So we got a very anemic little old lady from the nursing home, who was also septic and whose INR was oh, a ZILLION. Total mess. She coded twice while we were trying to stabilize her. And she came back (or at least her pulse did) twice.
I was trying to get her upstairs to the ICU as soon as possible, because I really didn't want to code her again. I called report to the ICU nurse:
Me: Hi, this is the ER. We have Mrs. At Death's Door. She is older than dirt and has sepsis and anemia. She is a full code. She's had cultures, foley, central line, levophed, dopamine, blood transfusion, platelets, CVP monitoring, antibiotics, intubated, ventilated, you name it, we did it. Oh, and we coded her twice. And she has a pneumothorax so she has a chest tube. Her vital signs are pulse too high, blood pressure too low, 100% O2 sat vented. Skin is intact--oh, but she has a very large hematoma on her left hand from an IV attempt by EMS. It's very swollen and is actually heavy. Well, that's it! I'll bring her up as soon as respiratory gets here.
ICU Nurse: Did you put a warm compress on the hematoma on her hand?
Me: Hee hee, yeah right.
ICU Nurse: (silence)
Me: Why, yes, I gently applied a wrapped heat pack to her hand, brushed her three teeth, and did full range-of-motion exercises IN BETWEEN CHEST COMPRESSIONS AND PUSHING EPI WHILE WE TRIED TO GET HER HEART STARTED AGAIN.
ICU Nurse: (silence)
And that, in a nutshell, is the difference between the thinking of ICU nurses and ER nurses.
(please don't yell at me, ICU nurses. I'm not saying that ICU nurses are BAD, I'm saying that the nature of their jobs is very detail-oriented, where the nature of an ER nurse's job is very big-picture oriented. And that we're oriented toward snarky comments at times.)
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13 comments:
Now now. We aren't *all* like that!
In my mind's eye I can see Bugs Bunny dressed as an ICU nurse saying,"You realize that THIS means war!"
That is so funny!! I have had those discussions with ICU nurses. And they never seem to have a sense of humor about it either!
Are you missing your methadonian friends and branching out to a new social group?
oh mah gawd puhleeze read the fine printz people!
come one, I know there are ICU nurses with senses of humor out there! Geena? come on? Anyone? Bueller?
You can have your own nursery rhyme - GuitarGirlRN and the 7 trolls.
Make that The Adventures of GuitarGirlRN and the 7 trolls.
This is the reason that while I love working critical care, I HATE working critical care! I can't stand the prioritizing of silly things such as...."did you fill out the QA on the foley catheter? "did you label your tubing? "did you change the foley to a urimeter?" I will send you a CLEAN AND ALIVE patient, with orders. Everything else is negotiable!
You mean the ICU nurse didn't ask when her last bowel movement was???
And she calls herself a CCRN!!!
"Why, yes, I gently applied a wrapped heat pack to her hand, brushed her three teeth, and did full range-of-motion exercises IN BETWEEN CHEST COMPRESSIONS AND PUSHING EPI WHILE WE TRIED TO GET HER HEART STARTED AGAIN."
Hee!
Geena's right, ICU nurses aren't all like that. But there's no point in denying there's a reason why the stereotype exists. When I interviewed for my first ICU position, the charge nurse said, "Welcome to ICU, home of the obsessive-compulsive nurse."
Wow, not as snarky replies as I expected!!!
Actually, I have found med/surg nurses to ask the inane "when did they last have a BM" type of questions. Our ICU nurses are more worried about the exacting details of pressure monitoring, etc... that I didn't even have time to look at..
But you are right, there is a reason I do what I do, and they do what they do... I thrive on insanity; them, not so much...
lets not forget- is her family at the bedside? Will she be able to be discharged back to the facility?
I am an ICU nurse, and am married to an ER nurse! So, my wife keeps me informed on how to take report from the ER! lol.
We ICU nurses have the same problems with the floors nurses when we move out patients from ICU. :O)
Great story though...couldnt stop laughing! I cant wait to tell it to my wife in the morning!
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