Unbelievable floor nurses.

TachyBrady · Jan 28, 2007

Sounds like you've got some kind of ego trip going on. Good thing you were there to "save" this patient in your world of incompetent doctors and nurses! (sarcasm).

Seriously, I applaud the floor nurses for turning you in. Rudeness/abuse is never appropriate nor should it ever be tolerated.

muffie, RN · Jan 28, 2007

two sides to every coin

Ann RN · Jan 28, 2007

A patient is brought down to SICU because of complications from a small bowel follow through. A little background info on this patient......obese..140 kg....5 ft 3 inches.....N/V x3 days.....mottle from nipple line down when she arrives.....no lower extremity pulses......sinus tach at 180..patient core temp at 94.0 degrees...no palpable blood pressure.......Anesthesia present at bedside to intubate, place aline, and right ij triple lumen, patient has a 22 gauge to right thumb...it works long enough to give 4 cc's of ROC....then blows..no other IV access before cline is placed. Meanhwhile I'm at the head of he bed trying to keep this lady from aspirating because she just vomited 800 cc's....patient finally gets intubated, cline done, aline is done. Cline completed by Site Rite...so we have immediate confirmation..Anesthesia leaves......primary Doc is out of town and OC doc is at home..but leaving for the hospital....the OC doc is a endocrinologist...freakin' great....meanwhile I decide to pump this lady with 4 liters of fluid in about 30 minutes...finallly doc shows up..doesn't know what the hell to do....what a surprise....floor nurses are standing around doing nothing...one is standing at the left side of the bed telling the patient to calm down....hello idiot...she just received a paralytic....the other nurses are now sitting down in the hallway while me and my co-workers save this lady. About 1 hour later my patients vital signs are now ABP125/87, CVP12, HR 102 SR, mottling has decreased considerably, patient now following commands, pH7.31, C02 42, P02 70, the initial gasses were 7.0, c02 41, p02 32, BE -13, long story short..three days later i am in the bosses office because I was written up by three floor nurses for my attitude when they brought the patient down......the floor nurses claimed that there was verbal abuse, and physical abuse(one nurse claimed that I shoved her), verbal abuse was cussing. Nevermind that this patient was under the care of these 3 genius floor nurses for three hours before they figured out that something was wrong. If I had to do it over again I would do the same thing because we discharged that patient home just recently after having a small bowel obstruction repaired. If I have to lose my job over a few idiot floor nurses so a family can enjoy there loved one for years to come then that's what I will do. As far as the shoving goes...nothing could be further from the truth.....cussing yea probably..but nothing a good seasoned ICU nurse hasn't said or heard before. Unbelievable floor nurses.

I would be proud to have you as my nurse. I expect every nurse to deliver "reasonable and prudent" care, which these floor nurses obviously did not. Good seasoned ICU nurses have little respect for floor nurses that do not provide safe care and really do not understand what is going on. Where are their critical thinking skills? I see no ego trip here, as one poster states. Just expectations of quality patient care.

Tweety, BSN, RN · Jan 28, 2007

Yep two sides to every coin.

Floor nurses can't "write you up", only your manager can.

Take a breath and consider how you acted. You definately think they were idiots and perhaps this shown loud and clear and wasn't appreciated. I know I've sometimes gotten "attitude" during transfers as well, and it wasn't warrented. Sometimes patients change and crash fast. A patient may be fine one one round and on the next round one or two hours later in pulmonary edema, mottled, or any kind of condition. It's scarey.

I've also received patients from ICU dirty, smelly, with decubs and improper wound care, infiltrated IVs, bleeding, the list goes on. But they knew the patients potassium level for the last four days. It took floor nurses to get the patient well enough to go home.

On the other hand the patient arrived in dreadful condition that shouldn't have been that bad and you're justified in your frustration. They sound like a dreadful miserable and dangerous bunch.

Sorry, I hope this thread doesn't become a floor nurse vs. ICU nurse thread.

GardenDove · Jan 28, 2007

Sounds like you've got some kind of ego trip going on. Good thing you were there to "save" this patient in your world of incompetent doctors and nurses! (sarcasm).
Seriously, I applaud the floor nurses for turning you in. Rudeness/abuse is never appropriate nor should it ever be tolerated.

I also did detect a strong tone of elitism and arrogence in the original post.

Trauma Columnist · Jan 28, 2007

Having worked in a high stress area (level one trauma center for 10 years), I think I can speak to stressful situations. You must always remain professional and polite. Maybe next time you can enlist the floor nurses assistance: have one suction the patient, one place a foley, one to give meds that you draw up?? That way, everyone has a role and you get the patient care done more quickly.

Believe me, I too have felt that I was the only one doing anything in some situations. However, what it usually means is that I'm not taking advantage of the help that I have available.

