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 unit - it doesn't matter which... Read More

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    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.

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  2. 1
    Quote from uRNmyway
    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!
    perfectly said!!
    Stalirris likes this.
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    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.
    Despareux likes this.
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    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.
    Despareux likes this.
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    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.
    uRNmyway, Stalirris, julieface, and 2 others like this.
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    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!
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    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.
    Stalirris likes this.
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    Quote from PatMac10,SN
    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.
    Last edit by PatMac10,RN on Apr 17, '13
    Janey496 likes this.
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    Quote from Craymond18
    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.
    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.
    PacoUSA likes this.
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    Quote from Craymond18
    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.
    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!


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