geminigirl11

Hello, I was talking with a veteran surgical floor nurse about the differences in work environment, culture and general attitudes of nurses between ICU and med/surg floors. At our facility, we have 3 ICUs that seem to have pretty different cultures. The SICU seems to have more nurses with elitist attitudes than the MICU. We have staff that are very respectful and grounded and some who are not. Sometimes ICU staff refer to themselves as more special than other nurses such as floor or Teley nurses. Although each individual nurse is unique of course, we have a grouping of nurses that are a little arrogant and disconnected from other types of nursing and they tend to call themselves "special". I have heard out-right demeaning comments about med/surg & MICU nurses while in the same breath referring to themselves in god-like fashion. We also have a group of staff who are more realistic and connected with nurses in other departments. They talk about med/surg nurses with respect and appreciation. Sometimes, other ICU nurses make snap decisions about who makes a "good" ICU nurse and they do not seem to have a good track record in accuracy. What makes them think they do know who would make a "good" ICU nurse? My question to you is, what is it like in your ICU? How would you describe the general culture? Are the nurses mostly down-to-earth, arrogant, elitist? Do they appreciate other types of nursing? Personalities; what types of people show up in your unit? Can you even draw a generalization? My friend talked about ICU nurses being more aggressive in general. Some of my friends who work in med/surg seem less assertive and avoid things such as being charge nurse. I can be aggressive (or assertive if you prefer that term) especially when I'm assigned charge nurse. But I have a distaste for any elitist behavior. Thanks for your thoughts.

I like the motto of focus on the issue, not the individual. A lot of these posts seems to attack individual opinions. I think students deserve respect and they should do a fair amount of observing before taking action on something like this. I am so glad the OP went to the CI and came here to ask us about it (despite all the flustering). Does your hospital have an actual policy on texting? If not, they soon may since we have many more tech toys and capabilities. My hospital has a policy (no cell phones in use in pt care areas incld front desk). People still text all the time though. As an aside, a coworker told me about a study done on cells phones in pt care areas harboring alot of bacteria, MRSA, etc. Scary! There's a good chance that what you see someone do is what they generally do although yes, the person could be having an emergency at home. I say this without having been there. People's habits seem to stay constant. I like the post that started out with how we will see lots of behaviors that are disappointing. I hate to see us throw each other under the bus AND I hate to see bad/unsafe/unprofessional behavior tolerated too. It's tricky. At least we can come to this board to think about things togther and hopefully not attack each other all the time. I like Brilliant Dreams posts and I am so, so sorry about the loss of your father.

Regarding working four 12h days in a row, we have a union contract that states management may not do this unless the nurse wants to. We have a limit of three 12h days or three 12's and an 8h day in a row. At my teaching hospital, our residents usually seek our opinion, especially if the doctor is a woman; the men sometimes don't ask outright. We sometimes write orders without discussion, knowing that the doctor will just sign it later, but only for more minor stuff. However, a nurse should never feel bad for waking them up. They are on-call or in house, etc. It is their job to also take care of the patient and work. If they get a chance to sleep, great. But it is not a sure thing. Please don't hesitate to call them if you need them. Go forward without guilt, RN's. It sounds like you are taking on too much for the workload and perhaps you could turf writing of the orders back to the doctor...? At my faciltiy, we are not required to write orders and if we do, it is a courtesy. It is an on-going problem with newish residents, that they do not write orders in a timely manner. I usually tell them that we need them to write orders a little more quickly. I also call them and remind them. It is difficult sometimes to do this along with my other work, but since it's a teaching hospital, I am expected to teach and in turn I expect to be taught new things daily as well. I wonder how different it would be to work in a non-teaching hospital. I never have and I have heard that the relationships bw docs and RNs is much more of a power dynamic than at a teaching facility... Take care!

