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!
Just a question for the ICU nurses...........Our ED faxes reports to the floors, but calls report to ICU and CVU. When you are notified you are getting an admission, do you then have the ability to access the pt's records/labs etc in the computer system? My question is.......when giving report, do the ICU nurses expect me to go over this information that they have access to at their fingertips? A few times, as I was giving report, the receiving nurse would be on the computer looking at the same info I was giving her. I'm just curious what the ICU nurses have access to via the computer.
Specializes in NICU, PICU, PCVICU and peds oncology.
Our place functions a bit differently from most. We don't accept patients from anywhere without an ICU consult. So when the ER calls to have our physician go assess a patient, we often get info from them and from the RT about what's going on. We have very little access to documented information until the kid arrives though. The average bedside nurse has no access to computerized info; we're not taught to access the different databases that could be helpful because that's reserved for those they deem worthy to be in charge. We're moving to computerized charting, but it's a "pilot programme" meaning that only the PICU and the SICU will be online. And they keep pushing the go-live date back. So for us, it will still be face-to-face report between the ER nurse and the PICU nurse for the foreseeable future.
Just as a word of encouragement from someone who has been using computerized charting since 1992. The initial learning curve is painful but you will love it! If they do it well at your facility you will be able to access info on patients even before the intensivist is consulted. It makes it sooo much easier to manage the shift both as a charge nurse and as the nurse receiving the patient. We can give a "heads up" to the ICU about a potential patient, they can review the chart and begin planning for patient transfers, room assignments and equipment needed before the patient has been completely evaluated in the ED. It makes for less "bad blood' between the two units because there are very few surprises and the receiving nurse has a chance to mentally prepare for the new admit.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
just a question for the icu nurses...........our ed faxes reports to the floors, but calls report to icu and cvu. when you are notified you are getting an admission, do you then have the ability to access the pt's records/labs etc in the computer system? my question is.......when giving report, do the icu nurses expect me to go over this information that they have access to at their fingertips? a few times, as i was giving report, the receiving nurse would be on the computer looking at the same info i was giving her. i'm just curious what the icu nurses have access to via the computer.
i think it varies -- some icu nurses have access to information via the computer ahead of time; some don't. part of it depends upon whether the er's computerized charting system will communicate with the icu's computerized charting system -- in my hospital right now, it doesn't. the lab, knowing that the patient is going to icu may put the results in so that icu nurses can read them, but they're not required to. some icu nurses, but not all, have access to the outpatient charts where the lab results from the er go. all this, of course, pre-supposes that the icu charge was actually given the name and a medical record number for the patient they're getting, and not just "dr. y's triple a" or "a life flight patient from atlanta." or, if they were given the name and mr number, that they pass it on to the nurse who is getting the patient.
speaking for myself, i like to know if lab values are seriously out of whack. if the hemoglobin is 6 or the k+ is 3 or 8, please mention it. if the patient is being admitted for "r/o sepsis" and the wbc count is 9,000, please mention that, too. (makes you wonder why the patient is really being admitted, but i digress.) if the patient has some outstandingly unusual family or social situation, please mention that. (a prisoner accompanied by guards, an elderly man accompanied by his wife who has alzheimer's and can't leave his side or she'll be lost and by the way, the son is coming to get her next week, something like that.)
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
i have the utmost respect for er nurses, and i know you aren't trying to make everyone's lives miserable. i apologize. i'd had a bad day culminated by the er secretary's boyfriend (a housekeeping supervisor) coming up to personally check on whether the bed the er was waiting for was actually empty. (it wasn't.) i shouldn't have generalized and brought it to this thread.
Specializes in NICU, PICU, PCVICU and peds oncology.
Janfrn,
Just as a word of encouragement from someone who has been using computerized charting since 1992. The initial learning curve is painful but you will love it! If they do it well at your facility you will be able to access info on patients even before the intensivist is consulted. It makes it sooo much easier to manage the shift both as a charge nurse and as the nurse receiving the patient. We can give a "heads up" to the ICU about a potential patient, they can review the chart and begin planning for patient transfers, room assignments and equipment needed before the patient has been completely evaluated in the ED. It makes for less "bad blood' between the two units because there are very few surprises and the receiving nurse has a chance to mentally prepare for the new admit.
