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?

[SICU_Murse]

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 teh sending nurse?

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

[SICU_Murse]

I forgot one of the most important parts -- We need to know that basic information so we can adequately care for the patient while he/she is critically ill. Knowing baseline information vs. current information will help us decide if the intervetions that are being done for the patient are adequate or need to be changed.

[BelgianRN]

*Raises a guilty hand*

I'm one of those ICU nurses that asks a thousand "irrelevant" questions. But I try not to be condescending while doing it. But if I manage to get at least a few questions answered it might save me a ton of time having to dig through a stash of documentation on a patient that I have no clue about how that's organised or where to find what.

I think the core problem why everytime it becomes and us vs. them kind of situation is that priorities are very different. The werkenvironment is completely different too. As ICU nurses we are blessed and cursed with knowing the most intimate details of everything that concerns the patient. If his CRP is up 0.2 we'll know it. A temperature that is 0.1 °C higher than the previous hour and we'll spot it.

I keep in mind that when a patient comes to the ICU that the nurse that is bringing them is probably not in her comfortzone anymore. She isn't used to caring for a patient with this level of acuity so I try to keep the tone in my questions light, but it's easy to loose the light tone when the patient is not doing well and you need answers fast. The same applies when I bring a patient to the ward I'm out of my comfortzone. These nurses won't ask the intimate details but they'll ask things that are totally alien to me (at least in the beginning). If I ordered food to be delivered to the ward and if I explained to the family that they need their own care supplies and if i notified for a different type of matress and if i ordered the meds that they don't have in the pyxis. Over the years I learned to anticipate on the needs/demands of our wards and order things ahead of time. But then again ICU nurses bring patients to the ward more often than the ward nurses bringing patients to us.

And most of the information asked in my experience is information that decides the course of events in the first hour after arrival. In that hour we really don't have time to look up information from different sources so we can get a good head start if we know the answers beforehand.

For me I'd like to know their history, what led them to the hospital and subsequently the ICU, what is their baseline, what are the medications they're on, what labs did they have drawn, and was the family informed about the transfer.

Some of the nurses from the ward are great at collecting presentable information on the patients others suck at it. Same goes vice versa some ICU nurses are great at delivering a patient to the ward and some couldn't care less.

[JennabeanRN]

I have a dear friend that looks down her nose at floor nurses. She alway says, "what do y'all do all day" and "why wasn't this caught in time". I tell her she could never come down and take 7 patients. She would be in the corner crying with her 2 patients. I also her her that lots of times, she have monitors that let her know ahead of time, we have to us assessment skills or walk in the room and find someone near coded! It drives me crazy but I still love her though! Lol.

[Bec7074]

I started our working in a med surg floor and cared for 4-8 patients. Then I did ICU Stepdown/PCU and cared for 3-4. Now I'm ICU and do 1-2. I sympathize with some of the sentiments expressed by you marisatheresa. I've been that nurse who gave report to an ICU nurse and felt so stupid/annoyed because I didn't know the answer to the ICU nurse's questions. I do think she was trying to be hard on me. And when you have 8 patients, and one is on the call light all night and you have to walk people to the bathroom, you don't have time to read through the patient's chart to understand what is going on. I also felt that on the floor, I more often got a crappy report for the nurse before me (which in turn, doesn't help you understand what is going on!) Now that I work in ICU, I can see why nurses who have been in ICU want to know all the details. We are TRAINED to be that way (call it anal if you will ). We know EVERYTHING about our patients and rightfully so! Patients that are critically ill need a nurse to know if they moved their left foot 2 inches to the left.

HOWEVER, I never give nurses a hard time getting report because I have been the nurse in that situation. I will ask questions for things that I think are truly relevant. And I would NEVER say to someone "Well why wasn't that done?" or "Why didn't you catch that?" I think to myself: It doesn't matter why. I'm the nurse now and I'm going to figure it out and get my patient better. I also usually pull the patient's chart up in front of me so I can see the labs for myself and only ask about anything unusual or obvious that should have been acted on (not a K of 3.7!). So please don't generalize all of us awful, mean ICU nurses. Perhaps some of us are more compassionate than you realize. Or perhaps your anger is just a result of being made to feel inadequate or stupid. And you're not. And I'm not. But I've felt that way too. It's the nature of nursing at times unfortunately. Chalk it up to experience and move on. And maybe next time, just ask the nurse you're giving report to "Is that really relevant?" and if you honestly feel that they are being crude and harsh to you, get their name and fill out an incident report.

[CalvinJ]

I get where you're coming from as I have been to the floors as well before becoming a CCRN. Personally, I don't ask irrelevant questions. I only ask questions to get a clear picture of the situation for faster management just as what BelgianRN mentioned. I'm sure that if you were to receive a patient in the ICU from the floors you would want to get details on what has happened to the patient that would lead to an ICU admission. Given the right situation I would also ask the patient's latest K+ and the one before that if the floor nurse would be aware of it. If not then I'll have to review the chart for the answer. I ask questions that I believe are relevant. The answer might help a lot in the timely management of thr patient

[theVaway]

I hear you loud and clear. Same story was once med surg now ICU. My father is med surg same hospital, I hear the same gripe. Each speciality should acknowledge the others strengths. Thank you for caring for so many patients and still identifying the need to transfer. That's all I really need for report, reason for transfer, with our electronic record the rest is my responsibility. :-)

[Hubby's girl]

I just erased the rant I had in reply to a couple of you. Take a look in the mirror and tell me you are perfect; NOT! It takes a lot to work med/surg and NOT all nurses have no clue - we DO have the knowledge of the pathophysiology of patients and their diagnosis; just no time to stay on the phone with you for 10 minutes while our pt's wait for us to answer questions you could look up for yourself. Not everyone is a bumbling idiot that you make out the floor nurses to be.

