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.

As I have said once I will say again I do not want to work in the ICU I want to be a critical care nurse who works in the ED. Yes ED is a specialized area but It is still critical care and should be placed in the forum for critical care nursing not other. After all the AACN states ED nurses are critical care nurses. Shouldn't this forum at least.:lol2:

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Specializes in CVICU-ICU.

It amazes me that this discussion is still going strong. I guess what I dont understand is why we have to "distinguish" ICU/ER nurse. I agree with all who said what ER nurses deal with everyday is difficult along with what ICU faces. Both ER and ICU nurses have a wealth of knowledge. I work in CVICU and I know that I can do my job very well. I also know that if I am floated to the ER I dont function as well as a trained ER nurse because I will have a hard time taking care of a OB, pediatric or psych patient. I know that I will be able to function and keep my patient alive because I know the ABC's of survival but that does not mean I will know what to do once my patient is stable if its a peds, OB or psych patient. On the flipside I have worked with ER nurses who have come into the ICU to work and really did not know how to do PA readings, monitor hemodynamics and treat the abnormal hemodynamics. They very rarely have a PA catheter. They were not sure of how to titrate different drips based on hemodynamics. Im not saying ICU is better than ER all Im saying is we are all unique in are knowledge base. I just dont understand why we have to classify ourselves. Adminstration, doctors, patients, families all place nursing at fault for most anything...I dont understand why we as nurses cant back each other and say good job.

I enjoy ICU...my knowledge base is ICU/CVICU and I know that ER, med-surg, telemetry and labor/delivery nurses all work very hard also and I also know that each and everyone of them knows something I dont or had different sets of issues to deal with working.

So to all my fellow nurses out there I'd like to say : GREAT JOB!!!!!

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Hi Again,

No harsh thoughts or words intended. It is not about the TITLE. You are an ER nurse with a passion for critical skills and interventions in your ER arena. Yes, I have many years experience PEDS, Trauma, PACU, Trauma OB/GYN, PALS, TNCC, and the rest of the alphabet that really does not mean a thing if I cannot participate with the care needed and improve patient outcomes. You are in a specialty area. There are some nurses that perform well in ER and ICU. They are talented professionals and are comfortable with who they are and wherever they practice. I hope no one has offended you that you are not a critical care nurse. Specialty areas require specialty skills which you have.

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Specializes in ER, telemetry.
I understand that for some masters programs such as nurse anesthetist, er is not considered critical care due to not having swans and balloon pumps. I am not saying that some er nurses aren't crtical care nurses but unfortunately have had quite a few that I have gotten report from that could not tell me what rhythm the patient was in and the patient was an acute mi. The same nurse told me that the patient was on a ntg drip at 30 and when the patient arrived he was on at 30cc/hr....100!!!, with unrelieved chest pain 6/10. I have gotten intubated and vented patients and the nurse had no idea what his settings were or where to find them. I think that just because one is an er nurse doew not make them a critical care nurse, it's what they choose to do when they get to the er.

I worked on a tele floor that also had a stepdown vent room, so I am familiar with vent settings. However, in the ER, if we have a critical pt, resp therapy is usually right there to manage the vent. We usually have bigger concerns than vent settings, and if I do not have the most current vent settings, resp therapy has written them all down for you on there flowsheet. If a pt has any problem on the vent that us nurses in the ER can not address, we will take the pt off the vent and bag them. As for telemetry interpretation, sadly, I work with many nurses (and some doctors) who have trouble interpretating rhythm strips. Very scary. And mistakes happen with drips unfortunately. Even in ICU units where I have floated many, many times while working as a telemetry nurse. ICU nurses make mistakes too (and there are bad ICU nurses too who really shouldn't be considered critical care even though they work it every day.)

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Specializes in ER, telemetry.

As an ER nurse, I am the first person to lay eyes on many pts coming in to the ER, so I am the one who assigns acuity to this pt. I decide who is the sickest and needs a doctor right now. So, having a doctor around 24/7 doesn't mean that the doctor is in the room assessing 24/7. The ER nurse is responsible for assessing pts and deciding which ones can wait and which need emergent, i.e. critical, care. We interpret vitals, ekgs, labs and SYMPTOMS, and THEN let the doc know. The good Er nurse can just look at a pt and know this pt needs an MD NOW. It IS nice to have docs available 24/7, in fact that is one of my favorite aspects of ER nursing, but the docs are not always aware of what is going on in the ER unless an educated and experienced nurse makes them aware. I don't know how many times I have come on to a shift with a critically ill pt who had not been seen by a doctor after hours of waiting. The nurses on the prior shift were ER nurses, but did not have good critically thinking skills. Bad nurses are everywhere!

