Condescension from Critical Care Nurses Towards Med-Surg Nurses

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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.

Specializes in Telemetry.
6 minutes ago, Wuzzie said:

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

It doesn’t and I never said the way he acted was justified. I said I understood why he was mad.

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2 minutes ago, PeakRN said:

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.

Since the vast majority of my career is in critical care at quaternary centers I am aware of this and have been in even worse situations where poor decisions by other health care providers have actually harmed the patient but that still does not give me the right to act out my anger towards them. You don't slam drawers, you don't raise your voice and you do not shame them in public. There are other ways to express anger that have much better results than having no learning taking place and you looking like a donkey's behind.

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Specializes in Adult and pediatric emergency and critical care.
7 minutes ago, Wuzzie said:

Since the vast majority of my career is in critical care at quaternary centers I am aware of this and have been in even worse situations where poor decisions by other health care providers have actually harmed the patient but that still does not give me the right to act out my anger towards them. You don't slam drawers, you don't raise your voice and you do not shame them in public. There are other ways to express anger that have much better results than having no learning taking place and you looking like a donkey's behind.

Again, I don't condone the behavior.

Also if the primary nurse performs CPR on their patient who has an order for no CPR, I doubt that any learning would ever happen. That is just plain incompetence.

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3 minutes ago, PeakRN said:

Also if the primary nurse performs CPR on their patient who has an order for no CPR, I doubt that any learning would ever happen. That is just plain incompetence.

Or panic or inexperience or lack of education. Look, I don't disagree that she screwed up and certainly should be held accountable but we are discussing bad behaviors by RRT nurses and there is no justification for them no matter what the situation.

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Specializes in PICU.
15 hours ago, GSDlvrRN said:

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.

From your previous posting about the Crisis Nurse asking you what you thought is actually very appropriate. The Crisis Nurse was trying to help you think about your patient a little more critically. Take some time now to think about it, what labs could be appropriate for a post ictal patient who has an altered baseline.

Perhaps if you had approached the situation by saying, " I have a question and want to run something by you. I feel like there might be more monitoring needed. I was thinking of suggesting a sodium level, and an ABG, (or insert what ever lab you had thought of). But I am not completely sure, is there anything else you think I should recommend, I am new at this, (or this is my first experience with this, etc)."

Starting off with your assessment and your thoughts at least let someone know you are thinking about your patient and have some knowledge about your patient and have put some thought into your patient's care. If you are just asking for someone to feed you the information, you haven't really thought about your patient.

Rapid Responses can be great teaching moments, but you need to be able to state your thoughts first, you had been caring for that patient and know their history. The crisis nurse wasn't quizzing you rather trying to see what knowledge you have and as a way to guide you to find the answer yourself.

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8 hours ago, PeakRN said:

Again, I don't condone the behavior.

Also if the primary nurse performs CPR on their patient who has an order for no CPR, I doubt that any learning would ever happen. That is just plain incompetence.

There are reasons other than incompetence that a nurse would start CPR. One of my colleagues, a very well-respected RN, coded her DNR patient a few months ago by accident. Because the patient was on contact isolation and the RN had no need for a computer at the time (not giving meds), she couldn't easily/quickly verify code status. In the moment of realizing a patient had gone into cardiac arrest, she couldn't remember which of her patients had DNR rather than FC status. So she started compressions.

When others responded to the code, someone checked the code orders, and compressions stopped. This RN was really beating herself up over it. But I think she made the right call.

If the patient had been FC and the RN waited to verify code status before starting compressions, that delay could have been the difference between a good and bad outcome. Better to start compressions if you're not totally sure than to fail to start them on someone who wants everything done.

Yes, she did know the patient's code status at the start of the shift, but there is SO MUCH information we're constantly dealing with that I can't call her incompetent for forgetting one piece of it in a high-stress situation.

We can be kind to each other and still hold ourselves accountable to do better next time. The doubt that "any learning would ever happen" is a condescending way to write off a nurse's entire career based on one mistake. Most of us make errors in our careers; that doesn't mean we are incapable of learning.

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Im sorry this happened to you.

