Experience with Critical Care Nurse vent

[Tweety]

First of all, ALL critical care nurses please don't flame me, as I'm talking about one situation not all critical care nurses.

I've had several experiences with critical care nurses over the years. A couple of them have been down right snooty.

We had a hypotensive patient that an MD ordered dopamine on. Naturally, in our facility on critical care does dopamine. Off to the unit he went.

Later the nurse comes by and says, "since we put him on the proper size cuff, his BP's have been triple digit and no dopamine is necessary, you're probably going to get him right back".

You had to have heard the arrogance and superiority involved to get the whole picture. I unfortunately, got very angry back at the CC nurse....."I NEVER intervene in BP issues without taking a BP's manually. Unless we are hard of hearing the BPs were critically low when we were taking them. They weren't too bad, and perhaps the MD overreacted when he ordered dopamine, but I'm not an MD and he MD ordered Dopamine. "

This nurse implied we were too stupid to know how to take BPs. Sigh....of course she found the cuff we were using under his pillow, and it was the same size she was using.

Anyway, the important thing is the patient is o.k. But I loathe arrogant critical care nurses who belittle the med-surg nurse.

Rant over. Don't flame please. I've always had a great relationship with this unit. I'm just tired right now.

[Tweety, BSN, RN]

Originally posted by JMP

interesting reading- I find in our hospital that floor nurses view the ICU nurses with "attitude"..... that we are all *****y and rude. Which I think is unfair and sometimes can make for uncomfortable transfers.

I hope I made it clear that I don't feel that way about all critical care nurses. This unit is my sister unit, and we're always there for each other. This nurse is new to this unit, and doesn't know me well. I hope we can get over this riff. But her arrogance was beyond what you described, it was pure arrogance and this is what puts critical care nurses to shame in the eyes of med-surg nurses.

I realize after many patients are transferred to the unit, ICU nurses roll their eyes, and question the nurses skills and decisions. I float to that unit occasionally and see both sides of the issue. But telling a med-surg nurse she has to manage a patient who once had a palable BP in the 60s, when she/he has a full load is not acceptable. Even if he is cured. It's too nerve wracking when you have seven patients to check a BP every 15 minutes or ever hour, or whatever.

Again, it was the pure arrogance she displayed that upset me. But since I have to work with that unit, I do hope we can get along. Every time we passed each other she turned her head in obvious anger. We're going to have to talk, as I'm sure I'm taking some of this out of context. She probably was just being herself and if I told her she was acting arrogant she would be appalled.

Thanks for listening.

[flowerchild]

In general, it takes a ton of confidence to work in ICU. All that confidence can make someone seem arrogant and egotistical but all it really is, is major confidence.

3rdShiftGuy, you were just the brunt of a nurses bad mood. That nurse took out the pressures of the shift on you. Perhaps she thought you were a safe person to unleash on. It's not right. You shouldn't have to put up with that. I hope that person thought about it later and felt bad for the way she spoke to you. Or perhaps she is one of those people who has a problem and must make others seem inferior (in her mind) in order for her to feel good about herself. I'd watch out to see if she does it again and if she does, let her have it with a swift and smart comeback. Don't let this person bully you and get away with it again. Isn't it nice to be able to come on this BB and vent. It does make it easier to handle and then forgive and forget it.

[flowerchild]

BTW, how long has this nurse been in ICU? Newbies tend to have a certain attitude that comes with trying to prove to oneself that they can handle it. What ever the reason, she needs to find another way to deal with the stress imo but it's not your job to teach her this. Or is it? Hopefully, she'll figure it out soon enough on her own. I'm sure your not the only one to be on the receiving end of her "problem".

[Jenny P]

As a 29-year veteran of critical care nursing, I stand in AWE of Med/Surg nurses! You guys are tops in organization and dealing with stressful situations (and families)! Don't let this creep put you down; she just has attitude that needs readjusting! My way of viewing this particular situation is that you were advocating for your patient; she should have been aware of that fact and kept her mouth shut and her frustration to herself.

