How to be on an ICU Nurse's good side?

ruby_jane, BSN, RN · Feb 26, 2019

ICU nurses are a particular bunch and until you demonstrate competence they may look at you as very much being in their way. Don't take it personally. Show up, do your job, and realize that sometimes you can't be on everybody's "good side" so just strive for professionalism.

Regarding overnight events: Perhaps if you tell them why you're asking? Are you asking for a reason? Or are you asking because you've been told to ask? What will you do with this information? When are you asking? Are you asking right as the nurse is attempting to do something else?

Do you have access to the chart? If you do, the best way to find out if there were adverse events is to read the chart.

I wish you the best of luck, OP. Curious, helpful, competent docs are few and far between - keep on keeping on!

Charge200J, BSN · Feb 26, 2019

Awesome question! MICU is a great place to learn for new docs. I love it when the day team comes to ask the night nurse how the night went, it gives me a chance to directly communicate issues that need to be fixed on day shift. However, they always have a tendency to show up and ask at 7ish AM right in the middle of our nursing shift change report. Try asking earlier (aka before 7AM) and I bet you'll receive a different vibe.

ArmaniX, MSN, APRN · Feb 26, 2019

Not sure why you’re getting attitude, or sense you are, when asking this routine question.

When I was an ICU RN I would most be annoyed when the resident/student would disrupt our shift report to ask about the patient or overnight events. Do not interrupt the nurses report.

For some reason the student/residents at my old job would try and get the entire patients narrative from nursing. You should know your patients and do your due diligence.

In my current job as an ICU nurse practitioner, we get provider sign out and look up our patients events. When I am assessing the patient if the RN comes in for a med pass or something I’ll casually ask if they had a good uneventful night or if there is anything I should know.

AceOfHearts<3 · Feb 27, 2019

One of my huge pet peeves is when I’m asked about hourly output- whether it’s a drain, urine, etc. or some other vital like temperatures (wanting to know if the patient was febrile and how high it went). All of that is charted and there is a reason we do hourly intake and output- take the 30 seconds to look it up. I sometimes wonder why I even bother charting things when it’s clear certain providers never even bother to look at it (and I know I’m charting it for other reasons too, but it’s just super frustrating).

For the most part I don’t mind answering questions, but if I’m clearly busy (especially if I’m doing something with my other patient) or it’s something that should very obviously be charted it gets a little old (especially when I have multiple people from different disciplines asking the same questions in a short time frame).

MaxAttack, BSN, RN · Feb 27, 2019

Welcome! Just the fact your asking this makes me think you'll be ok. I was a night nurse and I loved getting the chance to talk with doctors/residents before I left.

My only complaint was someone looking for a full-on conversation about a patient during report. Asking for a quick update or overnight events makes sense to me. It gets excessive when I'm interrupted for a history, vitals, or what brand of cigarettes they smoked.

That being said, don't let cranky nurses get under your skin.

Ruby Vee, BSN · Feb 28, 2019

It's already been said before, but do not interrupt the nurse's shift report.

Take a few minutes to look through your patient's chart before you approach the nurses. Know whether your patient was febrile, were there hyper- or hypo-tensive episodes, which labs are normal and which aren't. Glance at the med list, and if there was, for example, a big urine dump was it because a diuretic was given? If there are things you don't understand (patient's K+ went from 2.3 to 5 and there was no KCl dose charted, for example) ask the nurse. But try to figure things out before you ask the nurse -- it's better for your learning, and mornings are busy times for the nursing staff.

Get to know the nurses' names and use them.

Don't help yourself to food in the break room unless you've brought food to the potluck or have been invited to partake. And never, ever, no matter what you do or how hungry you are, eat the nurse's lunch. Yes, it does happen. It's a jerk move.

I'm guessing though, that because you're asking you're probably not a jerk and will get along just fine.

