ICU nurses attitude toward med-surg nurses

PostOpPrincess, BSN, RN · Aug 28, 2009

That's why we have NO POWER. We are the least empowered profession because we are conquered and divided. Too bad.

It isn't just ICU, it's all departments. Whenever you become compartmentalized, it becomes a YOU versus THEM.

This I find working with women....men, not so much.

Tait, MSN, RN · Aug 28, 2009

I was just thinking this the other day!!

Eventually it gets easier in my opinion and generally I just smirk as I leave and think how much they cower in their in scrubs at the thought of coming to the floor.

We actually had a float ICU nurse on the floor that was under the impression she would only have to carry four patients!

In the end my only concern is the patient, and 95% of the time I look the patients up again later and find they spent several days in the unit after my transfer. One was vented for a month after he went into respiratory distress on my shift.

I think sometimes the feeling of being dismissed comes from our experience with the patient versus theirs. Most of the time when we get down there we are on a major adrenaline high from the transfer/talking to docs/assessing the patient and calming family. They on the other hand have all the resources they need at their fingertips (as I am learning from a good friend who just transferred to the CCU) to begin taking care of that patient.

Tait

catshowlady · Aug 28, 2009

Are you sure is really a superiority thing, and not a stress/time issue? As an ICU nurse, I know there are times when I want just the barest of bones for report, especially if I am getting a crashing pt. I try to not make it sound like I'm not interested in what the reporting nurse has to say.

Maybe ask if they want much in the way of report. If they act disinterested, call them on it, say you're going back to your unit, and leave a phone number for them to call with questions.

PICNICRN, BSN, RN · Aug 28, 2009

You know... on the other end I often get so frustrated giving report to the floor............ I am trying to give a good history and physical and the nurse will cut me off and ask "do they have an IV" and "did you give the whatever o'clock meds"? Almost like they could care less about what I have to tell them. It works both ways.

And just to play devil's advocate.... I'm sure I've come off as disinterested at times when I'm getting a pt who is circling the drain from the floor- pushing fluids, starting and epi gtt and the floor nurse is trying to tell me when the next antibiotic is due. Not trying to be an a$$ .... just saying..... walk in someone else's shoes before you throw stones. :twocents:

Mike A. Fungin RN · Aug 28, 2009

Well, don't make a generalization about ICU nurses... that's not really any better.

I've never been the sort to engage in that kind of behavior. I have respect for our med-surg nurses -- they have a tough job too.

That said, I have come across nurses from the floors who have trouble giving a focused hand-off report in the unit. If I cut her off it's not to be rude, or because I think I'm better, or that I resent that she can't focus her report... it's that the patient's my priority, and I only need the info that I need... in a hurry. I'm not overly concerned about his bowels at the moment if he came to me because of his heart.

Does it sound like this could have been a factor in your encounter? What exactly do you mean by "brush off"?

Straydandelion · Aug 28, 2009

Not liking generalizations about ANY group, being a med-surg nurse for a few years I have only had a problem once giving report to an ICU nurse and it was explained to me by another nurse in the unit what a BAD day she was having being super busy, which we all have occasionally. Having gone to ICU in the capacity as UM and knowing what can happen, I would say the attitude or respect can go from the top down. As far as report, I generally keep mine in two parts for ICU... 1. initial diagnoses and what happened to bring them to ICU 2. extended report IF they have time to hear yet not necessary for the immediate situation. All of this information however can be obtained in the chart or nurses notes in case not obtained during the report.

Guest219794 · Aug 28, 2009

Part of any hospital training should involve spending a little time in other units. I see this kind of conflict in the ER. Having worked a couple years of ICU, I know the language, anddon't have this issue.