[240zRN]

Not sure if I picked up the mentality from school or what, but the mentality that ICU/ED nurses surpass med/surg in competency is pervasive-- and impressionable new nurses like myself tend to absorb such attitudes. It's funny how many people internalize this feeling though. Many (even seasoned/veteran) nurses I've worked with in the ICU snub their noses at floor nurses for being (clueless/incompetent/empty-headed) inferior to them in skill and/or importance. That is BS. Total and complete BS. I ate a huge piece of humble pie when I saw first hand what they do up their. They may task more than other nurses, but it is because they don't always have the time to "play doctor" like many ICU nurses. It is a lot of hard backbreaking work being a medsurg nurse, and my hats go off to them. To assume they can't wrap their head around patho the way ICU nurses can is also complete BS-many of them understand patho to a level that is acceptable for their required level of responsiveness. So what if they don't know the in depth pathways of hypotensive crisis and levophed; why should they? They don't use that stuff. I'll tell you what though, they are experts in their own ways--their expertize are simply not appreciated by ICU nurses because they can't relate to them.

*NOT ALL*, but many ICU nurses I've come across believe that the sun rises and sets on their ***. If report isn't given isn't an ICU report, it is "unsatisfactory,"--not all departments of nursing involve being familiar with every inch and crevice of a patient. ICU nurses are only fortunate in that they function in a society that tends to favor physical science over many other perspectives of practice. Technology and medical science gets respect FIRST, feelings and accessory matters of the human experience tend to get residual thanks in our society. Medsurg/LTC/Home Care/etc nurses are the unthanked bunch. It is a lot easier doing a job when you have the constant reinforcement of praise. "Oh you're an ICU nurse, WOW you TRULY SAVE LIVES." vs "Oh you're a med-surg nurse? Don't worry, put in your time and maybe you can be an ICU/ED nurse and REALLY save lives"

Rubbish.

By the way, I'm an ICU nurse who was lucky enough to find work in a Prevention/Public Health clinic PRN that taught me that PREVENTION/REHAB nurses are the REAL life savers in health care.

[eCCU]

Haha... I was much more patient in the ICU and yes some of the med-surg Nurses are awesome!.....some just push my buttons especially when they administer Lovenox right before i call the patient for a procedure under general anesthesia, or give patient a little water right before general anesthesia aaaarrggg!!! I just want to scream but i remain calm and cancel the procedure, let the surgeon do the yelling:-)

[Fox_RuN, BSN]

I have nothing but respect for floor nurses- I've never had more than 4 patients at a time, ever. One of my best friends is med-surg/tele nurse in a semi-rural hospital (or as she jokes, "we are the garbage dump for the rest of the hospital"); she'll be in charge with 6 patients.

I started out as a cardiac telemetry nurse with high acuity patients in a huge university hospital and have been working in their CVICU where we get the sickest of the sick since then. Full disclosure; I have never worked as a nurse anywhere without tele monitors except the clinic I volunteer in (when those people complain loudly, outwardly I'm all sympathetic like, "It must be rough to have a sprained ankle!"...in me head I'm like, "Y'all can walk and talk, autoregulate your hemodynamics and BREATHE on your own, you're doing juuuuust fine so take a number!") To be fair though, it's all a matter of perspective; I hope they never have to come to my unit and can continue to complain happily and healthily. Just do it away from me

How do you guys manage without tele?!

ANYWAY, I have been on the receiving end on the ICU snobbery as a new nurse from the neighboring CICU nurses who would literally sigh when I brought someone over (it wasn't just me either..), EVEN though with time, I had managed to make my transfer reports very thorough for them.....and they would STILL ask irrelevant questions (I say this now with hindsight too...they didn't need some of the info they asked for in order to provide post-arrest care). But, I think that was fairly isolated to that particular ICU and a core group of individuals.

We also had dual unit nurses who spent half their time on my unit and half in CICU. I used to get miffed when they would hardly ever seem to listen to my report. Now, having worked in a cardiac-focused ICU, I can understand why they did that. My patients were all fairly stable with AICDs/pacemakers; they were fine, no pressors, no swans, no assist devices...they are FINE....go home and sleep little tele nurse....even the sickie chronics on that floor were usually never quite ICU caliber. We all used to get excited when we had a patient on dopamine at 1 ...

And nowadays when I receive people, I do my very best to be thorough, but gentle, especially as many of the nurses on the floor are newer, and I've been there, not that long ago myself. I've always wanted a chance to grill the survival flight nurses but they don't give a report until at bedside and usually don't stay longer than 10 minutes unless someone is REALLY crashing as they roll them in.

I think many times, depending on the ICU, if they have intensivists and team with NPs/PAs, at least at my facility, they are grilling us about the details we learned from report, and many times they are not very gentle about it themselves. I think a lot of the snobbery is really displacement originating from the docs and advanced practitioners. It's not right, but there you have it.