Thanks for the words of encouragement, FlyingScot. I wish I could be optimistic about this, but I know it's going to be a gong show. As I said, they're piloting the programme with us and the SICU, with the intent to roll it out hospital- then region-wide over time. But my experience with "over time" is that it will be years before the system is up and running and in the interim there will be many changes in hardware, software, what is linked and what is not, and any other potential screw-up. We're only going to be "live" at two bedsides to start with, and then two more and so on until all 19 beds are online. And we're also going to continue paper charting for who-know-how-long in addition to the computer charting... There are shifts when I can't keep up now, so it's going to be Hell documenting everything in two places. The physical set-up is also less-than-swell. The terminals have been set up on a shelf on the back of the pillars that form our headwalls at our open beds... the ones we admit our post-op hearts into. The software doesn't allow for preadmission data entry, so all the demographic stuff, orders and so on have to be entered after the patient arrives. From behind the pillar, where I can't see what's going on, stop and intervene if I need to... and you get the drift. We'll have COWs at the foot of the bed for the rest of the stuff, which creates another huge problem... we don't have ROOM for that junk! The unit is already extremely crowded and there isn't room to move as is, so this is going to be bad. BAD. Really bad.
i have the utmost respect for er nurses, and i know you aren't trying to make everyone's lives miserable. i apologize. i'd had a bad day culminated by the er secretary's boyfriend (a housekeeping supervisor) coming up to personally check on whether the bed the er was waiting for was actually empty. (it wasn't.) i shouldn't have generalized and brought it to this thread.
I'm an ICU RN and have cross trained and spent quite a bit of time in ER. I think that in itself is the key to understanding between these departments. ICU is relatively controlled and happy.
But giving a good report is still a basic nursing responsibily as far as I'm concerned. Giving report over the patient is lazy and makes the patient feel like an item on the shelf at target.
I have to disagree. Giving report and being near the patient can have advantages. YOu have the patient right there, it gives both nurses the chance to make sure they've gone through everything. It is also a good time for the patient (if they are awake) to hear about his/her condition from the nurse and also ask questions once the report is over. (or the family, if they're there also)
I can't count how many times I've recieved report in the room with the patient and the ER nurse forgot to tell me about an art line or a wound.. etc.. and I found it while we were doing report.
IF your pt. isn't intubated, or other medical interventions aren't done prior to arriving to ICU. Most likely, it has to do with the ER Physician not being willing to do it. I often time run into this in the ED. However, I will tell the ICU RN that I'm giving report to that I've made the request & it has been shot down by the ER Physician. Please remember ICU folks, the rules don't change in the ED. Just because you have a request that seems like common-sense to you as the ICU nurse & most likely me as the ER nurse, ER Doc's often exercise their perogative & shoot down our requests for orders quite frequently. So, please keep this in mind.
Thanks for the words of encouragement, FlyingScot. I wish I could be optimistic about this, but I know it's going to be a gong show. As I said, they're piloting the programme with us and the SICU, with the intent to roll it out hospital- then region-wide over time. But my experience with "over time" is that it will be years before the system is up and running and in the interim there will be many changes in hardware, software, what is linked and what is not, and any other potential screw-up. We're only going to be "live" at two bedsides to start with, and then two more and so on until all 19 beds are online. And we're also going to continue paper charting for who-know-how-long in addition to the computer charting... There are shifts when I can't keep up now, so it's going to be Hell documenting everything in two places. The physical set-up is also less-than-swell. The terminals have been set up on a shelf on the back of the pillars that form our headwalls at our open beds... the ones we admit our post-op hearts into. The software doesn't allow for preadmission data entry, so all the demographic stuff, orders and so on have to be entered after the patient arrives. From behind the pillar, where I can't see what's going on, stop and intervene if I need to... and you get the drift. We'll have COWs at the foot of the bed for the rest of the stuff, which creates another huge problem... we don't have ROOM for that junk! The unit is already extremely crowded and there isn't room to move as is, so this is going to be bad. BAD. Really bad.
