Why are emergency nurses not considered critical care nurses?

[JessicRN]

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.

[larhigh]

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.

[EmerNurse, BSN, RN]

This shouldn't be an ICU vs. ER debate; both are critical care areas. Both ER and ICU nurses are considered critical care nurses by the AOCN and both are eligible to sit for the CCRN. We all take care of critical patients, though at different stages of the hospital visit. Many of our skills overlap, but there are many aspects an ICU nurse couldn't do without additional training and many an ER nurse couldn't do without additional training. Luckily, we can do critical care nursing in different areas with different focuses.

Why is it such a big deal where we are categorized on a message forum? I couldn't care less-there are way bigger issues to get worked up about.

Nene - I'd heard that one could sit the CCRN as an ER nurse, but I wondered - don't the straight-ICU nurses get peeved when a straight-ER nurse sits the CCRN (as opposed to the CEN)? I've considered taking the CCRN - lord knows I do enough critical care stuff in the ER - but *should* I, seeing as I've never worked an actually ICU (only ER)?

I read on the CCRN site that they do recognized that critical care nursing happens in places other than the ICU, but I wondered about this.

Thanks

[Miss1030]

I work in the province of Quebec, and few years ago, we (ER nurses) obtain from our government to be paid the same premium per shift as the Critical care nurses.

Our statement was: our patients are unstable, face lifethreathening situations, and we are the overflow of the ICU anyway so we also have to deal with intubated patients ( and not on a 1:1 ratio, as you know)

so yes, as an ER nurse in Quebec I'm considered as a critical care nurse and dare anyone to tell me I'm not!!! ;P

[tabymac]

I was just sent a survey from the NCSBN (National Council of state boards of nursing) asking the duties that I normally perfom in my job setting. They specifically list Emergency nursing together with All ICU nursing (Adult/neonatal/pediatric) as part of the CRITICAL CARE Nursing team. So, yes Emergency nurses are most definetly critical care nurses!!!

[CraigB-RN, MSN, RN]

I"M going to play the Devils Advocate.

I"m note sure the definition of Critical Care Nurse and Emergency Nurse has anything to with with a specific skill set, It's more a mindset.

1. Yes ER nurses can hang vasoactive drips and do all the time, But look at the IV tubing. The ICU nurse has the lines all nice and neat, the ER nurse has the begining and end lableled and doesn't care what the inbetween looks like.

2. The ICU nurse has the patient all nice and pretty and buffed for the next shift. At shift change my critical ER patient is still laying on the clothes we cut off him and the ambulance linen.

Now these are just generalizations, but they get my point across. I've done both jobs, but I consider myself and ER nurse and not a critical care nurse even though I probably spend more time reading critical care journals than ER journals.

ER Nurses aren't critical care nurses, they are a Separate and Distinct specialty all on their own.

[Knoodsen]

They pay me a "critical care differential" cuz I work in the ER.

[Altra, BSN, RN]

I"M going to play the Devils Advocate.

I"m note sure the definition of Critical Care Nurse and Emergency Nurse has anything to with with a specific skill set, It's more a mindset.

1. Yes ER nurses can hang vasoactive drips and do all the time, But look at the IV tubing. The ICU nurse has the lines all nice and neat, the ER nurse has the begining and end lableled and doesn't care what the inbetween looks like.

2. The ICU nurse has the patient all nice and pretty and buffed for the next shift. At shift change my critical ER patient is still laying on the clothes we cut off him and the ambulance linen.

Now these are just generalizations, but they get my point across. I've done both jobs, but I consider myself and ER nurse and not a critical care nurse even though I probably spend more time reading critical care journals than ER journals.

ER Nurses aren't critical care nurses, they are a Separate and Distinct specialty all on their own.

I really have no idea what you're trying to say. Surely you're not suggesting that what "makes" a critical care nurse is aesthetics ...

You may well be right about the tidiness or lack of tidiness in the 2 scenarios you give as examples, but that is the result of critical thinking and correctly setting priorities -- the ER nurse who has not made his/her lines sufficiently pleasing to your eye has 5+ other patients in addition to that one who is now vented and has 3 drips hanging. Keeping everyone breathing & perfused comes before appearances.

[WSH-RN]

MLOS is right, besides does it matter THAT much? We know who we are and what we do. As long as we keep that straight, nothing else matters much.

