Condescension from Critical Care Nurses Towards Med-Surg Nurses

Published

Rapid response systems are put in place to allow nurses to access potentially life-saving resources for their patients in a hurry, including the expertise of critical care RNs. At least that's my understanding. But whenever I call one I get push-back from the nurses responding. They act like a competent nurse should be able to handle any situation on their own no matter what. One of them took a passive-aggressive swipe at me today asking me, "Are you new?" & later told me if I didn't like the way the situation played out I should write myself up for causing a delay in care. I know ICU & ER RNs think of themselves as the only "real" nurses but when you scrap collegiality in favor of boosting your egos at Med-Surg nurses expense you also harm patients by making your fellow nurse leary of calling for help, fearing they'll get spit on by Super Nurse.

2 hours ago, PeakRN said:

I'm curious how you would have preferred the conversation to have happened. What were your expectations, what did you want to happen?

Kindly-spoken: "I can't think of anything in particular right now, but I'm open to suggestions if there's something you're concerned about..."

Unless someone is in a student position, anything approximating pimping is not appropriate...and even then...it's a lot less effective at teaching anything than those who are having a grand time feeling superior seem to think.

5 hours ago, GSDlvrRN said:

I monitored the patient the rest of the day and I kept feeling like I needed to do something else.

Don't forget the good old stand-by of talking to the admitting team responsible for the patient. RR/Crisis teams are awesome but one aspect I really dislike is that they sometimes reinforce nurses' reticence to do what we have always been able and allowed to do: Appropriately report concerns to the physician/provider team that admitted the patient. And by the way if you don't feel good about what you are seeing from your crisis team, you can do the same. We are still our patients' advocate.

2
Up Vote Up Vote ×
Specializes in Adult and pediatric emergency and critical care.
12 minutes ago, JKL33 said:

Kindly-spoken: "I can't think of anything in particular right now, but I'm open to suggestions if there's something you're concerned about..."

Unless someone is in a student position, anything approximating pimping is not appropriate...and even then...it's a lot less effective at teaching anything than those who are having a grand time feeling superior seem to think.

I don't think that asking appropriate questions on a patient you are being consulted on to be pimping.

1
Up Vote Up Vote ×
1 hour ago, Wuzzie said:

“As long as he was nice about it these seem like great questions to help you learn more about caring for a seizing/neurologically impaired pt. ”

I agree with this with one caveat. Time and place. In the heat of the moment is not the most effective time for teaching or learning. The questions were good but I’m pretty sure at the time they felt more like challenges of the OP’s competency. Debriefings after these kind of events are great times for education because people are usually motivated to do better.

Good point. I didn’t think of that. In my mind the pt was stable and sense of urgency was gone - probably not accurate but it’s where my mind went for some reason.

1
Up Vote Up Vote ×
45 minutes ago, PeakRN said:

I don't think that asking appropriate questions on a patient you are being consulted on to be pimping.

I see what you did there.

Okay.

Up Vote Up Vote ×
Specializes in Telemetry.
7 hours ago, PeakRN said:

Whenever we order a test we should already know what disease we are looking to find or exclude. While a sodium is a great thought depending on the patients individual presentation and medical course may not have been indicated.

I'm a bit confused. You say that the patient both returned to baseline but was also altered.

Also GCS is a test intended to be a very brief neuro exam in the setting to trauma.

I'm curious how you would have preferred the conversation to have happened. What were your expectations, what did you want to happen?

The patient's baseline was that he was disoriented to time and place and he was slow to respond when asked questions and slow to follow commands. This is what the patient's wife described to us as "normal" for him so we called his baseline.

I had asked the attending after the patient returned if there were any labs to be checked. I am not familiar with treatment of seizures, I really didn't know what labs should be checked, if any. He said "Whatever you want" and I had no idea! I also asked my supervisor and she said "What does the crisis nurse say?" I had expected that the crisis nurse would update me after the four hour follow up and he didn't, which I did not expect from this nurse. He usually comes up to me or calls and asks me how the patient has been doing and he offers suggestions at the four hour follow up. I wasn't sure if the scans, bolus with Keppra and neuro consult was all that should be done for the patient. I was afraid to miss something and I was hoping the crisis nurse could offer input when I didn't even know what I should be asking the attending for. If he didn't think anything else should be done I had expected he would say so, I didn't expect to be quizzed.

Up Vote Up Vote ×
Specializes in Telemetry.
On 10/20/2019 at 8:40 AM, Cowboyardee said:

ICU nurse here. I often train new rapid responders, and I make it a point to tell those new to the job not to be irritable or condescending in response to any stat team called in good faith, even if the situation didn't objectively warrant the call - the last thing we want is staff hesitating to call stat teams on a patient truly in crisis, and if the cost of that is the occasional stat team called out of abundant caution, that's not a bad trade off. Some ICU nurses do indeed look down their nose at other staff, especially if the nature of the situation at hand appears obvious to the ICU nurse but not to the floor staff. Some ICU nurses are irritable and frustrated less with you as a med surg nurse, and more because we have to leave our own busy assignments at the drop of a hat to fix problems elsewhere - of course the responder shouldn't take this out on you, but I hope you understand that frustrating situations lead to frustrated staff and that at least you shouldnt take it personally. And sometimes ICU nurses take their lead from the physicians/mid-levels responding to emergencies, in which case you have a bigger problem to address.

