Why are emergency nurses not considered critical care nurses?

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Just an observation but why are emergency nurses not considered critical care nurses? Who deals with more critical patients? We work on the same patients although we take care of more critical patients at one time on many occassions. We do the many of the same procedures (internal pacemakes, arterial lines,burr holes). We give the many of the same drips (dopamine,neosynephrine). We have the same education need the same prerequsites (ACLS PALS, arrythmia interpretation). If you work in an ED that has Pediatrics dept then you need to know more because we are dealing with completly different group of patients with different needs. We monotor many of our patients on telemetry and have no telemetry nurse manning the central monitors. I also can't tell you how many times we have kept patients in the ED because "they were not stable enough to go to the ICU". We are not allowed to sent patients to the ICU with critical low vital signs until we stabalize them. We have to do most of the admission orders before we send them. (put in central lines, start drips,give all IV meds, if we start blood we keep them one hour after we start. We have to address all abnormal blood values).Many times we board ICU patients in the ED many times we recover patients from the OR because there is no PACU nurse afterhours. I love it when an ICU nurse is floated to us. Half the time we give them the most critical person then devide the rest between us because they are totally overwhelmed. I am not saying we are more special then ICU or PACU or NICU nurses but we should at least be considered one of them.

Specializes in Med Surg, ICU, Infection, Home Health, and LTC.

in my experience and in the places that i have worked, the er nurse and the icu nurse are considered "critical care" nurses and each area is considered a specialty unit. there is also a differential in the pay scale as compared to the floor staff within the same facility.

many of the classes that er and icu's require are similar and the nurses in one area are often able to float to the other area as the census or the needs change.

acls and ekg classes are the very minimum required, along with a base of 1 year nursing experience in med/surg or comparable field. in many hospitals there is a 3 month to 1 year preceptor program in the specialty unit. i have seen the same type of requirements for or and pacu.

imho, the critical care nurse is to be respected and supported. she/he has taken special classes to learn their area of expertise and have to be able to make acute care decisions at a moments notice. critical care includes er, all the various icu's, or, pacu, and any other "specialized" unit.

nursing today requires so much additional learning in each area ... from pediatrics to l&d to even med/surg. there are so many medical advancements that require ongoing learning and certification that nurses are no longer like light bulbs that can be interchanged or floated without respect to their specialty area. (((higher management needs to comprehend that fact.)))

a nurse with 20 years experience in labor and delivery or er cannot be dropped onto a med/surg telemetry unit and given a load of 8 patients and expected to "ace it" solely because she has a "nursing license" any more than a podiatry doctor can fill in for a cardiologist just because they both have an md license.

nursing has become as specialized as the medical field and to me we each need to respect each other regardless of what area or unit the person works in. anyway, that's my 2 cents worth.

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Specializes in Emergency/Trauma/Education.
...I'm very glad to take the sickest off thier hands. I KNOW I can do it better, and they know it too. I've got the time, and the equipment. Let those great nurses triage and once the matter is settled, I'll be happy to take over, so they are free to use those diagnostic skills on someone else.

And I'm very glad to ship them to you! :) Very well said!

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Specializes in Critical Care.

I think ED, CCU, and PACU are 'lateral' specialties. I don't think the ED is any less a skill than CCU.

But, there ARE some differences. ED deals more w/ the stabilization towards hospitalization and CCU deals more w/ the continuity of illness.

For example in CCU:

You are much more likely to titrate drips independently over a longer term.

You are much more likely to have more detailed experience w/ things like swans and balloon pumps. How many ED nurses routinely evaluate hemodynamics such as CO and SVR? How many titrate drips based on them without physician oversight?

You are more likely to have detailed experiences w/ vents. How many ED nurses deal w/ their vents, and how many have an RT sit on it till they 'go upstairs'?

You are more likely to use and troubleshoot monitors and monitoring lines such as abp and cvp.

I'm not saying this means CCU nurses are mo' better. ED nurses do plenty of things that CCU nurses do not. I'm saying is that I think this question is in reference to required experience for CRNA and CCU focuses more on skills that CRNA schools want.

That does't put ED down. As I said, having worked both, I consider them to be lateral specialties. It just means that CRNA is looking for skills better honed in a longer term 1:2 ratio environment and focus.

~faith,

Timothy.

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To all the nurses who have responded about the difference between ICU and ED all good in practice but not true. I used to work in an ED in Texas and In Canada where they had a cardiac ED section and a trauma section so we did stay with the same critical patient for many days at a time. We also inserted art lines and SG's we hung and titrated drips we also gave TPA and dealt with reperfusion if we were not getting them ready for cardiac cath. Insertion of pacers were a matter of course. I did comeplete assessments regularly as well. The trauma section was just as crazy. Why, for several reasons because the doctors preferred doing procedures in the ED then the ICU ( getting xrays ultrasounds and cat scans were so much faster and less hassle for them) as a result when I had a criticle pt I had them the entire shift not a few minutes or hours. The other reason was the ICU refused unstable patients they were only allowed to become unstable after we brought them, and any orders written by the intensivist who came down to the ED had to be performed before going up to the ICU. The third reason the ICU did not have enough nurses to handle the overflow (they had a ratio of 1:2) so we boarded at least one to two ICU patients each night. Many hospitals board ICU patients in the ED and no they do not get the pleasure of a ratio of 1:2. And the forth reason many times the ICU pt would get assigned a bed but the ICU nurse was too busy to get the pt so we would have to hold them until she could come down which sometimes took all shift.. I had yet to find and ICU nurse race down to the ED and relieve me of my sickest critical pt. Here is the kicker. The ICU nurses got extra pay for being critical care nurses and we did not. :angryfire

That was a few years ago and I hope some strong willed ED nurses finally stood up and said no more and administration smartened up.

