High Acuity Step Down ICU Nurses vs the MICU

[ZombieBunnyRN]

I have been working on a step down critical care unit for a little over 2 years now. Most of my time on this unit was as a Nurse Intern (AKA glorified Nurses Aid with no benefits), and in the past 2 months as a Registered Nurse. I knew very well what I was getting in to, and I was okay with that. I knew the environment, the equipment, the staff, and the expectations. What I did not know was the absolute disrespect I would be facing from the younger MICU nurses, and it was horrifying and upsetting. What was more upsetting, was that this unit has a reputation for being disrespectful and condescending to other units and nurses as well.

Back tracking just a little bit, I want to share what our unit is like, in hopes other nurses in other places can relate and find that they are not alone.

The 14 bed SD MICU I am a part of is a world of it's own. We are not a medicine floor, nor are we an intensive care unit. We are a High Acuity Critical Care unit. Our patients are too sick to be medicine, but stable enough to not occupy an MICU, SICU, or TICU bed (sometimes). The majority of patients we see and care for are respiratory patients (COPD and CHF exacerbations are some big ones, along with chronic respiratory failures secondary to muscular dystrophy, autoimmune disease, and spina bifida/CP). We have joked that we should really be and Respiratory and Heart Failure ICU. I can't even count how many times we have had patients inappropriately triaged to us, and like troopers we stabilize them and get them to where they need to go. It is a wonderful, chaotic, hot mess of a unit and I would not change what I do for anything. The Acuity of our floor is so intense that only ICU nurses and PRN ICU floats are allowed to float to our unit when we need the extra hand. Med-Surg nurses do not have the required ACLS or Basic Critical Care training needed to manage our patients.

I have friends in the ED, SICU, CICU and Trauma ICU... and a few acquaintances in the Burns ICU. All of them have done some time on my unit and agree it's no different from an MICU. Major differences: our patients are not sedated and intubated, they are capable of getting on that call light every 5 minutes, we do not have the ability to give pressors or propofol infusions (making our patients stably instable), we are part psychiatric unit, and having that one extra patient (compared to the usual 2 on an ICU) makes it all the harder. No one likes floating to our unit... its chaos. And now, on any given night, our most senior nurses only have 2 years experience as a nurse. It's nuts!

The down fall to all this isn't the chaos or the sudden changes from stable to crashing. The down fall to being a nurse on this unit is the amount of disrespect we face from MICU nurses and the lack of credit as Critical Care Nurses.I am seeing this mostly with the young invincible ones who have maybe 2 years under their belts as a nurse in general. The ones who I often see disrespecting and ignoring the advice of the more seasoned ICU nurses.

The bad mouthing, disrespectful tone, and condescending attitudes are more than I can bare. I am actually quite proud for keeping my mouth shut to avoid stirring up any trouble. There is one in particular, that the second I hear her name when I give report, my stomach turns and eye twitches. I dread bringing my poor patient down because I have to deal with the poor attitude and higher than thou attitude. We are here to work as a team in saving lives, improving health, and stabilizing patients... this not survivor. No one is going to get voted off the island. So why is it that these nurses act . like we are on some kind of game show??? Or worse, on Grey's Anatomy??

I let it go. I don't really have time to take poor attitudes personally. I believe in karma, and someday these girls will have to face their own negativity. However, I see it affecting other nurses on other units. It ruins their whole day. We had one nurse get in trouble because she responded "you know you don't have to be so snotty with me, I am trying to give you a detailed and elaborate report so you don't find yourself trying to find it when your getting busy, so please let me finish." I guess the MICU nurse was offended and reported our nurse. I could say a few things about that, but I will refrain.

I know I am still learning, and I have a long road ahead of me as a life time learner. However, the dynamic between the MICU nurses and SD-MICU nurses needs to change. One day our unit will have MICU beds on it when our new Critical Care building is done. Our main respiratory attending is fighting for it. The transfer of many of our unstable respiratory patients is not safe and we run the risk of facing a sentinel event one day, and we want to avoid that. They will have to work with us side by side, and we work as a team unit and do not take too well to solo flying divas.

[Esme12, ASN, BSN, RN]

I knew a unit like this at a large well known facility...in this case is was the SICU. The unit was notorious for it's arrogant nasty nurses. They were THE ONLY competent nurses in the entire hospital...or so they thought. They had trouble keeping staff and no one wanted to float there....it is very hard to change a culture. It was my first job as a seasoned nurse when I moved to New England...I quit within 2 weeks.

[Here.I.Stand, BSN, RN]

(((Hugs))) I hate it when nurses feel the need to disrespect each other. Nurses rock, whether you work in ICU, SD, public health, LTC, acute, sub-acute, long-term acute, or home care, urban or rural, critical access or level 1 trauma. We shouldn't tear each other down like that.

I mean I say that as one whose grandpa fell and got some compression fractures at age 102 and never really recovered. He was too big and too weak for his family to care for him at home, so he went to LTC. We were blessed with another two years with him, and I give most of that credit to the LTC nurses who cared for him every day. He survived several bouts of pneumonia because their assessment eyes were so keen, they got him the treatments he needed right away. Because of them, he got to meet my then-youngest child, and my older ones actually remember him cuddling them in his lap.

I know what you mean about your type of unit. We too, as ICU nurses at my hospital, float to the SD floors. They get DKA pts with BGs in the 700s, unstable VS, all sorts of things that make the nurses ICU-level busy, but yet the pt doesn't need pressors or to be intubated, those things that warrant an ICU bed. And if that's not enough, many of them are jerks to the staff to be frank.

I'm sorry you're dealing with this. Their attitude really stinks.

[JeanOfAllTraits]

I habe always said that the hardest unit I have ever worked on is our stepdown unit. Broad range of diagnoses, all the services in the hospital, the need to be hypervigilant and have keen assessment skills. All of this while dealing with the psychosocial aspects of critically ill patients and very concerned families. My deepest respect goes out to you guys who do a lot with a little. Hats off to you!