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!
:yeah:I applaud you for taking a look at this real and very frustrating disconnect between the ER and ICU. As a Neuro ICU Nurse and cross trained in the ER, I truly understand you and your managers frustration. Unfortunately this has been going on years. What ICU nurses fail to realize is that your type of nursing in the ER is Task oriented and stabilization, not cure. You address the issue at hand, stabilize and either d/c home or stransfer off. ICU Nurses on the otherhand, are systems nurses, we look at entire system dysfunction and are given a set of orders to treat such. As far as the full head to toe report, that is something that is just engrained in us. I have no doubt that you could do CCRN work, because ER nurses ARE Critcal Care Nurses. When you Work Trauma ER, or Cardiac Er etc, does one think that you do not have to have critical thinking skills, if nothing else, probably more so than any other area. I'm not sure that there is anything different that your manager can do other than what they are doing... Know the saying "Walk a mile in my shoes" it really is the best thing, and personally, I feel that I am a better trained nurse for knowing how to treat patients in both settings, and yes, when I receive a patient from the ER, and ask for report, I ask for the quick down and dirty... Why are they here, what did you do, and what's left to do...
One thing that gripes me is this... Even when I do have an extra minute to give a thorough report, the unit nurses will find something out of left field to ask. It's like they're looking for something to ask that they know you probably won't know... I'm usually like, um really? Who give's a ---- about that? Completely irrelevant. My facilities latest thing is bedside reporting within the unit, well last week I tried to transfer a critical pt to ccu, there were several empty beds up there, several nonbusy nurses and the little ----- of a nurse says "I'll have to put you on hold while I look at the report sheet." A major delay in pt care. Refused to take bs report when I said I'm bringing this pt up. She said NO, you have to give report. We do assessments in relation to the given problem. We do tons of testing and the pt always has the CT/Xray and labs with the exception of an occasional urine or stool. Only, unlike the unit nurses who are pretty much 1:1, we are 1:4 or sometimes 5. At the time of this incident last week, I had an insulin OD with fsbs q15 min while constantly titrating the D5, 2 CP that were in the middle of cardiac workups, and an unstable GI bleed who was tachy sustaining in the 150's and bp dropping. I did not have time to hold while she drank her coffee and read the report sheet. (the GI bleed was the pt going up and needed blood immed, but wasn't ready in lab). To top it all off, when I got up there, the place was dark, most all (very low census) the pts were sleeping and 5 nurses came to the bedside to help unload the pt. I just figured they were mad cause they actually had to work. I have friends who are unit nurses, and they are good, but the more incidences like this that I experience makes it hard not to stereotype them all. It is getting to where when I hear "unit nurse", I think ewww and roll my eyes. I know there are some really great ones up there, I used to work in cvi, but when it comes to ED vs CVI, the ED nurse is busier tenfold. I think I did more venting than helping giving a solution tonight. And, I'm sorry if some of this is harsh, and hope not to offend anyone, but it's just the way I am feeling more lately. I would love to work somewhere that the unit and ed worked in sync with each other. That's how I always imagined it would be. After all, we are all involved in critical care and have most of the same certifications, but it's not at all like that in reality. At my current facility, it is constant drama between the two.
One thing that gripes me is this... Even when I do have an extra minute to give a thorough report, the unit nurses will find something out of left field to ask. It's like they're looking for something to ask that they know you probably won't know... I'm usually like, um really? Who give's a ---- about that? Completely irrelevant. My facilities latest thing is bedside reporting within the unit, well last week I tried to transfer a critical pt to ccu, there were several empty beds up there, several nonbusy nurses and the little ----- of a nurse says "I'll have to put you on hold while I look at the report sheet." A major delay in pt care. Refused to take bs report when I said I'm bringing this pt up. She said NO, you have to give report. We do assessments in relation to the given problem. We do tons of testing and the pt always has the CT/Xray and labs with the exception of an occasional urine or stool. Only, unlike the unit nurses who are pretty much 1:1, we are 1:4 or sometimes 5. At the time of this incident last week, I had an insulin OD with fsbs q15 min while constantly titrating the D5, 2 CP that were in the middle of cardiac workups, and an unstable GI bleed who was tachy sustaining in the 150's and bp dropping. I did not have time to hold while she drank her coffee and read the report sheet. (the GI bleed was the pt going up and needed blood immed, but wasn't ready in lab). To top it all off, when I got up there, the place was dark, most all (very low census) the pts were sleeping and 5 nurses came to the bedside to help unload the pt. I just figured they were mad cause they actually had to work. I have friends who are unit nurses, and they are good, but the more incidences like this that I experience makes it hard not to stereotype them all. It is getting to where when I hear "unit nurse", I think ewww and roll my eyes. I know there are some really great ones up there, I used to work in cvi, but when it comes to ED vs CVI, the ED nurse is busier tenfold. I think I did more venting than helping giving a solution tonight. And, I'm sorry if some of this is harsh, and hope not to offend anyone, but it's just the way I am feeling more lately. I would love to work somewhere that the unit and ed worked in sync with each other. That's how I always imagined it would be. After all, we are all involved in critical care and have most of the same certifications, but it's not at all like that in reality. At my current facility, it is constant drama between the two.