OMG what are your IT people smoking?!!!!!!!!! I was there for the switch from paper to computers in the ER and we did it all at once. Sure it was a nightmare for about 3 days but what your place has planned sounds like prolonged torture. When we did it we had extra staff on hand (2 extra nurses per zone so total of 5 nurses for 13 patients) to make sure that nobody got overwhelmed because the charting took a little longer. Not to mention half of IT and also the vendor IT people as well to help out plus we had weeks of training prior to going live. Forgot to mention we were a Beta test site so we were one of the first in the country to use this particular program. Fortunately that meant it was pretty much written to our specifications. Still it wasn't easy but it was definitely worth it. My ER sees approximately 300 patients a day in a 47 bed unit which is astounding. At my last gig the COWS were laptops so they took up very little room. In the ER they are regular PCs with flat screen monitors. Oh, I forgot to tell you. One of the rather puffed-up docs decided that since we had the COWs it would look bad if the nurses were seen sitting in front of them so they removed ALL OF OUR STOOLS!!!!!!He felt we should never sit down or we weren't working hard enough. That lasted less than 24 hours before we mutinied. I feel for you guys. You're right it does sound bad:eek:
Specializes in NICU, PICU, PCVICU and peds oncology.
Oh, it will be prolonged torture, I have no doubt of that. But I can't lay the blame on our IT people. It's administration that is at the heart of this. They're very reluctant to spend money on anything that will make things better for nurses. (Even more nurses...) It has already taken more than a year to wire and WiFi the unit. The terminals are on shelves that are about mid-chest height on me (I'm 5'5") so any data entry on that baby is going to be ergonomically challenging. But that's where they had to go because the unit is so short on space. We're going to be renovating (eventually) because TPTB want to open 4 more beds on top of our 19 existing beds in our unit-designed-for-15, so they aren't going to spend a dime on anything that would make our lives easier. And when our new cardiac sciences wing opens (it's already almost 18 months behind schedule and isn't likely to open in '09) we'll be expanding into the old CVICU, so why do anything now? Same song and dance we got about the other ergonomic adjustments that OH&S told them they had to make.
Another thing that might turn out to be a huge hassle is that our managers move patients around like checkers, so there may be issues related to that that no one has considered. As it is, the monitors have to be programmed with the patient info which is supposed to be transferable but every time I've moved a kid I've had to reprogram all the parameters, even though the kid's name and med record numbers are there. OMG, I'm giving myself a headache. I have my training class tomorrow and I should be making a list of questions I want answered, shouldn't I?
I know I said I was exiting this forum, but I was discussing this with an ICU colleague I respect very much (whom I mentored years ago), and she had a great deal of insight for all of us. She has a friend that she went to nursing school with who works the ED. Because this friend has experience in ICU and NICU, she gets any kind of patient that walks through the door. As you ED nurses all know, you may have 4 patients,and the next one assigned to you all of a sudden is a critical patient (yet you have 4 other non-critical patients). When you all of a sudden have to tube, and line, and code, and road trip this critical patient, what happens to your other 4 patients????
The thing is, honestly most of us ICU nurses did not know that when you have a patient that critical, no one picks up the other non-criticals. Swear to God, I would not do that. It is dangerous for both the critical and non-critical patients you are responsible for. (That is why the Californai Nurses Association pushed for and got minimum ratios established- in the ED if your patient is considered ICU, the ratio is 1:2 even in ED). Now I see the need for minimum ratio mandates all the more!
My friend had a great idea that she has been thinking about for quite some time. I don't think hospitals would go for it though, especailly in this economy of cutbacks. She thought of having a float/swat nurse between the ED and ICU that when a patient in the ED was determined to be critical or ICU status, this nurse would immediately be taken out of swat and that nurse would take over the patient in the ED until transitioned into ICU. That nurse would take over the ED critical patients from the ed nurses who have 4-6 other patients. Is this realistic and doable? Or do you get too many criticals or not enough criticals to warrant this in a hospital's budget? Just food for thought. Then we were thinking that if the budget was the issue, this ED/ICU hybrid miracle nurse could be part of the "stroke team" or "sepsis team", but then what do you do when you have other ED critical patients when strokes or sepsis patients arrive to the ED? Maybe there could be an ED/ICU transition team that took care of all of it: stroke, sepsis, trauma, and any critical care patient in the ED (this would take more than one nurse to sit in this srole, but they would be working (swatting in between no patients--swatting in ED and ICU both).
BeachGirl08
28 Posts
Just a question for the ICU nurses...........Our ED faxes reports to the floors, but calls report to ICU and CVU. When you are notified you are getting an admission, do you then have the ability to access the pt's records/labs etc in the computer system? My question is.......when giving report, do the ICU nurses expect me to go over this information that they have access to at their fingertips? A few times, as I was giving report, the receiving nurse would be on the computer looking at the same info I was giving her. I'm just curious what the ICU nurses have access to via the computer.