Why do Critical Care nurses look down their noses at Med-Surg nurses? - page 3

by marisatheresa

44,340 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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    Quote from ruby vee
    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!
    you are so right! i too started in med/surg because we didn't have an icu when i started out in nursing. when the icu opened, i floated down a couple of times and i ended up transferring shortly after that. icu nurses work hard, but so do med/surg nurses. physically i would never have lasted 54 years in acute care nursing had i stayed a med/surg nurse. any icu nurse who is critical of med/surg nurses needs to work on the floor for a few years to see what its like. i was draw to the icu because, honestly, because its easier for me to be organized when one or two patients who i know are very sick vs having 7-10 patients who could go south. i was less stressed in the icu once i transferred. there are med/surg nurses and icu nurses out there who could work in any kind of nursing and they would be great. there are others who are good within a narrow scope of nursing...one or the other. i am in that narrow scope. i was a great icu nurse back in my day. i was an okay floor nurse.

    cheers to you from one old school nurse to another.

    mrs h.
    Janey496 and CoffeeGeekRN like this.
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    Im from the ED so its kinda of like ED vs the rest of the hospital. Anyways, one day i felt that an ICU nurse talked down on me. Im not sure why but it happened. It didnt bother me at all. Ive never worked a single shift in icu but i got my CCRN anyway. Now nobody in the icu can feel like theyre "superior" compared to me.I guess its like the more you know, the more you expect from people. I do not talk down on people but when their ego gets too much of themselves, i just ignore them.
    ERnurseM likes this.
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    I'm a ER guy. I think when you assume you make an ass out of yourself. You think when I get someone critical from the field I get every single info about them. But I still have to work with pretty much nothing. Get over it. Find the most important stuff stabilize the person first. And don't give ppl hard time bc they don't know if the pt has hairs on her toes or not. If your on a team you pick up the game you don't blame your teammates, management will do that for you. Help your fellow nurse not pick on them.
    Janey496, tonightwedance, KayRN1, and 3 others like this.
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    I am going to be brutally honest here. I am an ICU nurse. I work in a hospital where the ICU nurses respond to all codes or MET calls. I have seen the sheer utter stupidity of floor nurses. I have walked in on a coding patient and seen the floor nurses standing there. No one doing compressions, no one bagging. I have coded a DNR because the floor nurse forgot to band the patient. I have been delivered a dead patient to the ICU because the floor nurse didnt think to attach a monitor for transport. I have transferred a patient to the floor and had them code hours later because the floor nurse gave him ativan when he was SOB which further depressed his respiratory drive and led to respiratory failure. I worked on a med surg unit as a tech and watched the nurses sit around and eat bon bons all day. Those patients are allowed out of bed, they can feed themselves and if they cant do either of these things, you have a CNA to do them for you. You have a CNA to get their vitals. You have transport to take them for their tests. You have MIVF and maybe some antibiotics and pain medicine to give. I have floated to med/surg floors. The charting sucks because you have to do assessments on 5-6 patients. BOO HOO. In ICU you have to chart hourly intake and output on all drips infusing, while titrating the drips while medicating the patient with sedation and pain medication while managing the ventilator while turning your patient every two hours. Sometimes they are on CRRT (dialysis) which the nurse manages, they can have q30 min accuchecks or q1h accuchecks. You have to do Q1h neuro checks on neuro patients. You have to deal with distraught family members and be able to accurately describe every intervention that you do every medicine they are on and every wire attached to them. You have to manage a bolts in their heads and patients with bone flaps missing and open bellys and open chests. You still have to bathe them and clean **** and change linens on top of trying to stabalize a bp or icp or cpp or hr or ci or co or svv or pap. You have patients that are on ventilators and need suctioning every 30 minutes or they will drown in their secretions. You have nights where you transfuse 30 units of blood and 18 liters of fluid and the patient lives. You change dressings on patients with open chests or fasciotomies or open bellies. You have chest tubes dumping 400cc of frank blood and hour. And you have protocols that detail every move you make, you call a doctor for any of this stuff and you get yelled at. If you are upset because an ICU nurse was mean to you when she was getting report it was because she didnt want to hear the bs report you were giving and wanted to jump to the nitty gritty. If she wants to know labs its because we have a protocol that tells us we have to replace all their electrolytes and get them in a perfect balance. If she wants to know where the family is its because she plans to spend ungodly amounts of time updating them on the current plan of care and explaining the pathophysiology of whats gone on thus far. We dont have CNAs to do our work, they arent even allowed to empty our foleys or get a BS for us. Give the ICU nurse some slack... Im sure med surg nurses can have hell shifts and have to run their butts of but when every day is like i described to you and the easy shifts are few and far between you learn to ask what you want to know and get it over with quick so that you can get to what matters... saving lives.
    Heather33, tazz_rn, Akewataru, and 1 other like this.
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    Well said Craymond!
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    Huh, if I didn't know better, after reading this thread I'd conclude that nursing is a hard job on most fronts.
    Silly, eh? It's best we just plug along with the idea that we all suffer alone.
    Savvy20RN, Rosegachau, HMAmara, and 5 others like this.
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    Craymond +1.

