Why do Critical Care nurses look down their noses at Med-Surg nurses?

[marisatheresa]

I'm a med-surg nurse and proud to be one. I routinely care for 5-7 patients on day shift, who present with a variety of complex, acute conditions. Whenever I transfer a patient to a critical care unit - it doesn't matter which one- MI, CTI CCI, Neuro, or Burn, the critical care nurse asks all sorts of irrelevant questions, such as what K+ was four shifts ago? Why is it so hard for critical care nurses to understand that floor nurses don't have the luxury of sitting in their little booths outside the patient's room and picking through the weeds in the chart? I understand that medical nursing and CC nursing are two different levels of care, so why ca't CC nurses understand that as well. Why do they think we are grunts and they are the fighter pilots of the hospital? Can anyone who works in CC give me some insight into the condescending attitude of CC nurses toward floor nurses? Oh well, for every time I encounter condescension from a CC receiving nurse, I have just as many opportunities to graciously throw them a life preserver when they are forced to float to the floor and can't handle the 5 easiest patients on the floor. Seriously, can anyone help me better understand where a CC nurse is coming from and what/why they expect so many details - details that they could just as easily find in the chart vs. expecting to be spoon feed from the sending nurse?

[yshell12]

Not sure if I picked up the mentality from school or what, but the mentality that ICU/ED nurses surpass med/surg in competency is pervasive-- and impressionable new nurses like myself tend to absorb such attitudes. It's funny how many people internalize this feeling though. Many (even seasoned/veteran) nurses I've worked with in the ICU snub their noses at floor nurses for being (clueless/incompetent/empty-headed) inferior to them in skill and/or importance. That is BS. Total and complete BS. I ate a huge piece of humble pie when I saw first hand what they do up their. They may task more than other nurses, but it is because they don't always have the time to "play doctor" like many ICU nurses. It is a lot of hard backbreaking work being a medsurg nurse, and my hats go off to them. To assume they can't wrap their head around patho the way ICU nurses can is also complete BS-many of them understand patho to a level that is acceptable for their required level of responsiveness. So what if they don't know the in depth pathways of hypotensive crisis and levophed; why should they? They don't use that stuff. I'll tell you what though, they are experts in their own ways--their expertize are simply not appreciated by ICU nurses because they can't relate to them.

*NOT ALL*, but many ICU nurses I've come across believe that the sun rises and sets on their ***. If report isn't given isn't an ICU report, it is "unsatisfactory,"--not all departments of nursing involve being familiar with every inch and crevice of a patient. ICU nurses are only fortunate in that they function in a society that tends to favor physical science over many other perspectives of practice. Technology and medical science gets respect FIRST, feelings and accessory matters of the human experience tend to get residual thanks in our society. Medsurg/LTC/Home Care/etc nurses are the unthanked bunch. It is a lot easier doing a job when you have the constant reinforcement of praise. "Oh you're an ICU nurse, WOW you TRULY SAVE LIVES." vs "Oh you're a med-surg nurse? Don't worry, put in your time and maybe you can be an ICU/ED nurse and REALLY save lives"

Rubbish.

By the way, I'm an ICU nurse who was lucky enough to find work in a Prevention/Public Health clinic PRN that taught me that PREVENTION/REHAB nurses are the REAL life savers in health care.

Hell yeah! You rock!!!

[Ruby Vee, BSN]

i suspect than an icu nurse who looks down on a med/surg nurse is someone who has never worked anywhere other than icu. i've worked med/surg, and i'm too old to work that hard any more!

[yshell12]

Let me begin by telling you -- I began my career on a tele unit where I routinely cared for 5-6 patients a night. I currently work FT in the SICU at a large community hospital and I also work per deim in the critical care float pool for a large university hospital.

When I recieve report on a patient coming from the floor I expect the M/S RN to know some basic information about their patient for example -- PMHX, Reason for current admission, events leading up to deterioration / ICU transfer, baseline vitals, current vitals, baseline physical assessment, current physical assessment, current IV lines, current medications that could have contributed to the transfer, and lab results from the day of transfer. These are basic things that ALL nurses should know about their patients -- ESPECIALLY if they are working on transferring them to a higher level of care.

