Why do Critical Care nurses look down their noses at Med-Surg nurses? - page 5

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... Read More

  1. by   ABitterPill
    Just reading through this thread caused such anxiety in me from memories!!!! I could never understand why this was happening and it was something that drove me absolutely nuts! The ER nurses and the ICU nurses both act like they are sooo much more intelligent than a floor nurse----it's totally ridiculous and makes me furious! I've recently retired as a Med/Surg staff RN and hope to never have go back to hospital floor nursing ever again!! Sorry--just had to get that out.
  2. by   Tnmom3
    Everyone is right. The different focuses b/w units make what's important in report totally different. Kuddos to u, I know I couldn't manage 6 or 7 pts. You are competent enough to detect changes to warrant transfer. So don't feel dumb or belittled. Just glance over last few days labs and X-rays and note changes. I have mrt a floor pt and taken them to icu and caught the grief you feel for no reason. Some are just mad to get a pt. she was asking why we didn't clean her up b/c she pooped in transport. I told her it was best to get her here for intubation rather than a bath in the elevator. She didn't say another word
  3. by   O'Rion
    Let me preface my remarks by saying that I started out on a busy Med/Surg floor with 7-11 and once 13 patients. So I know where you are coming from. I now work PICU and have worked Adult ICU as well as Burns ICU. The level of care is totally different and the things you need to know to care for a deteriorating or crashing patient you need to know them NOW so you can get to the business of saving them. It is stressful for the ICU nurse to get a patient who is not doing well. And you guys on the floor are very very busy and sometimes patients go bad quickly, I get it. I feel we all need to respect each other and be kinder to our colleagues. You never know what someone else is going through and to just assume we're in it together works for me. Shame on those who belittle their colleagues, wherever they work. One day it might be them on YOUR Med/Surg bed! Then how will they act??
    Last edit by O'Rion on Jun 21, '13
  4. by   tigerRN2013
    I am an ICU nurse and I have a lot of respect for floor nurses. I would never want to trade places. Each individual nurse has their own gifts and talents that makes them an asset to a particular kind of unit. ICU nurses are very detail oriented and seem to have the ability to pick up on the most minute changes on their patients. Floor nurses have other skill sets though that make them equally essential to the hospital.
  5. by   Preeps
    I am referring to the Sicu murses reply in this RANT
    Me thinks this is the exact attitude to OP was referring to Funny, first post out of the box reflex this horrible attitude and way of relating to others. Very sad. And very telling. I would not even want someone with a mind set like this taking care of anyone. Your "most of you don't even understand the patho etc" is completely condescending and lumping a large group of people into a box that evidently you have experienced. I actually am sorry for you and the hospital that you work in (not to mention the people that you care for). Sorry for the rant. But this is classic. Maybe, since you are so smart and all you should, instead of belittling and making nurses feel bad you should actually HELP them grow. This posters attitude is a perfect example of What Is Wrong With Nursing (Nurses).
  6. by   GundeRN
    Oh. my. word. I would LOVE to not have to be so task oriented but you know what? Some days I have NO CHOICE. There are just too many tasks to do. I would love to be able to sit down and read through my H&P but in all honesty, sometimes I can't even sit down and chart what I have done until the end of my shift, let alone look anything up during. If I have to transfer a patient for declining on one of these days, I am just breathing a sigh of relief that I caught it. Having someone make me feel like a dope because I can't recite the chart for them is NOT COOL.
  7. by   TrevyRN
    Hahaha... we must celebrate nursing diversity. And when another group of nurses does something that ticks you off, you just shake your head and say, "Ooooh... you ______ nurses... always doing ________!" As an ER nurse I give lots of report to lots of different people (ICU, medical, surgical, hospitals with higher levels of care, nursing homes), you can clearly see the different problems and priorities that people have by the questions asked. You just have to learn to speak different nursing languages :-)

