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!
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Personally, I am not understanding how an ER is not capable of handling there own codes.
*** Who said they are not capable?
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.
*** Nobody said the ICU nurses run the codes or that the ER nurses job is to record, it's not. That job falls to the nursing supervisor. ER physicians run the codes. Two ICU nurses are on the code team, one from MICU and one from SICU. The MICU nurses job is to run the defibrillator, the SICU nurses job is to establish or maintain IV access and give all drugs. The ER nurse does not have a role on the code team. In the ER as on the floors that patients primary nurse has a role. If the code is in the ER then there is an ER nurse who is that patients primary nurse.
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.
*** (Chuckle, chuckle) No of course I did not and am not saying anything like that. In the situation you described I would expect the code to be well underway with ER staff when the ICU nurse gets there in response to the code team activation. As ICU nurse we feel considerably less need to get to the code ASAP when it is in the ER. We know the ER nurses will have things well under control and will be doing the right thing.
I think with you being a small rural facility is even more of the reason to have to be able to have this capability.
*** Our ER nurses are very capable and competent. There's just not very many of them. We are a 500+ bed Magnet tertiary care and regional trauma facility. Not a small rural facility.
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
*** Of course they can handle anything that walks through the door. They have all the same certifications and training the ICU nurses do. At a minimum BLS, ACLS, PALS & TNCC (or ATCN). The ER nurses are also required to have NRP. On any one sift there may be (between MICU and SICU) 15-25 ICU nurses working and maybe four ER nurses. It's pretty easy to see that get a couple of bad traumas and we would quickly overwhelm the ERs ability to staff the traumas and take care of the other ER patients. We staff two nurses to a code and two for a trauma activation. Not at all unusual to have multiple traumas at the same time and or a code.
Many ICU nurses also work in the ER. We have several who do half their hours in ICU and half in ER. Many ICU nurses pick up shifts in the ER. I don't know of any ER nurses who pick up in the ICU, but then they are never low censed because of low patient census like ICU nurses are.
Very strange concepts mentioned here...have not heard of this...
We have 80 ICU beds and 45 ER beds. We have over 160 ICU nurses on at a time, and right around 20 ER nurses.
Also, we don't swap responsibilities, we can all handle our own jobs. I would not work at a facility, & would be very upset at a place that required me to receive MULTIPLE certifications and then told me that I was not qualified to use them.
Also, as far as codes go...we don't "call" a code in the ER, why would we, it's the EMERGENCY ROOM & all the nurses, doctors, & RTs are already there, what would we need anyone else for? Calling codes is something only done on the floors.
So tired of this argument...please ER nurses just start posting about how much help we need & how inferior we are & we will not have to continue this battle.
THREAD UPDATE: not one change has come about at my place either... We are still not able to live in harmony...sigh
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Also, we don't swap responsibilities, we can all handle our own jobs.
*** We don't swap responsibilities either and we do handle our own jobs.
I would not work at a facility, & would be very upset at a place that required me to receive MULTIPLE certifications and then told me that I was not qualified to use them.
*** I am wondering if you have this discussion confused with some other discussion? Are you replying without reading my messages? Nobody has said the nurses in the ER are not "qualified".
So tired of this argument...please ER nurses just start posting about how much help we need & how inferior we are & we will not have to continue this battle.
*** Why are you so hyper sensitive about this that you simply make stuff up?
It seems like you are the one being Sensitive and getting offended by some of the comments. Regardless of what you are trying to say your post states and come across as if your ER is not capable of running a code. You have to keep in mind that everyone has an opinion and its just that an opinion.
We have 80 ICU beds and 45 ER beds. We have over 160 ICU nurses on at a time, and right around 20 ER nurses.
sigh
Wow...this seems like generous staffing! 160 nurses for 80 ICU patients? Does every patient have 2 nurses???
And 20 ER nurses for a max of 45 patients? This would make sense to me only if your ER is ALWAYS full, 24/7! And even then, I'm not an ER nurse, but the ER nurses on these threads don't usually seem to have ratios of 2:1.
