Things you'd like the ER to Know

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I'm working on an education program on Critical Care Education for ER Nurses. My question is;

What things the you as ICU nurses know that you'd like the ER nurses to know?

for starters I"m working hemodymic monitoring and how to use MAP.

Specializes in Tele, and now ICU !!.

ya, whats up with the AC site..everytime!! my favorite was when my pt rolled up with the tourniquet still tied on the poor lil pt. HELLOOO!!!!!! :banghead:

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There are other pressors to choose from aside from Dopamine, Dopamine, Dopamine.

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Ok you have a certain amount of rooms and that's it. We are constantly revolving patients sometimes we get patients with toothaches and other times we get a MI rolling through the door. When we get a bed and give report we have to get the patient up in order to prepare for our next patient.

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ER nurses take alot of crap from unit nurses...many times unjustified...but,

Anyway, i think ER nurses being inserviced on hemodynamics is a waste of time (outside of simple CVPs and MAPs). ER nurses dont (speaking vast majority) ever see SWANs...so it's a waste of your time/resources in my opinion.

I think a solid understanding of ABG interpretation and Vent-settings would be infinitely more useful...as well as intensive 12-ECG interpretation. This has been my personal experience. Of course, the no-brainer idea that they shouldn't bring their patients over in a mess is at the top of the list...

ER nurses come in all sorts and flavors (just like ICU nurses), so i'm not making blanket statements...just some things that can facilitate patient report/transfer.

OK so I don't know what kind of hospital you all work at, but where I work we are held responsible to know how to read an ECG, know about CVP, and MAP. It is kind of disturbing that your ER is not considered a critical care area. Think about it where do most of your patients come from the ER. I think before you try to decide what an ER RN doesn't know you need to work a 12 hour shift with them, and I am sure you will see what they know.

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Specializes in Cardiac, ER.

I transfered from a cardiac unit to ER (same hospital) about 2 yrs ago. I will admit my first few weeks were filled with thoughts of how the ER nurses were doing so many things wrong! I watched in awe as so many things were "missed", not done or not even considered important. I began asking lots of "why" questions. I honestly felt the ER wasn't a safe place for me to work.

Fast forward about 6 weeks. I'm now off orientation and no longer have my preceptor at my side. I walk into work and receive report on my 3 rooms plus 2 hall beds. I'm told there are 36 people in the waiting room. Two of my pts have been assigned beds, but at last check those beds were dirty. I have 2 stable chest pains, a CVA who has rec'd TPA (dirty NTICU bed), a long term COPD'er on a vent, and a drunk MVI trauma with a fx C3, fx arm and multiple lacs to the face (dirty NTICU bed). Day shift leaves,.I walk into assess my CVA, the sec yells "your bed for 3 is ready, they're on the phone for report". Report??? I haven't even seen this pt yet! I have options now. I can tell the unit I'll call back for report after I've had time to asses the pt(and hope the unit nurse has time to talk then) , or I can grab the chart and do the best I can. Then the radio blares,..two class I traumas 4 min out. I have to have that bed,..so I wing a report. My class I trauma arrives about the same time as my other bed is clean,..and they want report,...one of my co workers wings a report for me and transfers the pt. EMS quickly fills that bed with a 3yr old resp distress. My night goes on like this for 10 hours.

I had to learn to be very focused in the ER. To think about what must be done NOW, to give this pt the best outcome. If something can wait even an hour without changing the outcome, then it waits, it has to. If I have the option of cleaning up soiled sheets or hanging nitro the nitro wins.

I also learned that the ER doesn't have the same protocols that I had upstairs. We do have protocols, but not like we had upstairs. Our protocols are very c/o focused and every time I've questioned "why" we don't do this or can't do that I'm given the latest research regarding pt outcomes and told that delaying A, B or C doesn't change the outcome.

It was very difficult for me to train my brain to think in terms of minutes and hours rather than shifts or days. We can't close the doors or ask EMS to circle the block for 15 minutes while we get a bed ready. It doesn't matter if we're in the middle of a sterile procedure, a code, or trying to wrestle with the drunk who is climbing out of bed,.they keep coming, we do the best we can with what we have.