Think about how long a new nurse orientation is, and think about what a good time investment it would be to spend a couple days working/observing in the hospital's other units.

i recently wrote up an ICU style report format for a new nurse intimidated by giving report to the unit. She found it helpful.

meandragonbrett · Aug 28, 2009

It works both ways. I've given report to hostile medsurg nurses who act like I am ruining their day because they're getting a patient. I can't help it. There is somebody SICK that needs this bed and needs it now! ICU nurses tend to come off sometimes as being rude or jerks and I think a lot of it has to do with our Type A personalities, attention to the minutia of the patient, and the assertiveness that we have to have with the physicians. ICU RNs have a totally different mindset than any other specialty in the hospital and we get a bad rap for it.

Just let it roll off your shoulder and know that some nurses will always be jerks.

meandragonbrett · Aug 28, 2009

We actually had a float ICU nurse on the floor that was under the impression she would only have to carry four patients!

I REFUSE to float to any other unit outside of an ICU and accept a patient assignment. I will float around, do accu checks, give meds, help with vitals, etc. but I am NOT taking a patient assignment. If they are demanding that I take an assignment I'll delcare it unsafe and go home.

I don't know why administratio and other non-critical care nurses think that because we can manage 2-3 critically ill patients that we can manage 7-8 medsurg patients. It doesn't work that way. I cannot turn the critical care nurse off and the medsurg nurse on. I am certified as a critical care nurse and am trained in that fashion. I have *no* training how to function on a medsurg/stepdown/tele floor and I shouldn't be expected to carry a patient assignment when I've not received a proper orientation to that unit.

eriksoln, BSN, RN · Aug 28, 2009

No matter how much you feel that way, even if it is true that they are acting this way..........let it go and move on.

As a lifetime M/S nurse, I can tell you I do notice the way certain departments tend to be an island from the other units..........not just professionally but personally. I always figured there was some reason I didn't understand for it that I'd probably understand better if I worked on their unit.

As a M/S nurse, I can say I have gone out of my way to keep peace with other departments. I don't refuse report from ER, I do whatever it is the ICU nurse wants when I am transferring a pt to them, I always make the call to a doctor when Pharmacy asks me to.

There will come a time when I/you need them, and you'll be glad there is no bad blood there when that time comes if you've managed to keep the peace with them.

Good example I can think of is my last code. Respiratory Therapy was there in a jiff doing things for me, the ICU nurse stepped in and took control of the situation and really made a difference in helping the pt survive. I was very grateful to both teams that night.

So, if I have to trade of being treated like a "remedial" nurse by an ICU nurse in exchange for top notch Rapid Response Team performance............eh, so be it, I'm OK with it.

Tait, MSN, RN · Aug 28, 2009

I REFUSE to float to any other unit outside of an ICU and accept a patient assignment. I will float around, do accu checks, give meds, help with vitals, etc. but I am NOT taking a patient assignment. If they are demanding that I take an assignment I'll delcare it unsafe and go home.
I don't know why administratio and other non-critical care nurses think that because we can manage 2-3 critically ill patients that we can manage 7-8 medsurg patients. It doesn't work that way. I cannot turn the critical care nurse off and the medsurg nurse on. I am certified as a critical care nurse and am trained in that fashion. I have *no* training how to function on a medsurg/stepdown/tele floor and I shouldn't be expected to carry a patient assignment when I've not received a proper orientation to that unit.

Wow. I am not even sure how to respond to that, and most of what I could say is merely assumptions about your hospital and would be unfair generalizations. So I will refrain from trying to fully negotiate this post.

I guess I can just state from a charge nurse perspective on our floor how we treat our floats:

-Our heaviest patients always go to a home floor nurse for continuity of care. Therefore anyone who would really be complicated a float nurse would never have.

-No one has more than 6 patients and has a balanced mix of lighter and heavier patients. (This is on nights, 4-5 on days)

-That night they did respect the wishes of that nurse, until the floor got slammed and the charge nurse was nearing patient seven and SHE herself wasn't from our floor. (We still aren't sure how that schedule got so out of whack to have 3 floats and new grad on that shift.)

Interesting.

Tait