I havent been a nurse for long ( a year and a half) so I have only worked in ER. I have noticed when I give report to ICU they often times speak "down" to us constantly asking why didnt you do this? Why that? why didnt the dr. do this? Its like they're trying to guilt me all the time...
Some of the questions I can answer but often times I just say "the dr. is aware and no further orders were given"
I had a RN get ****** last night because we didnt start a central line on a pt who was supposed to get an insulin drip!??? I DON'T PUT IN CENTRAL LINES!!!
Does anyone else have similiar issues? Also, I think its funny how the male ICU nurses NEVER give me crap when reporting...its always pleasant, short and simple. :)
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
and To my fellow ICU RN's...GO TO YOUR HOME!!! This is why you have your own forum.
Other than that, yes there is a battle between ICU/ED...yes there will ALWAYS be a battle.
*** First I didn't see this discussion in the emergency nursing forum. Second I am amazed when I read about report problems between ER/ICU. In over 15 years of ER and ICU nursing in four states and 12 hospital (counting hospitals I just worked casual or agency in) I have never exerienced such a problem either as an ER or ICU nurse, except for some specific individuals. IF some hospitals have this problem it has to do with the culture and leadership in those hospitals.
Yeah I was on a soap box for sure but how many threads have been stirred up by ICU nurses here???
I'm not in management but am a charge nurse in a very busy ED.
I would never drink decaf and am actually a very laid back person.
I worked the floor the other day for some OT and tried to call report to ICU on one of my 4 patients but the secretary said the nurse was on lunch so she would have to call me back. So I charted as such then sent an email to their manager because in this scenario their charge nurse is supposed to take report and we can send the patient up when the nurse comes back...wasn't offered and they didn't know it was me trying to call report (the other nurses probably wouldn't pitch the fit I did).
Back to the OP...please don't let them bully you, just give a complete report and if they give you grief about not knowing every lab or having every procedure done for them just tell them..."I can't do all of your work for you". And if they are mean to you please tell your charge nurse so they can call either their charge nurse or their manager because that should not be tolerated in any dept. Write them up...yes nurses (even union nurses) get fired from time to time.
I may have a little supervisory outlook on the matter but have been there when I was a new nurse so I know where you are coming from.
Maybe Allnurses needs to address the General Nursing thread issue?
I have "lurked" in the ICU forums but out of respect I would never post a "troll" response to a thread in their neck of the woods. I don't think you'll find an ED nurse that doesn't know that all the ICU nurses want is "a little more" than we give them.
Peace...sorry for the double post...I won't post again in this thread :-)
Dude, why're you so territorial? Like other posters have said, this thread was on the AN home page. And so far, you're the only one all in a bunch about ICU nurses replying to this thread, so I guess it is okay to cross-pollinate.
And no wonder you have issues with nurses in other departments. You advise someone to handle a rude ICU nurse by throwing gas on the fire with your brilliant "I can't do all of your work for you." line? And then when surprise, surprise you get a nasty response go cry to the manager? How about dealing with the ICU nurse directly, try de-escalating their stress by showing a little empathy for their situation? Let them know, in a non-defensive way that you're stuck between a rock and a hard place as well. It goes both ways. It works for me. I have great relationships with our ED nurses and I'm the poster child for the anal compulsive nurse.
Deal with people directly. Did you even ask the secretary to be transfered to the charge nurse to give report? Due to the fact that you stated they didn't even know you were calling to try to give report it sounds like there was a lot more you could have done on your part, but instead you chose to hang up and "pitch a fit" to the manager. And incidentally, that kind of thing can bite you in the ass should that patient have had a bad outcome due to the delay in transfer to higher level of care. You nailed yourself in the coffin when you put that in writing in the chart.
Fine I'll respond again...I actually have a great relationship with other dept's and the reason I said to let your charge nurse know is usually we can find out why they are delaying and give a little push back if needed because we need to move patients. Directly doesn't usually work when you have an ICU nurse blocking or avoiding report, you have to go around them. How is a floor nurse supposed to handle an ICU nurse who won't get on the phone??? Also how is a floor nurse supposed to handle the rude ICU nurse who is rude to every nurse in the ED??? Management and leadership need to know about the problem to deal with it. I'm not talking about a nurse who is rude to someone once or having a bad day...I'm talking about patterns in behavior.
If this was the first time ICU nurses have trolled on the ED forum I wouldn't have reacted at all...but there is a history of this in the 7 years I've been on this site. I'm sorry if I reacted without knowing this thread was listed in "General Nursing".
The secretary in my case said "The charge nurse said the nurse taking that patient is at lunch, she'll call you back"...then she promptly hung-up. This has been an ongoing issue in our hospital so severe that I was on a committee to improve ICU/ED relationships...and they were not holding to their agreement (the charge on that day was also on this committee). So no I did not run to management without there being a HUGE history.
