Why Are Nurses So Critical of Other Nurses?

[bluegeegoo2, LPN]

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.

[TheCommuter, BSN, RN]

I cannot stand the Monday-morning quarterback nurses. These are the ones who criticize after the fact and have holier-than-thou attitudes.

I might get flamed for this, but I feel that nursing attracts its fair share of people who have low self esteem. These types of nurses seek validation through caring for patients. They also achieve an ego boost through being critical and putting down others. Belittling a coworker's actions causes these nurses to temporarily feel better about themselves.

Keep your head up and be ready to defend your actions at all times. Good luck!

[TriciaJ, RN]

It might just be that you're all tired, damned tired, and disheartened. Instead of addressing the real problem collaboratively, you take your frustration out on one another. An ESRD pt who is non-compliant and keeps needing to be sent out: maybe it's time to address the issue of hospice/comfort/palliative care. This pt doesn't seem interested in keeping himself alive, as evidenced by all the pt-teaching and continued non-compliance. Does your facility pay a big ER tab every time you send someone out? Do your supervisors get chewed out for this? You're all trying to handle the situation independently as it comes up on your respective shifts.

Maybe it's time for a care conference so you can come up with a game plan that you can all follow. If you show them your ability to cut through the sniping and deal with the real issue, they might have to start respecting you.

[bluegeegoo2, LPN]

Forgive me for not feeling it necessary to include the details of this resident's care plan meetings, or the fact that they routinely claim to want to live as well as the full code status. Whether or not this person being sent to the ER costs my facility is not my priority. My resident's life/health/safety is. Obviously you missed the bigger point of the post. This particular case was meant to merely highlight the problem of some nurse's habits of criticizing others actions without bothering with the details of said action. That type of attitude does nothing to improve the quality of care for our resident's, and can actually prove to undermine their care if some nurse's begin to feel afraid to take a pertinent course of action d/t fear of being critisized. That, is a problem.

[HappyWife77, BSN, RN]

Forget the haters.....your doing what you need to do...that should be the only thing that matters.

You can't please them all. Get some thicker skin and let it roll off. You did that right thing sending them out.

[CapeCodMermaid, RN]

I try to have the 'I'm smarter than you and I would have done x,y,z' attitude squashed. We're all in this together. I am extremely intelligent (though not modest) but even I don't know everything. The nurse who was there with the resident at the time of the event is the best nurse to determine the course of treatment.

[TriciaJ, RN]

Forgive me for not feeling it necessary to include the details of this resident's care plan meetings, or the fact that they routinely claim to want to live as well as the full code status. Whether or not this person being sent to the ER costs my facility is not my priority. My resident's life/health/safety is. Obviously you missed the bigger point of the post. This particular case was meant to merely highlight the problem of some nurse's habits of criticizing others actions without bothering with the details of said action. That type of attitude does nothing to improve the quality of care for our resident's, and can actually prove to undermine their care if some nurse's begin to feel afraid to take a pertinent course of action d/t fear of being critisized. That, is a problem.

You're right. Some nurses do seem to have a need to snipe at others. I was just hoping there was something more to it that could be addressed. It does sound like you'e all in an impossible position with this particular resident. I wasn't suggesting you don't send out just to save money. The findings you described make an ER visit pretty imperative, yet other nurses saw fit to disagree.

That's where the care plan comes in. If the resident can't be placed on comfort care and you are getting criticized for ER transports, then what is it you are expected to do? Are there set parameters for transport? I was just trying to make sure the whole picture was addressed before calling this a clear case of bullying.

If you've made every effort to come up with a collaborative, realistic plan, and you are still getting sniped at for doing the right thing, then it's bullying, and I'm sorry you're in that situation. I applaud you for not backing down. Good luck.

[Esme12, ASN, BSN, RN]

I live by the motto...."No one can make you feel inferior without your consent" Eleanor Roosevelt

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.

Although I would have had the NRB mask at 100%. It is clear this patient was in fluid over load and flash Pulmonary edema. If they are a full code...they go to the ED. It's not like lasix will help them. You did the right thing.

My response to that other nurse would be..."well good for you. It must be wonderful to have such skills"....and walk away sweetly.

"No one can make you feel inferior without your consent" Eleanor Roosevelt

((HUGS))

[NurseDirtyBird]

I cannot stand the Monday-morning quarterback nurses. These are the ones who criticize after the fact and have holier-than-thou attitudes.

I might get flamed for this, but I feel that nursing attracts its fair share of people who have low self esteem. These types of nurses seek validation through caring for patients. They also achieve an ego boost through being critical and putting down others. Belittling a coworker's actions causes these nurses to temporarily feel better about themselves.

Keep your head up and be ready to defend your actions at all times. Good luck!

Yeah, I think you might have something there. I don't believe there is a such thing as a completely altruistic motive, and the main reason many people become nurses is helping people makes them feel good. Lots of people get sort of a high from helping people.

Know what feels even better? Being right. At least believing you are, anyway.

[CapeCodMermaid, RN]

What's the hospital going to do? Give them Lasix IV or IM. Given the information in this post, we would have kept the resident in house, given Lasix, and go from there. If he were really in respiratory distress, we might send him.

The point is, we weren't there. The OP was there and used her judgement. Her co-workers had no need to "Monday morning quarterback" her decision.

[systoly]

you probably can't do much about the quarterbacks, but you can

change how you react

you can avoid taking up defense right away, but let the snarky one

explain how keeping the patient for two shifts was prudent nursing judgement

of course most of the time, when working nocs, i was too tired to get involved

so would just say, "someone had to clean up your mess, you're welcome"

[withasmilelpn]

I don't ever worry about it. I was there, they were not. It's my judgement and my license and my patient. I'm always interested to hear others views, but am very matter of fact about what and why I do the things I do. I find that if you are confident, and have the facts to back you, it's rare that another nurse will give you trouble (at least to your face. And they can say whatever they want behind my back.)