Why do Critical Care nurses look down their noses at Med-Surg nurses? - page 6

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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    Quote from SICU_Murse

    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
    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!
    ABitterPill likes this.

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    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.
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    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.
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    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
    uRNmyway likes this.
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    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
    Jkan likes this.
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    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.
    Jkan likes this.
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    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).
    Jkan likes this.
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    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.
    uRNmyway, icuRNmaggie, SlinkyheadRN, and 2 others like this.
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    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!
    uRNmyway, Stalirris, and Esme12 like this.
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    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.
    PatMac10,RN likes this.

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