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.