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

[marisatheresa]

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 one- MI, CTI CCI, Neuro, or Burn, the critical care nurse asks all sorts of irrelevant questions, such as what K+ was four shifts ago? Why is it so hard for critical care nurses to understand that floor nurses don't have the luxury of sitting in their little booths outside the patient's room and picking through the weeds in the chart? I understand that medical nursing and CC nursing are two different levels of care, so why ca't CC nurses understand that as well. Why do they think we are grunts and they are the fighter pilots of the hospital? Can anyone who works in CC give me some insight into the condescending attitude of CC nurses toward floor nurses? Oh well, for every time I encounter condescension from a CC receiving nurse, I have just as many opportunities to graciously throw them a life preserver when they are forced to float to the floor and can't handle the 5 easiest patients on the floor. Seriously, can anyone help me better understand where a CC nurse is coming from and what/why they expect so many details - details that they could just as easily find in the chart vs. expecting to be spoon feed from the sending nurse?

[festanie1]

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.

[nursetvs]

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.

[Stratiotes]

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.

[uRNmyway, ASN, RN]

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! ), 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!

Instead of complaining about each other, lets try empathy and appreciation for the HARD WORK that we ALL DO!

[Despareux]

Just accepted a neurotrauma ICU position after working as a med/surg telemetry RN for the last 6 months. I'm keeping my med/surg position as a casual and my new position will be part-time. Now I understand why my med/surg colleagues told me to try to work our unit at least a few times per month to maintain med/surg skills.

[tazz_rn]

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! ), 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!

Instead of complaining about each other, lets try empathy and appreciation for the HARD WORK that we ALL DO!

perfectly said!!:)

[PatMac10,RN, RN]

Critical care nurses look at trends in caring for their patients, as most nurses should and probably do, even on Med-Surg/Tele units.

The critical care nurse needs to know what that K+ was 4 data ago bc they know they if the patient went from 4.3 to 3.0 over the course of three days then there are significant risks for cardiac abnormalities or contribute to other electrolyte imbalances.

[PRNketamine]

There is stupid in every unit. It really isn't about where you work.

I have to say I cringe at getting report from the ED. But it doesn't necessarily reflect on the unit. Just the person giving the report. You should know basic things. Do they have IV access, do they have fluids running, if they are intubated what are the vent settings, baseline vitals, anything out of the ordinary. That's all I really want to know. I can figure the rest out.

Again, we are all nurses, we all went to school. They only time I look down on the person giving me report is when it is clear they haven't even assessed them. What do you mean you don't know if they have an IV? That is ridiculous.

But again, the person not the unit.

[sixfigurenurse]

I started off in a Cardio-Vascular Surgical Intensive Care Unit when I first graduated from school. I was told to apply anywhere else because the CVSICU did not accept new grads. I told them this was the only unit I was applying for. The next day she called me back and I had the job. I say this story to let you know a little bit of the mindset of Critical Care nurses. We are bold, we are brash, we are in the doctor's faces telling them what WE think needs to be done for this patient. We know where every freckle on our patient's body is. I am now in the ICU float pool. Recently I accepted a float shift on a med surge unit. I am always being told that if I can work ICU then I can work med-surge no problem. I had a fine shift, but it was chaotic and I have no intention of making it back there anytime soon. I think that med-surge nurses are ANGELS. Taking care of that many patients is extremely difficult. I felt like I was simply walking into random patients' rooms, handing them a few meds and that was the last I saw them. I think the thing for ICU nurses (and I am not saying I agree with it, just simply a doorway into their mind), is that we have gotten transfers from the floor where the nurse taking care of them did not know how to answer ANY of our questions. Basic things like admitting diagnosis. I can remember getting a patient transferred to my ICU with STAT medications that were over 2 hours past due - the nurse told me that he was too busy with his other patients to give the meds to him. The problem with that for me is that this patient is being transferred to the ICU! Someone needs to give STAT meds in a timely manner for a patient that is being transferred to an ICU. This lack of care by one nurse on a med-surge unit gets over-generalized to ALL med-surge nurses. We all do this in many things. In fact, your own post suggests that ICU nurses are generally snobs. This is perhaps true as a generalization but not for each individual. You are right, most ICU nurses would drowned if they had to do what you do. I did it one night and I see you in a whole new light. Again, I now say that you are an ANGEL and I have re-evaluated my thoughts toward med-surge nurses and I try to be more patient. Unfortunately, not enough ICU nurses have walked in your shoes, and unfortunately, not enough med-surge nurses have walked in our shoes. Compassion TOWARDS all nurses should be a focus FOR all nurses.

[Julius Seizure]

Wow. As an ICU nurse, I feel really beat up on in this thread.

I'm sorry that so many of you have had bad experiences, but this isn't how it is at my hospital at all. I often hear ICU nurses say to the floor nurses that they would never be able to do their job. I would never be happy as a med surg nurse myself, not because it is easy, but because its just not how my brain works. More power to ya, med surg nurses. I could never do your job and do it well. But please, can't BOTH sides cut EACH OTHER a break? If you are asked a question and don't know just say "I don't know, but it's in the record." Or that you arent sure off the top of your head. Youve been busy with pt care, its ok that you havent been reading up for the last hour on your pts history while they are needing your constant attention. lets work together. Some people are nasty, sure, but most are probably just asking what they are wondering about with their ICU-world brains. You know? Maybe you are hearing nastiness where none is meant sometimes? Anyway, I don't mean to offend with any of this......but it just seems like a lot of anger and generalization!

[Julius Seizure]

I'd also add that I think many hospitals have poor staffing levels, as we all know.....if you have 9 patients and don't have time to read up on their histories and they nurse before you gave a poor report because she didn't have time either.....well that's not because you are a bad nurse. Is a system problem. I think sometimes maybe the frustration that you hear in the ICU nurses voice is in response to THAT, not an affront to you personally.

[PatMac10,RN, RN]

Critical care nurses look at trends in caring for their patients, as most nurses should and probably do, even on Med-Surg/Tele units.

The critical care nurse needs to know what that K+ was 4 data ago bc they know they if the patient went from 4.3 to 3.0 over the course of three days then there are significant risks for cardiac abnormalities or contribute to other electrolyte imbalances.

I want to add something to my statement. I never condone ill-treatment. Some people just have bad days or highly stressful jobs. I've worked many twelves and have has to check my attitude. Most nurses that will work on the floor will not remember a 4day old lab of the top of their head, unless it was some crazy level or attached to some crazy event.

I think when a critical care nurse asks for such a lab, they are trying to get an understanding of how this patients condition is progressing (or worsening) and what things they'll need to keep in mind during their care of a patient. Do if you can't remember that lab off back, maybe you can give the critical care nurse an idea of how they were trending. In the end, a CC nurse has a lot to do, just as the MS nurse does. I would rather get a detailed report with some "extra" and seemingly "unnecessary" thrown in there than a shabby report any day!

Med-Surg Nurses do have difficult jobs, so do critic care nurses. If the skill of teamwork and tolerance was integrated into some people's heads a little more, maybe we could have more functional nursing units.