Now I still do all of the above procedures for the same reason only the ED's are not devided in cardiac/trauma/acutecare/express/pediatrics and it is not as often. I work nights so staffing is decreased and there is no 1:2 or 1:1 ratio except an actual code. Here noone gets extra pay whether you are a floor nurse or critical care nurse so not sure how we would be labeled. But we need all of the ICU's courses and TNCC and /ENPC PALS which ICU nurses do not and they are pushing us doing the CEN (I have it).

I have floated to ICU's and not every pt is critical and on a respirator with art lines and SG's and drips needing titration. Some are ready for the floors but have yet to be transfered until the ED needs to send a pt and they need a bed. Some are also stable but have the critical lab values that do not meet the criteria for the floor (high Troponin and CK's, DKA treated in ED to name a few)

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Specializes in Emergency Department.

I am an ER nurse, and I think that ER nurses should be proud of what we do, not try and mold ourselves into "ICU Nurses". I consider ER critical care, but it is just different in the ER. It's a whole different nursing specialty. Just as ICU nurses have certain skills that aren't used much in the ER, ER nurses have skills that aren't used in the ICU. So be proud of what you know and what you can do!

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Specializes in ICU.
I am an ER nurse, and I think that ER nurses should be proud of what we do, not try and mold ourselves into "ICU Nurses". I consider ER critical care, but it is just different in the ER. It's a whole different nursing specialty. Just as ICU nurses have certain skills that aren't used much in the ER, ER nurses have skills that aren't used in the ICU. So be proud of what you know and what you can do!

I wholeheartedly agree! I worked in the ER for 6 yrs and am now in the ICU. I know that in the ER you get critically ill pts, of course you do as well as everything else the cat dragged in. But it is not an ICU, It is not meant to care for critical care nursing where many potent and dangerous drug infusions are infusing, are on ventilators, where they have the nursing staffing and experience to monitor these pts closely, drugs, status, lab values etc. Pts, that require one to one nursing. Yeah, I've been in many situations where pts require one to one, but of course because they were in the ER , were not.

This isn't about who is smarter... the care /focus is different. That's all. Why do we as nurses always have to put down /compete with ourselves? When an ICU floated down to the ER, I have to say , they were the least useful, it was so different, more task oriented and they couldn't comprehend the whole revolving door system/care in the ER. But if an ER nurse were to go up to the ICU, we couldn't do what they do either.

I have to say, I get pissed when I tell people I work in the ICU, and they're first reaction is " Oh! So you're a real REAL nurse then! " *** does that mean? I was a real nurse and took care of plenty of sick pts when I was on the ward, the ER and the ICU. We dont' need to do the same crap to ourselves!

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Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

very well said .weekened warriop.i was an icu/ccu nurse for 11 yrs now i have been er nurse for 4 .both are critical care but thje focus is different.its not a matter of 1 being better then the other.

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This has always been a pet peeve of mine. I have argued for years that ER Nurses, are Critical Care Nurses also. As someone else has pointed out the AACN considers us Critical Care Nurses, and we can sit for our CCRN being ER Nurses. In my opinion we are just like the other specialty units.

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Specializes in CCU/CVU/ICU.

And another point...

An ER nurse who says "i'm a critical care nurse" is wrong...She should say "i do critical care" and she'd be much more accurate.

An ER nurse who says "i do critical care nursing" is correct to an extent...

An ER nurse who says "i do OB/GYN nursing" is correct to an extent...

An ER nurse who says "i do pediatric nursing" is correct to an extent...

An ER nurse who says "i do office nursing" is correct to an extent...

etc., ad-nauseum.

These 'true' statements are what make ER nurses what they are.

But to claim they're just as 'deep' into these specialties as the nurses who work these specialties all-the-time would be wrong in my opinion.

So...yes ER nurses can be 'considered' (by master 'considerers' such as AACN :) ) critical care nurses....and so can recovery rooms...and step-downs...and IMCU's...and anyone tele-acls trained...and...

It's funny how we can become anxious over who considers us what...unless of course they're important 'considerers'...i think.

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And another point...

An ER nurse who says "i'm a critical care nurse" is wrong...She should say "i do critical care" and she'd be much more accurate.

An ER nurse who says "i do critical care nursing" is correct to an extent...

An ER nurse who says "i do OB/GYN nursing" is correct to an extent...

An ER nurse who says "i do pediatric nursing" is correct to an extent...

An ER nurse who says "i do office nursing" is correct to an extent...

etc., ad-nauseum.

These 'true' statements are what make ER nurses what they are.

But to claim they're just as 'deep' into these specialties as the nurses who work these specialties all-the-time would be wrong in my opinion.

So...yes ER nurses can be 'considered' (by master 'considerers' such as AACN :) ) critical care nurses....and so can recovery rooms...and step-downs...and IMCU's...and anyone tele-acls trained...and...

It's funny how we can become anxious over who considers us what...unless of course they're important 'considerers'...i think.

There was a time that I would have agreed with this statement, but with the way the trend is going with the ER's across the country, and the way many have to hold pt's for extended periods of time I just can't agree with this.

Also AACN does not consider the tele trained , nurses Critical Care Nurse's. They have a separate test they can take for certification it is called the PCRN. It stands for Progressive Care RN.

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Specializes in Emergency/Trauma/Education.
There was a time that I would have agreed with this statement, but with the way the trend is going with the ER's across the country, and the way many have to hold pt's for extended periods of time I just can't agree with this.

Also AACN does not consider the tele trained , nurses Critical Care Nurse's. They have a separate test they can take for certification it is called the PCRN. It stands for Progressive Care RN.

PCCN

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Sorry my mistake. it is PCCN

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