Do you work in dreamland, or am I misunderstanding your staffing?
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
It seems like you are the one being Sensitive and getting offended by some of the comments. Regardless of what you are trying to say your post states and come across as if your ER is not capable of running a code. You have to keep in mind that everyone has an opinion and its just that an opinion.
*** Not offended, frustrated that some people are putting things into my messages that I didn't write. I call it wishful reading, reading what one wishes to read rather than what has been written. What I wrote was the way it is done at the hospital where I work. I didn't make it that way. The ER does call codes when they have one. ER nurses are not on the code team, nor do I think they would want to be running all over the hospital to codes but that's just a guess on my part. I never once said anything about the abilities of our ER nurses, except to point out that when we go there for a code they have things well under control.
Okay.....we got it the first 4 times. Your hospital sounds great! However it appears that none of the experienced, knowledgeable, educated, skilled, and highly trained ED nurses here are feeling it and it doesn't sound as though any of us will be applying at your very special facility anytime soon. So, byeeeee, nice hearing about you and your hospital! Later!!!
Back on topic: (what ED nurses wish ICU nurses would understand): this hospital, this ED, nor my job revolve around you or what you want. We have different priorities. I will never manage the care of an holding ICU pt as well as you would in ICU, so accept report sooner and there'll be less work for you later!
Wow...this seems like generous staffing! 160 nurses for 80 ICU patients? Does every patient have 2 nurses???
And 20 ER nurses for a max of 45 patients? This would make sense to me only if your ER is ALWAYS full, 24/7! And even then, I'm not an ER nurse, but the ER nurses on these threads don't usually seem to have ratios of 2:1.
Do you work in dreamland, or am I misunderstanding your staffing?
No, your right, we don't have 2:1 staffing; we usually have 4 or even 6:1 or more. I said that we have 45 beds, not a max of 45 like you mentioned. It would be a very, very slow night at work if we only saw 45 patients-try 245 and you would be a little closer! You also gotta count all of those in the waiting room, all of those in the hall way, and all of those on the way with EMS, and life flight.
Like you mentioned..."I'm not an ER nurse," you shouldn"t be making assumptioned about our "dreamland!"
You guys will NEVER get it...even though we keep explaining it, so just give it up already would ya. We admit it, we are incapable of working in an ICU (way to incompetent), (even though I work in one )!
There is no way this *hasn't* been said in this thread, but it bears repeating:
We don't get any kicks out of calling report before/during/after shift change. When a patient is assigned a bed is totally out of my control. It happens at all times of the day, just like how the ER gets squads, traumas, and codes all times during the day or night. Do we get angry at the medics when they bring in a Level 1 Trauma at 06:50 or 18:50? No, because that is ridiculous and out of their control. It is the same situation when transferring a patient from ET to ICU.
I wish the ICU nurses would do what the ER sometimes does. When the ER gets a code or trauma alert within 10-15 minutes before shift change, the next shift will clock in early and take care of it. If I took care of an ER patient for the past 5 hours and now they are going to the ICU, wouldn't you rather get report from me and not a second hand report? And this is only concerning those patient who are assigned a bed right before shift change. I wish the ICU nurse would clock in early, take report from me, and then get report for his/her other patient. This is assuming a lot of things (ICU nurse is at work early, charge nurse knows who is going to get pt, etc) but I think it would be best for the patient.
I love our ICU nurses, it's just that some are much more fun to report off to than others! I can just predict when I get a certain one or two on the phone that I am going to be grilled rather than listened to as I give report.
I also know that I am never going to win in most situations so I don't try. I just stabilize the patient and get them up. If they wanted the patient faster because the attending is waiting and glaring at them, I was too slow. If they wanted me to hold the patient I was too fast. Recently the ICU department head came by at the beginning of my shift demanding an explanation for why a patient had been held in the ED over shift change. Her response was perfect when I told her the staff on the previous shift had asked us to hold the patient. She headed right up to address the issue.
