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.

That was my question. Why are you accepting patients by air that you than have to send out. Perhaps the bird should have stayed inthe air for a couple more minutes and taken them to a hospital that could have fixed all their systems....

Because we are the only facility for at least 50 miles in any direction. Another 20 minutes in the air could kill a pt. We get them by air only if they need the nearest facility and stabilize. As for the firefighters, they came in by CDF helicopters that needed to get back to the fires asap. Going 20 minutes farther to another hospital would have ended up being an hour total, with flight time and landing/taking off.

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:welcome: The only difference I see is attitude.

:eek: ER nurses look at the critical problem, stabilize it and than treat and street or treat and ship; Whereas Critical Care nurses look at the whole patient, the why's and wherefore's.:studyowl:

We the ER nurses just try to keep the really critical patients alive long enought for you the critical care nurses to cure them if you can.

Without one you can't have the other.:caduceus:

Well said Debby, I agree.

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Specializes in Emergency.

It actually saddens me that ER nurses are not thought of as critical care nurses.

I've been in some ERs that sit on vent/gtt patients for days, because the ICUs are full. You would then think there would be a change in your ER assignment, like only care for 1 other patient, but NO, you still have your other 3 ER patients to care for at the same time.

Then the respiratory therapist assigned to the ER is oftentimes also assigned to a floor or 2, and can't always be in the ER for that vent patient.

I've also worked at ERs that would ship everything out, and the hospital's ICU would care for at worst, a stable pancreatitis case.

California's staffing laws are wonderful!!! In the ER I worked in there, if I was holding an ICU patient in the ER, I could have only one other patient. Too bad the rest of the country doesn't understand acuity.

I once held an LVAD patient that was flown in by helicopter waiting to go to the OR for a heart transplant.

All ERs are different. Some put in ICP monitors and A-lines, and actually monitor them, other ER's just don't.

I've learned alot by working strictly ER. Would I be able to fly in an ICU? I highly doubt it.

I think that ER and ICU are both critical care areas, just in different ways. I also know that alot of patients are brought into the ER very critical and are sometimes turned around during that ER stay.

Alot of the vent, gtt, monitor experience that i've recieved in the ER, I would have never got, if it hadn't been for patient holds.

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My understanding of a critical care nurse is anyone who is trained to deal with pts on monitors and drips and needing life support. That covers ER, ICU, tele, and PACU.

I had this same question regarding the heart cath lab because my cath lab is a high risk one. We do many high risk procedures. Many of our patients fly to us very unstable. We stabalize them, do the procedure, place a balloon pump, and do all of the crititcal care procedures that an ER nurse or MCCU, ICU, nurse etc would perform. However, we are not considered critical care nurses. The reason that I understand is that all cath labs are different. This sounds funny when you think about it, but there are cath labs that are only diagnostic. They only do heart caths. Therefore, if someone says they have experience in the cath lab, which one was it? A high risk cath lab or a diagnostic? It could be the same for an ED. I say that becasue we own two hospitals with different types of ED's. One is in an area that has a younger population, so the patients coming in are more likely to be young adults, children and infants. If they get a heart attack victim, they stablize and send them to the cath lab at the other campus. The campus with the cath lab caters to the older generation (location is partly the reason, the other is due to our specialty). We recieve many geriatric and older adults along with middle age adults with possible heart attacks, chest pain, etc. It makes alot of sense if you look at the broad picture. Yes, we do critical care procedures in the ED and cath lab areas, but not all hospitals ED or cath lab are the same, so there is a difference in the rating of the critical care nurse. Like I said, this is the way it was explained to me. It is great experience and I think that if you want to transfer or switch jobs, you could list the skills that you have from working in your current ER position.

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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.

This is well said, I have been doing Critical Care Nursing for 11 years and PACU recovering CABG/Valve, Vascular surgery patients. The autonomy and familiarity with titration of vasopressors, ventilator management and evaluation of hemodynamic values can not be matched in the ER, Cath Lab (even interventional ). The direct supervision of an MD takes some of the pressure off of the RN. I do consider ER nurse to be highly competent in their scope of practice and are Critical Care Nurses. But I know and agree with the CRNA programs looking at ICU nursing in a different light. It is the independent assesment skills and decision making that CRNA schools look to this area. I still love ED nurses and value their role. I will be thanking god someday that a qaulified ED nurse is a critical care nurse when it is my time to rool through the ED doors. I would llike to add I am starting CRNA school this January...... here comes the fun......:uhoh3:

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ER nurses are not asking to be called ICU nurses or NICU or PICU. Just like the PACU nurses they do a different kind of nursing but it IS STILL CRITICAL CARE NURSING. We do it every day and for more then one person every day. Just because we don't titrate a medicine for 24 hours does not make us less of a critical nurse.