Still, while ICU snobbishness is indeed a real phenomenon, so is that of some (certainly not all) med surg nurses having a chip on their shoulders. If you present a responder nurse with scorn as soon as they show up, you are a lot more likely to have a little shade thrown back at you. The bolded section above might indicate a bit of that tendency. I'm not there with you and I can't tell you whether the problem is your attitude, the responders' attitudes, or both. However, please do examine your own attitudes and demeanor.

Yes!!! A rapid response nurse once verbally berated the primary nurse and respiratory tech when he responded to a code blue. When the rapid response got there and opened the chart he saw that the patient was DNR Limited Treatment and had orders for NO CPR. The respiratory tech was already doing compressions when the crisis nurse got there. Crisis nurse printed an ECG strip, ripped it off the machine, signed it and SLAMMED the crash cart closed before storming out and meeting the primary nurse in the hallway. He said some nasty things to her and she cried...Totally understand why he was mad, I was mad too as a bystander!

1
Up Vote Up Vote ×
Specializes in Telemetry.
5 hours ago, JKL33 said:

Don't forget the good old stand-by of talking to the admitting team responsible for the patient. RR/Crisis teams are awesome but one aspect I really dislike is that they sometimes reinforce nurses' reticence to do what we have always been able and allowed to do: Appropriately report concerns to the physician/provider team that admitted the patient. And by the way if you don't feel good about what you are seeing from your crisis team, you can do the same. We are still our patients' advocate.

Unfortunately I felt stuck, I had asked the attending if any labs should be checked and he said "whatever you want". Buh!! I didn't even know what to ask for, I was overwhelmed in the moment and couldn't think of anything.

Up Vote Up Vote ×
6 hours ago, GSDlvrRN said:

He said some nasty things to her and she cried...Totally understand why he was mad, I was mad too as a bystander!

So, please clarify because your sentence is unclear. Are you saying it was okay for the rapid response nurse to be nasty and make a colleague cry because she made a mistake or are you saying you were mad because he was treating her so badly?

1
Up Vote Up Vote ×
4 hours ago, Wuzzie said:

So, please clarify because your sentence is unclear. Are you saying it was okay for the rapid response nurse to be nasty and make a colleague cry because she made a mistake or are you saying you were mad because he was treating her so badly?

Can't really speak for GSD, but take note which part of my post GSD bolded. Some situations are just plain frustrating in the medical field, and it would be nice if we could all do a couple things with that knowledge:

1) try not to take our frustration out on others, like the rapid response nurse maybe did in GSDs story

2) try to do our own job to the best of our ability and carry our own weight so we don't create problems for other frustrated and busy staff, like maybe the floor nurse in the story did.

3) try to keep in mind that these are hard jobs worked by fallible human beings who occasionally mess up or get visibly irritated or even uncivil, and forgive and forget a bit of the drama that comes from working in a high stress environment.

2
Up Vote Up Vote ×
Specializes in Telemetry.
7 hours ago, Wuzzie said:

So, please clarify because your sentence is unclear. Are you saying it was okay for the rapid response nurse to be nasty and make a colleague cry because she made a mistake or are you saying you were mad because he was treating her so badly?

I understood why he was mad. I was also mad because a code was called on a patient who had clear orders for no CPR and chest compressions were in progress. If the RN saw that the patient was going south, she should’ve clarified the code status. The RT is also responsible for clarifying code status. The surprising thing was the nurse had the patient the day before, which was when the doctor had a conversation with the patient’s son about the code status. The nurse was made aware of the code status the day before, specifically no intubation and no CPR. The son still wanted full treatment so the nurse confused that as treating the bradycardia with CPR.

1
Up Vote Up Vote ×
3 minutes ago, GSDlvrRN said:

The nurse was made aware of the code status the day before, specifically no intubation and no CPR. The son still wanted full treatment so the nurse confused that as treating the bradycardia with CPR.

So she was confused and made a mistake how does that justify being publicly berated and reduced to tears?

3
Up Vote Up Vote ×
Specializes in Adult and pediatric emergency and critical care.
2 minutes ago, Wuzzie said:

So she was confused and made a mistake how does that justify being publicly berated and reduced to tears?

The patient did not want to be resuscitated and the primary nurse who was aware of that started CPR. I don't understand the confusion as to why you don't do cardio-pulmonary resuscitation on a patient who you know has a do not resuscitate order.

I don't condone public shaming, especially if it was in front of the family. That being said these are the exact things that set off critical care nurses. The patient wanted to pass in a dignified manner and did not want CPR, and yet in his dying moments the nurse charged with his care did exactly what he didn't want.

3
Up Vote Up Vote ×
+ Join the Discussion