The quintessential ICU question is, of course, "Why didn't you guys do _____?" The quintessential ED answer is, "Ask the cardiologist who followed me up here and was with the patient for the last hour in the ED."
I love the fluff and perfect sheets that ICU seems to maintain. Now if I could just train radiology to straighten my sheets after they are done. I have pulled and straightened and changed sheets over and over with all sorts of unmentionables on them.
All in all, I want the ICU nurses to know that I am happy that they are there (whenever that is) to take these gifts of nursing excellence that I am sending to them, whether or not they understand or appreciate my efforts.
Specializes in Emergency, Critical Care (CEN, CCRN).
Our ICUs and Progressive Care Units have a policy in place that they will refuse report on any patient called up within one hour of shift change (changes for them are at 0700 and 1900, so you can't call between 0630-0730 or 1830-1930). This results in patients sitting in the Emergency Center for at least an hour longer than they needed to, second-hand reporting since the EC has now had to conduct two handoffs (one from off-going to oncoming EC nurse, and again from oncoming EC to ICU), and general ill will between patients, family members, EC and ICU staff. (Frequently this takes the form of "Nurse! You people told me I was going to my room an hour ago, and I'm still sitting in this **** hallway! What the **** is the holdup?")
It also frequently seems to occur that Bed Management kicks loose a whole pile of beds right around 1800, so there's a huge flurry of activity as everyone races to get their patients packaged, reported and out the door before the witching hour begins at 1830. That in turn causes a sudden dearth of transporters, and frequently we go down two or three nurses at the same time, since a lot of those patients are RN transports r/t vasoactive drips, unstable chest pain and so forth. If a trauma or a resus comes in at 1820, we're comprehensively screwed (as happened yesterday).
This garbage needs to stop. It seems that in trying to prevent one patient safety issue (interruption of report), the ICU just created a bunch more (second-hand reporting, delay of care and inadequate staffing).
)!
PMFB-RN, RN
5,351 Posts
Personally, I am not understanding how an ER is not capable of handling there own codes.
*** Who said they are not capable?
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.
*** Nobody said the ICU nurses run the codes or that the ER nurses job is to record, it's not. That job falls to the nursing supervisor. ER physicians run the codes. Two ICU nurses are on the code team, one from MICU and one from SICU. The MICU nurses job is to run the defibrillator, the SICU nurses job is to establish or maintain IV access and give all drugs. The ER nurse does not have a role on the code team. In the ER as on the floors that patients primary nurse has a role. If the code is in the ER then there is an ER nurse who is that patients primary nurse.
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.
*** (Chuckle, chuckle) No of course I did not and am not saying anything like that. In the situation you described I would expect the code to be well underway with ER staff when the ICU nurse gets there in response to the code team activation. As ICU nurse we feel considerably less need to get to the code ASAP when it is in the ER. We know the ER nurses will have things well under control and will be doing the right thing.
I think with you being a small rural facility is even more of the reason to have to be able to have this capability.
*** Our ER nurses are very capable and competent. There's just not very many of them. We are a 500+ bed Magnet tertiary care and regional trauma facility. Not a small rural facility.
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
*** Of course they can handle anything that walks through the door. They have all the same certifications and training the ICU nurses do. At a minimum BLS, ACLS, PALS & TNCC (or ATCN). The ER nurses are also required to have NRP. On any one sift there may be (between MICU and SICU) 15-25 ICU nurses working and maybe four ER nurses. It's pretty easy to see that get a couple of bad traumas and we would quickly overwhelm the ERs ability to staff the traumas and take care of the other ER patients. We staff two nurses to a code and two for a trauma activation. Not at all unusual to have multiple traumas at the same time and or a code.
Many ICU nurses also work in the ER. We have several who do half their hours in ICU and half in ER. Many ICU nurses pick up shifts in the ER. I don't know of any ER nurses who pick up in the ICU, but then they are never low censed because of low patient census like ICU nurses are.