You guys on the floor are very task oriented. I am not discrediting this type of nursing, but most of you do not understand the pathophysiology behind many of the disease processes for which you care for. Many times you do not know what to do for your patients when there is a devation in their vital signs from baseline. Many of you are not proficent in basic nursing procedures such as establishing adequate IV access (no that #24G you just put in is not considered adequate). Many of you do not understand the physiological effects of the medications that you administer. -- It would be my best guess that these are some of the many reasons ICU nurses get irritated with you when you transfer a patient to thier unit.

Just my

I'm soon to be a graduate nurse but I've worked in the medical field for almost 10 yrs. This is so condescending. Seriously, you have a couple of patients. Take the time & go thru your own charts! Memories are faulty & you're supposed to assess your patient anyway! I'm going to be a Med Surg RN & I will refuse to put up w/ that holier than thou attitude.

[Ruby Vee, BSN]

i'm soon to be a graduate nurse but i've worked in the medical field for almost 10 yrs. this is so condescending. seriously, you have a couple of patients. take the time & go thru your own charts! memories are faulty & you're supposed to assess your patient anyway! i'm going to be a med surg rn & i will refuse to put up w/ that holier than thou attitude.

​ouch! speaking of attitude . . . .

[FMF Corpsman, MSN, RN]

Having been on every side of a six sided fence, military, private duty, agency, med-surg, step down and critical care. I do know what each side is referring to. I also know that it is all a matter of perception, no really, it is. It is what you become accustomed to. If you work on a med-surg unit with 7-9 patients / shift then, you become used to that workload and pace yourself for that. If you were to transfer to another unit that only took 5-6 patients per shift, you might say, wow, this is a piece of cake for a week or so, but after a short period of adjustment your cognition would begin to evolve and your work habits would adjust and you'd once again, be busy for your entire shift, and happy to see the time clock signal the end of your shift. You may wonder what this has to do with one unit supposedly looking down their noses at another. Let me say, for me, I don't. I thank God there are Nurses who love to work in the various units, because I don't like it. In fact, I've already admitted in another blog, I don't like sick people. I can be up to my elbows in someone's chest or doing open heart massage all day long, but don't let them puke on me. If they do that, I'm done. I just can't get past the smell. After I worked in the units for so many years, I had a real problem floating as well. Later on in my career, if I was called on to float, I would go to the floors and try to do the same things I did in the unit, head to toe assessments, yada, yada, etc, not good. So, I thank God there are people who love med-surg and I got along with them quite well. Most of them understood the necessity of what was required for report and usually it was readily supplied. I don't want this to sound sexist but to be honest, I think being a male had something to do with the way I was treated. Back then there weren't as many males in the Nursing profession and we tended to be treated with more respect than I saw some of the newer grad being treated as I progressed in my career.

[raedar63]

I am sorry that you get treated like this. Unfortunatly I see it all the time , I am an older nurse and have worked every unit over the span of my nursing career. If I hear this going on I do not hesitate to tell my co-worker how it is! I still have to occasionally float to the med surg/med tel units and I see how horrible it can be . I also do remember what it is like to try to keep track of 6-8 pts and two to three admissions a shift . The ICU nurses need to be kinder to the over-worked "floor" nurses !

[blucrna]

Good for you yshell. I agree that post did come off with a "chip on my shoulder" vibe. I'm new to icu nursing but I started off Tele . I've run into a bunch of icu-rns that give others a hard time. You just have to stick to your ground and give em what you got. My hospital uses online health records so in the time I could argue over moot info I could just as easily look it up

[eatmysoxRN, ASN, RN]

I usually work on a tele floor with 6-8 patients. I've been pulled to almost every other floor in the hospital, including the ICU. I love the unit. I got an amazingly thorough report for the outgoing nurse and gave a spectacular report when leaving. I knew my patients (2 of them) very well. Yes, they were more critical. Much more. However, I've had the same level when our floor is the ICU diversion acceptor. Having 1 unit level patient really causes problems when there are 5 other patients you are also responsible for.

