I had a patient the other day that although I worked my butt off, but I was made to feel like I did a bad job with, and it's still nagging at me.Pt was a sixty-something year old male, lifelong smoker, not been to a doctor in YEARS, who had been having SOB, productive cough, low-grade temp and chest tightness for two days. Seen in another ER day before, and dx with bronchitis, given a mega-dose of steroids/IV antibiotics, and discharged with amoxicillin.Showed up at my ED with same complaints, RR of 26-30, sat of 90%, rhonchi and audible wheezing, yellow sputum, fever, so I did the complete pneumonia bundle on him, as well as a full cardiac workup. His labs came back crappy... 18000 WBC, K of 3.2, slightly bumped troponin (0.19), CPK of 1800, a pro-BNP of 1800, and a d-dimer of 1.3. But his x-ray didn't show an infiltrate, he responded very well to duoneb tx/solu-medrol, and his ct chest was negative for PE. Pt was actually wanting to go home...he didn't look as bad in person as he did on paper! He kept insisting, "I'm alright, I'm okay." I spent a lot of time with him, explaining lab results/medicine, talking about smoking cessation, the importance of getting a PCP and having regular checkups, etc. We had great rapport...he was getting a kick out of me fussing at and over him.Every single issue that arose with him was addressed in the ED. He got two lines, BC x 2, sputum culture, Vanc, Levaquin, aspirin, NTG paste, Lovenox, K-Dur, and Lasix just in the ED. His admission orders were dx: bronchitis/chest pain, written for bedrest, serial cardiac enzymes, scheduled steroids/duoneb treatments, IV antibiotics, and an echo in the AM, and a stress test as soon as his respiratory problems improved. He literally had three pages of orders, and I checked off every single thing I could do in the ED, got all his meds, etc.When I called report on him, his vitals were actually pretty good. HR of 96, RR of 24, 02 sat of 95-96% on 2 liters, BP of 130/80 and temp down to 99. I called report, and noticed that he was due for an albuterol/atrovent treatment. I called respiratory to meet me upstairs, and me and the pt went up. I put him on the monitor, hooked up his 02, bid him goodbye, went to the desk and gave additional report to the nurse, and told her respiratory was on the way for his treatment. When I left him at 2am, he was sitting in bed, laughing and talking, watching some infomercial on TV, and had only slightly increased work of breathing. Still some expiratory wheezing in his upper lung fields, but not audible without a stethoscope.Then I get a call 20 minutes later from the nurse, yelling that this patient is too sick, he needs to be in ICU, why did I leave him up there, etc. I can hear him in the background saying, "I'm alright, I'm okay." Unbeknowst to me, the admitting nurse didn't go right into his room, and neither did the CNA. The patient took off his 02, went to the bathroom, then walked all the way down the hall because he wanted some juice. Respiratory never showed up to the room for the treatment, and by the time the pt was seen in the hallway and escorted back to his room, he was very SOB, audible wheezing, etc. Instead of calling respiratory, the nurse on the floor called the medical response team and the ICU doc to come see this patient that was probably going to need to be intubated(!) She pitched such a fit that the critical care hospitalist agreed to take him to the ICU. I went right up, and he was in ICU, FINALLY getting his breathing treatment, laughing at me, joking "Why didn't you tell me that I was going to get a tour of the whole place, I've done been in three rooms tonight already!" Sure enough, after the breathing treatment, he looked and sounded much better, and it was time for his steroids, so the ICU nurse gave them to him. I went back at 7am before I left, and they were going to downgrade him back to a tele bed after his echo was done. He spent less than four hours in the ICU.Yet...I still got written up by the nurse on the floor. I feel like this patient was completely manageable. I took care of him along with my four other assigned beds in the ED most of the night, and we also had a full arrest and a STEMI come in that I worked on. I'm mostly just pissed that the patient really had confidence in me, and then it got undermined as soon as the admitting nurse called me yelling in FRONT of him.