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!
ThrowEdNurse: "I reserve a lot of time and energy for the ones who haven't been seen yet, they depend on me and only on me. That is a lot of responsibility".
I agree that is alot of responsibility. It seems that we are all trying not to let the non-critical patients suffer in the shuffle of critical care patients and bed availability. I can appreciate that.
I was referring to critical pts as well as stable.
You have to agree though that in your whole ER...you will have one stable patient that can move to the hall to open a bed up...which sucks, I know, I have done some shifts in the ER...not alot but enough to appreciate what you all do down there. Sometimes...when I say I do not have a bed...I really do not....I may not have someone I can send out. This past week out of 15 pt's in one unit I had 13 vents. We have worked with the staff in the unit to not sit on patients and to get report ASAP from ER, because if it is me I want them now rather than later. Some nurses just suck that that. Some will sit all day on a downgrade and that is absolutely unacceptable. However as charge I do not have time to go read every chart to make sure they are telling me that they recieved downgrade orders. I mean really they should do their job. There are also times that I have to have the ER hold, because I have very sick patients on the floor that i have to move. I mean seriously I cannot leave an aortic dissection on a floor with a nurse that has 6 other patients, and has no idea what esmolol is. At least I know that you guys know how to handle the patients in the ER. I am sure that they are taken care of...that cannot always be said about a bad pt on the floors. But as ER and ICU nurses we really need each other to keep the wheels turning.
I agree with you totally, and don't get me wrong I've coded a few in the nurses station cause we just didn't have anywhere else for them. And I understand if you have no beds avail. I don't care to hold them all night. I am talking about the times when bedboard assigns us a clean ICU bed and we take flac on it, like we can just hold on to them while they "Find the unit nurse" for 15 minutes or "We didn't know we were getting a patient?! " It take us an hour to get ready.
Maybe all of us ED nurses should go to the ICU page and stir up their posts....lol
C'mon guys. I honestly don't think of it as "stirring up" . I did rant (and I explained), but so did many of you. I believe these threads are to gain insight from each other. Some of what was said here by some of the ED nurses lacked insight into ICU. I am very willing to concede and see that you have some very valid points, and I did. But not one single person from the ED in this thread validated any point from my perspective or the other poster's perspective from ICU. If you truly want to make things better then you also need to be a little more receptive and open minded. There are very valid issues on both sides..... This is apparantly not a thread that offers growth for either perspective, but just an angry negative bashing place. So, even though I did try to gain and offer some insight, and realized I was offending and tried to correct myself and just explain my perspective without the frustration I feel when dealing with all I described, I see it is to no avail, and will exit this thread adn not return to the ED forum. I only came because it was on the front page when logging onto the sight, and as I said some comments made lacked insight into the ICU perspective. I do enjoy when other's join in the ICU discussions.
I apologize my friends, I guess, "Things you would like the ICU to understand" was not very clear. I guess I should have titled it, "Things ER nurses would like the ICU nurses to understand." I will be more careful next time, to help ensure that we will receive more appropriate responses. I just assumed we could talk freely amongst ourselves here.
C'mon guys. I honestly don't think of it as "stirring up" . I did rant (and I explained), but so did many of you. I believe these threads are to gain insight from each other. Some of what was said here by some of the ED nurses lacked insight into ICU. I am very willing to concede and see that you have some very valid points, and I did. But not one single person from the ED in this thread validated any point from my perspective or the other poster's perspective from ICU. If you truly want to make things better then you also need to be a little more receptive and open minded. There are very valid issues on both sides..... This is apparantly not a thread that offers growth for either perspective, but just an angry negative bashing place. So, even though I did try to gain and offer some insight, and realized I was offending and tried to correct myself and just explain my perspective without the frustration I feel when dealing with all I described, I see it is to no avail, and will exit this thread adn not return to the ED forum. I only came because it was on the front page when logging onto the sight, and as I said some comments made lacked insight into the ICU perspective. I do enjoy when other's join in the ICU discussions.
