ICU gets differential and not ER??

wayover20 · Jun 25, 2005

Well all I know is that our ICU nurses tell us "We hate to get pulled down there.....you all (er) work TOO HARD!" And they're right. So paying a critical care differential for ER is, I believe, our hospital's way of attracting/retaining nurses. Not to say med surg, L&D, Onc, etc. don't work hard, rather that the ED nurse must be just as (if not more) proficient in managing ALL TYPES of patients with different levels of acuity from basic med surg to the highest level of critical care....and do it well. The argument that the money issue only serves to "divide" nurses is silly and immature. I have worked SICU, med surg, onc. and ER, and no one had to maintain as many credentials as er nurses. We are all BLS, ACLS, PALS, TNCC, ENPC certified, and many of us are CEN as well. After all, when everyone else's doors have closed, the ER is open and highly skilled nurses are there to continue serving the public.

Dinith88 · Jun 29, 2005

I havent read mosts of the posts...but in my opinion,

The reason many institutions (including mine) give differentials to people in certain areas (icu) and not others (er) is simply a matter of supply and demand. If the ER had trouble with retaining staff and/or covering shifts for an extended period then this would surely become more common.

Fact is, more nurses (and students) are drawn to ER's than other ICU-type areas...for various reasons (many of which are pure misconceptions).

Luckily for ER, all the cool TV shows tend to go far in assisting recruitment into ER's...even if they have nothing to do with reality. (who wouldn't want to spend all day in a bloody dramatic trauma saving lives and then sexing-up George clooney all night).

Perhaps some-day a show called "ICU (starring brad-pitt)" or maybe "very cool smart people saving lives..life in the ICU" will come to be. In which case the ICU recruitment will increase and we'll have to start bribing people to work ER by offering differentials..

Dinith88 · Jun 29, 2005

: But, the ICU nurses only have two patients to one nurse, and the ER nurses have up to six patients. We are way too valuable to be let go, and we know it. :chuckle

I kinda take a little offense to this comment. It shows an ignorance as to what ICU nursing is really about.

Yes you're valuable, smart, and all of that....but:

1) in ICU the 'only 2 patients' you have may both be trying to die at the same time

2) In ICU we dont have doctors on our hips 24/7...we have to be much more autonomous in emergent situations

3) we're expected to know and be responsible for highly advanced procedures/treatments that ER-nurses arent (ie: CRRT, continuous EEG, hemodynamic monitoring, IABP, etc., etc.)

4) in ER there's a very good chance that during any given shift you WONT care for critically sick patients...whereas in ICU you get critically sick patients all day every day.

5) To assume people dont get tubed, treatment initiated, or transported to various scans, etc. while in ICU is well...duhhh.

Anyway...yes you're smart, valuable, important, and all the rest....

But dont assume ICU nursing is less difficult, demanding, or crazy than the 'finely tuned machine' ER you work in.

judy ann · Jun 29, 2005

Just an aside. What does your ER do with a patient in the third trimester of pregnancy who is critical when she arrives--ie:mva, seizing, etc? Usually she goes to OB.

I worked in a terciary high risk antipartum unit. We used all the same equiptment and knowledge as if we were in an ICU, and in fact, we were. Also, we had at least one patient per bed that we couldn't treat directly. Please remember that all specialties have their own "attractions". :nurse:

Marie_LPN, RN, LPN, RN · Jun 29, 2005

But, the ICU nurses only have two patients to one nurse,

Depending on the aucuity, our ICU nurses might have 4 pts.

mommatrauma, RN · Jun 30, 2005

Just an aside. What does your ER do with a patient in the third trimester of pregnancy who is critical when she arrives--ie:mva, seizing, etc? Usually she goes to OB.
I worked in a terciary high risk antipartum unit. We used all the same equiptment and knowledge as if we were in an ICU, and in fact, we were. Also, we had at least one patient per bed that we couldn't treat directly. Please remember that all specialties have their own "attractions".

If she's actively seizing we keep her, give her Mag stabalize her and invite OB to come to the ER until she is stable enough to go to L and D. If she is in an MVC, we clear her first and again invite OB to come to the ER and monitor her, when she's trauma cleared, she'll go to OB...and not a minute before...If she is unstable in any way shape or form...she doesn't go to OB until we stabalize her, and we invite all the appropriate players down..If she comes to the ER with her only c/o of preg related issues, ie abd pain, non-traumatic vag bleeding, then yes, she goes right over...however, if her water broke, we do a check before she goes over to make sure delivery isn't iminent, if it is...we call OB and NICU team and she delivers in the ER...We don't like to birth babies, but in the last 2 years, I've been present for 7 births in the ER...and that's only the one's I was present for!

fergus51 · Jun 30, 2005

LOL! I've never known an ER nurse that wanted to be around for deliveries:) In every hospital I've been in they call OB as soon as any pregnant women came through the door, so the pregnant woman was their patient for about 10 minutes.