Should Emergency Nursing be part of the Critical Care Nursing Specialty on this site?

[loricatus]

This issue has been much discussed under the Emergency Nursing Forum prior to the new upgrade. With the upgrade making Critical Care Nursing a link in the above tab, do you think it is time to move emergency nursing to that subspecialty?

I certainly do. Great arguments have been made (in the Emergency Nursing Forum)to support it being a critical care specialty.

[meandragonbrett]

It's a matter of semantics really. What defines critical care?

Also, what is the point of having a Trauma Nursing forum? The ED forum doesn't see TONS of traffic as it is. Just keep it all in the same forum. If there is a post you are not interested in reading, then don't.

[JessicRN]

ED nurses can get CCRN, in addition to CEN. The critical care nursing association recognizes emergency nursing as a critical care specialty. In fact, I am planning to take my CCRN exam next month & already have my CEN

I think everyone knows my opinion. There are also alot of non critical pt in our ICU you can be a chronic pt and still stay in the ICU because you have a vent. I have also seen several ICU pt awaiting beds to the floors that are no longer critical. Our place you cannot send any unstable critical pts to the ICU only stable ones they remain in the ED until they die or are stablized.

[Dallas_RN, BSN, EMT-P]

Just curious why it only includes the ICU/CCU specialties? I mainly work E.R. but also pick up shifts on the ICU as well and this baffles me? I mean who do you think takes care of these patients before they go to ICU? Are they not considered "Critical" until they have a ICU room number despite having ICU orders and sitting in the E.R. for 24hours while waiting for a unit bed? My facility recognizes it and pays us accordingly but just curious why the way it is listed here? :)

[ThrowEdNurse, BSN, RN]

Many don't consider ED nursing to be critical. The hospital I work for doesn't consider us to be specialized critical nurses either and we don't get the pay differential. It really makes us bitter to hold ICU boarders in the ED. Where do you work and can I come?

[ThrowEdNurse, BSN, RN]

and, how can anyone think ed nurses aren't specialized critical nurses? we bring people back from death and keep them here. we get to decide who is sick enough to take the md by the hand and lead him into the room. "that's enough about golf, this pt is sick!" have you ever heard an ed nurse say, "oh, this pt looks bad. we can't take him down here! send him to fill-in-the-blank."? is it mandatory at your hospital that ed staff responds to code blue? i wonder why? when trauma pts come in, does ems bring them to the ed or icu? again, why? is it because half dead people need inferior nursing care? we manage every vital sign, every eyelash flutter, every muscle twitch, every natural body function as we tritrate multiple, lifesaving medications with opposing and potentially serious side effects, often without the benefit of knowing the pt's pmh or even what the hell happened to him to wind up here in our bed without report (augh!!!!) and if we miss calculate then people die. yeah, ed nursing isn't "critical." we can run an ad:

ed nursing, so easy a caveman can do it!!!!

this has obviously been a rant. as i have said before, anyone who disagrees or has an opposing view from anything i have just said, we know. please don't leave a long winded story about when your (blank) was (blank) and you had (blank) and the nurse (blank)....so on and so forth. we get it!!! and you are important to us. do you see the red x?

ok, sorry, i'm done now and better. i think i'll be okay.

[traumaRUs, MSN, APRN]

Still vote that ER nursing is not critical care. Yes, we do take care of critical patients, but our focus is stabilize and transfer. And...fully 50% of ER patients aren't even emergencies as we all know.

We do need critical care skills but our focus is resuscitation.

[sirI, MSN, APRN, NP]

Have to agree with traumaRUs. Majority of the ones I see in ED as PCP are not critical.

[ThrowEdNurse, BSN, RN]

Is resuscitation not considered critical care? I am asking because I genuinely don't know. Also, I thought as nurses we tend to swing to the conservative side. That's how we triage and treat pts, right? We use the system of the sickest pt, etc. So, a med-surg nurse without the proper, indepth training can't manage the sickest ED pt, although vice a versa is true, then why aren't we defaulted to the specialty position? Hope this makes sense, I abbreviated my thoughts and am v tired.

