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

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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?

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.[/quote']

I'm going to be brutally honest. We all have RN after our name. I'm sorry the MS nurses at your hospital aren't up to standards with your skills. However I have been trained as a MICU nurse and have my CCRN. I specialize in MS nursing however. I can manage 6 very sick patients without invasive monitoring and take care of all of them with excellent interventions. Do not make assumptions based on your experiences with med surg nurses and relate them to the whole profession. It is not our job to make judgements as I'm sure you know. All nurses save lives- don't place yourself in a pedestal because your patients are one ventilators and monitored with machines.

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.[/quote']

I'm going to be brutally honest. I'm trained in ICU and have my CCRN. We all have RN after our name. Don't look down on MS nursing. It is it's own specialty. We take care of 5-6+ patients with high acuity. We don't have invasive monitoring and need excellent assessment skills. Don't hold yourself on a pedestal because you take care of 1-2 vented patients with multiple monitors. Respect all nursing specialties!

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 :twocents:

You are discrediting this type of nurses AEB all of your statements. We understand patho and can assess all 6+ of our patient without the use of invasive monitors. I have certified in both MS and CCRN. We all have RN after our name. Don't hold yourself on a pedestal because your patients are vented, monitored and you haven't likely taken a manual blood pressure throughout your entire critical care career. Respect your colleague. Everything we do is for our patients!

I don't ask for too much in report. If I want to know the potassium 4 shifts ago, I can look that up myself. However, when I get a patient from the floor, I'm usually so busy for the next 2-3 hours that I don't get to sit and go through their chart. So optimally I'd like maybe a few critical/important labs that would immediately affect the way I care for my new patient. Even something simple like, "The white count's way up, we took a lactate and that came back elevated as well. Lytes are WNL."

I'm easygoing. But there are a few things that will make me cranky. I understand that when you have a bunch of sick patients and one is crashing that things are going to get stressful. BUT please be honest with me. Don't say, "I held the morning meds because she is SOB and I didn't think she could swallow" (fair enough!) only for me to look at the MAR and see that NOTHING was passed including IV antibiotics and non-oral meds, everything is red and overdue, and now it's all on me. That's not fair. If it's noon and you didn't give your 9 o clocks, mark as them as not done or reschedule them. Either that or say, "I have been so busy I haven't even gotten the chance to look at her meds." That way at least I can prepare. Also please don't give me a covering nurse on the phone to give report because the primary is at lunch or is heading home. Call me sooner if need be, but I really hate hearing, "Well I don't know about her history or anything, but it looks like she has a foley and two peripherals." Not safe!

An optimal report for me would be age/allergies/code status, pertinent pmhx, a brief summation of their hospital course including what happened before the event, current vitals, interventions done during the rapid response (i.e. given 4L fluid, blood cultures sent), a quick review of systems, any lines/drains/access devices, and I always like to hear a quick thing about their family so I'm not surprised when I see them strolling along side the stretcher as they're pushed into my room. It only takes 5 minutes. I'm not going to badger you for information that I can look up myself later and I don't look down on anyone. Transferring a patient from the floor to the ICU is stressful for us, too (these patients are typically way sicker/busier than admissions from the ED) and we just want things to go as smoothly as possibly and be prepared.

Specializes in Med/Surg.

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.

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

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??

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.

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).

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.

Specializes in ER.

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!

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.

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