Experience with Critical Care Nurse vent

[Tweety]

First of all, ALL critical care nurses please don't flame me, as I'm talking about one situation not all critical care nurses.

I've had several experiences with critical care nurses over the years. A couple of them have been down right snooty.

We had a hypotensive patient that an MD ordered dopamine on. Naturally, in our facility on critical care does dopamine. Off to the unit he went.

Later the nurse comes by and says, "since we put him on the proper size cuff, his BP's have been triple digit and no dopamine is necessary, you're probably going to get him right back".

You had to have heard the arrogance and superiority involved to get the whole picture. I unfortunately, got very angry back at the CC nurse....."I NEVER intervene in BP issues without taking a BP's manually. Unless we are hard of hearing the BPs were critically low when we were taking them. They weren't too bad, and perhaps the MD overreacted when he ordered dopamine, but I'm not an MD and he MD ordered Dopamine. "

This nurse implied we were too stupid to know how to take BPs. Sigh....of course she found the cuff we were using under his pillow, and it was the same size she was using.

Anyway, the important thing is the patient is o.k. But I loathe arrogant critical care nurses who belittle the med-surg nurse.

Rant over. Don't flame please. I've always had a great relationship with this unit. I'm just tired right now.

[montroyal]

3edShiftGuy,

I understand your frustration. I did the mandatory one year of floor nursing before I went to ICU and ER. What floor nurses deal with on a daily basis, blows my mind. Personally, there isn't enough money in the world for me to work in the enviorment floor nurses work in. My hat is off to all you floor nurses.You are right, a nurses with seven patients shouldn't have to provide a couple hours of intensive nursing to one patient, which leaves the other patients without care. .

Originally posted by 3rdShiftGuy

The question being even if he did not need dopamine how much of this type of monitoring should a med-surg nurse do? Our critical care beds are always dangerously low, and this one the last critical care bed outside of the ER, so I knew better than to rush someone to the ICU lightly.

There has to be a better option than ICU though. Some hospitals have float critical care nurses who act as trouble shooters in situations like this. Some hospitals have step down units or intermediate care units. The ER is never an option for a inpatient, as an ER is an outpatient facility and EMTELA prohibits transfering an inpatient to an outpatiet facility, if the patient still requires inpatient care.

Talk with your unit manager, and explain what is going on. Maybe between your unit manager, the ICU manager and the director of nursing, they can come up with a plan of action which will see to the needs of the patients and help relieve the stresses of all the nurses in your hospital. Nurses should never treat other nurses as you were treated. That nurses should be spoken too. But what causes nurses to treat other nurses this way should also be addressed. I wish you the best of luck.

[mattsmom81]

...."Most of the work is done before the patient hits ICU doors". ..

Hmm. Well, I don't find that is the case generally... and that's a fairly ridiculous and antagonistic statement, IMO.

Is this thread going to turn into 'floors vs ICU'???

We all work hard and a lot of the troubles between depts is that other depts often DO try to turf their problems elsewhere...cuz we are ALL overworked. A little understanding of all sides is helpful, IMO, and effective problem solving through useful policies is the best solution.

[Tweety, BSN, RN]

Mattsmom81, wasn't it an ICU nurse that made that statement? But that's definately not true, sometimes we just ship the patient off as quickly as possible without doing anything.

I have tried very hard not to let this be a us against them thread. I don't think that has happened. Your statements are right on the mark!

Montroyal, the idea of a float ICU nurse sounds awesome. He/she could have assessed the patient, stablized the patient, or if needed given dopamine until BP stablized. I have in some instances had the charge nurse from the units come over to see if the patient really was critical. But we are so horribly short if ICU nurses and ICU beds, I doubt that they could spare the staff, but if they could it could potentially save some beds.....hmmm....We are finally opening a floor for chronic vents which is going to help as well.

When I do supervision, Critical Care is always the thorn in my side. I'm not talking about the nurses, I'm just talking the whole critical care bed/nursing shortage, and being the trauma center for the area, the extreme need for critical care beds/nurses...sigh....

Update: Patient came back to the floor after a couple of hours of triple-digit BPs. About 48 hours laters he's back, this time for a while I believe.

[l.rae]

Originally posted by 3rdShiftGuy

I hope I made it clear that I don't feel that way about all critical care nurses. This unit is my sister unit, and we're always there for each other. This nurse is new to this unit, and doesn't know me well. I hope we can get over this riff. But her arrogance was beyond what you described, it was pure arrogance and this is what puts critical care nurses to shame in the eyes of med-surg nurses.

I realize after many patients are transferred to the unit, ICU nurses roll their eyes, and question the nurses skills and decisions. I float to that unit occasionally and see both sides of the issue. But telling a med-surg nurse she has to manage a patient who once had a palable BP in the 60s, when she/he has a full load is not acceptable. Even if he is cured. It's too nerve wracking when you have seven patients to check a BP every 15 minutes or ever hour, or whatever.

Again, it was the pure arrogance she displayed that upset me. But since I have to work with that unit, I do hope we can get along. Every time we passed each other she turned her head in obvious anger. We're going to have to talk, as I'm sure I'm taking some of this out of context. She probably was just being herself and if I told her she was acting arrogant she would be appalled.

Thanks for listening.

