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 ICU,ER.

In the ER, we take care of up to 6 or 7 pts. at a time. I have had nights where a pt. having an MI was not my priority (my co-workers were pulled from their less acute pts to help me out).... When there is an unstable or "crashing" pt, it makes an ER nurse have to go one-on-one. Ok, here we go.... I am saying in general....I am sure I'll hear from the exceptions...but in general, ICU is 1:2 or 1:3.....with "settled in" pts. (ETT,Propofol,ect)

Regularly, after I have rushed my pt. up to ICU, I come back to the ER to ask my co-workers..."ok, what all do I have?".........and while they don't mind helping, are relieved because they have their own fish to fry.

It's simply a matter of resources.....period.

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Specializes in ICU, Home Health, PACU, ER.

Hi there, I am new to this web site and forum. I am an ICU nurse that for the past 18 months have been working both ICU and ER. I think that some of you have hit on the similarities and differences that keep me on my toes (and changing hats quickly). I must say that I have never heard anyone infer that ER nursing is not critical care nursing. As a matter of fact, the AACN accepts ER nursing experience when applying to take the CCRN exam. I think the challenge of ER nursing is the rapid change from ambulatory urgent care to life threatening unstable from pediatrics to geriatrics. I love my job(s).;)

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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."

And that comment was coming from a very weary PACU nurse (me) after a rough night who was resentful about being told that the ER was very slow, yet it was an absolute emergency that this patient be transferred to PACU for ICU care that apparently, in the MD's opinion, was not possible in this level 1 trauma center's ER.

Thank you for understanding. I've never done ER except to float on certain occasions, so I have no authority to speak specifically of their average days and/or abilities and situations, but I will always stand in awe of ER nurses who take patients from a blank slate with no "report" from another unit, no IV started, no labs drawn, etc. things that we as nurses who receive patients from the ER take for granted that think "should" be done before we receive them.

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:yeahthat: :yeahthat: :yeahthat:

i've been doing critical care and ed for 20 years and have my cen and ccrn certifications.

er IS critical care and i'll go head on with anyone who doesn't think so.

AMEN!!!!

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Welcome to the new world of ED. Because our ED director wants more money and because our interns and residents now have a cap of patients they can take, we are now no divert, no transfer when the floors are full. Because of this many times now we are boarding patients some until they either get better die or go home. There is also a new rule if the pt is not hemodynamically stable he/she can not go to ICU until they are. As a result many times now, we have an ICU pt's that stay over 24 hours.

I was also talking to another ED nurse for another facilty and they have the same policy and they do arterial lines in the ED This is the new wave of the future.

I think the concensus is that ED is Critical care and the AACN believes this to be so. Maybe we should write to the moderator on this website to put ED nursing where it belongs, not specialty areas but critical care nursing where they put PACU and NICU and ICU nursing. For the person who asked me who said we weren't critical care nurses, the answer is OUR MODERATORS by there actions.

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Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.

I started out as an LPN in ER and then an RN, now I work in SICU and ER, and I would just like someone to tell us were not critical care nurses Ill smack them square in the face. Were every bit as much of critical care nurses as are the Icu nurses, also why arent the flight nurses under critical care too?

We may not be in the ICU physically but we can run a pretty d@mn good ICU in the er and @ least we take more critical pts at one time in er then they do in ICU with there stupid ratios.

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Specializes in Emergency.

How about it MODS? I vote to move us to Critical Care.

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Specializes in ED, ICU, PACU.
Welcome to the new world of ED. Because our ED director wants more money and because our interns and residents now have a cap of patients they can take, we are now no divert, no transfer when the floors are full. Because of this many times now we are boarding patients some until they either get better die or go home. There is also a new rule if the pt is not hemodynamically stable he/she can not go to ICU until they are. As a result many times now, we have an ICU pt's that stay over 24 hours.

I was also talking to another ED nurse for another facilty and they have the same policy and they do arterial lines in the ED This is the new wave of the future.

When I have 4 ICU holds (2/4 hemodynamically unstable) because the 1:2 Nurse-Patient ICU ratio must be maintained on the floor, I think I qualify as a critical care nurse +++. Didn't have that high of a ratio when I did ICU nursing.:rolleyes:

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Specializes in ICU/ER/TRANSPORT.