How did I "nail myself to the coffin" by charting the nurse could not take report because she was at lunch? I was still caring for the patient in an acute care environment and actually initiating the ICU admit orders. (Love the "higher level of care dig too" :-))
You may be surprised to know that I am very easy to get along with and have many friends who work in ICU as well as other departments...I do expect people to work hard, do their jobs, and to take care of the most important person--the patient. There have been many studies that show what's better for the patient is to get them out of a busy ED and up to a more controlled environment where the nurses are much better, smarter, nicer, and a little wider (sorry had to throw my dig in as well :-))
BTW I was joking about the "I can't do all your work" comment I would only say that as a joke to one of my friends in ICU...I am a smart a$$ when it's appropriate--life is too short to live it seriously :-)
Fine I'll respond again...I actually have a great relationship with other dept's and the reason I said to let your charge nurse know is usually we can find out why they are delaying and give a little push back if needed because we need to move patients. Directly doesn't usually work when you have an ICU nurse blocking or avoiding report, you have to go around them. How is a floor nurse supposed to handle an ICU nurse who won't get on the phone??? Also how is a floor nurse supposed to handle the rude ICU nurse who is rude to every nurse in the ED??? Management and leadership need to know about the problem to deal with it. I'm not talking about a nurse who is rude to someone once or having a bad day...I'm talking about patterns in behavior.
If this was the first time ICU nurses have trolled on the ED forum I wouldn't have reacted at all...but there is a history of this in the 7 years I've been on this site. I'm sorry if I reacted without knowing this thread was listed in "General Nursing".
The secretary in my case said "The charge nurse said the nurse taking that patient is at lunch, she'll call you back"...then she promptly hung-up. This has been an ongoing issue in our hospital so severe that I was on a committee to improve ICU/ED relationships...and they were not holding to their agreement (the charge on that day was also on this committee). So no I did not run to management without there being a HUGE history.
How did I "nail myself to the coffin" by charting the nurse could not take report because she was at lunch? I was still caring for the patient in an acute care environment and actually initiating the ICU admit orders. (Love the "higher level of care dig too" :-))
You may be surprised to know that I am very easy to get along with and have many friends who work in ICU as well as other departments...I do expect people to work hard, do their jobs, and to take care of the most important person--the patient. There have been many studies that show what's better for the patient is to get them out of a busy ED and up to a more controlled environment where the nurses are much better, smarter, nicer, and a little wider (sorry had to throw my dig in as well :-))
BTW I was joking about the "I can't do all your work" comment I would only say that as a joke to one of my friends in ICU...I am a smart a$$ when it's appropriate--life is too short to live it seriously :-)
Larry, obviously I'm in no position to comment on the general state of affairs in your hospital. Speaking in generalities for all hospitals, of course, blocking and/or delaying admissions is a problem- and when it is an ongoing problem, of course it needs to be addressed. Same with individuals with a pattern of rudeness that isn't responsive to the extended olive branch and heart-to-heart.
As for the time you needed to call report and the secretary hung up- yeah, I really don't know what goes on there, but maybe she was new, maybe she floated from another unit, or maybe she just spaced out. You could have called back and specifically asked for the charge nurse. I dunno- just suggesting. And the "higher level of care" thing wasn't a dig- I don't know where that notion came from. It wasn't an insult- it simply means that a patient's acuity has increased and needs an environment in which closer monitoring and/or ICU level interventions are possible. And when that's the case, the patient doesn't have the leisure of being mosied on down. I'm sure you're perfectly capable of handling emergent situations- however it isn't fair to you or your 5, 6, 7? other patients to be entrenched with a critical patient. And I'm thinking that should something have gone wrong with the patient, I wouldn't want to be on the hook for not transfering sooner because the receiving nurse was at lunch. And if asked what I did to try to get the patient down there- I should think I ought to have a better response than "I pitched a fit" to the manager because the secretary gave me the run around.
And as for ICU nurses "trolling" the ED forum- I don't see where that is going on in this thread, so why bring it up? The overwhelming majority of the responses from ICU nurses have been very positive and appropriate. Don't be such a hater.
You know...I work in the ER and share my bed with an ICU nurse. We can go round and round about ER versus ICU. It really comes down to completely different personalites as someone here has already pointed out:
1. The foley thing: As an ER nurse, I don't get it. ICU seems to have an obsession with them. They love counting their I&Os with a foley. They are convinced even a coherent CPAP patient who wants a urinal can't be trusted. It's such bizarre thinking to me.
2. The report thing: I don't get this one either. Why why WHY must I read the entire chart and ALL of the labs to you? WHY do you do this to one another? Does it not make you crazy? The ICU nurse in my life can't explain this. (Alas, he is a male and he wants to know where the IV access is. Apparently, he can read charts all on his own but gladly obliges and reads the charts to his colleagues.)
3. The poop thing: I swear they poop when we transfer them off the stretcher or in the elevator on the way up. I SWEAR. There is nothing worse then getting to the ICU and having to explain that they were changed but...ugh.