I have just read the majority of posts on this topic and am surprised at the lack of support for this guy who made a mistake as well as at the remarks like "I would've failed you too", and other mean, vicious comments. In general, I am not sure what good it does to kick people out or fire them for mistakes (unless the mistakes are so severe such as violence or severe theft just to name 2 examples). Also, there were some pretty sarcastic postings...one said something like 'so now you've made it the school's fault; what an amazing skill'....comments like these are unecessary and unprofessional. I don't want to write anything here that I would not sign my name and email address to. Attacking each other is a waste of our time. I've been in the working world for awhile now and have seen lots of people make stupid mistakes. I think it is rarely warranted to take someone's job away or in this guy's case, take away his student status. There are ways of having people pay consequences that help them learn from their mistakes but without driving them to lawyers and other extremes. To the person who got expelled, I hope you find a good lawyer who will tell it to you straight. My university accepts transfer credits (Univ Washington, Seattle). I've seen people get targeted in clinicals due to persoanl issues with instructors and schools that overreact; sounds to me like your school fits this. But I mainly wanted to say that regardless of whether or not we're getting the 'whole story', the responses on this stream have been very revealing of why we have the saying 'nurses eat their young'.

Orientation at my hospital for ICU is 6 months or whatever the person needs, sometimes it's 3 months; sometimes it's 7 or 9. Safe practice is the key guide. While it is possible people may "milk" the system, it is more likely that they need the time or support. Three months is usually reserved for people who have already been practicing nursing for some time. Working on one's own time while useful for the person who can do it, is not expected at my facility because not everyone can do it. Good luck everyone!

My hospital definitely hires new grads in the ICU. I joined the SICU with almost 4 years med/surg experience and it still felt very difficult. In fact, some of the new grads I started with may have had an advantage from just finishing pathophys, anatomy, etc. I am interested in the discussion of whether or not new grads belong in an ICU and whether or not accelerated programs are a good idea. People have argued that accelerated programs don't prepare nurses well enough, etc. But, the vibe that I get when people speak against these 2 things often has to do with the speakers' feelings of resentment that they did not have those same opportunities. It is unfortunate that they did not have the same chances BUT we are in a crisis with our nursing shortage. We need nurses!!!!! I recently heard an 'old-timer' criticize a newbie for being unwilling to "do her time". Not a helpful attitude especially since he sounded so personally cheated & offended. I know some people who have gone the accelerated route and they are stellar, amazing folks (and they were able to get into these competitive programs!). We need them. And they are required to take & pass the same NCLEX. One way to look at accelerated programs is, that you can either get your experience first then obtain a higher degree or get the degree then gain your experience. People that graduate from the accel. program here do not immediately hop into higher positions with prescriptive authority...they work as RN's like everyone else and gain the required experience first. And a final question on new grads in ICU...are there any rational reasons to not have them there? I have heard a lot of blather but no real critical thinking yet. We are supposed to look a things objectively with a researcher's eye . Tradition should not dictate how every person comes into the field of nursing. What do you all think?

Hi Squirtle, one thing I've noticed is that teaching can sometimes bring up feelings of embarrassment on the part of the preceptor. And this happens with people who want to teach! They have to really show themselves and this can be hard at times (even for the experienced ones). If they get frustrated with your lack of knowledge, it is about them, really. Hopefully they will not aim this at you. I remember asking questions that my preceptors could not answer and I felt badly for them. I started changing how I asked questions leaving plenty of room for not knowing the answer and this helped. I would be very observant at first especially if you are feeling urgent about anything day-to-day. I'm remembering that my over-eagerness got in the way once in awhile. The problem that I've seen for new grads and especially new docs/med students, is they are so urgent to know something and show this that they end up coming on too strong and eager, firing off questions or comments. I agree with a previous post-if you don't feel it's a good fit with your preceptor, speak up sooner rather than later. I chuckled when I read "I would stand at the nurses station while the team leader would beg each nurse to allow me to be with them... someone usually gave in after about 6 or 7 declined". BUT, a team leader shouldn't have to ask over & over. If they assign someone a student, that RN should be gracious and take their asignment, for goodness sakes! Remember, your preceptor will shine when you do and you have every right to be there as a new grad. You seem very thoughtful and caring. How lucky for them! Have fun!!!!!

