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.

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.

:balloons: Excellent point. I'm an E.R. nurse with experience in ICU also. We all need to respect one another and quit cutting each other up. We only have each other. No one else understands us like other nurses. We need to try and nurture each other. Isn't that what nursing is about caring for people?

RN46

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When I first started, the hospital I was at did give ER nurses a critical care differential......don't remember now how much it was........but when they did away with Baylor, they also took away the CC diff. As usual, it all comes down to money. Where I work now, ER nurses are considered Critical Care, but we don't get extra money for it.

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I work in a very busy ED. When all 50 rooms are full (not including the hall beds), medic after medic is coming in, triage is holding pt that need acute rooms, and there is 30 patients waiting in the lobby (then the ****hits the fan) I thank my lucky stars when ICU, PCU can finally take one of my pt and continue their care. At my hospital we have a great working relationship with ICU and PCU. We do our part and they do their's with respect. I think we all feel the same when it comes to working short all the time and being paperworked to death. Just my thoughts!

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Specializes in ER.

I love love love the ER. I love the critical patinet, and when its all said and done and the golden hour is over, I love sending my patinet to ICU. I really really would not want to take care of the same pt for 12 hours. when we have campers in the ER, we all draw straws to see who is stuck with them....Thank god for ICU.

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Specializes in Spinal Cord injuries, Emergency+EMS.
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.

only until you get a legislative / financial climate that favours throughput ...

for all the 'evisl' of socialised medicine getting people into a suitable bed in an approrpaite timeframe is something the NHS has become adept at ...

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Specializes in Critical care/ER, SRNA.

I have read many of the replies here but didn't have time to read them all. I am an ER and ICU nurse. I agree with what most people say, but here's something interesting. I worked at Yale ER for many years, and I can tell you, most of the nurses there have no clue on titrating drips and starting them at the appropriate doses. Most of them couldn't even tell you what a CVP measures. As far as an art line set up, only the nurses who had ICU experience knew how to do that. I don't mean to slam Yale's er, but they were very good at the "task" type things, but lousy if they had to take care of an ICU patient. Thank goodness for most of the patients, they went to the ICU asap.:idea:

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Specializes in ER Nursing.

I don't know why, but I became aggravated after reading some of these posts. Especially posts that refer to ER nurses as "undereducated" regarding arterial lines and critically ill patients.

Just a reminder...The critically ill patients you receive in the ICU were MINE first. If their heart is beating, if their drips are hanging, If the NG is collecting all that nasty blood from that unstable GI bleed, you have me to thank. In addition, I perform moderate sedation at the bedside, care for sick children, work with psychiatric crisis, and am beaten, sworn at, and spat upon by the masses I work to save. I also have to deal with end of life issues, unfortunately with small children at times. I also endeavor to take the time to send that critically ill soiled patient clean and powdered before the ICU gets them out of courtesy. I would argue that ER nurses are critical care nurses due to a number of reasons, primarily that we treat patients at their MOST critical. I love my ICU sisters and brothers, but remember I do all of this in an often frantic environment which requires insanely honed critical thinking skills and reprioritization literally from moment to moment, with a 5:1 to 7:1 ratio!!!

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Specializes in ER, telemetry.
I don't know why, but I became aggravated after reading some of these posts. Especially posts that refer to ER nurses as "undereducated" regarding arterial lines and critically ill patients.

Just a reminder...The critically ill patients you receive in the ICU were MINE first. If their heart is beating, if their drips are hanging, If the NG is collecting all that nasty blood from that unstable GI bleed, you have me to thank. In addition, I perform moderate sedation at the bedside, care for sick children, work with psychiatric crisis, and am beaten, sworn at, and spat upon by the masses I work to save. I also have to deal with end of life issues, unfortunately with small children at times. I also endeavor to take the time to send that critically ill soiled patient clean and powdered before the ICU gets them out of courtesy. I would argue that ER nurses are critical care nurses due to a number of reasons, primarily that we treat patients at their MOST critical. I love my ICU sisters and brothers, but remember I do all of this in an often frantic environment which requires insanely honed critical thinking skills and reprioritization literally from moment to moment, with a 5:1 to 7:1 ratio!!!

KUDOS!!!! Try giving an ICU nurse 6 pts and then a trauma!!!!

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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.

just a note of correction - podiatrists are not medical doctors!

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Specializes in Med-Surg.

You have to take the same critical care course.........and then some to work in the ER in my facility. So yes, duh...ER nurses are critical care nurses. :)

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Specializes in ED.

The difference is just a state of mind. ER nurses are good at seeing the big picture. ICU nurses are detail oriented. I work ER and admit that my knowledge of all those lines the ICU nurse deals with is limited. They can have them.

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If you work in an ED that has great patient access to the ICU, your ICU skills might not be up to par. I know a lot of ED nurses who have real trouble calculating constants for vasoactive drugs for example. Many ER nurses use a standard starting rate for each of their inotropes, etc.

On the other, hand if you work in an ED where ICU patients are frequently held over, you should qualify as a critical care nurse. I think that JCAHO requires that patients who "are admitted" receive the same standard of care that they would receive in the area that they would be admitted to if a bed was available.

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