Why do Critical Care nurses look down their noses at Med-Surg nurses? - page 2

by marisatheresa

43,225 Views | 58 Comments

I'm a med-surg nurse and proud to be one. I routinely care for 5-7 patients on day shift, who present with a variety of complex, acute conditions. Whenever I transfer a patient to a critical care unit - it doesn't matter which... Read More


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    Haha... I was much more patient in the ICU and yes some of the med-surg Nurses are awesome!.....some just push my buttons especially when they administer Lovenox right before i call the patient for a procedure under general anesthesia, or give patient a little water right before general anesthesia aaaarrggg!!! I just want to scream but i remain calm and cancel the procedure, let the surgeon do the yelling:-)
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    I have nothing but respect for floor nurses- I've never had more than 4 patients at a time, ever. One of my best friends is med-surg/tele nurse in a semi-rural hospital (or as she jokes, "we are the garbage dump for the rest of the hospital"); she'll be in charge with 6 patients.

    I started out as a cardiac telemetry nurse with high acuity patients in a huge university hospital and have been working in their CVICU where we get the sickest of the sick since then. Full disclosure; I have never worked as a nurse anywhere without tele monitors except the clinic I volunteer in (when those people complain loudly, outwardly I'm all sympathetic like, "It must be rough to have a sprained ankle!"...in me head I'm like, "Y'all can walk and talk, autoregulate your hemodynamics and BREATHE on your own, you're doing juuuuust fine so take a number!") To be fair though, it's all a matter of perspective; I hope they never have to come to my unit and can continue to complain happily and healthily. Just do it away from me

    How do you guys manage without tele?!

    ANYWAY, I have been on the receiving end on the ICU snobbery as a new nurse from the neighboring CICU nurses who would literally sigh when I brought someone over (it wasn't just me either..), EVEN though with time, I had managed to make my transfer reports very thorough for them.....and they would STILL ask irrelevant questions (I say this now with hindsight too...they didn't need some of the info they asked for in order to provide post-arrest care). But, I think that was fairly isolated to that particular ICU and a core group of individuals.

    We also had dual unit nurses who spent half their time on my unit and half in CICU. I used to get miffed when they would hardly ever seem to listen to my report. Now, having worked in a cardiac-focused ICU, I can understand why they did that. My patients were all fairly stable with AICDs/pacemakers; they were fine, no pressors, no swans, no assist devices...they are FINE....go home and sleep little tele nurse....even the sickie chronics on that floor were usually never quite ICU caliber. We all used to get excited when we had a patient on dopamine at 1 ...

    And nowadays when I receive people, I do my very best to be thorough, but gentle, especially as many of the nurses on the floor are newer, and I've been there, not that long ago myself. I've always wanted a chance to grill the survival flight nurses but they don't give a report until at bedside and usually don't stay longer than 10 minutes unless someone is REALLY crashing as they roll them in.

    I think many times, depending on the ICU, if they have intensivists and team with NPs/PAs, at least at my facility, they are grilling us about the details we learned from report, and many times they are not very gentle about it themselves. I think a lot of the snobbery is really displacement originating from the docs and advanced practitioners. It's not right, but there you have it.
    tazz_rn, not.done.yet, and CoffeeGeekRN like this.
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    Quote from 240zRN
    Not sure if I picked up the mentality from school or what, but the mentality that ICU/ED nurses surpass med/surg in competency is pervasive-- and impressionable new nurses like myself tend to absorb such attitudes. It's funny how many people internalize this feeling though. Many (even seasoned/veteran) nurses I've worked with in the ICU snub their noses at floor nurses for being (clueless/incompetent/empty-headed) inferior to them in skill and/or importance. That is BS. Total and complete BS. I ate a huge piece of humble pie when I saw first hand what they do up their. They may task more than other nurses, but it is because they don't always have the time to "play doctor" like many ICU nurses. It is a lot of hard backbreaking work being a medsurg nurse, and my hats go off to them. To assume they can't wrap their head around patho the way ICU nurses can is also complete BS-many of them understand patho to a level that is acceptable for their required level of responsiveness. So what if they don't know the in depth pathways of hypotensive crisis and levophed; why should they? They don't use that stuff. I'll tell you what though, they are experts in their own ways--their expertize are simply not appreciated by ICU nurses because they can't relate to them.

    *NOT ALL*, but many ICU nurses I've come across believe that the sun rises and sets on their ***. If report isn't given isn't an ICU report, it is "unsatisfactory,"--not all departments of nursing involve being familiar with every inch and crevice of a patient. ICU nurses are only fortunate in that they function in a society that tends to favor physical science over many other perspectives of practice. Technology and medical science gets respect FIRST, feelings and accessory matters of the human experience tend to get residual thanks in our society. Medsurg/LTC/Home Care/etc nurses are the unthanked bunch. It is a lot easier doing a job when you have the constant reinforcement of praise. "Oh you're an ICU nurse, WOW you TRULY SAVE LIVES." vs "Oh you're a med-surg nurse? Don't worry, put in your time and maybe you can be an ICU/ED nurse and REALLY save lives"

    Rubbish.

