As usual, there is some animosity amongst the ER nurses and the ICU nurses at my hospital. We are a very large level 1 trauma center. The managers of both of these departments would like us to become more educated about the very different roles that we have, and are even thinking about making I float to the ICU (and vice versa) to try and make us understand the differences. Some of the problems that have occurred b/n myself and some of the ICU staff relates to them wanting a very detailed, full-bodied system (when I barely got to know the pt.cause the is a constant flow in the pit), putting off taking report even though they have the staff/bed( they are constantly arriving through our door and we can't make them wait), thinking that ER nurses don't understand how to do CCRN "stuff" (I kept them alive didn't I), expecting the pt. to be clean, totally medicated, and cured before I send them up (charcoal, ETOH, GI blood, and poop stain and sometimes they just keep coming). I would really like to hear how other places have overcome their barriers related to this. What has helped other hospitals ER/ICU nurses better understand each other and how their roles differ, but are equally important. Our managers are fed up and would surely welcome any advice! Thanks ahead of time for your thoughts!
Letting your patient lie in their own feces or not get the meds they need because they don't have adequate access because you are attempting to retaliate against one of your professional peers is pretty despicable, in my humble opinion. I hope I don't get a nurse like you when I eventually become ill myself.
Wow. Be careful not to hurt yourself leaping to conclusions. I have never once, and do not condone or advocate making patients suffer in order to retaliate against anyone. I'm a damn good nurse, and you'd be lucky to have a nurse like me.
Had patient yesterday, pressure in the toilet, we're putting Dopamine through a 20 in the wrist. I asked 2 ER physicians to put in a central line, they both initially agreed, then changed their minds once they looked at the patient. Called the intensivist to come down and do it, who stated he would put one in once they patient was moved upstairs to the ICU, as he had plenty of other patients to take care of. Went back to the ER docs, they at first agreed again to take another look, then decided they didn't want to do the intensivist's job for him, as the patient was now his. Meanwhile it's been about an hour, Dopamine's not doing the job, we need something else, patient has no other access. Called the intensivist back, he said finally he would come down and do it. Pt is better now, but I've never had to fight for a central line like that, and take care of 3 other patients at the same time, and monitor with a blood pressure cuff. It just didn't feel safe.
When I transferred the patient up to ICU, they had nothing to say, patient was clean, had a-line, central line, meds were up to date, and vital signs were stable. They were still "catty", and acted weird (they know me, and never treated me like that before). But I really didn't care, I did the best I could for that patient.
The ICU nurses will always talk and act b$tchy when you give them a new patient, it's a lot more work once they get upstairs, and sometimes they haven't eaten or peed b/c they've been chasing a BP or pulse ox in another room for the last 3 hours. You just have to do the best you can, and grit your teeth when you take them upstairs. :) But as someone who's seen a little of both floors, the ER nurses are MUCH TOUGHER than the ICU nurses! They rarely call in sick, will work through breaks w/o much complaining, are on their feet for 11.5 hours a day.
But as someone who's seen a little of both floors, the ER nurses are MUCH TOUGHER than the ICU nurses! They rarely call in sick, will work through breaks w/o much complaining, are on their feet for 11.5 hours a day.
Is this healthy? For the nurse, the patients, or the rest of the staff? I hope neither our ICU nurses nor our ED nurses push themselves to the max like this all the time. A nurse who has eaten (while sitting down and not charting), used the bathroom, and isn't sick is much more valuable to his/her patients, whether they are in the ICU, ED, or on the floor. It is extremely unfortunate that hospitals routinely staff like this, although I strongly suspect that when people talk about their "typical" days in their posts, they might be leaning a little more toward their busy days. I guess I'm lucky to work somewhere where most ICU patients are 1:1 and our ED nurses seem to have pretty reasonable ratios (per their assessment, not mine). In addition, our ICUs are required to have our own docs in house 24/7. This martyr image of the nurse who doesn't need to eat or pee in a 12 hour shift only supports hospitals poor staffing and patient flow practices. If we want to continue to work in poorly staffed hospitals, we better continue to make it work with what we've got and not make too much noise about it...
And, sometimes they pee and their bed is all wet and I just changed their wet depends not even 30 minutes ago! I do not intentionally bring a wet patient up to you.
