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.

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...

YES !! i agree.

i still think we deserve a diff like that of any other critical care specialty gets and to be graced by the powers that be enough to be considered critical care.

if we can get the bucks then at least recognize us.

i love the game to, wouldn't work anywhere else. :rotfl:

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Specializes in ER.
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.

I have worked in quite a few hospitals, I have worked in med/surg, tele, I was an oncology nurse, and I worked in ICU for a short stint...and I never have seen in any hospital I have ever worked in a patient be admitted to the floor and spend more than a few minutes in the hallway...I'm not saying that it doesn't happen in other hospitals, but not nearly as often as it does in the ER...because its not just the M/S floors that get full we have to worry about...when the ICU is full, where are the patients? In the ER...When Step-down is full...where do the patients stay? In the ER...We are the dumping ground...sorry no beds doesn't stop the ambulances from rolling in...doesn't stop the patients from walking in the front door, on top of the patients that aren't getting beds...Is it optimal...not at all, but you do what you have to do...Divert is a courtousy...which means squat when it comes down to it...We don't know what is stumbling in our door next...noone calls us from home and gives us report before they get to us...We might get a 5 minute heads-up for a GSW, but thats about it...I am pro-walk in the shoes...I think every nurse at some point in their career should spend at least one day in the shoes of another department...just to see what it is like...That includes ER nurses that never worked med-surg or ICU...Everyone's job is important...Everyone's job is stressful in its own way. Noone is better than anyone else...Yes, some are more educated with certifications, but when it comes down to it...its all about the ABCs....the basics...that's what saves lives...that's what we're ALL taught in school....That's our common link...so when it all comes down to it...it's not all about the Benjamin's its about taking care of the patients, the best we can, with sometimes, the limited resources that we have...

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Can I just say this is exactly why nursing gets no respect, we all sit around and bicker between ourselves about who works harder and yada yada yada. Every nurse works hard at where they are placed. If you were to take an ICU nurse and place them in a peds unit, or a med surg unit it is a totally different type of nursing and they would be lost. Same goes the other way take a med surg nurse and place them in an ICU or and ER and they would be totally lost. Maybe if we would all band together we could all make the money we deserve rather than being treated like the doctor's hand maiden or whatnot.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Can I just say this is exactly why nursing gets no respect, we all sit around and bicker between ourselves about who works harder and yada yada yada. Every nurse works hard at where they are placed. If you were to take an ICU nurse and place them in a peds unit, or a med surg unit it is a totally different type of nursing and they would be lost. Same goes the other way take a med surg nurse and place them in an ICU or and ER and they would be totally lost. Maybe if we would all band together we could all make the money we deserve rather than being treated like the doctor's hand maiden or whatnot.

Excellent!

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Can I just say this is exactly why nursing gets no respect, we all sit around and bicker between ourselves about who works harder and yada yada yada. Every nurse works hard at where they are placed. If you were to take an ICU nurse and place them in a peds unit, or a med surg unit it is a totally different type of nursing and they would be lost. Same goes the other way take a med surg nurse and place them in an ICU or and ER and they would be totally lost. Maybe if we would all band together we could all make the money we deserve rather than being treated like the doctor's hand maiden or whatnot.

i don't think it is bickering. sometimes we just need to vent. this is helpful to do verses repressing all frustrations inside (that is unhealthy). you also have to try to not confuse opinions to bickering. but, that is your perception and you are entitled to it, just as the rest of the experienced er nurses are entitled to ours. thank you for our input.

p.s. you don't have to be a hand maiden if you don't want to be. stand up for yourself! you are worth it! :) :)

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Specializes in ER.
Can I just say this is exactly why nursing gets no respect, we all sit around and bicker between ourselves about who works harder and yada yada yada. Every nurse works hard at where they are placed. If you were to take an ICU nurse and place them in a peds unit, or a med surg unit it is a totally different type of nursing and they would be lost. Same goes the other way take a med surg nurse and place them in an ICU or and ER and they would be totally lost. Maybe if we would all band together we could all make the money we deserve rather than being treated like the doctor's hand maiden or whatnot.

Its that close mindedness that keeps nurses separated....not the opinions people may have and just because they are different opinions, does not make it bickering...we all start somewhere...the idea isn't to confuse and overwhelm, it is for the experience...to see how the other world lives...and to be honest...when I went to the ER I was from med/surg...and I did okay...It was different and something to get used to...but lost...I wasn't...and to be honest...I've never felt I was a doctor's handmaiden...In the places I have worked and especially the place I work now...the nurses and their opinions are VERY respected and actually encouraged...

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I work in a very busy ER where we pay critical staffing for extra shifts that a nurse picks up. I have an amazing Nurse Manager whose goal is to have a waiting list for ER nurses. The critical staffing shift diff is an incentive to come in for extra shifts that are low on nursing staff.

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I work in a very busy ER where we pay critical staffing for extra shifts that a nurse picks up. I have an amazing Nurse Manager whose goal is to have a waiting list for ER nurses. The critical staffing shift diff is an incentive to come in for extra shifts that are low on nursing staff.