Can anyone tell me how to position a patient with a newly developed pneumothorax? Is it affected side down with good lung up or the other way around? I have heard this makes a difference in helping the patient breath better until a chest tube can be placed. Thank you!

I have seen lots of people die and I think I will never not feel a sense of grief and loss at least on behalf of the patient's loved-ones. I remember being in a code recently-the excitement of doing chest compressions and the adrenaline rush of it all. When the patient finally died, I allowed myself to feel really sad too. Sometimes when other nurses or doctors see me, they ask (if they don't know me) if this is my "first death" and I just matter-of-fact say no. Do any of you ever get this reaction? It's not a goal of mine personally to harden myself around death at work. It helps me stay on top of the intensity of ICU nursing.

Hello Everyone, It seems like a toxic environment if an experienced nurse "reams out" an orientee in front of others. How disrespectful! You do not deserve this no matter what. I also think it's impossible to learn when something like that is coming at you. Brains work best in open, encouraging environments. I have been in my ICU for awhile now and I think I must still have some track marks on my back from my orientation! I worked for 4 years in Med/Surg first but I can still remember nursing school and being a new RN (scary). When I joined the ICU, I noticed people acted like I was just born and did not have a brain. They also felt it was okay to make disrespectful remarks about 'floor nurses'. I have stood up to people on this and it has at least helped them not make these remarks if I am around. Good luck and you are most likely more than capable of succeeding in your ICU. I think we just need to figure out is whether or not it is for us long term.

almost 70K/yr base pay, full time, before taxes. shift diff is 25% of base pay. VA Federal hospital, Seattle, WA. BSN/RN, 4 years experience. At my hospital, most start at 54K/yr depending on other degrees and experience. Housing is expensive but it's possible to find a home in surrounding areas. My home was 278K and is less than 15 minutes from work. My neighbor is a traveler, I can't remember her salary but its very good plus most travelers in Seattle (incl her) receive 2K/month for housing whether you live here or not. -gg

Thanks for this question; it's been weighing on my mind. I started in my current ICU 7 months ago after a few years of floor nursing. I noticed that the ICU nurses who have never worked outside of the ICU have a really different sense of themselves as nurses, not right or wrong but different. I work with people from so many different cultures and backgrounds, ages and ethnicities. I think my unit, like so many of yours, is a microcosm of whatever struggles are going on in the larger society. Luckily, I am an incredibly outgoing person and had a few close connections walking into this unit. This has helped. Having a strong work ethic has also helped and I would reccommend regular venting with close friends so that we can keep reaching past the clique barrier. Cliques are paper thin at times and I believe persistence is key. Humor helps too as long as you get enough time to vent about the real hurtfulness of cliques. I have quite a reputation at my facility that does not really reflect who I am. It reflects people's issues with having to interact with a strong female. I would say that racism is in the mix too as people from all over the world and the USA work at my facility. (I am white). I also could see why people need to leave their units; we've got to take care of ourselves. Thanks.

Hi, Exair, I'd love to hear an update on your class discussion of this topic. I work at a VA hospital and the Director of Nursing is fond of the saying, "a nurse is a nurse is a nurse" to our dismay. When nurses hear this statement, they may easily feel belittled or like chattle. It helps me to think about the history of nursing...someone mentioned that doctors would not be asked to cover outside of their specialties; HOW TRUE. People have an incorrect view of nursing as, "well, you're just taking care of patients". It's been enlightening talking with the public about nursing-they have no idea what we do and the media does not portray us accurately. There is still a huge notion that nurses are simple caretakers and for this and other reasons, they can be easily interchanged. It sends a message that we don't matter as much (as doctors, as male-dominated professions, etc). Nice to hear many of us talking about protecting our licenses; when I was a new RN, I didn't really get what my boss what talking about. Now I have a better picture of how doctor-culture, institutional sexism, and the nursing shortage intersect to cause this attitude. Thank you.