4. The orders: Once the patient is admitted, there is a timer that starts. If I can't do orders before 30 minutes goes by, they have to go upstairs. Why don't ICU nurses know this? But why would I do routine floor orders unless I was without something else to do? (Will do routine meds on floor patients that are still in dept)
5. IV access: We were recently told they wouldn't accept any patients without two IV accesses in place. I don't get it. You have an access. If you want a second access, then get it. Also, if you want a central line, you can ask for one but like another poster said, I don't put those in and the ER docs don't want to but they are staying with you for sooooo long so why you fussing at me over it? lol.
it's the same story no matter where you go. we've got a great new intensivist who believes that ICU pts are to be in the ER for as short of time as possible - which means we often don't have time to do all the little things, just enough to stabilize and make sure they'll survive transport. love that new doc! no more ICU patients in the ER for hours and hours on end... ::crosses fingers::
I have never observed or experienced any problems between ER vs ICU nurses. Many of the ICU nurses at my hospital also work part time or casual in the ER. We all get along great.
For us the problem is between ICU/ER nurses and the med-surg floors.
Somebody mentioned an ICU nurse wanted to know why a central line wasn't places for an insulin gtt. Why would you need a central line just for an insulin gtt?[/quote
That was me...exactly. why would you need a triple lumen??
For what it's worth, this thread actually showed up under the general nursing discussion....I don't know how that happens when you post in a specific section, but that's how I found it. I don't go to the ER nursing section.
it did?? I always try to post a thread in the ED forum...if it came up in gen nursing, i wasn't supposed to...ooops:uhoh3:
5. IV access: We were recently told they wouldn't accept any patients without two IV accesses in place. I don't get it. You have an access. If you want a second access, then get it. Also, if you want a central line, you can ask for one but like another poster said, I don't put those in and the ER docs don't want to but they are staying with you for sooooo long so why you fussing at me over it? lol.
^ great post, but regarding IVs the reason we like you guys to give us two is because we are used to having central lines so if a tough stick comes in it will take us about an hour to get access when you could have done it in 15 minutes.
^ great post, but regarding IVs the reason we like you guys to give us two is because we are used to having central lines so if a tough stick comes in it will take us about an hour to get access when you could have done it in 15 minutes.
That sounds like a compliment to ED nurses for being able to establish IVs in tough sticks better than ICU nurses! However, a though stick is a tough stick, regardless of who does it. I've had some of them take more than an hour to get one IV let alone two, and that's with several different nurses trying.
I'll never forget one extremely obese man who was impossible to establish a PIV in. The ED doc tried a central line with no success so we called in the anesthesiologist who couldn't get it done in five tries (which tied me up in the room with one pt for almost and hour and a half when I had four other pts). We finally had to get a PICC line in the guy. He was struggling to breath this whole time and needed IV lasix or we would have shipped him to the floor without a line and got it done there. Or, if we could have gotten a PIV good enough for the lasix, he would have gone then.
It isn't logical to assume that the ED could have done it in 15 minutes (which is still a long time to put in an IV), and it isn't right to expect the ED to hang onto a patient however long it will take to establish a second line just to make ICU's job easier when the ED needs to move patients for the sakes of all patients involved. So I have to agree with with those who stated that ICU needs to get a second line if they want one (with a few exceptions), and be happy about the pt coming to them with one.
i havent been a nurse for long ( a year and a half) so i have only worked in er. i have noticed when i give report to icu they often times speak "down" to us constantly asking why didnt you do this? why that? why didnt the dr. do this? its like they're trying to guilt me all the time...
some of the questions i can answer but often times i just say "the dr. is aware and no further orders were given"
i had a rn get ****** last night because we didnt start a central line on a pt who was supposed to get an insulin drip!??? i don't put in central lines!!!
does anyone else have similiar issues? also, i think its funny how the male icu nurses never give me crap when reporting...its always pleasant, short and simple. :)
not to mention the risk of infection that er lines can get because all of the foot traffic in er. ewww.
I could not testify as to whether calling report to male or female ICU nurses differ, but ICU nurses tend to focus on specific things that are a priority for them, but not for our department. We focus on emergent meds, situations, etc. and defer the rest for admission. I had a nurse last week get all huffy with me about routine meds. I told her we give stat meds only. I'd only give routine meds if first of all the meds were ready and most of all, if the patient was held in the ER for a period of time where it was appropriate. Only then would I consider anti-arrythmic meds or diabetic meds... never Colace. haa!!
love that new doc! no more ICU patients in the ER for hours and hours on end... ::crosses fingers::
However, a though stick is a tough stick, regardless of who does it. I've had some of them take more than an hour to get one IV let alone two, and that's with several different nurses trying. 
PMFB-RN, RN
5,351 Posts
*** First I didn't see this discussion in the emergency nursing forum. Second I am amazed when I read about report problems between ER/ICU. In over 15 years of ER and ICU nursing in four states and 12 hospital (counting hospitals I just worked casual or agency in) I have never exerienced such a problem either as an ER or ICU nurse, except for some specific individuals. IF some hospitals have this problem it has to do with the culture and leadership in those hospitals.