[ThrowEdNurse, BSN, RN]

I've also noted you say that a majority of the pts "I see aren't critical." Well, we all work in different EDs and I rarely see a pt who isn't critical. Yeah, when I am triage, I see a lot of the "unsick" but when in the back most of my pts are very critical. The unsick get fast tracked. A new grad started last week and on her first day out of orientation she had 5 rooms: 1 NH pt in severe resp distress and unknown code status (lucky she was DNR because she did go) , 1 GSW to abd that just rolled in hypotensive and with abd distention, 1 Spanish only speaking woman in active labor, head crowning and "WE DON'T DO OB AT MY HOSPITAL!" , and an ICU hold boarding in the ED pending room assignment, and she was unable to recall her last pt's chief complaint. She told me all this the next day and I hugged her and told her to just laugh because it is just that asinine. I mean honestly, she didn't stand a chance in those circumstances. She did have 1 other nurse who was able to help but everyone else had their own sick pts. That's typical of my ED. Maybe it's not considered "critical" for some reason, but it is some kind of specialty! She even came back to work the next day. I was so proud!

[mwboswell]

I say, until we start doing Swan's, and shooting cardiac outputs, and titrating fluids to the CWP and/or balloon pumps or managing ventricular shunt drainage for more than a couple of hours, it is not "Critical Care".

At times the acuity can elevate to critical care levels for a while, but it doesn't remain there.

Oh, and if you ARE doing all the above in your ER, you need to be very careful of your practice of nursing, cause you probably don't get the required inservicing or continuing education/competency training to do the above.....

ER (actually ED) is it's own niche I believe, it is a mix of:

(1) Primary care

(2) Acute care

(3) L/D-OB/GYN

(4) Peri-op

(5) Psych

(6) Peds

(7) Trauma

(8) Some Critical Care.

If you look at the CEN (Certified Emergency Nurse) core competencies, they don't even go into central lines and such. Pretty much the only critical care there is vents and ACLS type critical care. I reference the Emergency Nursing Core Curriculum because if you were to write a job description and competencies, something like that would be your guide.

[nrsang97, BSN, RN]

ER is it's own specialty. With GPU and ICU mixed in.

[Dallas_RN, BSN, EMT-P]

What I like about picking up shifts in the ICU is that I have a whopping TWO patients to care for, TWO. In the ER, I'll have up to 5 at a time. Our admit percentage is 72% so we see a lot of sick patients. And as far as "clinic patients" they go through fast track, so we don't have the luxury of treating those folks in the main ER.

One night last week in the E.R. I had a subarachnoid vented pt awaiting an ICU bed, another ICU pt who was on Levo along with a faulty pacemaker/Difib, a telemetry pt (3 previous MI's) who was on Cardene as well as an insulin drip who must drink prune juice and mag citrate by the gallon it seemed, and a Lower GI bleed admitted to the floor who's was getting 2units of blood all at the same time. Everyone's on the call light (except for the vented pt of course) for various things, have to change sheets because they are soiled (We don't have the luxury of rectal tubes like we have in the ICU.), MD calling to give verbal orders, pain meds, etc...

And the entire time I couldn't help to think how if I was only in the ICU, I'd have two of them. Half of these people I had to work up, start lines, get labs, intubate, throw in NG tubes, foleys, etc. We don't have all the work done for us like I do in the ICU, we initiate everything, we even stabilize them before going to the unit, all is needed then is to maintain. Luckily for me we were completely saturated up stairs with zero beds available in the house so I took care of all FOUR patients the entire 12hours of the shift. But that's life in a busy E.R., I guess those critical patients I take care in the ICU magically become "critical" when they get on the unit because E.R. nursing doesn't involve critical care.

I do find it odd we have lots of ER nurses who pickup shifts in ICU, yet the ICU nurses "looking to make a change" never last long in the E.R. They typically make comments about the "workload" and "their feet hurting from standing" in the ED. I guess they must be bored from the slow pace and overabundance of clinic patients we see down there.