Exactly. I used to work CVICU (we would take ICU overflow pts), never gave the ED nurse a hard time, mostly b/c I was impressed they had the time to intubate this sick pt, start a line in him, get a central line, draw all those labs, start pressors, pan-culture him, take him to CT all in under an hour and a half sometimes... We usually don't have a problem with the CVICU nurses, but the MSICU nurses, I think mostly because they're unhappy with their jobs. I've floated there more than a few times, and I've seen a lot of depressing cases: nursing home patients that are trach'd and PEG'd, with full codes and family members that don't come in to see them anymore, but don't want to discuss the code status. There's a LOT of backbiting and this nurse didn't do that. The general consensus is that the floor nurses are idiots, they will call a code and hide in the corner, and ER nurses don't know anything about their patients, they just do procedures, and do what the MD tells them to do. I wish I could tell them about ER: I've never had more autonomy than I do now!
I am an ICU nurse. It seems things are pretty much the same at a lot of places. I would like the ER not to try to send a patient at change of shift. This happens all too often where I work. We have shift change at 3p,7p, and 7a, inevitable we get a call at those times to take an admission.
I am an ICU nurse. It seems things are pretty much the same at a lot of places. I would like the ER not to try to send a patient at change of shift. This happens all too often where I work. We have shift change at 3p,7p, and 7a, inevitable we get a call at those times to take an admission.
When a bed becomes available, we call report. There's almost always another pt in the hallway waiting for thatroom to be cleared. This complaint seems to go straight to the lack of understanding about how the er operates. Triage doesn't stop sending pts because it's shift change and ems doesn't hold up either.
You don't want us calling report during your shift change? Fine, call my manager and explain it to her. I'm sure she'll understand....
just face it er nurses are wimpy...dont take it to be a black mark on you, heck when i goto work in the er i find myself becomming a wimp too. as stated on another thread icu nurses are way more macho!!!
DIFF.
bahahahahaha!!!!!!
Dude, you seriously need to get those meds adjusted.
I completely get what you are saying. I have worked as a staff nurse and manager (currently staff again) and have tried what you suggested in both my roles (doing a shift in each area) with limited sucess. What I found is that the ER staff reluctantly go do the shift in ICU and see that there can be challenges there too. It doesn't change the fact that the ER patients continue to arrive and you HAVE TO get some of them out the door. In my experience with floating to the other units, we had a very hard time getting the ICU to come and do their shift in ER. It is not their preferred environment and I can't really blame them.
I think the best approach I have seen work is to have a float nurse in the ICU that can take admissions and get them started so that there are not delays from the ER side that cause bottlenecks. It takes a champoin at the top who is committed to patient flow to ehlp get patients out of the ER. Otherwise, you may continue to be frustrated.
I am an ICU nurse. It seems things are pretty much the same at a lot of places. I would like the ER not to try to send a patient at change of shift. This happens all too often where I work. We have shift change at 3p,7p, and 7a, inevitable we get a call at those times to take an admission.
A lot of times, and I don't know why this is, but the bed becomes available at 1848 or somewhere around there. We have 30 minutes from the time that bed is available to fax and call report, make copies of the chart, call transport or take the pt up ourselves if they are going to a unit/sd. That is very little time when the whole place is even more chaotic b/c of our shift change as well. They have monthly printouts of the nurses who held their pts in the ED longer than the alloted 30 minutes, and with that comes a letter of reprimand wanting to know why you didn't get your pt out on time. It is not an option to put a note in the pts legal medical record of "bed ready right at shift change, receiving nurse taking report from offgoing shift". I work midshift 3p-3a so shift change doesn't really affect me. When it happens to be that a bed is ready like this, I have to stop and rethink what the problem is, and it always happens to be that we have to get them up during shift change. When I come in, I either have to open rooms, or take the rooms the charge nurse had to open. I have often wondered why it is the bed always becomes ready right before end of shift. I think it has something to do with housekeeping having the same shift change. Maybe they move slower earlier in the day, then have so much to get done before leaving. I don't know. I think housekeeping should come and go on completely different shifts. Maybe 9-5 or something like that. Maybe that would solve everything.
A lot of times, and I don't know why this is, but the bed becomes available at 1848 or somewhere around there. We have 30 minutes from the time that bed is available to fax and call report, make copies of the chart, call transport or take the pt up ourselves if they are going to a unit/sd.
Same here. 30 minutes from the time the bed is assigned until the patient is in said bed. Our official policy is that the unit is expected to take patients during shift change. I try to avoid this as best as I can, but the charge nurses are on top of it and will ride you if you are taking too long to move a patient out.
What I would like the ICU to understand is that their silent treatment and catty remarks do not endear them to me, and make it less likely that I will give a rip what kind of condition the patient is in when I take them up there. They may need to be cleaned and have only a 22g. in the hand, and I'll happily hand them off, because I get the same response whether this is the case, or whether they are clean and fresh and have a central line. If it doesn't matter, every single time I take a patient to you I get the same attitude, then why work harder to make the patient ICU ready?