I just worked a weekend from He!! myself and saw 5 patients admitted to our unit inappropriately; but they were admitted by docs who wouldn't listen to the nurses! Then when we had "real" CV-ICU patients in need of critical care, they had to go to one of the other critical care units instead because our beds were all full of COPD'ers who were sat'ing at 95% ON 2L/NC!

[Tweety, BSN, RN]

Flowerchild, she has is not a newbie, a seasoned traveler with many years experience. But it's true, confidence is sometimes interpreted as arrogance, but you add that to a statement like "you don't now how to take a blood pressure" and I'm ticked. LOL

Nothing rocks your world like an addmission or a transfer, she was probably venting her frustrations.

Thanks Jenny P, coming from a nurse that has been in ICU that long, that's amazing!

[montroyal]

3rdShiftGuy, What was said to you was inapproriate, but as a critical care nurse, I have a few questions. If someone was to read this patients chart, how many low b/p's were documented? Does it say which ones were done with a machine and which ones were manual? Was the patient A+Ox3? Was the patient in any distress?Were any fluid boluses given? What was the patients urine output ? What were the patients labs? What had happened to the patient prior to the hypotension? Was the patient given any meds which could explain the hypotension? Remember, what isn't written in the patients chart,NEVER HAPPENED. These questions are not to excuse what was said to you, only to explain what can be a very frustrating part of a critical care nurse's job. If the only reason the patient was transfered to the ICU was to have dopamine, and the dopamine was never given, there must be a review of what happened. Not to punish anyone, but to find out why we failed to meet this patients needs appropriately. An ICU admission is stressful to the patient and their family. If after reviewing a chart, a justifiable reasoning can not be found, the insurance companies can and have refused payment for the ICU and this leaves the patient stuck with the bill as well as all the anxieties. Often times, the patients or families take their anxiety and frustrations out on the ICU staff. Unfortunately, some staff then take this out on others.

Critical Care Nurses are trained to evaluate and intervene, often times without having to confer with a MD. Critical Care orders are often written with ranges and ICU's have protocols which do not require MD notification. This requires us to have a level of cofidence that is often perceived as arrogance. Unfortunately, there are some that look down on others who do not have the same trainning or cofidence. A few bad apples can spoil the barrel.

[2banurse]

When a patient is transferred from med/surg to ICU, is that on an MD order or will a nurse make the arrangements without an MD?

It would seem that if the MD ordered that the patient be transferred to the ICU, the ICU nurse should be talking (nastily) with the MD, not you.

Just a question from a nonnurse at this time.

[mattsmom81]

What happens usually is the floor nurse takes a phone order from the doc to move to ICU. the ICU nurse then has to evaluate the situation and call the doc BACK.

Nothing excuses rudeness and arrogance in my opinion, and as an experienced critical care nurse I echo Jenny's and Montroyal's sentiments.

3rdshift nurse...I'm sorry she was rude...no excuse. ICU's can become revolving door ER's for patients who do not need to be there and this is probably where this nurses' frustrations came from. Do consider talking to her or another ICU nurse and ask what you might have done differently from a medsurg standpoint....perhaps she can shed some light on the situation for future reference. Hypotension has many causes and it may be a good inservice for your unit to avoid unnecessary transfers in the future. :)

[hapeewendy]

dont make excuses for her she was a witch and it was uncalled for

no justification

human beings , the ugly and the pretty exist in every aspect of life, and nursing...

the doctor ordered the transfer to the ICU , so beyatch at him or her....

as long as you do what you can do for your patients and leave work with a clear mind and heart youre doing okay, whatever area you work in

no one is better than the other, just different.