    And OMG kudos to you nursing home and med surg nurses. I don't have the patience for those patients, heheh. And sorry ICU nurses... every time I transfer a patient to you I'm like "SCORE! Moved 'em out!" You know what, I think nurses are pretty awesome generally. We're all cool. Even some of the mean, burned out ones have good sides... for instance, they... uuuh.... uuuuuuuh... set examples of how not to act! Yeaaa...and remind us to use our vacation time every once in a while!
  8. by   Jkan
    I really enjoyed reading everyone's view on ICU, ER and med surg nurses. I've been a nurse for 25 years and left an in patient med/surg floor after being there for 13 years. I worked in a small hospital where a lot of times I would run to codes. It was only in the last few of those 13 years that a hospitalist was present on nights ( only an ER physician was in house). At that little hospital, I never felt that the ICU nurse looked down on me. The nurses on med surg and tele were very autonomous and if you worked nights, you could not be a new grad ( nights had a 15% shift differential).
    I think we all respected one another and the sentiment seemed as though the ICU nurse had no business trying to work on med/surg and vise versa.
    Now that I work in an outpatient setting, I've learned that you really need to know what you are talking about in preventive medicine.
    I see ICU, tele and med/surg as a timeline in a patients path of his/her health care. If you're in ICU there is only so much more that can go wrong until you have no choices left. So yes, the ICU nurse has to be detailed oriented because the patients health has no reserves.
    It has been a misconception that you somehow have to be smarter to be an ICU nurse than a med/surg nurse or other types of nursing but in truth, to think of all the possibilities of a seriously ill or injured patient is minuscule compared to all the possible outcomes of someone healthy with no guidance in their health maintenance.
  9. by   Stalirris
    Interesting thread. I've worked in multiple ICU's 16 years (Trauma, CT, General, CCU) and Medical Tele for 6 years prior to that. I don't think finding a uncooperative receiving RN unique to ICU or MS/Tele. We all have 'rhymes with witch' peers. Some have confidence issues and overcompensate by portraying themselves as a know it all. Some are just burnt out, and some are just irate they are getting the next hit because they are lazy. Some are new and scared about what's coming over.

    As for getting report from the floor, or even the ER, I've learned to bring up the patient in the computer and browse though what I think is important. It's all right there... H&P, Labs, VS trends, radiology, consults. I just want the last few hours of the pt's day and a warning about incoming family dysfunction. It's easier on me because I get the info I need and I know the floor RN is jammed for time. It seriously takes about 5 minutes to get the gist of a crashing patient and start thinking what interventions you will need if you just look the stuff up.

    On the other hand, I'm always confused when I transfer a patient out and the nurse asks me what diet they are on. It's the tone of voice and how they ask...like I forgot something life or death to tell them. It cracks me up.

    Sorry the OP feels she is being mistreated. ICU nursing and floor nursing have wildly different focuses, but that's not floor nurses fault. It's staffing!!! Nurset ratio on the floors just does not allow for digging deeper in pt cases, most of the time. It does boil down to forcing floor nurses having to be more task oriented just to get their jobs done. It's not that they aren't good critical thinkers, because they are! It's the hyper-super-multi-tasking they are forced to do for 5-8 pts in a limited amount of time.
  10. by   bsayzhi
    I'm an ICU nurse. I was born to do this, codes, rapid responses, circling the drain, pathophysiology, sepsis... All that stuff makes me warm and fuzzing inside.

    I respond to a large majority of rapid responses all over the hospital. I see fantastic calls by floor nurses who have been trying to get someone (docs) to listen to them for hours! I've seen some really poor displays of patient care in both the ICU and on the floor.

    The problem I see... People bring their feelings to the patients room. During a rapid I try EXTREMELY hard not to come off condescending but there are some insecure people that still take it that way. In the ICU theres a common thread amongst most of the nurses... We're analytical, practical and the only person we're really I tune with is that patient. This no nonsense, direct attitude is our default mode when things get critical. The sicker the patient, the more feelings are hurt, so to speak. I'm not TRYING to make you feel bad, but I also don't have time to make you feel better. Like a few have said, we're expected to have information and be able to filter out the unnecessary. Some docs expect us to to tell them what to do and how to do it. Some docs expect us to have them fixed by the time they see the patient. The pressure an ICU nurse is under is indescribable. Especially working at night. Until my hospital blessed us with intensivists, if someone died, got worse or changed WE had to talk to the family. Bad test results, we are left explaining what they mean. Even now we often have "the talk" with families about withdrawing care when treatment is futile. We meet most families on the worst day of their lives and their in an emotional hell the entire time their loved one is in our care.

    And as for report... This is to my fellow ICU nurses. Personally, I hate report. When someone calls report from the ER or the floor, frankly I don't care about 99% of what they have to say. I don't expect them to do my assessment for me. Most of the vitals and labs I can see in the computer. Tell me their story, why the ended up coming to me! This business of asking every detail is especially stupid when a patient is transferring to a higher level of care... Just get them to the ICU and we can sort it out! It's all gonna change anyway!

    That being said, I WOULD NEVER MAKE IT IN ER, MED/SURG OR TELE! Don't even get me started on the tiny humans -- they freak me out!

    In closing there are just as many bad floor nurses as there are bad ICU nurses. ER nurses on the other hand...

    Just kidding, ER. I THINK YOUR JOB SUCKS THE MOST. I applaud anyone that can deal with the ridiculous things you see there!
  11. by   TransportJockey
    As an ER paramedic transferring my patients from the dept to the unit or as a flight medic dropping off in the unit I have been on the receiving end of such attitude as the OP had. But generally I know what kind of stress they're under and that that generally consider medics to not be up to their level and let it go. They have plenty of things to worry about and so do I. If we don't work together we won't get anything done
  12. by   Nonyvole
    Quote from bsayzhi
    That being said, I WOULD NEVER MAKE IT IN ER, MED/SURG OR TELE! Don't even get me started on the tiny humans -- they freak me out!

