ICU VS. the ER?

npingeorgia · Dec 14, 2006

I promise you that there is nothing and I do mean nothing easy about working in the ER. I do also hate the "ER vs ICU" . I agree that it is entirely 2 different worlds but neither nurse is the less for it. I will say that in this crazy time of healthcare that we are in, often times the ER is holding ICU patients for hours and the critical care must go on, the patient does not suddenly become less stable because they are being held in the ER, and believe me no one cares that you are already holding 2 ICU patients and you still have the potential to have 1-2 more patients that are considered urgent if not emergent in their needs. I have had the experience to have to call upon an ICU nurse to clarify protocols not typically used in the ER and ICU nurses have often called the ER to clarify protocols for patients that may require some expertise from the ER nurse. We are all a team and let's keep it professional.

Dinith88 · Dec 14, 2006

Just to clarify what I meant by "Jocks and Nerds"...I think of ER nurses as "Jocks" just because we like to be where the action is and enjoy running are butts off. And ICU nurses as "Nerds" because they are the braniacs who like to study everything and tinker with settings and machines.
I do not care about "image" at all and would never consider myself better than any other kind of nurse but also would not consider myself less.

OK. should've read your stuff better.

I think the reason i get so involved in er-vs-icu threads so much is because i've a chip on my shoulder regarding this stuff (inferiority complex?).

I know you'll probably think this is stupid...but i beleive the root of my problem with this is not er-nurses...but rather popular opinion of what 'er' is. So many people (mostly lay-persons and eager student-types) have such a mis-conception of the health-care system...and especially Er (from all the shows). And i also dislike nurses who (out of ignorance) put their jobs on pedestals(sp?) and talk-down other areas/positions.

NOthing personal of course...it's just my pet-peeve.

And you're probably right about the 'nerd' thing :specs:

Altra, BSN, RN · Dec 14, 2006

I agree w/all the reasonable posters who have stated that the 2 units are different types of nursing ... one is not better than the other.

But this stuff about ICU nurses being more independent & making more independent decisions than ED nurses is killing me ... maybe in your community, non-teaching hospitals where there are no residents, just attendings who breeze in & out once or twice a day. But in my teaching, Level I hospital, the ICUs are just as overrun with hovering residents 24/7 as the ED ... often more so. Where I am, both environments are team environments.

If I didn't "make the decision" to do an EKG, start a line, draw appropriate labs, call respiratory, call CT or x-ray, administer appropriate meds for a fever, give ASA to the CP patient, have a thoracotomy tray ready, tell the doc the pt. has no gag reflex, etc. etc. ... I'd be looked at like I was stupid ... and rightfully so. Also ... we nurses have (generally) 3-5 patients ... the docs are juggling 8-10. They depend on us to assess a pt. & tell them "yes, the chief complaint entered by registration says chest pain, but what she's really got is bilateral, reproducible upper arm pain & some nausea. I've done an EKG & it's a sinus rhythm. No fall or injury to the extremities, so I did not order any x-rays." Or, "the cough in Room 5 is hypertensive, states he cannot remember when he last saw a doctor, & has a family hx of sudden cardiac death. Here's the EKG, I've sent off labs & put in the order for the CXR."

Sorry, but anyone who feels ED nurses are not independent do not understand the concept of triage. And also does not understand that triage is not just at the triage desk in the waiting room.

And the hospital where ICU nurses come down to the ED to run a code? Really?? Oy!

miracle1986 · Dec 14, 2006

Where I live....nurses are not alot to do squat without consent / order from the docs. They are at the beck and call for the docs....it is bull....but how it has been here since the beinning of the hospital......There are usually 3-4 docs on a shift....and they do call all the shots. I live in a rural / country area.

ND76 · Dec 15, 2006

But this stuff about ICU nurses being more independent & making more independent decisions than ED nurses is killing me ... maybe in your community, non-teaching hospitals where there are no residents, just attendings who breeze in & out once or twice a day. But in my teaching, Level I hospital, the ICUs are just as overrun with hovering residents 24/7 as the ED ... often more so. Where I am, both environments are team environments.
If I didn't "make the decision" to do an EKG, start a line, draw appropriate labs, call respiratory, call CT or x-ray, administer appropriate meds for a fever, give ASA to the CP patient, have a thoracotomy tray ready, tell the doc the pt. has no gag reflex, etc. etc. ... I'd be looked at like I was stupid ... and rightfully so. Also ... we nurses have (generally) 3-5 patients ... the docs are juggling 8-10. They depend on us to assess a pt. & tell them "yes, the chief complaint entered by registration says chest pain, but what she's really got is bilateral, reproducible upper arm pain & some nausea. I've done an EKG & it's a sinus rhythm. No fall or injury to the extremities, so I did not order any x-rays." Or, "the cough in Room 5 is hypertensive, states he cannot remember when he last saw a doctor, & has a family hx of sudden cardiac death. Here's the EKG, I've sent off labs & put in the order for the CXR."
Sorry, but anyone who feels ED nurses are not independent do not understand the concept of triage. And also does not understand that triage is not just at the triage desk in the waiting room.

I completely agree! I work in an very fast-paced ED where we are encouraged to be autonomous. My patients are usually completely worked up by the time an ED doctor sees them, and almost always medicated for pain, given their first dose antibiotics, etc. through my advocacy. My doctors have worked with me for years and trust my nursing judgement, and will sign off on my orders or take two seconds to discuss medicating a patient although they're still five down in the rack. Same goes for triage. We usually run two triage nurses with a tech, and we order labs, x-rays, meds, etc. from triage.

Then again, I'm a Type A, hyper eager beaver, and not all the nurses I work with do these things. It's kind of frustrating to be efficient and truly trying to help people as quickly as possible when some of your co-workers sit there like trained monkeys waiting on a doctor to tell them to collect a u/a on a female with belly pain!

The ICU and ED where I work mostly get along...we recognize that we're all overworked and underappreciated, and try to help each other out. In fact, at my facility, it's more a ED/ICU/Tele against the rest of the units situation... I realize that the ICU nurses are swamped, they are almost always at capacity. But they realize that due to that, we are almost always holding ICU patients, while also dealing with our own ED patients.

The only time I really see any problems arise is when the patient didn't get good care down in the ED. When you have an ICU hold, you HAVE to try and think like an ICU nurse and be detail oriented...that patient needs constant monitoring, reassessment, you have to make sure your labs, meds, etc. are done on time and interpreted and relayed to the MD if abnormal, and you have to chart all this concisely and usually on MUCH different paperwork than you're used to as an ER nurse. It's a personal source of pride for me to deliver a pt to the ICU and the level of care be up to par. But I've seen ICU patients go up NOT in a gown, or with no vitals charted for 3 hours, or no foley, or the q1hour neuro checks neglected, and if it makes me mad, I can't imagine what the ICU nurse must be feeling!