Standby: VENTING

[FlyingED]

Why is it that there is a large percentage of ICU nurses who think that ED nurses are unable to correctly monitor cardiac gtts and vent settings in the ER?

Here is a little background r/t my venting. I have been monitoring the CRNA board and reading how ICU is really needed to prepare yourself for CRNA school.

I know for a fact that When I take my patient up to ICU who is vented and on multiple drips and who I have been monitoring for the last 6 hours waiting for an ICU bed to be opened is alive because I know what I am doing (run-on sentance). When a patient arrives intubated with CPR in progress I know I don't quickly say, "not here, take them directly to ICU!" because Boy Howdy, we may have to start a cardiac drip and set up a vent.

Granted this is mostly in JEST! Most ICU nurses and Most ED nurses really appreciate what the other does and the skill required to perform both in the ICU and ED. I just had had enough of a few postings. Forgive my flippant remarks they are not to be taken seriously.

[TraumaQueen]

Wow, I'm still a pretty fresh RN, 2 years, all in a surgical/trauma/transplant ICU, and I had no idea such drama existed.

I don't work in Neverneverland, but we rarely ever have conflicts with other parts of the hospital.

We work closely with the ED nurses when a trauma comes in, because one of our nurses has to be present if it's during a time that a TNS isn't in house, and we always have mutual respect for eachother's jobs.

I also think that each hospital is different. Our ED nurses will rarely assist in line or CT placement, because they call us to help. We don't have a big metropolitan sized hospital, but we're a level one center.

I guess I'm surprised to see so much bitterness between the two areas, when I've never seen it myself. :)

[RNin92]

It is both hilarious and sad to be reading this discussion.

Some things are pretty universal no matter where you work! And apart from TraumaQueen...I'ld say that the rivalry between ICU and ED is alive and kicking throughout the country.

I am not sure where it starts but it sure impacts us all. I think both critical areas (and if someones hospital doesn't consider ED a critical area they have obviously not crossed through the ER doors) are filled with assertive and empowered nurses. You MUST be in order to survive in these departments. I just cannot figure out how to join us together against the TRUE enemy...the administration!!!

I personally think that the leadership is quite happy about the in-fighting that goes on between departments...then no one is REALLY look at the bigger issues.

:)

[Iam46yearsold]

The old ER vs ICU debate

[veronicajr]

Yes indeed, the rivalry is alive and well. I respect ICU nurses, and know that they have a stressful job just like we do. My only gripe is that at times, it seems they wil do ANYTHING to avoid getting a new patient. The nurse will be "out of the dept," on their lunch break, assisting with another pt, the list goes on and on. After I've called two or three times and been told things like this over and over, I'm going to get my charge nurse involved. We consistently have unstable patients in the ER, and we need to eat and go to the bathroom and drink our coffee too...and yet we can't tell EMS that, "well, we can't accept that patient yet."

I just don't understand why people don't want the patients that their job depends on.

[360joules]

The baseline difference between ICU and ER nursing:

Patients coming through the door of the ICU have a diagnosis and everyone has some idea what the plan is, and the nurse can focus on the pertinant clinical details of that patient's case. The ICU nurse typically sees a narrower range of patients and over time can develop a very strong clinical skill set for that range.

ER nurses don't get the time for focused contemplation of the patient's needs, and more times than seems possible, we have NO IDEA what's wrong with the patient besides the symptoms. The ER knowledge base is a mile wide, but by circumstances is an inch deep.

I do not think the skill sets are directly interchangeable, nor is the stereotypical "personality" of an ICU nurse likely to interact with the "ER" personality well.

[TraumaNurseRN]

I hope I can add something useful to this discussion, as a current SRNA who did SICU/CVRU/ER/CCL. Speaking from my personal experience, the experience I had that is proving to be the most beneficial to me now that I'm actually studying anesthesia is my unit experience. That is where I had the most ventilators and drips. But I think this goes much deeper than whether a nurse has simply cared for someone who is being ventilated and on some drips. Almost anyone can be taught those purely technical skills. The issues (at least I think for NA school) is a deeper understanding of these things. In my experience, I found that taking care of two ventilated patients in the unit and truly trying to understand what was going on was a better learning experience. Things such as relating changing your vent settings to changing ABG results, figuring out why your pt's peak pressures are going up, and why you have a horrible V/Q mismatch, are things usually only learned from experience in ICU's. And NA schools know this. Most hospitals don't have to hold ICU pt's in the ER, so therefore those nurses may start these things, but then transfer the patient. I understand and appreciate that there ARE some ER nurses who do have to hold these pt's, and therefore know more than some ICU nurses give them credit for. And yes, people do get in anesthesia school with only ER experience, if they can prove they do have the experience and critical thinking skills needed to succeed.

I would also like to make the following point about this whole argument regarding drips. ANYONE can start a drip. All that's needed is RN behind your name. And many nurses know to start dopa for low BP and nitro for high BP. That's great, and much more than some others know. Where I believe some resentment may come in is this: where a CVRU nurse, who is attuned in to tell when her post op cabg/mvr needs which of 7 drips titrated to decrease preload according to a wide variety of hemodynamic numbers from a swan, is told by an ER nurse that they know just as much about drips. That is offensive to some unit nurses, b/c they know that is simply not always the case. To you ER nurses who are that knowledgeable about the pharmacodynamics of vasopressors and inotropes from ER experience only, then I commend you. I'd love to see your ER, b/c it must be one amazing place.

So this is just my two cents.....

NCgirl,

I am an ER nurse of 11 years and I work in a level II Pediatric/Adult hospital (90,000 visits/yr)....I agree with you that the titration of multiple meds is a skill that the ICU nurse is much more versed in, especially post operatively, but the ER nurse is as well and does it in the wide range of the healthcare continuim (infant>elderly).....But the one thing I must argue with is your knowledge base of Vents coming from the ICU nurses. As an RRT for 14 years prior to getting my RN.....the RNs (Anywhere) were not well versed in that specialized field and I would be scared if that's where you claim to have recieved your knowledge base. In my 14 years I was hard pressed to even find an RN who knew ABGs/ V/Q mismatch or the reasons certain vent settings were good or bad for the patient, weaning perameters, educating family, etc. Shoot, for the most part they had difficulty suctioning a vented patient.