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?

[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!!! Nurse:pt 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.

[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!

[TransportJockey, EMT-P]

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

[Nonyvole, BSN, RN]

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.

[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.

[mmm_016RN]

As a brand new floor nurse...I find myself getting really frustrated on my shifts because I know it's such a rich learning environment but I just don't. have. time! I want to understand all the small details of what is happening with each patient, their particular pathophysiology, an in-depth assessment of interventions and rationales. I agree with what an above poster said that floor nurses are task oriented but in my limited experience, that's what I have to be to get through a shift. When I'm at work I make a mental note of something I don't understand or want to look up and I research it on my days off. I feel like I'm missing a lot of learning but it's simply because I NEED to stay on task.

[baleen]

great post. the ego involved in these debates has me asking questions. Why are these nurses so ready to defend their egos? Is there an ego issue in nursing...ie: do people that go into nursing have trouble with carrying an adult ego with self responsible and actualized aspects.......or does nursing itself tend to tear them down?

[Ruby Vee, BSN]

great post. the ego involved in these debates has me asking questions. Why are these nurses so ready to defend their egos? Is there an ego issue in nursing...ie: do people that go into nursing have trouble with carrying an adult ego with self responsible and actualized aspects.......or does nursing itself tend to tear them down?

Please use the Quote function so we know whose post you are admiring.

No, there is not an ego issue in nursing. There may be an ego issue with some PEOPLE, and some of those people may be nurses. But the majority of those people aren't nurses. Lawyers, physicians, taxicab drivers, wait staff and folks from all walks of life have ego issues.

[baleen]

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.

knowing my self worth comes from the inside out and not from the outside in.

Sorry. I think it was this quote and another that I cannot find about nurses getting pressure from all sides. People telling you what to do all over. Patients, Doctors, Family, etc etc. The hospital milieu puts nurses right in the middle. Being told what to do, not being respected over and over again....well I find it intolerable and I see how, long term it can wear on your sense of self worth. Most of the people treating you like an idiot have no idea where Lithuania is....can't name 3 people on the supreme court, may read one book a year, havent seen a New York Times or an Economist outside of a waiting room. And nursing school does not give nurses enough training in school to really understand deeply all that is going on with the patient. When I say deeply....I mean deeply. Chemical, full system, not just pressures and large compensatory mechanisms. Minute compensatory mechanisms. There is a problem that they focus on trying to make Nursing theory a disipline. It is lfe experience and humility. You have it or you don't. Focus on the natural life cycle of the human being....I say anyway. But I am often wrong.

[Ruby Vee, BSN]

Sorry. I think it was this quote and another that I cannot find about nurses getting pressure from all sides. People telling you what to do all over. Patients, Doctors, Family, etc etc. The hospital milieu puts nurses right in the middle. Being told what to do, not being respected over and over again....well I find it intolerable and I see how, long term it can wear on your sense of self worth. Most of the people treating you like an idiot have no idea where Lithuania is....can't name 3 people on the supreme court, may read one book a year, havent seen a New York Times or an Economist outside of a waiting room. And nursing school does not give nurses enough training in school to really understand deeply all that is going on with the patient. When I say deeply....I mean deeply. Chemical, full system, not just pressures and large compensatory mechanisms. Minute compensatory mechanisms. There is a problem that they focus on trying to make Nursing theory a disipline. It is lfe experience and humility. You have it or you don't. Focus on the natural life cycle of the human being....I say anyway. But I am often wrong.

I'm not sure I understand your rather obscure post, but I feel subtly put down. I have never gone out looking for copies of "The New York Times" or "The Economist", but that seems like a very east coast centric idea anyway. Do I get points for seeking out the newspaper from the big city nearest to me, or does only the New York Times count? Do I get points for reading over 100 books a year, even if none of them are on the NYT best seller list?

Nurses get pressure from physicians, management, patients, families, other services as well as from CNAs, biomes, housekeeping, dietary . . . All of that is true.

I'm not sure what your point is.

[baleen]

I'm not sure I understand your rather obscure post, but I feel subtly put down. I have never gone out looking for copies of "The New York Times" or "The Economist", but that seems like a very east coast centric idea anyway. Do I get points for seeking out the newspaper from the big city nearest to me, or does only the New York Times count? Do I get points for reading over 100 books a year, even if none of them are on the NYT best seller list?

Nurses get pressure from physicians, management, patients, families, other services as well as from CNAs, biomes, housekeeping, dietary . . . All of that is true.

I'm not sure what your point is.

I am sorry you feel put down. It is my frustration writ small (on here). I have never found a nurse to be interested in the types of things I am interested in. It was judgmental and not related to the OP, unfortunately.

So as to how it relates to the OP. It may be tangentially related to the OP and to my own question....that is....

do ICU nurses have to deal with the constant lack of respect from so many people that med-surg nurses, with their large case loads and, perhaps, greater number of forced interactions, have to deal with?

Do ICU nurses get more autonomy and respect is my basic question?

My assesment of nurses getting a heap of disrespect from all comers is based only on med-surg. would I find less of these things in the ICU?

[Wile E Coyote, ASN, RN]

I am sorry you feel put down. It is my frustration writ small (on here). I have never found a nurse to be interested in the types of things I am interested in. It was judgmental and not related to the OP, unfortunately.

So as to how it relates to the OP. It may be tangentially related to the OP and to my own question....that is....

do ICU nurses have to deal with the constant lack of respect from so many people that med-surg nurses, with their large case loads and, perhaps, greater number of forced interactions, have to deal with?

Do ICU nurses get more autonomy and respect is my basic question?

My assesment of nurses getting a heap of disrespect from all comers is based only on med-surg. would I find less of these things in the ICU?

Collectively, yes on both fronts.