Hey Guy.....you can always take her a tube of lipstick as a peace offering!:roll

The ER l worked a t prior had pit bulls for ICU nurses and for whatever reason, they did not consider ER nurses real nurses.....needed a whole case of Avon for that crew. The ICU nurses at the facility l am at now are great.....let us know how this ends......LR

[New CCU RN]

I was also a little insulted about the comment that all the work is done once the patient hits the ICU doors.... HELLO...do you think we all sit around on our A**with our one or two patients comparing lipstick colors??????

While I agree that the individual, one nurse that 3rd shift had to deal with was not so nice....and probably a little out of line... let's not generalize...we all have our jobs to do and that is to get the patient well....we're all working for the same cause, the PATIENT.

With that being said there is a reason why the patient comes to the ICU....and that is to recieve ICU care... which cannot be done on the floor...and while I have the uttermost respect for floor nurses.....you all work very hard just as ICU nurses do.... let's not get into an argument about floor vs ICU..... and let's not make judgement calls such as all the work is done before the patient even gets there..come on now...why dont we just leave em on the floor then???

[OzNurse69]

Originally posted by 3rdShiftGuy

Montroyal, the idea of a float ICU nurse sounds awesome. He/she could have assessed the patient, stablized the patient, or if needed given dopamine until BP stablized. I have in some instances had the charge nurse from the units come over to see if the patient really was critical. But we are so horribly short if ICU nurses and ICU beds, I doubt that they could spare the staff, but if they could it could potentially save some beds.....hmmm....

I worked in a hospital once where they employed someone to do this very job...float around, help assess critically ill pts, transport from ED to ICU etc. Great in theory...BUT...in reality every time we paged them to do a transfer (I was working in ED at the time) they had been sent to a ward that was down staff so the hosp didn't have to call in agency - NOT what the original intention of the job was. So we ended up not bothering to page & just doing the tfrs ourselves...don't know what happened to floor nurses who asked for help!!

Another one of those "great in theory, doesn't actually work in practice" things.

[hapeewendy]

the insults and bad feelings, unfortunately go both ways, in my opinion its like apples and oranges, no one is better than the other, they are just different... everyone chooses the area in which they work for a reason - doesnt make anyone superior at all!

I hate the whole floor vs ICU or vs Emerg thing ,I'm getting better at ignoring it all and not participating because it always ends up with bad feelings involved. everyone in the health care team is important and the things that connect us all are the fact that we are nurses (which means a heck of a lot!) , that we all work to improve the lives of our patients and that we provide a valuable and vital role in the health care team..

lets not regress to making assumptions and generalizations.....

as for the comment about all the work being done before the patient hits the ICU - it seems like that was meant as a compliment in reference to a particular individuals experience, to compliment and counteract that I would like to say that on our unit when a patient goes sour or in a code situation our ICU nurses have taught me a heck of a lot and have been the first ones to step up and tell me what a good job I did , regardless of the outcome... on one particular night shift we had a nurse just lose it , long long story there but basically she just lost it and hightailed it out of there leaving us with 3 on the floor - her patient had coded and was going to the ICU- let me tell you the ICU nurses just took control of her, we didnt have to go and give report or anything they got her meds n chart n brought her up to the unit and one of the ICU nurses came back down just to see if there was anything she could do to help

THAT is what nursing is all about !

[Tweety, BSN, RN]

Originally posted by OzNurse69

I worked in a hospital once where they employed someone to do this very job...float around, help assess critically ill pts, transport from ED to ICU etc. Great in theory...BUT...in reality every time we paged them to do a transfer (I was working in ED at the time) they had been sent to a ward that was down staff so the hosp didn't have to call in agency - NOT what the original intention of the job was. So we ended up not bothering to page & just doing the tfrs ourselves...don't know what happened to floor nurses who asked for help!!

Another one of those "great in theory, doesn't actually work in practice" things.

We actually had an "Admit Team" which was a nurse and a CNA to go to the ER and admit patients, start the paper work, take vitals, bring the patient to the floor and settle them in the room. That lasted a few weeks before, when they were short nurses on the floor and started using them essentially as part of the float team. Another of those "great in theory, doesn't actually work in practice things". sigh...

[montroyal]

Originally posted by OzNurse69

I worked in a hospital once where they employed someone to do this very job...float around, help assess critically ill pts, transport from ED to ICU etc. Great in theory...BUT...in reality every time we paged them to do a transfer (I was working in ED at the time) they had been sent to a ward that was down staff so the hosp didn't have to call in agency - NOT what the original intention of the job was. So we ended up not bothering to page & just doing the tfrs ourselves...don't know what happened to floor nurses who asked for help!!

Another one of those "great in theory, doesn't actually work in practice" things.

Its unfortunate this has happened at your facility. I have worked at facilities were it has worked. I guess my question is why did it not work? The float nurse should of had a copy of their job description. Being forced to take an assignment on a short floor cannot be included in that description. If a float nurses is told to do an assignment, they should politely refuse and explain that an assignment would prohibit them from caring for the patients the were hired to care for. Hospitals have a bad habit of looking at short term only. A true critical care float nurse could help ensure appropriate care is given to patients while helping with the shortage of critical care beds and helping the hospitals bottom line. Transport should only be done by the critical care nurse if they have provided the stabilization care. That way they can give an accurate report to the nurse assuming the patients care.

[mattsmom81]

The idea of a free floating charge nurse to do these types of things is a good one I've seen utilized...but as mentioned, inevitably he/she ends up with a full assignment and the idea gets defeated.

I loved being free to troubleshoot, teach, supervise, etc.. and go out to the floors and help out if needed...and it's great for unit morale and relationships between units. Too bad we never get staffed to do it too much anymore.