    As an icu nurse, and a former stepdown nurse, I will say that floor nursing is not easy. But it's on a whole different level of hard when compared to "hard" in the icu. In the ICU, the bar is set high as far as nursing expectations, critical thinking, & pathophysiology, and any momentary lapse has grave consequences. I felt like a hard day on stepdown was related more to difficulty with multiple tasks and completing them... honestly some days I felt like a glorified waiter. Nowadays, I feel like a hard day in the ICU is both physically and mentally draining, as there is no time for a "mental break," and you are constantly problem solving and trying to stay 2 steps ahead.

    I know that many of the floor nurses where I work do look at ICU nurses as snobby, standoffish, elitist, & aggressive. However, just know, most of the time it's nothing personal. I think part of the aggressive attitude has to do with the type of personality needed in the ICU. Additionally, 99% of the time, ICU nurses are under crazy time constraints, especially when it comes to transferring patients out to admit crashing or fresh post-op patients. That's why we always seem in a rush & why we are ancy to get to the nitty gritty.. again nothing personal, but just a little insight from someone who's been on both sides.
    Janey496, tazz_rn, and njs5068 like this.
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    Quote from EtherFever
    Craymond +1.

    As an icu nurse, and a former stepdown nurse, I will say that floor nursing is not easy. But it's on a whole different level of hard when compared to "hard" in the icu. In the ICU, the bar is set high as far as nursing expectations, critical thinking, & pathophysiology, and any momentary lapse has grave consequences. I felt like a hard day on stepdown was related more to difficulty with multiple tasks and completing them... honestly some days I felt like a glorified waiter. Nowadays, I feel like a hard day in the ICU is both physically and mentally draining, as there is no time for a "mental break," and you are constantly problem solving and trying to stay 2 steps ahead.

    I know that many of the floor nurses where I work do look at ICU nurses as snobby, standoffish, elitist, & aggressive. However, just know, most of the time it's nothing personal. I think part of the aggressive attitude has to do with the type of personality needed in the ICU. Additionally, 99% of the time, ICU nurses are under crazy time constraints, especially when it comes to transferring patients out to admit crashing or fresh post-op patients. That's why we always seem in a rush & why we are ancy to get to the nitty gritty.. again nothing personal, but just a little insight from someone who's been on both sides.
    This describes ICU nurses as loosing the ability to converse tactfully. You indirectly described floor nurses as glorified waiters. Medical floor nurses where I work routinely get unstable patients. Otherwise they would be discharged and get outpatient treatment.
    littlepeopleRNICU likes this.
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    The funny thing is from my experience floor nurses and ICU nurses are paid the same rate.

    We all went to nursing school and learned the same thing. Some choose to take additional training in order to specialize. It doesn't matter if you work in the ICU, floor or clinic we are there to do one thing. Take care of the patients. And yes, I have worked in the ICU and the floors.
    littlepeopleRNICU and EtherFever like this.
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    Quote from maryray
    This describes ICU nurses as loosing the ability to converse tactfully. You indirectly described floor nurses as glorified waiters. Medical floor nurses where I work routinely get unstable patients. Otherwise they would be discharged and get outpatient treatment.
    I'm not looking down at floor nurses, nor am I calling them glorified waiters. I'm simply making a comparision that some days as a floor nurse, I felt like one ex. having a busy day r/t to the multitude of small and insignificant things that patients ask for. And I'm not saying its always like that. I do respect floor nurses, as they have to catch small details that hint at a patient about to go downhill, with less concrete numbers available compared to the ICU. Floor nursing is difficult, but in ways that differ than in the ICU.

    ICU nurses where I work are usually very aggressive in advocating for patients, are aggressive in getting things done in fast but in a safe and correct way. We do this to stay 2 steps ahead in case something unexpected happens. Sometimes this personality can come across when giving or getting report from floor nurses, hence the idea that ICU nurses look down on floor nurses. Some strongly opinionated ICU nurses that I know don't care what other nurses think of them, so this can come off as standoffish. I personally do not look down on floor nurses, nor do I think I am better than floor nurses. I'm just offerring some perspective as to the reasons why some of us are the way we are.

    Since I do have floor nursing exp, I try to apply that to my practice i.e. changing dsg in the am so they don't have to do them, getting an extra walk in with my pt so it's one less they have to do on the floor, etc. I am more patient when giving or receiving report, because I do remember how it was on the floor. And I try to help other nurses on my unit, specifically the newer orientees, in understanding floor nursing, and in trying to dispel this attitude that ICU nurses are superior to floor nurses. So I hope this clarifies my previous post, in that I do not support the idea of ICU v. Floor nurse, I'm merely stating the reasons why it exists.

    ICU & floor nursing...It's all apples to oranges, and unless you've done both, it is difficult to understand.
    Last edit by EtherFever on Nov 28, '12
    Heather33, Janey496, and tazz_rn like this.


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