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where I work they are considered Critical Care Nurses. Probably because they don't accept new grads and you can only work there if you have worked in the ED prior or have ICU/Critical Care experience. All have BLS, ACLS, PALS, a lot have CCRN, they all have to go through TNCC also within 1st year of hire.

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where I work they are considered Critical Care Nurses. Probably because they don't accept new grads and you can only work there if you have worked in the ED prior or have ICU/Critical Care experience. All have BLS, ACLS, PALS, a lot have CCRN, they all have to go through TNCC also within 1st year of hire.

Where I work we too only have RN's no new grads. Noone has less then 10 years experience and most have ICU/PACU experience as well all have the ACLS TNCC BLS and there is a push for CEN/CCRN

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To my knowledge anyone looking after a critical case, even if only stabilizing it, should be considered as critical care nurses. As an emergency nurse , I don't think we have to stand back for ICU nurses.:paw:

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Hi,

I wish more ER nurses had your enthusiasm. ER nurses want to be considered ER nurses. They do not want to be critical care nurses or they would be working in the ICU. Majority of ER nurses are afraid to float to critical care areas because of fear of what goes into critical care standards of care. ER nurses work under the supervision of a physician all day long. Unfortunately, the ICU intensivist does not exist in the critical care arena like it used too!!!!!!!!! ICU nurses now function as 1st, 2nd, 3rd, 4th, and 5th year residents!!!!!!!!! The pathophysiology and ongoing clinical assessment skills goes way beyond what happens in the ER. It is very easy for me to float to ER and get through the day. I usually tell the ER MD what needs to be done stat during the admission process. We work very well together as a team. It is nice to know that my skills are valued and appreciated when I float to ER. But I must tell you, the ER nurses are scared to death to float into the ICU. I wish it would change. I appreciate all their concerns and understand. I am a CCRN and hope you are a CEN and promote this certification process. Your knowledge and expertise should continue to grow. I do not want ICU patients remaining in the ER because you are not set up to provide critical care standards. That does not translate into you are not a critical care nurse. ERs cannot be used as primary care areas. It is a batlle we continue to deal with.

Activism

Activism

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Wow, Activism, some compliments, and some harsh statements. I do not agree that it is easy to be an ER nurse because there is a doc to back you up. Often times, an ER doc won't see a pt. for an hour after admission, and it is up to the RN to decide what should be done first, make a plan of care, and go to the Doc for orders. What you think is so easy for you in ER as a CCU nurse is what is what ER nurses do every day. They have different, but not lesser, training.

As a CCU nurse, you are looking ahead to what will be needed down the road, and that IS a diifferent focus from the ER nurses.

I have worked in ER as a CCU nurse as well, and it IS a different view. Generally, however, they assign us the medical pt.s we are best at: "you take the chest pain in 7, and the distended abdomen in 3".

But the ER nurse is NOT inadequately educated because she does not have YOUR education. You could not HOPE to be able to do some of the things she does, or you would also be able to handle GYN, Pedi, Pysch, and L&D

issues. And I don't know of any ICU in the country that does all those specialities.

I respect CEN as much as I do CCRN. They are equal, just not equivalent.

If not for the quick thinking and excellent skills of my team members in ER, I might not HAVE a pt. to admit into CCU.

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I think ER nurses are in a category of their own. Cheers to what you do every day.

I'm a lowly step-down med/surg nurse, so I would never be considered a critical care nurse. (Hmmmmmm.) Each specialty has it's own challenges, so why try to aspire being one or the other? I respect every concentration.

If any nurse gets the sham it's a med/surg nurse - we get the easy patients, right? Our patients often turn into ICU patients while on our floor and we have to deal with it while juggling with the needs of 4-5 other patients at the same time. No continuous monitoring, so we walk in on surprises. And try to get a doctor to address a problem quickly on our floor? Forget about it. They're all hanging out in the ICU.

Anyway, any nurse is amazing as far as I'm concerned.

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