WSH

[JessicRN]

I"M going to play the Devils Advocate.

I"m note sure the definition of Critical Care Nurse and Emergency Nurse has anything to with with a specific skill set, It's more a mindset.

1. Yes ER nurses can hang vasoactive drips and do all the time, But look at the IV tubing. The ICU nurse has the lines all nice and neat, the ER nurse has the begining and end lableled and doesn't care what the inbetween looks like.

2. The ICU nurse has the patient all nice and pretty and buffed for the next shift. At shift change my critical ER patient is still laying on the clothes we cut off him and the ambulance linen.

Now these are just generalizations, but they get my point across. I've done both jobs, but I consider myself and ER nurse and not a critical care nurse even though I probably spend more time reading critical care journals than ER journals.

ER Nurses aren't critical care nurses, they are a Separate and Distinct specialty all on their own.

It is funny I never realized when I started this post just how many people do not think we are critical care nurses. So much so another post was started with a poll by the allnurses staff to move the ER nurse to there rightful place. How can AACN believe we are critical care nurses when our own nurses do not. This is a great definition of the critical care nurse http://www.nursesource.org/critical_care.html does the ED fit You bet. No I do not fluff and buff patients I stabelize them enough so ICU nurses can fluff and buff them and if they have time to do that then I did my job and I did it well. As for drips I sometimes more drips in a shift then ICU do and no I do not label them and I titrate them for hours and hours when I have ICU hold overs. (no my patient does not suffer if I do not label the tubing either)Critical care is not a mind set. It is an actuallity. But I do much more I deal with trauma and overdoses which do not have driips all the time but the pt is equally critical am I a specialty nurse yes I am a specialty critical care nurse who works in an ED and many others are critical care nurses who work in the ICU.

[deeDawntee, RN]

Wow I had no idea there was this schism between ED and ICU nurses. In my hospital, the pay scale is the same for all nurses, no matter what department you are in. I am shocked that some "ICU" nurses are arrogant!! Arrogant about what???!!!! What do we know or do that justifies that kind of behavior?! I have been an ICU nurse for over a year now and I have to say, I am in awe of the ED nurses. I couldn't deal with all those different situations and patients and angry people. Oh my god, you people are saints! You should be proud of all the skills you bring to that job. Lets face it, it is where all of the desperate, uninsured in this country end up. You are dealing with true despair and some profound societal woes. I think you are true heroes.

:bowingpur:bowingpur:bowingpur What the ICU nurses and the administrators should be doing!!!!

[Altra, BSN, RN]

Critical care is not a mind set. It is an actuallity.

I was just going to say "thanks" to this post, but this sentence deserved to be quoted again.

Thanks, JessicRN.

[loricatus]

It is funny I never realized when I started this post just how many people do not think we are critical care nurses. So much so another post was started with a poll by the allnurses staff to move the ER nurse to there rightful place. How can AACN believe we are critical care nurses when our own nurses do not. This is a great definition of the critical care nurse http://www.nursesource.org/critical_care.html does the ED fit You bet. No I do not fluff and buff patients I stabelize them enough so ICU nurses can fluff and buff them and if they have time to do that then I did my job and I did it well. As for drips I sometimes more drips in a shift then ICU do and no I do not label them and I titrate them for hours and hours when I have ICU hold overs. (no my patient does not suffer if I do not label the tubing either)Critical care is not a mind set. It is an actuallity. But I do much more I deal with trauma and overdoses which do not have driips all the time but the pt is equally critical am I a specialty nurse yes I am a specialty critical care nurse who works in an ED and many others are critical care nurses who work in the ICU.

Funny thing I noticed about the poll I started is the specialty (majority) of those against putting Emergency Nursing into the critical care forum. Take a look for yourself and see if you feel the way I do.

And thank you Jessic RN for the inspiration to pose that question in a poll. Wonder why we threaten the 'other' critical care nurses so much? I've done the ICU thing and it was much easier work than what I do now; and, it laid the foundation to being able to handle the higher load of ICU patients I now have waiting to go to the floor so the ICU nurse can maintain no more than a 1:2 ratio. You would think they would appreciate our help in keeping their patient load down (giving them the time to attend to the aesthetics)---go figure:smackingf