No one gets points for being a martyr. Have a nice day.

GardenDove · Jan 29, 2007

It's possible that the Med-Surg nurses didn't properly access this pt in a timely manner. It could be that they had multiple pts and other crisises on their hands that day. They don't have the luxury that we have in an ICU setting to do so, so it's possible that there is a reasonable explanation for the pt's condition at the time of transfer.

Your harsh communication style probably didn't make them feel comfortable to pitch in to help. They are not used to operating under these foreign circumstances and probably felt that they would get in the way. I, myself, am new to the ICU setting, and in our small ICU we don't see alot of heavy action as a larger one does. Therefore, I too would probably not live up to your high standards.

Med Surg nurses don't run codes. Rarely, they'll call a code and people who do codes often will come and do a code. That's just the way it is. Calling people idiots isn't exactly the sign of a respectful professional. We've had pts suddenly change in our unit at shift change, someone who seemed relatively stable, then suddenly we are conducting a code or near code. You should know very well that a pt can go down the tubes in a short time.

caroladybelle, BSN, RN · Jan 29, 2007

Sounds like you've got some kind of ego trip going on. Good thing you were there to "save" this patient in your world of incompetent doctors and nurses! (sarcasm).
Seriously, I applaud the floor nurses for turning you in. Rudeness/abuse is never appropriate nor should it ever be tolerated.

I too note the arrogance more than anything else.

I am wondering how many patients the floor nurses had apiece, how many hours and days that they were fighting with the MD to get the patient taken care of? How many supervisors that they had to argue with to finally get the patient to the ICU?

I have worked critical and I have worked MS onco. I would rather work critical any day. The MDs give you leave way and you actually have time to concentrate on your patient. But I would no more jump into the ICU when I am not oriented to it and unaware of their protocols. Just as do not expect ICU to jump into MS without orientation.

I have also seen my chemo/neutropenic patients receive utterly wretched care in ICUs. Such as not a bit of mouthcare done for a pt despite the notations for QID mouthcare. They come to me with scabs in their mouth and throat from mucositis. And that is much easier to prevent than fix. We manage it on the floor with 5-10 patients, yet ICU cannot manage it with two - or one since many of ours are CVVHDs. Or cases of hemmorhagic cystitis that occur, despite proper therapy being prescribed and ICU instructed in post chemo care.

We can fling verbal stones at each other about the deficits on both sides, but it accomplishes nothing, but alienate each other. As does using abusive behavior and cursing each other.

It might also be suggested that some anger management might be useful.

fakebee · Jan 29, 2007

:confused: I have been an ICU/CVICU RN for 11 years in level 1 and 2 trauma hospitals and I will never consider myself equal to a good med-surg nurse. I

don't know where you work but my experience is that the floors now house the patients I had in ICU 5 years ago. Heck, nowadays my primary mission as the night ICU charge nurse is to triage the "least sick" patients so I can transfer them to medsurg/tele floors when the even sicker patients arrive from OR/ER. Yeah I'm often overwhelmed with 2 sick patients but at least my

fellow RNs are within shouting distance, unlike the floor that has fifty totally enclosed rooms. We also don't invite the transferring RNs to assist c the care of a pt that is now our responsibility, it's already been traumatic enough for them(I haven't worked with a nurse yet who likes to see a pt go bad and who doesn't feel they are responsible for the decline). As much as they would like to stay and help, they've got to get back to the 6-8 other patients they still have, anyone of whom might be circling the drain now because the RN is having to deal with the 8 family members in each room who want to rant and rave about the care their family members are receiving. There are reasons medsurg and telemetry floors can't stay staffed and beyond the obvious crappy nurse/pt ratios and the overwhelming acuity of the patients is the subtle and in your case not so subtle attitude that nurses outside my specialty are idiots attitude so many RNs exude. Every time I float to the floor I pray that I don't kill somebody

or harm a patient because I am always completely overwhelmed at the pace and the workload. I'm grateful that your pt had a positive outcome but am dismayed by your lack ok professionalism to the point that if I were one of those floor nurses you wouldn't have to worry about a writeup we would settle this in the parking lot...you need to spend ayear on the floor and then update us on your attitude. It's not surprising to me that I find this same attitude in so many new grad critical care nurses who make it clear that floor nursing was not foe them-too much work and too many patients. Well

somebody has to do it, so show some respect, even if you have to fake it, to those brave souls. I'll say it again-a good floor nurse has few equals and a great floor nurse sits at the right hand of God as his most trusted advisor because they have seen and done it all. Sorry for the rant but this issue touches a nerve.:smilecoffeecup:

muffie, RN · Jan 29, 2007

:thankya: :bowingpur

nicely said and thanks from a lowly med-surg nurse

GardenDove · Jan 29, 2007

Well said, fakebee!