Why do Critical Care nurses look down their noses at Med-Surg nurses? - page 4

by marisatheresa 45,574 Views | 60 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


  1. 1
    Woww....we all have right to speak our opinion so here goes mine in response to yours...I feel sorry that there are people like you in this profession that feel it's okay to speak down about others..."many of you are not proficient in basic nursing procedures..." Really?!?!

    You obviously need some growth or can I say maturity. I wish you well.
    tonightwedance likes this.
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    My comment was for SICU Murse
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    Settle down everyone! Haha. Cray cray.

    I think med-surg nurses have a roooouuuugh job. They have 6-10 patients at a time. And even if they are the healthiest patients that's still a lot to keep track of during a shift with regular patient care and meds. They don't have the time or luxury to know every single thing about their patients like us ICU nurses do. It's apples and oranges. My time is filled with charting q1 and q2, drawing serial labs and abgs, replacing electrolytes and blood products, managing their vent, titrating their pressors and sedatives, dealing with rotoprone beds, CRRT, ECMO, IABPs, swans, hypothermia, etc. So there's a reason I have 2 patients at time. But it's not like med-surg nurses are just sitting around either.

    Although, I do have one story about a med surg nurse that just irritated me so much for some reason. I was transferring a patient out of the ICU to a monitored bed and the zoll started ringing out v-tach, but it was obviously not v-tach. Obviously. And the nurse started panicking and asking if we should start cpr. I said no, it's just artifact and it's nothing to worry about. But she would not believe me and just let it alone. It was aggravating. Even more-so because she works with monitored patients fairly often so she should know how to interperet an ekg.
    Stalirris likes this.
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    I work on a medical respiratory ward and care for 9 patients on a good day. If we are short staffed however (which is the majority of the time) I look after 12 patients. Its hard work, you are constantly run off your feet and unfortunately you cannot possibly be able to recall every detail about a patient who you are transferring. I can understand why critical care nurses need to have all the information so I do try to have it to hand in advance, but CC nurses do sometimes need to be a little more understanding of the fact that us floor nurses are extremely busy, often caring for several complex care patients aswell as the critical patient whom we are transferring to your care, we can only be in one place at a time and have lots of patients who need us. I'm not trying to criticize anyone, we should all have more respect and understanding for one anothers roles, after all we are a team and there is no 'I' in team.
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    Craymond18, you list all of the jobs you have to do with your 2 patients in a day. I will say two things.
    1. I have to do many of the same jobs for my 9-12 patients every day.
    2. ICU nurses are very good at delegating the non nursing tasks to healthcare assistants.
    That is all.
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    Quote from loftay13
    Craymond18, you list all of the jobs you have to do with your 2 patients in a day. I will say two things. 1. I have to do many of the same jobs for my 9-12 patients every day. 2. ICU nurses are very good at delegating the non nursing tasks to healthcare assistants.That is all.
    For your second point, I find the opposite to be true. The floors at my hospital have PCTs that do the majority of basic pt care, while the ICUs don't have PCTs. Or they do but they stock supplies and maybe do blood sugars. If my ICU has a PCT on a shift they do blood sugars and restock basic things like gloves. And maybe help boost a pt in bed. I give all my baths, wipe crap, etc. At any rate, when I get a transfer up I ask about why they're coming and the physical assessment. I can look up labs and everything else in the computer. I work with a few high strung CC nurses and they grind my gears sometimes too. Do I know what a pt's abg looked like a week ago? No. Not generally.
    Stalirris and Janey496 like this.
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    Wow. There is such animosity on here. We are all nurses and all have our own specialties. but yes. Icu nurses ask a lot of questions when the patient is brought. I am such a nurse. Here's why I ask what I ask. Generally from the floor the patient is rushed down in a hurry. More times than not the patient is circling the drain during that time all hands are on deck so to speak. The reason questions are asked is because THE DOCTOR asks us those questions!!! We have become accustomed to answering the doctors questions on the fly while providing care (starting second and third iv's setting up for Intubation and ect..) The reason why we ask what happened and why was this not done is again because the doctor asks. But also some times this is a vital piece of the puzzle that might have been over looked. Like a med was not given because a patient was nauseated or having swallowing difficulties ect.... another thing as far as lab values go you should know your lab values on a medsurg floor. There are so many medications that are given that u need to know. You ESP need to know potassium!
    I am afraid to admit that sometime I get short with a nurse bringing a patient. But That's when every question I ask is followed with a response of "I don't know."
    Please tell us what happened. Why do u think it happened. What is their history. Could it have contributed? What are any pertinent labs. Have u noticed anything changing. Like wbc from 5 to 35. Ect.... U know what needs to be shared. Info u would need yourself. Don't make this about messing vs icu. This is about the PATIENT. And that info the icu nurse quizzes u about.... U might have that one piece of info that you might not perceive as being important but it sends a red flag to the icu nurse that ultimately saves their life. All because you the medsurg nurse had the answer. alot of time I know we come off as being hateful and short but too that's because our brains r going 100000 miles an hour of what's going on. What will the doctor want to know. What do I need to next. And so on and so on. As well as I have a sick pt next door and I have all this other stuff to do as well....
    Again you a medsurg nurse are asked a medly of questions because we value what u know and what u tell us is passed on.
    Janey496 likes this.
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    Shame on anyone of you who are talking down to Med/Surg and ICU nurses alike. We all went to nursing school, we all passed the NCLEX examination and at the end of the day, we are there for our patients! I am a RN who is trained in both critical care and medical/surgical specialties. I have my CMSRN credential, can take care of 6+ patients and have excellent assessment and management skills. I chose to specialize in medical/surgical nursing because I like the fast paced environment and patient interaction. I also enjoyed my time in MICU taking care of very high acuity patients and their families. The focus on each unit is different, the pace is different, the patient load is different, the acuity is different....but we are all nurses. ICU nurses are not smarter, they don't understand pathophysiology better....they have a specific interest and talent for working with very high acuity patients. Med/Surg nurses aren't always better at handling more patients and don't always work harder than ICU nurses on a given day.......they have an interest in working with many clients who have many unique medical conditions. These are two separate specialties within the same profession. We must stand our ground as professional nurses together. If you feel superior because you work in ICU or ED or OR, than I feel bad for you. Please do yourself a favor and leave the nursing profession. I became a nurse because I didn't feel like having ******* contests with my colleagues all day. I want my patients to go home to their families and get better. Remember where you came from please. If you need to see credentials or hear from someone how well they did in school or how well they know disease process based on their chosen specialty of nursing practice- then check your facts, I'm sure you will be surprised at what you find.
    IH8Poodlez likes this.
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    There is no excuse for any specialty to look down on another. We are all on the same team. That said, for anyone who hasn't worked in ICU, I want to highlight a few things I've noticed.