Also, my report is not going to be a detailed system by system report. This is just now how we do it in the ED. I will tell you why they came to us and what has been done and what the plan is. I will give you a heads up on anything that seems important for you to know. But I will not be giving you an ICU style report. Sorry.
What I would like the ICU to understand is that their silent treatment and catty remarks do not endear them to me, and make it less likely that I will give a rip what kind of condition the patient is in when I take them up there. They may need to be cleaned and have only a 22g. in the hand, and I'll happily hand them off, because I get the same response whether this is the case, or whether they are clean and fresh and have a central line. If it doesn't matter, every single time I take a patient to you I get the same attitude, then why work harder to make the patient ICU ready?
Also, my report is not going to be a detailed system by system report. This is just now how we do it in the ED. I will tell you why they came to us and what has been done and what the plan is. I will give you a heads up on anything that seems important for you to know. But I will not be giving you an ICU style report. Sorry.
I didn't feel catty in anyway until I read this post. How is it responsible nursing to allow the patient to suffer because you think some other nurses have an attitude? The ER and ICU where I work seem to get along just fine. I barely ever hear anyone complain about an admission other than a direct admit from an OLH that bed control neglected to tell us was even in house.
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.
As far as getting a super detailed report from the ER goes, it isn't going to happen. But a five minute head to toe assessment wouldn't hurt you. If the patient came to the ER because of a heart attack, I appreciate you telling me what their EKG and troponin look like, but if you didn't listen to their lungs, you obviously missed the fact that their MI caused HF and they are going into a serious case of pulmonary edema, which will now lead to them buying a tube, when bit of Lasix and some close monitoring might have helped avoid it. That actually happened to my patient last week. He was a direct admit and neither the EMS or the OLH ER noticed. I am fairly sure that had the pt presented to our ER, it would have been noticed and a stat chest XR would have revealed the nearly whited out left lung.
I don't know about everyone, but the VERY FIRST class I was made to take in nursing school was assessment. I doubt they would have made it first if it wasn't an important and basic nursing skill.
I am fairly sure that had the pt presented to our ER, it would have been noticed and a stat chest XR would have revealed the nearly whited out left lung.
I don't know about everyone, but the VERY FIRST class I was made to take in nursing school was assessment. I doubt they would have made it first if it wasn't an important and basic nursing skill.
While we all learn basic head to toe system assessments, in the ED most of the time it is a problem focused assessment that we have to do. That's the way it has to be. We don't have the time to listen to hypoactive bowel sounds 5 min in each quad. We have to take care of the most life threatening thing and then ship. I always listen to the lungs, and assess anything else that might be pertinent and chart it, but many times if they are sick enough to come to you, I am running 90 miles/hr to make sure all the tests are done. I hate to think of someone laying in their urine for a few extra min, but if there's not a tech to take care of it, then a lot of times it simply doesn't get cleaned until they get to you. It isn't life threatening and I just don't have the time to address it. As far as doing dispicable things to the pt in spite of the unit nurses, I don't think that's what the last poster was talking about. Sometimes they come in EMS with a 22g in the hand, which is an access after all, but if it were more appreciated then one would try to go the extra mile to start a 20 or 18 somewhere else. BTW, you sound like a wonderful nurse.
As far as doing dispicable things to the pt in spite of the unit nurses, I don't think that's what the last poster was talking about.
That is not at all what I was talking about! Thank you! I would never advocate making a patient suffer just to make life hard for the ICU nurse. It's just that sometimes, things are so busy, and we're running so fast and working so hard that some things have to fall by the wayside. It's just the way it is. If I have the time, I can try and package the patient up nicely for the receiving nurse, but when my efforts to do this are totally unappreciated, it is discouraging.
FMC Stroke Manager
5 Posts
:yeah:I applaud you for taking a look at this real and very frustrating disconnect between the ER and ICU. As a Neuro ICU Nurse and cross trained in the ER, I truly understand you and your managers frustration. Unfortunately this has been going on years. What ICU nurses fail to realize is that your type of nursing in the ER is Task oriented and stabilization, not cure. You address the issue at hand, stabilize and either d/c home or stransfer off. ICU Nurses on the otherhand, are systems nurses, we look at entire system dysfunction and are given a set of orders to treat such. As far as the full head to toe report, that is something that is just engrained in us. I have no doubt that you could do CCRN work, because ER nurses ARE Critcal Care Nurses. When you Work Trauma ER, or Cardiac Er etc, does one think that you do not have to have critical thinking skills, if nothing else, probably more so than any other area.
I'm not sure that there is anything different that your manager can do other than what they are doing... Know the saying "Walk a mile in my shoes" it really is the best thing, and personally, I feel that I am a better trained nurse for knowing how to treat patients in both settings, and yes, when I receive a patient from the ER, and ask for report, I ask for the quick down and dirty... Why are they here, what did you do, and what's left to do...
Hope this helps or motivates......
Anthony