I am Trauma ED nurse , ICU, rapid response. I see this every day regarding the ED and ICU. Nurses with God complexes " eating their young" . I guess I used to be like that during my first 2-3 years but I finally understood that floor nursing doesnt get expose to " emergencies" like we do, therefore you critical thinking is different. Its like me going to IR, OR for the day, I wouldnt know what to do. I wish ICU and ED nurses would teach other nurses and just be kind. At least thats what I try to do even I respond to any call. we all have the same purpose and it is to save the patient. Next time when they arrive to the bedside, if you arent the primary nurse step aside and just ask if there is anything you can do, if not just leave the room because it gets very busy. Make sure Vital, Blood sugar, etcs chart is pulled up. Please KNOW your patient. I cant tell you how many times I have arrived to the bedside and the primary nurse literally has no idea why the patient is in the hospital.

Anyways my point is that, dont feel bad about calling rapid on a patient EVER!!!!! call Rapid response every hour if you have to !!The bad behavior of that rapid response nurse only shows her own shortcomings and issues. It has nothing to do with you. BTW you should write her up. Im sure she would love that lol,

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On 10/22/2019 at 11:44 PM, GSDlvrRN said:

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.

1. Next time stop the Doctor and ask him what he needs or wants? Because Im sure the if some tells me ' whatever you want", they wont like it because I will order the FULL 1 million dollars work up and he will get called by his boss lol. seriously Thats the doctors Job and sometimes we as nurses have to " educate them'

2. Sounds like you might be new but try to get familiar with labs, procedures for some diseases CHF, MI, Sezuires, DM etcs. For example for . your patient, levels of the drug, CBC with diff, CMP, abgs, CT brain will be a good idea ( could a infection cause this ) I mean this will be the doctors job but yo can assist. Know the meds in case of the emergency for each disease. Ativan IM/IV for zesuires. oxygen, turn them on the side etcs. -- hypoglycemia -- DW50, CHF, nitro diuretics.

3. You supervior should know this - tell you to ask the crisis RN is passing the ball.

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18 hours ago, PeakRN said:

Also if the primary nurse performs CPR on their patient who has an order for no CPR, I doubt that any learning would ever happen.

Come on Peak, you're a better person than this. If I'm interpreting this correctly, and I may not be, you are saying this nurse is so incompetent that she is incapable of learning ever? If so then I believe you are making the OP's point.

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17 hours ago, RNNPICU said:

The Crisis Nurse was trying to help you think about your patient a little more critically.

I actually think both the MD/resident and the Crisis Nurse had no further thoughts and were waiting for the neuro consult they appropriately initiated. It's too bad they didn't just act like reasonable adults and say something like, "I don't think I have any other real concerns right now unless you have something specific. Let's wait and see what neuro says."

But apparently that's a little too I-actually-don't-know-everything.

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Specializes in Psych.

Yes, I feel this lol. I have respect for all nurses (it’s not an easy career) and I don’t think emergencies and death and codes are necessarily the worst things in health care, nor are they the hardest to deal with emotionally. It’s not a competition at all, nor is it an excuse or rationale for acting like a jerk. We all chose our specialties for different reasons, but hopefully (maybe?) our goal is all the same.

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Specializes in Adult and pediatric emergency and critical care.
6 hours ago, Wuzzie said:

Come on Peak, you're a better person than this. If I'm interpreting this correctly, and I may not be, you are saying this nurse is so incompetent that she is incapable of learning ever? If so then I believe you are making the OP's point.

In full transparency when I wrote that ,and am still currently, dealing with a very frustrating and emotionally taxing patient care situation. I meant what I said but I could have phrased it better.

What I meant was more to the effect that a person who performs CPR despite a DNR order is not going to learn in that situation regardless of whether it comes from the biggest jerk or the best educator in the hospital. Knowing code status is a basic tenant of competency when taking care of the patients you have assumed care for in the inpatient setting, especially when there are any end of life considerations. Knowing your orders is also absolutely mandatory in the acute care setting. I don't mean that said person is never capable of learning.

There are many people who don't fit well within a certain profession or a specific role. That doesn't make them a bad person or incapable of being successful in general, but they may need to recognize those limitations. This can be seen in a variety of professions both throughout nursing as well as many others. Personally I didn't do well with taking orders when I was in the fire service, but that is also part of the reason I left it.

As I have said repeatedly I do not condone rude behavior. I think that those who don't have good high acuity critical care experience can't really understand the specific stress that we are under on a daily basis, and I've tried to explain that. I'm not saying that floor nursing is not stressful, but it isn't the same. On the rare occasion that I've been floated to the floor I've hated every minute of it, it is a type of care that I do not enjoy or do well at. I'm very appreciative of all of the floor nurses who take care of my patients when they are no longer critically ill.

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