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!
Wow...not every place is the same. If it'd be helpful for me to come got my pt then tell me that but I'd prefer not to leave THE other nurse in the unit alone. If the psychs are causing you problems Im sorry...but guess what they are going to cause me a problem when you send them to me w/o the security & and special "psych" room. If for whatever reason it's going to be a while would it really be that big of a deal to have the HUC call and tell me that, or use that little communicator thing that is around your neck? Yeah...just play nice for crying out loud.
Why can you not leave the other ICU nurses alone????
When I have a psych pt "acting up" they don't go to ICU but anyway, what's a "special psych room?" Security? Ha-ha! Hi, I'm the nurse AND security.
And I don't have a "communicator thing" around my neck. I don't know what that is but it sounds dangerous around the psych pts. I usually don't have time to get on the phone and make calls. If I had time to be in the station, then there wouldn't be a need for delays. Think you've missed the big pic.
Why can you not leave the other ICU nurses alone????
When I have a psych pt "acting up" they don't go to ICU but anyway, what's a "special psych room?" Security? Ha-ha! Hi, I'm the nurse AND security.
And I don't have a "communicator thing" around my neck. I don't know what that is but it sounds dangerous around the psych pts. I usually don't have time to get on the phone and make calls. If I had time to be in the station, then there wouldn't be a need for delays. Think you've missed the big pic.
This is why I pointed out every place was different. By special psych room I mean one build so the walls are more or less indestructible and a locked door. As long as they are not hurting themselves they can pretty much be as ****** off as they want to be w/o having to interact with staff. And yes the communicators arent the most friendly but that is what admit says we will wear but I suppose they'd brake the pop off point (I hope). I'm sorry there isnt someone to make a quick phone call...must stink to work where you do. I suppose if that's the ER work conditions are it give me a little bit more perspective as to why ER and ICU seem to butt heads.
I just went back and read some of the other posts (suppose I should have before reposting). Just keep in mind that not all ICU nurses are the same just as not all ED nurses are the same. I tend to think Im not one of the "sticklers" so I fall victim to defending "us." Keep doing what you do (which is why you do it and not me). Thank you. Oh, and send me some good sick ones;)
I have been following this thread, but have yet to respond. I am an ICU nurse. I am responding to Roy's post, but I'm throwing in a few comments that don't pertain to what he's written
As an ICU nurse, understand that I don't have one or two patients, instead a shared responsibility for all 12 patients on my side of the unit. That means I must help with the alcoholic in DTs, the coding patient, covering the nurse who must spend an hour in MRI with his patient, the intern/resident who has left his/her phone in the lunch room and can't be found in the unit, the respiratory therapist who is off the floor and isn't answering their pages (or worst yet the RT who refuses to help you transport a patient because they are just too busy). A day rarely goes by that I don't feel the squeeze of a labor shortage too. We are expected to do more with less. I'm sorry, but understanding is important. How can we possibly know what is reasonable without understanding the other's side?
Understand that as an ER nurse - I have no "fixed" patient ratios. There is no "norm". As an ER nurse, my assignment can (and has been) as high as 9 patients (just me alone - my pod partner was responsible for the other 8) - and I'm not talking Fast-track here ... no knee scrapes and tetnus shots. And as an ER nurse I'm also obligated to help out my 'pod partner' [i had 3 vented patients, my pod partner had 2 including one with an active STEMI. I won't bother going into details about the pt. with a GI bleed Hgb of 3.7, the COPDer with a PH of 7.9 and PO2 of 65, the "stable" patients with troponins of 1.4 and others with pro-BNPs of 56700 and systolic of 90 on Bipap etc. etc.)
No, I'm not trying to "brag". You have "shared responsibility" - so do we... Just saying that "I understand things get ****** in the Unit too - just understand that while YOU can control the flow of patients to a large extent - we CAN'T. And by the way - when you are full, you don't get any more patients. The ER has no such luxury - immaterial of the kind of patients coming in."