I'm an ICU R.N. I'm known for being very friendly to ancillary staff, Dr. and other RN's. So maybe I don't see the big picture....but I think our nurses at my facility get along well with ER nurses. I've never really had a problem. They're kind...no one is ever rude. Sure the patient once in a while might not come up all cleaned and buffed up. But I just come with a big bucket of soap and water if old urine fragrance is coming from under the sheets. That doesn't happen often at all...I think our ER nurses do an excellent job!!!
I did notice this week a prior E.R. nurses saying..."you're a floor nurse, we try never to go to the floors." Went right over my head!!!
If any ER nurses have concerns about ICU nurses....or questions IM me....I'd love to answer.
Only reason I'm in the ER threads is I'm interested in a ER position.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i'm an icu r.n. i'm known for being very friendly to ancillary staff, dr. and other rn's. so maybe i don't see the big picture....but i think our nurses at my facility get along well with er nurses. i've never really had a problem. they're kind...no one is ever rude. sure the patient once in a while might not come up all cleaned and buffed up. but i just come with a big bucket of soap and water if old urine fragrance is coming from under the sheets. that doesn't happen often at all...i think our er nurses do an excellent job!!!
i did notice this week a prior e.r. nurses saying..."you're a floor nurse, we try never to go to the floors." went right over my head!!!
if any er nurses have concerns about icu nurses....or questions im me....i'd love to answer.
only reason i'm in the er threads is i'm interested in a er position.
i'm in the er threads because they're much funnier than the icu threads! i'm an icu nurse myself.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
As usual, there is some animosity amongst the ER nurses and the ICU nurses at my hospital. We are a very large level 1 trauma center. The managers of both of these departments would like us to become more educated about the very different roles that we have, and are even thinking about making I float to the ICU (and vice versa) to try and make us understand the differences. Some of the problems that have occurred b/n myself and some of the ICU staff relates to them wanting a very detailed, full-bodied system (when I barely got to know the pt.cause the is a constant flow in the pit), putting off taking report even though they have the staff/bed( they are constantly arriving through our door and we can't make them wait), thinking that ER nurses don't understand how to do CCRN "stuff" (I kept them alive didn't I), expecting the pt. to be clean, totally medicated, and cured before I send them up (charcoal, ETOH, GI blood, and poop stain and sometimes they just keep coming). I would really like to hear how other places have overcome their barriers related to this. What has helped other hospitals ER/ICU nurses better understand each other and how their roles differ, but are equally important. Our managers are fed up and would surely welcome any advice! Thanks ahead of time for your thoughts!
*** Our hospital solved this problem years ago by making SICU nurses part of the trauma response team. When a level I or II trauma comes in and there is an activation of the trauma response team a designated SICU nurse responds to the ER and is the primary nurse. An ER nurse is also present but their job is to document and go and get anything that is needed.
When the patient is admitted to the ICU the ICU nurse who attended the patient in the trauma bay, and likely took them over to CT is the nurse who admits them. No report between ER nurse and ICU nurse is needed.
Same thing for codes. The ICU nurses are part of the code team, not the ER nurses. If they have a code in the ER two ICU nurses respond. The ER nurse that is responsible for that patient will also be there of course. When the code patient is admitted to the ICU about the only report needed between ER & ICU is what happened before the code.
Our region has what they call "Rescue One" to get STEMIs into cath lab as fast as possible. When a STEMI is coming into the ER from a smaller hospital or from the field an ICU nurse is sent to the ER to be the primary nurse until they get to cath lab. After cath lab they ar admitted to the ICU to the nurse who took care of them in the ER.
We seldom have an opportunity for report between ER & ICU.
Maybe we have just pushed the problem further down the line as in our hospital there is much animosity between ICU and the floors.
*** Our hospital solved this problem years ago by making SICU nurses part of the trauma response team. When a level I or II trauma comes in and there is an activation of the trauma response team a designated SICU nurse responds to the ER and is the primary nurse. An ER nurse is also present but their job is to document and go and get anything that is needed.
When the patient is admitted to the ICU the ICU nurse who attended the patient in the trauma bay, and likely took them over to CT is the nurse who admits them. No report between ER nurse and ICU nurse is needed.
Same thing for codes. The ICU nurses are part of the code team, not the ER nurses. If they have a code in the ER two ICU nurses respond. The ER nurse that is responsible for that patient will also be there of course. When the code patient is admitted to the ICU about the only report needed between ER & ICU is what happened before the code.
