i wish we could all just get along. most of the ICU nurses i work with just denigrate the ER staff to no end, and my friends in the ER just hate those 'damn, know-it-all ICU nurses.'
when i hear an ICU nurse getting report from the ER, the ICU nurse keep asking questions that they HAVE to KNOW the ER nurse didn't ask, because the ER nurse is not an ICU nurse.
having recently graduated from Nursing Skool (December), and still remembering my rotations in the ER, which i really liked, i have to shake my head. ER nurses are classified as adrenaline junkies, and maybe they are. but lets look at what their skill set is, shall we? if a hooman comes in with a REAL emergency, like Something is Falling Off, Bleeding, Squirting Blood, Rhythmically Squirting Blood, Turning Blue, Not Beating, or with more Extra Holes than hoomans are supposed to have, than you want an ER nurse. by the same token, i know MANY ICU nurses that don't like the emergent trauma situations. they say things like, i like my patients AFTER they've been cleaned up.
well then, what the heck? stop raggin' on the ER staff when they don't know the history. all they need to know is that the damn bleeding has stopped, thank you very much. and if you want a foley or an IV in a certain place, put it there yourself. i remember from my clinical rotations in various ER's that working in the ER was about the staff including a lot of docs. it couldn't be about the patients, because it's an ER, the patients aren't there very long. so the work is either Very Boring, or Very Exciting. sometimes, things are just Mundane. in the ICU, the patients can be there for weeks at a time, and the docs are few and far between.
the only real complaint about the ER staff that i think is justifiable is that they only Assess the Complaint. many times, i've seen an ER nurse pop her head into a patients room, make sure that nothing is Falling Off, Turning Blue, etcetera, and walk on. Why bother? the doctor will be in a minute anyway, and he is really the one that runs the show, and if he doesn't find something that is wrong, what is the ER nurse gonna find differently?
my Dearly Beloved, who is also in the bizness (also an ICU nurse), is on some committee that looks at things like charting on CHF protocols and door to cath lab times, and one thing that they found was that the ER staff had missed something.
warning; teaching moment ahead.
when someone comes into an ER complaining of chest pain, there are Some Things That MUST Happen. the patient has to undergo tests to determine if they are, indeed, Having A Heart Attack. if, thanks to these test, they are found to be Having A Heart Attack, then they needs to Get To a Cath Lab. cath labs are places where specialized teams go into a femoral artery to the heart and clear up whatever it is that is occluding blood flow to the heart. the timeline for all this to happen is 90 minutes, from Door to Cath Lab.
well, women have what is known as atypical symptoms of heart attack. so at the rural (read; small) hospital where my wife works, the ER had an older women come with a chief complaint of flu-like symptoms. so she got treated for the flu. until some time later, when she kinda sorta oh yeah, mentions-my chest kinda hurts. hmmm, turns out, flu-like symptoms are typical atypical MI (heart attack) symptoms for women. well, turns out she WAS having a heart attack, only now, her door to cath lab time was shot.
now, as an ICU nurse, i do a really thorough assessment of my patients, all the time. even multiple times during my shift. ER nurses? not so much.
would an ICU nurse doing an intake assessment on this lady have caught it? who knows. i just know that i like my friends in the ER, and when i get report from them, i expect that the bleeding will have stopped, or the holes have been patched and not much else. i'm the ICU nurse, i'll take it from here.
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