[Tweety, BSN, RN]

Originally posted by montroyal

3rdShiftGuy, What was said to you was inapproriate, but as a critical care nurse, I have a few questions. If someone was to read this patients chart, how many low b/p's were documented? Does it say which ones were done with a machine and which ones were manual? Was the patient A+Ox3? Was the patient in any distress?Were any fluid boluses given? What was the patients urine output ? What were the patients labs? What had happened to the patient prior to the hypotension? Was the patient given any meds which could explain the hypotension? Remember, what isn't written in the patients chart,NEVER HAPPENED. These questions are not to excuse what was said to you, only to explain what can be a very frustrating part of a critical care nurse's job. If the only reason the patient was transfered to the ICU was to have dopamine, and the dopamine was never given, there must be a review of what happened. Not to punish anyone, but to find out why we failed to meet this patients needs appropriately. An ICU admission is stressful to the patient and their family. If after reviewing a chart, a justifiable reasoning can not be found, the insurance companies can and have refused payment for the ICU and this leaves the patient stuck with the bill as well as all the anxieties. Often times, the patients or families take their anxiety and frustrations out on the ICU staff. Unfortunately, some staff then take this out on others.

Critical Care Nurses are trained to evaluate and intervene, often times without having to confer with a MD. Critical Care orders are often written with ranges and ICU's have protocols which do not require MD notification. This requires us to have a level of cofidence that is often perceived as arrogance. Unfortunately, there are some that look down on others who do not have the same trainning or cofidence. A few bad apples can spoil the barrel.

Hi!

Med surg nurses are also trained to evaluate and intervene, make life and death decisions without the precence of an MD. We don't have standing orders, but we get them (i.e. if BP sustains below 90 start dopamine). In this case, I though it was overkill since his BP was near 90 after some fluid challenges already, but wasn't meeting his parameters. There was a lot going on with this poor gentlemen, there was a hepatic component, his urine out initially was scant, he was tachycardic, tachypnic.

A total of about 2 hours of med-surg level of care was provided before the transfer. The patient was being cared for by a competent LPN and I was in charge. I can't vouche for the charting however since I didn't review her notes, but I know usually we do make notations of manual BPs when they are taken manually. The question being even if he did not need dopamine how much of this type of monitoring should a med-surg nurse do? Our critical care beds are always dangerously low, and this one the last critical care bed outside of the ER, so I knew better than to rush someone to the ICU lightly.

I think what the ICU nurse doesn't understand is that the med-surg nurse has seven patients, six of whom got no care for 2 hours, six of whom needing charting on, meds passed, etc. How many q15 minute or even qh vital signs can one med-surg nurse be expected to monitor?

I actually think it the fluid challenges and the stress of us bothering him so much bumped is BP up there.

As a charge nurse, I've been accused of arrogance before when I don't feel I was. But she was rude, but I understand.

Thanks for you input that helps, I wasn't taken into account the confidence thing.

As I said, this is our sister unit and we are very close, (literally they are ten steps from me) and I'm no drama queen. LOL

[mattsmom81]

Actually many of my coworker ICU nurses y WERE medsurg nurses once upon a time...or if not they should have been... and it sure helps to understand the difficulties faced on today's medsurg units. Hang in there medsurg guys and gals!!!

And...I always say a good medsurg nurse is worth their weight in gold and.... as well as making the BEST ICU nurses, IMHO. :kiss

[altomga, ADN, BSN, MSN, DNP, RN, APRN]

i have to agree; a lot of icu nurses tend to carry that "chip" on their shoulder; oh wait; or is that their a**? anyway, they do tend to have the i'm better than you attitude; and like it was said here; most of the work is done before the patient ever hits the icu doors. i fortunately have a wonderful rapport with my sistetr icu unit and would love to transfer over there; i don't know why i haven't; even the doctors keep asking me; i guess i just really like my co-workers? my floor is the one that gets the crumping patients from the general floors; we stabalize them and care for them; the only reason we send them to the icu after that is b/c the policy states if they code; they go for 24hrs; the other reason; simply b/c policy doesn't allow us to hang certain gtt's; heck we do everything else. i'm real sorry for the arrogance the nurse gave you! you certainly didn't deserve it. all nurses are in this profession for the same reason....to take care of the patients! doesn't matter what specific floor it is!!!! be a better person than she and just know that you did the right thing for the patient!