    When I worked med/surg, unless I had patients several nights in a row, I never felt like I really knew everything that was going on with them. I could grab my report sheet and tell you my current observations, admitting diagnosis, vitals, where their IV's are, lab values, etc--but I would never know all that off the top of my head or be able to tell you that their urine output had been falling over the past 3 hours, for example. When you're passing a million meds, restarting bad IVs, often covering for lack of PCA staffing, admitting, discharging, unless perhaps you're super nurse who's been doing it for 30 years, I don't think it is realistic to expect you to know your patients very well.

    From an ICU nurses perspective, it is really hard to treat a patient without knowing some things. When responding to rapid responses or codes, I don't know how often I hear "I don't know" to every question asked of the nurse caring for the patient. The patient is lethargic and diaphoretic... has anyone checked a blood sugar? "No, not yet." Blood pressure is dropping--how has the urine output been? "I don't know". They've had a heart rhythm change, what do their labs look like? "No idea." These are just examples I've come across again and again. Some nurses look at us like, "I don't know, just fix them or take them to ICU!" But we all know it isn't that simple most of the time. Do I look down on the nurse or think them less intelligent? Heck no. I remember feeling like a deer in the headlights whenever a patient went south. That isn't a fault of the nurse but a fault of the system for such a high patient to nurse ratio.

    On the flip side, I think med/surg nurses often think ICU nurses are just sitting around chilling with two patients. But those two patients truly do require almost constant attention. At my facility, we don't have PCA's in the ICU-and no secretary at night. So, we put orders in, clean the poop, get patients up, give the baths, draw labs, dress the wounds, and all this on top of managing drips, writing down vitals every 15 minutes, charting, etc.

    All this to say--I think we should all have respect for what we each do. We all do the jobs we're trained to do. If anyone could manage 6 patients and know and care for each of them as well as an ICU nurse with their 2 patients, there would be no need for ICUs in the first place.
    Yuppers21, Janey496, and nrsang97 like this.
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    I held onto this thought until I had browsed through all other posts, and am shocked no one else brought this up.

    As a med-surg nurse, night shift, typically 8-9 patient per shift (and I will um, witch-slap the next who tries to tell me patients just sleep all night, I swear I will! :P), with no PCTs and CNAs who could do little more than empty foleys, assist patients to the BR, and provide hygiene care, you do have tons of things to do. You might not have time to get down to the nitty gritty, certainly not every shift. But how about this: Instead of feeling sorry for yourself and getting upset at the mean old critical care nurses who are abrupt with you because you don't know everything, how about you use it as a learning opportunity? CC nurses are trained to see the bigger picture while we barely keep our heads above water with the general details at times. But that doesn't mean that it wouldn't be a GOOD thing to be able to see the bigger picture. As others have asked, if the CC nurse asks these details, they must think it is pertinent, that it might be related to the patient being transferred to their unit. Take a second and think about their rationale. Maybe one day you will end up picking up on something because you noticed a similar trend in those 'useless details' some CC nurse was harassing you for. Try to expand your mind as well as your nursing practice and critical thinking skills instead of feeling sorry for yourself and engaging in all this inter-unit hatred.

    Many CC nurses would be useless in med-surg, unless they worked their way up to their CC department. Just like many med-surg nurses would be curled up in a corner, fetal position and all, if they had to deal with the psychological, intellectual, and physical duress of CC. And put either of these nurses in LTC, stand back, and watch the utter chaos! :P

    Instead of complaining about each other, lets try empathy and appreciation for the HARD WORK that we ALL DO!
    Stalirris, txnurse48, julieface, and 5 others like this.


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