"How can you possibly know what is reasonable"?! I don't know what hospital you work at - but where I'm at, ICU patients from the ED cannot be transported 1/2 hour before AND after shift change (e.g. no report nor transfer between 6:30am/pm and 7:30am/pm). I wish we can apply the same rules to EMS - "Sorry, we're at shift change now. Can't bring us another patient ... Tell the ambulance to circle the block till we're done".
How can we do this when the stability of our unit is almost as unpredictable as yours? We have no control over the numerous rapid responses or a code on the floor, let alone on our unit. When I'm open to take an admission, rest assured that odds are I am the rapid responder. I try to hand off the rapid response, but sometimes (especially during certain hours) they is no one except myself to respond.
A. I accept that the unit CAN be unpredictable - but please don't say you're as unpredictable as the ER.
When was the last time you had 24 NEW patients (undiagnosed, multiple complaints, some critical) in less than 20 minutes? When was the last time EMS brought the victims of a bus crash on the turnpike to the ICU direct?
Yes, patients on the Unit do "go down the crapper", I hear the "code blue" just as everyone else does - but so do pts. in the ED.
B. AGAIN: "Bed assignments in the ER don't show up until a bed is ready and a nurse has been assigned to the bed [which means I should be able to call report and get it done without further delay]."
AND
"please don't say "5 minutes" when you mean "15 minutes". Pick a time and stick to it."
Like I said - I'm a reasonable guy. When I call for report - tell me why you can't take it right now ("Sorry Roy but this patient of mine just decided to drop his pressure. I need to keep a closer eye on him. Can I call you back? ... or something like that). Don't put me on hold for 15 minutes and not answer. Don't let the phone ring and not answer. Don't say "5 minutes" when you mean 20....
Depending on how pressured I am for a bed - I'll give you the full time you need or I'll insist on "giving report and bringing the pt. up to the unit because I have a stroke or an MI coming in". Again, I'm not trying to be an ******* - I'm pressed for a bed and I have acute pts. coming in.
Do you think our shift is any different?
That depends - how many patients have you coded in the hallway? Actually - how many patients have you coded at-a-time and how many were in the hallway during that time?
I'm sorry ER, but our ICU is often just an extension of your situation. Unstable patients with another one rolling through the doors. (And sometimes two at a time.)
Two at a time! *swoon* I WISH EMS would only bring 'em in "two at a time"!
Yes, an ICU is often the "extension" of the "critical care" that is started down in the ER.
But it is by NO MEANS an "extension" of my situation.
Maybe I shouldn't worry about starting extra IVs (since they're a "unit patient") or giving pts. foleys to monitor output (since they're a "unit patient") or worry about persuading Docs to place central lines for CVP monitoring (since they're a "unit patient") ... after all, ICU is just an extension of ER.
Sorry ICU... I have too many unstable patients rolling through. Two at a time even!
This isn't a *diss* on ICU nurses. Like I've said before and I'll say again - I don't think this is an issue of "ER nurses Vs ICU nurses". I think it depends on each individual nurse.
I don't have an issue with 90% of the ICU nurses I interact with. I'm sure if you polled the ICU nurses in my hospital, they'd return similar numbers about ER nurses.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Lots of the nurses where I work may be SICU one shift, ER the next and PICU or MICU the next. We don't have ER vs ICU issues since most all of us have "walked a mile" in the others shoes.
Another thing that helps is that an SICU RN resonds to all trauma activations and follows the patient from trauma bay to CT to OR or to admit to SICU and will be the nurse taking that patient. Same thing for STEMIs. An MICU/CCU RN comes down and takes care of the patient and (usually) is the nurse who will be taking that patient.
In these situations there is no need for ER to ICU report at all
ThrowEdNurse, BSN, RN
298 Posts
Why can you not leave the other ICU nurses alone????
When I have a psych pt "acting up" they don't go to ICU but anyway, what's a "special psych room?" Security? Ha-ha! Hi, I'm the nurse AND security.
And I don't have a "communicator thing" around my neck. I don't know what that is but it sounds dangerous around the psych pts. I usually don't have time to get on the phone and make calls. If I had time to be in the station, then there wouldn't be a need for delays. Think you've missed the big pic.