I remember a time when ER nurses weren't paid the Critical Care Diff. We complained, insisted on meetings and to make a long story short the changes were made after we showed how we did take care of critical patients and that the ER is the front line to the hospital. Our ER manager was behind us and it did make a difference.

I just know if I were unhappy in a situation I would try and make the changes by doing it appropriately and if that didn't work, move on. We in the nursing profession have so many choices now. Take advantage of the path the older nurses paved for you.

Seize the day and have no regrets!

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its that close mindedness that keeps nurses separated....not the opinions people may have and just because they are different opinions, does not make it bickering...we all start somewhere...the idea isn't to confuse and overwhelm, it is for the experience...to see how the other world lives...and to be honest...when i went to the er i was from med/surg...and i did okay...it was different and something to get used to...but lost...i wasn't...and to be honest...i've never felt i was a doctor's handmaiden...in the places i have worked and especially the place i work now...the nurses and their opinions are very respected and actually encouraged...

isn't it funny that people think we eat our young?!

i have worked in the er for a long time. i worked 6 months on tele then went to the er. best move ever! it was difficult at first but i did ok also. i have seen many changes over the years. most for the best. i have also seen er rn's responsibilities increase 3 fold. do i think we should be compensated for it? h... yes!

i repect each part of nursing. i have moonlighted to the floor, the unit, labor and delivery, iv therapy and many other places over the years. each place has their difficulties but none are like the er. (i am sure that each specialty feels this way.) but the er is like an island. we can not shut our doors or cap our unit for staffing or high census/acuity. they just keep coming. sure, we can go on divert (if you catch administration at 3am, just waking up to go to the bathroom hungover) for short periods of time to "catch up" but that does not stop the walk ins. that does not even stop the ambos who don't feel like going to a hospital that is farther away (sorry to the medics who don't do this, but it has happened) or have priority pts. prioity pts have to come to the er that is closest. no choice. also, you can't go out into the waiting room and make an announcement that "we are full and busy, we have an arrest or three in the back so if you are not really sick, go home! that would be thousands of dollars in cobra violations and some terminations!

so let us have our props! if we are not going to get the money, at least let us vent. i love my job but just like anyone else, venting helps me go back tomorrow! :rolleyes: :rolleyes: :rolleyes:

momma, i got your back!

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:angryfire I would be furious if we didn't get additional compensation for being an ER nurse. We have to have the patient stable before he's transferred to ICU, so that means the drips are up, the IV's are patent, the vent is in place...and then the RN must transport the patient, along with respiratory, to ICU, all the while, my four or five other patients must wait patiently for me to return to resume care of them. Luckily, our unit works like a fine machine. We depend on eachother to help, and are comfortable with that. But, the ICU nurses only have two patients to one nurse, and the ER nurses have up to six patients. Granted not all patients are critical, but you never know what will come through the doors at any given time. If I didn't get the better pay, I'd definately organize a grievance committee, and make sure the administrators knew what was wrong. We are way too valuable to be let go, and we know it. :chuckle

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:angryfire I would be furious if we didn't get additional compensation for being an ER nurse........... If I didn't get the better pay, I'd definately organize a grievance committee, and make sure the administrators knew what was wrong. We are way too valuable to be let go, and we know it. :chuckle

i agree with you 100%. we are valuable. but, i worked in a place where an adn program had their nursing students doing thier practicums in our er. then they were hired. in bunches. the students were given cart blanch and the experienced nurses were told to do what ever it took to "make them feel at home" and that we were expendable. we had to "make them feel at home because the students all know each other and if we didn't make them feel at home, they would tell thier friends and none of them would want to work there.....etc"

the er was staffed 50/50 new grads to experienced rn's. no offense meant to students or new nurses but how is this fair? i'm all for being nice, teaching and helping but i saw some real doozies.

silly nurse manager!!!!! :rotfl:

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I haven't read all the posts, so forgive if this is a repeat. One reason ER may not get a diff is most ER's have doctors immediately available, where many ICU's don't, at least at night. It's only recently that the two hospitals I work in instituted Intensivist programs.

I know the ER is a busy place that runs most nurses ragged. I feel any unit that requires the certs that ICU/ER do should get a critical care diff.

OTOH, our ER, while very busy..we're level 2 trauma..has a plethora of techs that do most of the actual hands-on stuff...foley's, vitals, blood draws, etc. I worked a few days down there and everyone was busy, but there were 6 techs, 5 doctors, a unit secretary, and several nurses...and they were complaining because the coronary unit couldn't accept a patient until after they had gone to CT scan, because there were only 2 RN's in the Coronary ICU. The doctors complained bitterly about that..'what do they mean they're short staffed?" I pointed out it was against hospital policy to leave just one RN in the CCU, so they couldn't spare someone to take a patient to CT. That more than likely they didn't have a tech and were lucky if they had a unit secretary. Well, they just didn't understand that. But what doctor usually does understand anything about staffing?

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