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An ER nurse who does not know how to interpret rhythm strips,( we aretestedyearly) who cannot do drips without making errors (we are tested yearly),who does not know vent settings or where to get them,does not belong in an ED that has vents,cardiac monitors and critically sick people.(If they are not new grads that is) Our respiratory tech is there to put the pt on the vent takes the blood from the MD and does an ABG then leaves. I agree an ED nurse does not have to know how to read and interpret swans readings but I would hope if they have one in the unit my hope is that they get inserviced by someone who does know.

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I've posted on this thread before and just wanted to say that I recently worked agency at a big level one trauma center in the PACU when this subject came to mind.

The hospital administrator made rounds and told me that the ER was very slow on this particular night and that the ICU's were all full, so any new ICU patients would be ours.

At the same time, I was getting calls from from docs wanting ICU beds for their ER patients. One was so insistant that his patient go to PACU and when I questioned him, he said "This patient is too unstable to be in the ER."

What?? Are we not a level one trauma center with level one ER RN's to go along with that??

I'm not trying to say that I go by what the docs say regarding nursing care in any given unit because I think that they are clueless on many levels for the most part.

However, I found it quite ironic that this level one trauma center found itself with a patient "too unstable" to be managed in it's ER and was eager to send it to the PACU even though it was a very slow night.

I just couldn't help but think that this was a case of ER nurses having a slow night and wanting it to be even easier by pushing for their patients to get moved to wherever there was a bed.

ER will never get taken seriously as a critical care unit if it tries to push it's ICU patients to the PACU because they are too unstable to be managed in ER.

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Specializes in ER, Peds, Charge RN.

You're talking about one particular ER in one particular incident, and acting like all ER's are bad because of it?

You know, I had a lot to say about this one... but nevermind. I just don't have the time...

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Specializes in ER, Cardiology, and GYN long ago.

Now children, let's play nicely...

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You're talking about one particular ER in one particular incident, and acting like all ER's are bad because of it?

You know, I had a lot to say about this one... but nevermind. I just don't have the time...

Let me clarify.

Yes I was only talking about one incident in one hospital on one night.

I consider ER nurses to be critical care without any doubt and am dumbfounded by anyone who believes otherwise. The nurses in this particular ER take some of the most critical patients flown in from all over the state and are prepared to take literally anything that comes through the door.

It was the MD's comments about the patient being too unstable to be managed in the ER that I found to be degrading to the nurses in this ER.

Comments like that perpetuate a false idea of what ER nurses are all about and what their knowledge, skills, and capabilites are, IMHO.

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Specializes in ER, Peds, Charge RN.

It was the MD's comments about the patient being too unstable to be managed in the ER that I found to be degrading to the nurses in this ER.

Comments like that perpetuate a false idea of what ER nurses are all about and what their knowledge, skills, and capabilites are, IMHO.

I think it is comments like the following that perpetuate a false idea of what ER nurses are all about:

"I just couldn't help but think that this was a case of ER nurses having a slow night and wanting it to be even easier by pushing for their patients to get moved to wherever there was a bed."

I've never heard of a patient "too unstable" to be managed in the ER. That's what we do: emergencies. We work in different facilities, so I can't speak for your particular ER, but I know that when we get a bed, we can't move a patient if they are too unstable. We don't even get a bed assignment until we are pretty sure the patient isn't going to die anytime soon... they would rather give that open bed to someone who will keep breathing. I guess it may be a different ballgame in your facility. Thank you, though, for your clarification. I got a little ruffled there, and I appreciate you further explaining.

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Specializes in neuro/trauma/surgical/medical ICU's.

Wow, I don't know what hospital your @; our ER nurses send us crashing pt's on a daily basis. I am not disagreeing with you, I do consider ER to be critical care. I am just surprised @ your description, it sounds to me you work in a ED that seconds as ICU.:pumpiron:

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