    By the way, I'm an ICU nurse who was lucky enough to find work in a Prevention/Public Health clinic PRN that taught me that PREVENTION/REHAB nurses are the REAL life savers in health care.
    Hell yeah! You rock!!!
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    i suspect than an icu nurse who looks down on a med/surg nurse is someone who has never worked anywhere other than icu. i've worked med/surg, and i'm too old to work that hard any more!
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    Quote from SICU_Murse

    Let me begin by telling you -- I began my career on a tele unit where I routinely cared for 5-6 patients a night. I currently work FT in the SICU at a large community hospital and I also work per deim in the critical care float pool for a large university hospital.

    When I recieve report on a patient coming from the floor I expect the M/S RN to know some basic information about their patient for example -- PMHX, Reason for current admission, events leading up to deterioration / ICU transfer, baseline vitals, current vitals, baseline physical assessment, current physical assessment, current IV lines, current medications that could have contributed to the transfer, and lab results from the day of transfer. These are basic things that ALL nurses should know about their patients -- ESPECIALLY if they are working on transferring them to a higher level of care.

    You guys on the floor are very task oriented. I am not discrediting this type of nursing, but most of you do not understand the pathophysiology behind many of the disease processes for which you care for. Many times you do not know what to do for your patients when there is a devation in their vital signs from baseline. Many of you are not proficent in basic nursing procedures such as establishing adequate IV access (no that #24G you just put in is not considered adequate). Many of you do not understand the physiological effects of the medications that you administer. -- It would be my best guess that these are some of the many reasons ICU nurses get irritated with you when you transfer a patient to thier unit.

    Just my
    I'm soon to be a graduate nurse but I've worked in the medical field for almost 10 yrs. This is so condescending. Seriously, you have a couple of patients. Take the time & go thru your own charts! Memories are faulty & you're supposed to assess your patient anyway! I'm going to be a Med Surg RN & I will refuse to put up w/ that holier than thou attitude.
    Peninah7 and parker86 like this.
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    Quote from yshell12
    i'm soon to be a graduate nurse but i've worked in the medical field for almost 10 yrs. this is so condescending. seriously, you have a couple of patients. take the time & go thru your own charts! memories are faulty & you're supposed to assess your patient anyway! i'm going to be a med surg rn & i will refuse to put up w/ that holier than thou attitude.
    ​ouch! speaking of attitude . . . .
    tazz_rn and CoffeeGeekRN like this.
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    Having been on every side of a six sided fence, military, private duty, agency, med-surg, step down and critical care. I do know what each side is referring to. I also know that it is all a matter of perception, no really, it is. It is what you become accustomed to. If you work on a med-surg unit with 7-9 patients / shift then, you become used to that workload and pace yourself for that. If you were to transfer to another unit that only took 5-6 patients per shift, you might say, wow, this is a piece of cake for a week or so, but after a short period of adjustment your cognition would begin to evolve and your work habits would adjust and you'd once again, be busy for your entire shift, and happy to see the time clock signal the end of your shift. You may wonder what this has to do with one unit supposedly looking down their noses at another. Let me say, for me, I don't. I thank God there are Nurses who love to work in the various units, because I don't like it. In fact, I've already admitted in another blog, I don't like sick people. I can be up to my elbows in someone's chest or doing open heart massage all day long, but don't let them puke on me. If they do that, I'm done. I just can't get past the smell. After I worked in the units for so many years, I had a real problem floating as well. Later on in my career, if I was called on to float, I would go to the floors and try to do the same things I did in the unit, head to toe assessments, yada, yada, etc, not good. So, I thank God there are people who love med-surg and I got along with them quite well. Most of them understood the necessity of what was required for report and usually it was readily supplied. I don't want this to sound sexist but to be honest, I think being a male had something to do with the way I was treated. Back then there weren't as many males in the Nursing profession and we tended to be treated with more respect than I saw some of the newer grad being treated as I progressed in my career.
    limaRN likes this.
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    I am sorry that you get treated like this. Unfortunatly I see it all the time , I am an older nurse and have worked every unit over the span of my nursing career. If I hear this going on I do not hesitate to tell my co-worker how it is! I still have to occasionally float to the med surg/med tel units and I see how horrible it can be . I also do remember what it is like to try to keep track of 6-8 pts and two to three admissions a shift . The ICU nurses need to be kinder to the over-worked "floor" nurses !
    CoffeeGeekRN likes this.
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    Good for you yshell. I agree that post did come off with a "chip on my shoulder" vibe. I'm new to icu nursing but I started off Tele . I've run into a bunch of icu-rns that give others a hard time. You just have to stick to your ground and give em what you got. My hospital uses online health records so in the time I could argue over moot info I could just as easily look it up
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    I usually work on a tele floor with 6-8 patients. I've been pulled to almost every other floor in the hospital, including the ICU. I love the unit. I got an amazingly thorough report for the outgoing nurse and gave a spectacular report when leaving. I knew my patients (2 of them) very well. Yes, they were more critical. Much more. However, I've had the same level when our floor is the ICU diversion acceptor. Having 1 unit level patient really causes problems when there are 5 other patients you are also responsible for.

    Anyhow, I hadnt encountered rude ICU nurses until a couple were pulled to my unit. They were hazy receiving report on 6 patients. They asked what I felt to be crazy questions. Unrelated to the diagnosis. Or asked me what a decub looked like and acted shocked when I told her we could go see it together. Honestly, I'd felt superior after not being able to hand the same report to her as I'd given when floated to ICU. She apologized profusely that night and said she hadn't worked the floor in so long the forgot how challenging it can be.


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