Now, some of your c/o make me cringe,..etomidate as a paralytic? Atropine as a seditave,...this is scary and I hope that someone said something! As far as the dopamine,...the doc orders it, we have to use it,...occasionally we can very nicely make alternate suggestions,..sometimes it works,.other times not so much. Where I work,..the ER docs can't admit,..we often don't actually see the admit orders,.we are told the pt needs a unit bed, a tele bed etc,.so we don't even know about the stat orders and honestly,..if the ER doc doesn't order it we aren't supposed to give it.

Sorry this got so long,...it frustrates me to here the ER nurses whine about the floor nurses, floor nurses c/o ER nurses, Unit nurses c/o ER,....we all have different jobs with different expectations and goals,..we are all here to do the best for our pts and we all just do it differently.

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I transfered from a cardiac unit to ER (same hospital) about 2 yrs ago. I will admit my first few weeks were filled with thoughts of how the ER nurses were doing so many things wrong! I watched in awe as so many things were "missed", not done or not even considered important. I began asking lots of "why" questions. I honestly felt the ER wasn't a safe place for me to work.

Fast forward about 6 weeks. I'm now off orientation and no longer have my preceptor at my side. I walk into work and receive report on my 3 rooms plus 2 hall beds. I'm told there are 36 people in the waiting room. Two of my pts have been assigned beds, but at last check those beds were dirty. I have 2 stable chest pains, a CVA who has rec'd TPA (dirty NTICU bed), a long term COPD'er on a vent, and a drunk MVI trauma with a fx C3, fx arm and multiple lacs to the face (dirty NTICU bed). Day shift leaves,.I walk into assess my CVA, the sec yells "your bed for 3 is ready, they're on the phone for report". Report??? I haven't even seen this pt yet! I have options now. I can tell the unit I'll call back for report after I've had time to asses the pt(and hope the unit nurse has time to talk then) , or I can grab the chart and do the best I can. Then the radio blares,..two class I traumas 4 min out. I have to have that bed,..so I wing a report. My class I trauma arrives about the same time as my other bed is clean,..and they want report,...one of my co workers wings a report for me and transfers the pt. EMS quickly fills that bed with a 3yr old resp distress. My night goes on like this for 10 hours.

I had to learn to be very focused in the ER. To think about what must be done NOW, to give this pt the best outcome. If something can wait even an hour without changing the outcome, then it waits, it has to. If I have the option of cleaning up soiled sheets or hanging nitro the nitro wins.

I also learned that the ER doesn't have the same protocols that I had upstairs. We do have protocols, but not like we had upstairs. Our protocols are very c/o focused and every time I've questioned "why" we don't do this or can't do that I'm given the latest research regarding pt outcomes and told that delaying A, B or C doesn't change the outcome.

It was very difficult for me to train my brain to think in terms of minutes and hours rather than shifts or days. We can't close the doors or ask EMS to circle the block for 15 minutes while we get a bed ready. It doesn't matter if we're in the middle of a sterile procedure, a code, or trying to wrestle with the drunk who is climbing out of bed,.they keep coming, we do the best we can with what we have.

Now, some of your c/o make me cringe,..etomidate as a paralytic? Atropine as a seditave,...this is scary and I hope that someone said something! As far as the dopamine,...the doc orders it, we have to use it,...occasionally we can very nicely make alternate suggestions,..sometimes it works,.other times not so much. Where I work,..the ER docs can't admit,..we often don't actually see the admit orders,.we are told the pt needs a unit bed, a tele bed etc,.so we don't even know about the stat orders and honestly,..if the ER doc doesn't order it we aren't supposed to give it.

Sorry this got so long,...it frustrates me to here the ER nurses whine about the floor nurses, floor nurses c/o ER nurses, Unit nurses c/o ER,....we all have different jobs with different expectations and goals,..we are all here to do the best for our pts and we all just do it differently.

I just transfered to the SICU and I still work in the ER, and I also teach a clinical on a med/surg floor. Someone the other day called me out on talking about the ER and saying we, becuase they thought I didn't feel apart of their team, but I do. I told them I am a we with everybody, because I feel apart of the whole nursing team.

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