    In closing there are just as many bad floor nurses as there are bad ICU nurses. ER nurses on the other hand...

    Just kidding, ER. I THINK YOUR JOB SUCKS THE MOST. I applaud anyone that can deal with the ridiculous things you see there!
    The ER nurse...Jack of all trade, master of none. (Tonight, we explore the area of the hospital that many people see first, the ER. Watch as the physician stalks majestically around, going from room to room, and then springing into action. The charge nurse, with a cool and calm appearance on their face, but paddling madly to stay afloat. The bedside nurse, hurrying from one area to another, with nary a chance to sit.) (Yeahhhhh...)

    But, when we get down to the nitty gritty, we all have our own specialties. Does it drive me batty when I'm trying to transfer a patient to the floor and I'm being asked about their skin? Well, yes. But it's not up to me to get frustrated. They don't know that I'm busy, short-staffed, and work with patient ratios that can get a little out of whack. My preference is to give a report that is short and to the point; the key points are name, age, diagnosis, lines and tubes, medications given, allergies, past medical history, admitting doctor, any abnormal lab values, and if they might have a headache after meeting the patient and their family. Boom, any questions, no? See you in 15.

    I've had to board patients before and chart on them as a floor nurse. I didn't think it was that hard, but if I had to take 7 patients? Couldn't do it. In nursing school I didn't enjoy most of my rotations simply because I don't have the personality to be on the floor. ICU, yes. ER, most definitely.
  13. by   Bluebolt
    This is an interesting thread that seems to be universal for nurses. I'm a travel ICU nurse and every location I've gone to has this same dynamic between floor nurses and ICU nurses. It's similar to the LPN vs. ADN vs. BSN debate. It all seems to stem from a root of ego, a sense of self.

    Strive to be confident in yourself, not just your title as an RN but really "yourself". I think if you try to do that you'll find this rampant issue in hospitals dissipates.

    It's nice to be able to say a kind word and smile at fellow hospital RN's and even build up your fellow nurse at times. Although there is a time and a place to enter direct and serious inquiry and implementation. Critical care is where this is most common, you get lots of practice, so therefore you get good at this.

    When I am the rapid response nurse and there to prevent the imminent decline of your patient I am not focusing on building anyone's ego or attempting to make you feel better about the patients decline. I will not point fingers and waste time attempting to insinuate incompetence either. I will assess and bring about a change in the patients condition or will transfer them to the ICU where I have more tools to do so. Please pull your ego out of this situation, it has no place.

    Now taking report on a patient transferring to Critical Care is complicated. Yes I will look up lab data, vitals, H&P, I&O in the computer if I have quick access and time in that moment but what if my other patient has current immediate needs? It saves the receiving nurse a lot of time if you already have that data pulled up and ready to give. If your patient is acutely critical and I need to take them on I cannot guarantee that I'll have enough spare time to research information on them before you rush them in the doors. I'll have to go set up the room, get respiratory to set up a vent, get all my suction, cords, supplies together. I'll have to guarantee that my other patient is stable and secure and caught up with so I can focus for the foreseeable future on this new patient. Any time you receive a new ICU patient it could be a train wreck that turns into a very long series of codes, doctors, families, drips, machines, rushing to OR/Cathlab, CT scans you have to go to, eventually post mortem care, etc.

    Not to mention that the reason we ask all these questions is because the moment (sometimes before) we receive this patient we will be bombarded with the 5 physicians consulted on this declining patient and they will all want EVERY detail of what's happened. Many times they will expect you to tell them what your opinion on what's wrong is and often they'll ask if you've already implemented things to fix it. This is expected of you, that's why we ask so many in depth (seemingly to you) irrelevant questions. If I'm curious why the K+ was low 48hrs ago I may be looking for a trend in why it's low every morning with labs or something to that effect. Don't get discouraged if you don't know the answer to all my questions, I'm expecting you to not know some things, but i'm hopeful that I might be surprised and you can be a part of the critical thinking of repairing this patient. I've even found sometimes that by investigating things in report with the ED or Med Surg nurse they've revealed assessment data that was important to helping the patient without even realizing it.

    I took a year of German as a foreign language when I was 16. I haven't studied it really since then and I always speak English instead. I don't get upset about not speaking German as well as a professor in German language at the local university. He speaks it all day and has studied and continues to study German in his direct job. I can speak some basic phrases that I recall from school but while living here in America it's not important that I know fluent German, I'm glad he does though. If I ever need to go to Germany I'll ask him to come along, but in the meantime I'm perfectly satisfied speaking English and knowing my self worth comes from the inside out and not from the outside in.