Our region has what they call "Rescue One" to get STEMIs into cath lab as fast as possible. When a STEMI is coming into the ER from a smaller hospital or from the field an ICU nurse is sent to the ER to be the primary nurse until they get to cath lab. After cath lab they ar admitted to the ICU to the nurse who took care of them in the ER.
We seldom have an opportunity for report between ER & ICU.
Maybe we have just pushed the problem further down the line as in our hospital there is much animosity between ICU and the floors.
I would never consider working in or seeking ER care as a patient at a hospital in which the ER had to call the Big Boys & Girls from Upstairs to handle a code or trauma.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I would never consider working in or seeking ER care as a patient at a hospital in which the ER had to call the Big Boys & Girls from Upstairs to handle a code or trauma.
*** I's a large hospital, 500+ beds in a very small town. The hospital serves a huge geographic area, the ER serves a small town. It's a much smaller department than you would expect with such a large hospital.
You don't have a code team in your facility? Or you do but you don't activate it when there is a code in ER?
I have been an ER nurse for 5 years and I have worked part-time in the ICU as a 2nd Job. ER and ICU are both Critical Care Nursing but totally different nursing. My ER back ground is Level I and II. In the ER is fast paced, non-stop and you are treating a problem. In a trauma pt. our main concern is to stabilize the pt. and get them to the unit as quickly as possible. My report will consist of the pt. name , age, sex, what they came in for ex: 27 yr old male, unresponsive, epi / atropine given, has gsw to the chest, intubate with size 8 tube, lip line 22, vent settings 450, 14, 10%, 5 of peep, drugs give, etomidate, Succ, sedated with Propofol at a rate of, left side chest tube with 250cc of bloody drainage, vitals are, iv sites are, foley inserted, abnormal labs are, transfused x amount of units, If ct showed anything significant, I will convey that as well. If I feel it something that need to be conveyed I will but If I dont , then they can read it in the chart. Some nurses dont want to open the chart and read it. Yes, the pt. should go to ct and mri before arriving to the unit, but if its a repeat ct or mri that is ordered after the fact, then ICU will transport the pt. ICU needs to understand that its urgent that we get the pt. to the unit for the one on one care that is needed. Yes, if necessary an ER nurse is more than capable but that is not what the er is set up for. I totally respect the icu nurses. ICU is more one on one and get more involved. When it comes to multiple drips and invasive lines. ER start the drips and insert some invasive lines in the ER but its the ICU that maintains and wean the pt.
Personally, I am not understanding how an ER is not capable of handling there own codes. I dont understand why an ICU nurse have to come down and run your code and as the ER nurse your responsibility is to record. That is the purpose and the title of an ER and nurse is to capable of responding and handling any emergent situation that walks thru the door because you are the first person that pt and family see's. So are you stating that if a car pulls up with an unresponsive pt in it. That you are not capable or have the required acls / trauma certification and skills to begin cpr, administer life saving drugs, defibrillate, that you have to call the icu nurse down to begin and facilitate this process. How are you guys labeled ER nurses? I think with you being a small rural facility is even more of the reason to have to be able to have this capability. Im not judging because I dont know the policies of your facility nor have I ever worked at a small rural facility, but when I hear ER or see an ER I am expecting the ER to be able to handle anything that walks thru that door, at least be able to stabilize and transfer out to a more capable facility if necessary.
*** I's a large hospital, 500+ beds in a very small town. The hospital serves a huge geographic area, the ER serves a small town. It's a much smaller department than you would expect with such a large hospital.
You don't have a code team in your facility? Or you do but you don't activate it when there is a code in ER?
PMFB-RN, I believe your hospital's unique approach has been discussed in a thread here before - I just can't remember which thread. In that thread, there was considerable skepticism about what you were describing, because it is that atypical.
In my experience working urban Level I trauma centers and a small community hospital, and in attending emergency nursing conferences both locally and far and wide ... your account is the only instance I have ever heard of in which the ER dispenses bandaids but can't handle a cardiac arrest.
If your hospital is a trauma center/tertiary care center then by definition the ER is "serving" a much larger area than its local area.
Code teams are activated for codes on the floors, not the ER.
Virgo_RN, BSN, RN
3,543 Posts
Wow. Be careful not to hurt yourself leaping to conclusions. I have never once, and do not condone or advocate making patients suffer in order to retaliate against anyone. I'm a damn good nurse, and you'd be lucky to have a nurse like me.