The problem is that in your first post literally everything you listed was a medical issue not a nursing issue. Your subsequent posts have made it clear that the ER where you work is a mess, the doctors are incompetent and the nurses aren't very smart. We can't change that. But not every ER nurse is like that. I have excellent critical thinking and assessment skills. I go to bat for my patients. I repeatedly get in trouble because I will hound a doctor until I get what the patient needs (CVLs, intubation) and it drives them crazy. I give as thorough a report as I possibly can. I put in foleys and NG's and try to reconcile the meds. I don't make promises to the families about anything that will happen in the ICU. I try to clean the patient up. All while also taking care of at least 4 other people some sick...some not so much. But all demanding my attention in one way or another. In addition as a senior nurse I am the resource person for everyone else in my zone. So when I finally get the patient up to the ICU only to have the receiving nurse read me the riot act because the IV is in the antecubital and "don't you know that makes the pumps beep all night" I just want to give up. It's never good enough. And maybe that's what the crux of the issue is. The vast majority of us try really, really hard to give excellent care to our patients and to our co-workers (yes even the ones in the ICU) only to be constantly picked apart by nurses receiving our patients. So maybe we just want you guys to know that we are trying our best in the worst of situations and yes we sometimes fall short of the mark. We know this and everyone of us has gone home feeling like failures from time to time because we didn't give the kind of nursing care we wanted to give. We beat ourselves up over it but to also be beaten up by our co-workers just sucks the life out of us. So next time if I can't remember if the IV is an 18 or a 20 because all I really cared was it was running please don't roll your eyes at me and treat me like I'm an idiot.:bowingpur
I hate when I give report and not know the exact location of the IV (it's on the L, somewhere....) I swear I was accused of not assessing the pt because iI didn't know the exact location. It's that kind of garbage, like the previous poster said, that makes me feel like it is not good enough. I don't know what they want, but I get the feeling I will never be able to provied it. You get an ER report from an ER nurse. You can give your fellow ICU nurses grief for not giving you an ICU report.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
while i'm glad i don't work in the chaos that is er, i do appreciate those of you who can and do work there. i guess i'd like to feel that the love goes both ways.
that totally obnoxious family taking up your entire waiting room with their greek festival costumes and food -- they're in your er for one shift. they'll probably be stinking up our waiting room for weeks to come. believe me, there are times when i'd love to leave them all in their dramatic, disruptive glory and come down to the er for a nice, quiet shift where the patients actually might turn over. we've had our same group of chrons for four or five months now, and if mr. b's son tells me one more time that "you'd be a purty woman if ya weren't so fat" i may decide to debfibrillate him even if he is standing upright. i'm not to crazy about mr. b, either, come to think of it. his combative behavior is no longer particularly entertaining. (y'all will have to tell me the trick to getting an ama form signed!)
i just wanted to say that when i tell you our bed isn't ready (maybe because it still has a patient in it) it really is not ready. i'm doing all i can, but the floor says their patient hasn't left, the room isn't cleaned or their nurse is on break . . . gee, i wish we could turn down a transfer because we're on break! i really will call you the minute the room is clean -- i figure the cavicide can dry while you're in the elevator. please don't send your tech, your secretary or your secretary's boyfriend up to peer into all of the rooms and report back to you about the empty bed we have in room 4. honestly, the patient that belongs in room 4 is in the or having his chest washed out and closed and he'll be back before we know it. i find it somewhat indicative of a lack in trust for you to attempt to spy on us.
but if you're determined to spy on someone, please send your spy to the stepdown unit and let us know of their bed is empty their room is clean and their nurse is almost done with her break so that we can send our patient to you while my charge nurse cleans our bed and calls you for report on the patient you want to send to us.
Ruby, I have appreciated your insightful and polite posts on other forums but can we just try not to go down this path again? This thread started out with a great idea on getting dialogue started, then changed to ER bashing by an ICU nurse which in turn became mutual bashing, then an attempt to bring things back on track followed by more bashing and some rather snarky remarks and ending with a sincere plea from me to try to get people to understand that ER nurses aren't trying to make everybody else's lives miserable by giving "bad" reports, dirty patients and crabby families. We realize our shortcomings, we know you, the ICU nurses, have to tolerate the crap longer than we do but it's such a personal blow when we've tried really hard to stabilize a patient and given everything we've got only to be picked apart over some minor infraction such as not being absolutely sure exactly how much urine is in the foley bag because simply knowing that the patient is actually making urine isn't good enough. Again, I think the major point we, as ER nurses, are trying to get across is we are trying, really we are, to do the best we can in sometimes desperate situations to provide the best nursing care we can and we need your help and support.
ThrowEdNurse, BSN, RN
298 Posts
I was referring to critical pts as well as stable.