Well cominig from someone who floats regularly from er to icu and who basically "cut his teeth" on emergency nursing, I find the main difference for me is autonomy. Now I can only speak for the icu's that I work in which is here in Ms, that range from 6 to 25 beds. And what I mean by the autonomy is in these little "country icu's" you are it.... meaning you and the other nurse run the show.. there is no er doc, or pa/np to tell you what to do or to titrate what gtt or when or what x-ray to get. Everything goes by your assessment at that time. Now some of the "big city" icu nurses out there may have a critical care doc or resident that stays in the unit or a room down the hall from the unit that might give them some direction from time to time, but small icus do not have that luxury. We also recover fresh post op pt's that range from any type of blasted surgery you can think of, now thats a whole different type of pt modality you don't see everyday in the er "not to say a competent er nurse could'nt handle it". I know the old maxim "acls is acls" but it's different when you and your partner are coding a pt and no doc or rt can respond to help you out, and you are having to intubate and the whole nine yards, then if the pt has a well documentation of other health probs.. renal,sepsis etc.. you have to adjust your post arrest care accordingly, meaning hanging what gtts and titrating them to the right strenght to not effect the other potentially dangerous condition, now you'll have to do this without any medical supervision at times, and when the doc finally shows up you feel like you have to explain every action you took to the spanish inquisition.. I'm sure most of the nurses that work in small rural icu's can understand that. Now all the ers I've work in that range from level IV to II, there are doc's np's that will give you guidance or sometype of range on things, And in the unit will have 1-3:1 ratio and er I've had as many as 6-7 pts before, but in the er we see em and street them, in the unit they are there to stay...another thing is I've tend to play around more with swanz, iabp and crrt units in the icus and we don't do much of any of that in the er's i work at. Now I feel I can state all this cause like I said above I go from one unit to the other freq, I'm not here to say which unit is superior or say something stupid like these nurses are better that those. But I do have friends that are pissed cause they can't get into crna cause of only er and no icu exp. Hey, I had to leave a dream full time er job to get icu exp. to chase that dream, so I know the anger. But there is a difference between the 2 types of nursing, I can only recomend to get up in the unit and find out, as far as er going under critical care, hell I don't know maybe they should.

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Specializes in general surgery/ER/PACU.
future.

I think the concensus is that ED is Critical care and the AACN believes this to be so. Maybe we should write to the moderator on this website to put ED nursing where it belongs, not specialty areas but critical care nursing where they put PACU and NICU and ICU nursing. For the person who asked me who said we weren't critical care nurses, the answer is OUR MODERATORS by there actions.

Actually, I think they have lumped PACU into specialty area and not as Critical Care. I know I deal with my share of critical patients every day.

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Actually, I do know of CRNA schools that except ER nursing as long as that ER is in a level 1 trauma center. I am a ER nurse and a critical care nurse, however, I do not work in the ICU and do not want to or thats where I'd be. I have taken care of patients with balloon pumps, LVADS, etc. I do not believe, I could just go to the ICU and take on a fresh heart. I also do not believe that just any ICU nurse could do it either. I highly doubt that the ICU nurses would be able to take care of half the heart babies etc, that we see either.

I believe that every facility is different. I worked in one facility that if a patient had in a chest tube they were automatically in the ICU. In the facility I work in now, there are patients with chest tubes hanging them off their IV poles and ambulating in the hall.

About the comment about the patient being too unstable to be in the ER. Thats pretty funny. However, I will say this: ER docs are just that. An ER doc is not an ICU doc the same as an ER nurse is not an ICU nurse. So, yes we have had docs wanting to get a patient upstairs ASAP because of their condition. We do have parameters however, before we can send a patient upstairs. Systolic BP must be above 70 for instance. We cannot, and will not transfer a patient that is too unstable for transport.

It may be nice to have a doc in the ER however, they are not the ones running between all 30 beds in my ED. It is the nurses. I have had 4 and 5 vented/critical patients at the same time, and oddly enough when we are boarding this many ICU patients in the ED, there is a bad accident and the traumas start comming in. That ER doc is with those traumas. He could care less about the other "hold ICU" patients. They are no longer under his service. I am the one hanging/titrating gtts until I have a bed ready. I once asked an ED doc to write me an order for propofol for a vented patient and was looked at like I had 3 heads. Our patients have A-lines, we monitor end tidal CO2 etc. Am I a critical care nurse Yes! ICU nurse however NO!

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Specializes in ICU/ER/TRANSPORT.

Iabp in the er..hmmm. interesting. So does the er doc give the initial orders for timing and cycling of the machine?

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