someone else said--every area of nursing now is it's own specialty and to think one is "harder" than another is doing nursing a disservice. We're not better--just different

Good luck

Anne

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
But as someone else said--every area of nursing now is it's own specialty and to think one is "harder" than another is doing nursing a disservice. We're not better--just different

Well put.

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Specializes in ER.

My paranoid self said that hospitals that offer differentials like this are only try to divide the nursing staff and create havoc. They will automatically create allies of the staff that gets the differentials, and will tick off the ones who don't. You will never get a united staff that will rise up and make reasonable demands, because you will always have the group (the ones with the diffs) who think they are smarter, better, and more loved because administration has told them they were. They will either be silent for fear of losing their special status or they will actively work against the rest of the staff, because they are, after all, much smarter, better looking and more loved than the rest of the great unwashed, and they are paid more because they are worth it!

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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...

Mine have. And I was an an ICU.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Just curious though...do any of your patients have to sit in the hallway the entire time they are getting cared for? Mine do...

What does this have to do with differential? A differential wouldn't help those pts. be more comfortable, better management and staffing would.

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

Nope. You got me there! :)

I actually worked a level I ER for a couple of months (would have stayed but they weren't hiring new grads from out of house) and just luuuuuuuuv my ER brothers and sisters. :kiss

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What does this have to do with differential? A differential wouldn't help those pts. be more comfortable, better management and staffing would.

eeeeeeeeeeeeeeeverything!

we are different nurses that have to do critical care plus ob, plus med surg, plus or, plus peds, plus icu and ccu. don't forget urgent care and fast trac er. this qualifies us for critical care and it's diff. i think the o.p. wanted to point out that our job may not be exactly the same as icu's but it is just as critical, hectic and out there. :balloons:

we like our jobs and we do them well, now pay us for it! :coollook:

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

we are different nurses that have to do critical care plus ob, plus med surg, plus or, plus peds, plus icu and ccu. don't forget urgent care and fast trac er. this qualifies us for critical care and it's diff. i think the o.p. wanted to point out that our job may not be exactly the same as icu's but it is just as critical, hectic and out there. :balloons:

we like our jobs and we do them well, now pay us for it! :coollook:

That still doesn't address how a differential is going to help a pt. in the hall who has zero privacy, was my point.

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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

This is entirely correct. Pay and differentials are driven by and reflect the local market. They are NOT recognition of persons or their contributions or their jobs.

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That still doesn't address how a differential is going to help a pt. in the hall who has zero privacy, was my point.

the patients privacy is not the issue here. the money for the nurse is.

and on the privacy note, i am a believer in privacy. i hate it when we can't provide the greatest. sometimes it can not be helped and i think for the most part the pt understands our plight. the unspoken staffing and space issues. what i think is horrible is taking a pt to the floor and having the floor nurses and techs get the pt off of the stretcher and weigh them in the hall, flapping in the breeze. how rude! i make a fuss about it and it is done in the room or i make the floor get a robe or something.

as far as having hallway pts, put yourself in the place of the pts in the waiting room. i am not talking about the sick ones. i am talking about the 80% who probably should have gone to patient first or private docs. the one's with the stub toes who are complaining about the wait. these people are usually given the choice of sitting in the hall or waiting. generally they gladly choose the hall. there lies the tie of money and pt care. if they are willing to sit in the hall, my nurse pt ratio just went up. this is cause for me, and every one i work with, to work that much harder to keep ALL of our patients safe.

nothing personal to staff or the patients. it is just business. :balloons:

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Specializes in ER.
What does this have to do with differential? A differential wouldn't help those pts. be more comfortable, better management and staffing would.

It was in response to someone elses post...It had to do with number of patients you take care of...Although most units and floors move their patients out to make room for new ones....we don't...when our beds are full, and their beds are full...we have to go to the hallways to care for our patients, so I have all the patients in my rooms, plus some in the hallway, I can't tell a paramedic he is going to have to come back in 10 minutes with the patient because I'm busy with another...I can't say, can you hold the patient in the ambulance for a few more minutes so I can have 10 seconds to pee, ...and I may have 2 vents and multiple gtts, plus a conscious sedation pediatric head lac, and 2 pregnant vag bleeders, and that is just a noraml monday night...I had one in our conference room tonight...and thats saying something being in a 48 bed ER with every hallway full and we still had 20 people in the waiting room at midnight when I left...I agree, every specialty has their challenges...so to be quite honest...its really not fair to compare them...they are apples and oranges...I love my job and that is why I do it...Is part of it about money? Sure I wouldn't be human if I said it wasn't...but I work in the ER for the love of the game, not to get rich...I make no more than the floor nurses with same experience, except for my certifications that I hold...and I am ok with that...

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Specializes in Oncology/Haemetology/HIV.

How about the neutropenic Oncology patients that I had in the hall?

When the floor beds on MS are full, we have to pick up patients in the hall with screens around them. This is not limited to the ER.

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