Cowboyardee · Mar 1, 2019

It helps to know why the ICU nurse is getting annoyed. Off hand, I can think of several different scenarios:

- ICU nurse is annoyed because they're busy and you're interrupting.

solution: don't do things like interrupt a med pass to ask them or their patient questions. Find a quiet moment to approach the nurse.

- The ICU nurse is just crabby in general and/or has a kind of bias against med students.

solution: this is a tougher one, but mostly it comes down to building a bit of rapport before pumping them for information. Also, see the next problem...

- The ICU nurse gets the impression that you want them to do an unreasonable amount of your job for you, asking them for lots of information that you could readily see or look up yourself.

solution: get very familiar with the charting system as soon as possible and get in the habit of looking wherever the staff tends to document important events before asking (nursing progress notes, often). Learn to spot the vent settings by looking at the vent, iv gtt rates from the charting or the pump, etc. A lot of times, leading in with asking about some particular event, change, lab values, etc makes for an easier conversation than just right off the bat asking the much more open question about overnight events. It's easier to talk about the patient with a lead in for both parties.

- The nurse is insecure about not knowing the answers to your questions.

solution: adjust your expectations. For one, we don't always get the whole picture in report and we often have to look things up as the day goes on. For another, not all ICU nurses are actually good at their jobs or particularly competent, and some attempt to cover this with preemptive icy-ness. Don't take it personally, but also try not to make them feel like they're getting a pop quiz.

KeepinitrealCCRN · Mar 1, 2019

Just being nice and not a know-it-all goes a long way. Also, clean up your *** when you're done, put my blankets back on the patient the way you found it and don't touch/unplug anything without asking first.

AGRN152 · Apr 8, 2019

My response is similar to what others have already said:

1. If you're asking about a patient's condition or intake/output or any other data, are you asking because you truly want to know? Or is it because you need to fill out your flowsheet and report to your superior. As an ICU nurse, I can tell you that we couldn't care less about what means you employ to fill out your morning sheet, in the morning, after we worked all night long with no sleep or food or bathroom break sometimes, the last thing we want is to spend the last 20 minutes of our shift giving information to a student/ first year resident when we are doing last minute care, med passes, charting, and cleaning up the shift. At this point in your career/education, you are not ordering anything, you are not directing the patient's care, and you have no decision making power over that patient. We ICU nurses know this, and will not waste time feeding you information that you will do nothing with aside than relay it to your superior with whom we have likely already spoken.

2. Do not interrupt change of shift report

3. One day you will be the experienced resident with the authority, and we will love you. We will call you, trust you, and seek your input. We will include you in our circle and celebrate your victories. This is a rite of passage. If we seem indifferent now, it is because we are. We are here to care for our patient's.

4. Get your numbers at 5am, long before the morning bustle. Sacrifice your sleep and we will sacrifice our time.

ptier_MNMurse, BSN, RN · May 18, 2019

I know this is a little old post, but BRING FOOD! Always a good way to break in and get on someone's good side! Donuts, cookies, pizza, whatever! I'm glad to hear you care enough to ask a nursing forum about how to build relationships with the nursing staff!

We can be a tough bunch, rightfully so as we need that to protect our patients health and wellbeing. Hang in there!

JKL33 · May 21, 2019

On 5/18/2019 at 10:23 AM, ptier_MNMurse said:
I know this is a little old post, but BRING FOOD! Always a good way to break in and get on someone's good side! Donuts, cookies, pizza, whatever! I'm glad to hear you care enough to ask a nursing forum about how to build relationships with the nursing staff!
We can be a tough bunch, rightfully so as we need that to protect our patients health and wellbeing. Hang in there!

Speak for yourself! ?

In the setting/situation posed in the OP, this ^ amounts to nothing but a patronizing attempted end-around. I know this is an older thread, but I won't leave this post hanging out here un-contended. To be patronizing is to be disrespectful.

If you feel respected and won over by food gifts (or any gifts) without any attempted collegial relationship, be my guest. But heck no that is not what I want. I hope most nurses don't, because it's insulting. You can win over a nurse with a donut" -- NOPE!!