Why Are Nurses So Critical of Other Nurses?

[bluegeegoo2]

Be warned, this is a rant.

The story: I have an a/o ESRD/dialysis resident who is woefully non-compliant with fluid restriction despite numerous attempts at teaching of the consequences. I have had to send this person out 4 times now in the middle of the night d/t resp distress. Each time this res returns from the hospital they have been dialyzed and pt teaching has occured. The diagnosis, in black and white in the H&P is: Fluid volume overload. Pretty straight forward, right? Evidently, this person was having SOB on day and evening shift before the last time I had to send out. They were ordered Duoneb QID, as the day shift nurse "Dx'd" them with Anxiety and convinced the MD of that. On my shift, this res presented with SOB, diaphoresis, audible crackles bilaterally and O2 was 81% on RA. I started O2 via NC @ 4L and started the Duoneb. (Only because I am aware that the one of the reasons the Duonebs were started is because "they" think I'm sending this res out unnecessarily.) Sats remained in the low 80's so I put them on a NR

@ 6L, O2 came up to the low 90's. BP was 200's/120's, P 143. Res remained diaphoretic, crackles continued, accessory muscles cont for resp, etc. So, I sent him out. At the end of my shift, the day nurse had come in and the nurse who had worked 2nds was still there as well. (Had worked a double.) The day nurse made a snarky comment to the eve nurse that we managed to keep them here through both shifts but you got rid of them. Grrrrr!!!! I was also interrogated about how he presented, and did I give him a neb? (That's why I wasted time giving a neb. I knew that would come up.) I chart everything, and make it clear as to the presentation and reason for sending out, as well as the Dx in the H&P from the hosp supporting why this res needed acute tx, but I still get the snarky remarks and haughty attitude from this nurse. This situation is by far not the only one, which leads to the title and ultimate question: Why are some nurses so critical of other nurses and their decisions? She wasn't there, so doesn't know how this res looked/sounded/etc., and even though I charted and the H&P supports what I saw and why I took the action I did there's always the "holier than thou" attitude. It's not just this particular nurse, or always directed at me. I've seen and experienced this type of attitude throughout my career, and it irritates the crap out of me. We are all in this together, right? For the residents? Same team? No? It is disheartening and a detriment to the very people we are charged with taking care of. Someone please explain this behavior to me for I am at a loss. And tired. Damned tired.

[toomuchbaloney]

I didn't bother to read all of the replies to your post.

From what you describe it is clear that the nurses who accosted you were advocating for the unit/facility and not for the patient.

I am an honest and direct person and would have told them as much.

If the company is paying the nurses to protect their bottom line rather than their patients/residents they obviously made an error when they hired you! Bravo

Will they feel better letting a person suffer for a few hours longer when the plan of care is unsuccessful in resolving health issues? Will they be content when they delay transfer long enough that the patient dies? How does any of that benefit the facility in the long run.

I really do not like working with dumb nurses.

[VANurse2010]

Severe overload in a ESRD patient is not appropriate to be treated in-house at SNF. I don't care how much IV therapy you do.

[CapeCodMermaid, RN]

We have many protocols which are successful in treating our patients so they don't have to go to the hospital. Your blanket statement about what should or shouldn't happen in a SNF is just as critical as the nurses in the original post.

[VANurse2010]

I didn't make a blanket statement. I made statement about ESRD - patients who may have to be emergently dialyzed. Are your nurses going to do that in-house? Methinks not.

[CapeCodMermaid, RN]

Not every ESRD patient wants dialysis.

[withasmilelpn]

Clearly it's a case by case basis, as some facilities staff are able to initiate IV s and administer IV Lasix, and some are not. I've worked in facilities that we could, but the one I'm in now we are not allowed to start IVs, so out they would go.