Wednesday, April 22, 2009
ICU vs ED
I have an enormous amount of respect for ICU nurses. However; if they are specially trained to take care of ICU patients and have a ratio of 1 nurse to 2 patients (generally) why are ED nurses expected to hold multiple ICU patients and also take care of walk-ins and those patients that arrive via ambulance. Honestly, these patients do not receive the same care as they would if they were in the unit. I think that ED nurses are very capable of multi-tasking and do the best they can taking care of these patients. If it were my family member and they were sick enough to be admitted to the ICU, then that is the type of care I would want them to have.
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I agree 100%. I have been an ICU nurse and an ED nurse. Both positions have their challenges. Unfortunately, it is the patient who ultimately suffers when an ICU deserving patient is "held" in the ED. If an ED nurse had only 2 patients, she could "ICU it" with the best of them. I have seen ED nurses with 2 ICU holds and 2 additional patients. What makes it less tolerable is when you do transfer to the ICU, the ICU nurse is not always very sympathetic or understanding when every "i" is not dotted and each "t" crossed as they would have been or should have been. The patient has the potential to suffer in 2 very real ways. First, without proper oral care like clock work, HOB elevation, suctioning and ancillary ETT port to wall suction, the patient is at increased risk for VAP. This is routine standard of care in the ICU, is charted as such and is audited daily by the Nursing Director. Most ED nurses do some of these and some ED nurses do most of these, but who can do it all? ...especially when the standard of care is that each is done on each patient and in a consistent, timely fashion. The second risk to patient safety that could lead to negative outcomes is the risk for skin breakdown. If there is known to be absolutely no room in the ICU, more appropriate bedding is obtained, other than a lovely ED stretcher. At that point, how long has the patient been on that stretcher? Skin breakdown does not often appear until 2 days after the initial injury that caused the breakdown. Frequent repositioning of the unconscious patient is a standard of care. Proper bathing and skin protectant can also be used. Sure we reposition our patients; how I dare I say we dont. I'm not. I'm saying, goodness forbid it's Monday and chaos has broken loose...a typical Monday. For each item of care that is delayed or missed, the patient has received subpar care. This is not the fault of the ED, but of the system. If the facility cares about its patients and outcomes, these issues should be looked at by the highest of administrators. An ICU patient is an ICU patient no matter where they are physically located and should be treated as such. They deserve our best. And please, ICU nurses, it's not that we don't know HOW to take care of your patients, we are just dealing with a different set of rules...please be kind and give us a little slack.
ReplyDeleteHey, Nice blog action. You are catching on very quickly. Don't forget to add a Twitter widget.
ReplyDeleteIt's a nurse thing - I couldn't have said it better myself!!!!
ReplyDeleteThe title of ICU vs ED is very appropriate. We are all here for patient care, we went to the same schools and read the same books. Why don't ED and ICU nurses mesh? I honestly don't understand how it all started. Maybe they think we're not as smart or as educated. I wish some ICU nurses would let us in on the "deal." We need some open communication so that each unit can understand the circumstances and pressures of the other. I actually had 3 occasions lately that an ICU nurse was pleasant to me. If you can count them on one hand or even remember each incident individually...it's not a good thing. If something didn't get done, it's a matter of time, not laziness...trust me. In the best interest of the patient, let's work together and spend our time taking care of those who are critically ill that need skills and attention and not spend our time pointing out shortcomings and "bad mouthing" each other. Just a thought.
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