Anyhow, I hadnt encountered rude ICU nurses until a couple were pulled to my unit. They were hazy receiving report on 6 patients. They asked what I felt to be crazy questions. Unrelated to the diagnosis. Or asked me what a decub looked like and acted shocked when I told her we could go see it together. Honestly, I'd felt superior after not being able to hand the same report to her as I'd given when floated to ICU. She apologized profusely that night and said she hadn't worked the floor in so long the forgot how challenging it can be.

[HazelLPN, LPN]

i suspect than an icu nurse who looks down on a med/surg nurse is someone who has never worked anywhere other than icu. i've worked med/surg, and i'm too old to work that hard any more!

you are so right! i too started in med/surg because we didn't have an icu when i started out in nursing. when the icu opened, i floated down a couple of times and i ended up transferring shortly after that. icu nurses work hard, but so do med/surg nurses. physically i would never have lasted 54 years in acute care nursing had i stayed a med/surg nurse. any icu nurse who is critical of med/surg nurses needs to work on the floor for a few years to see what its like. i was draw to the icu because, honestly, because its easier for me to be organized when one or two patients who i know are very sick vs having 7-10 patients who could go south. i was less stressed in the icu once i transferred. there are med/surg nurses and icu nurses out there who could work in any kind of nursing and they would be great. there are others who are good within a narrow scope of nursing...one or the other. i am in that narrow scope. i was a great icu nurse back in my day. i was an okay floor nurse.

cheers to you from one old school nurse to another.

mrs h.

[Ryan RN]

Im from the ED so its kinda of like ED vs the rest of the hospital. Anyways, one day i felt that an ICU nurse talked down on me. Im not sure why but it happened. It didnt bother me at all. Ive never worked a single shift in icu but i got my CCRN anyway. Now nobody in the icu can feel like theyre "superior" compared to me.I guess its like the more you know, the more you expect from people. I do not talk down on people but when their ego gets too much of themselves, i just ignore them.

[ERnurseM]

I'm a ER guy. I think when you assume you make an ass out of yourself. You think when I get someone critical from the field I get every single info about them. But I still have to work with pretty much nothing. Get over it. Find the most important stuff stabilize the person first. And don't give ppl hard time bc they don't know if the pt has hairs on her toes or not. If your on a team you pick up the game you don't blame your teammates, management will do that for you. Help your fellow nurse not pick on them.

[Craymond18]

I am going to be brutally honest here. I am an ICU nurse. I work in a hospital where the ICU nurses respond to all codes or MET calls. I have seen the sheer utter stupidity of floor nurses. I have walked in on a coding patient and seen the floor nurses standing there. No one doing compressions, no one bagging. I have coded a DNR because the floor nurse forgot to band the patient. I have been delivered a dead patient to the ICU because the floor nurse didnt think to attach a monitor for transport. I have transferred a patient to the floor and had them code hours later because the floor nurse gave him ativan when he was SOB which further depressed his respiratory drive and led to respiratory failure. I worked on a med surg unit as a tech and watched the nurses sit around and eat bon bons all day. Those patients are allowed out of bed, they can feed themselves and if they cant do either of these things, you have a CNA to do them for you. You have a CNA to get their vitals. You have transport to take them for their tests. You have MIVF and maybe some antibiotics and pain medicine to give. I have floated to med/surg floors. The charting sucks because you have to do assessments on 5-6 patients. BOO HOO. In ICU you have to chart hourly intake and output on all drips infusing, while titrating the drips while medicating the patient with sedation and pain medication while managing the ventilator while turning your patient every two hours. Sometimes they are on CRRT (dialysis) which the nurse manages, they can have q30 min accuchecks or q1h accuchecks. You have to do Q1h neuro checks on neuro patients. You have to deal with distraught family members and be able to accurately describe every intervention that you do every medicine they are on and every wire attached to them. You have to manage a bolts in their heads and patients with bone flaps missing and open bellys and open chests. You still have to bathe them and clean **** and change linens on top of trying to stabalize a bp or icp or cpp or hr or ci or co or svv or pap. You have patients that are on ventilators and need suctioning every 30 minutes or they will drown in their secretions. You have nights where you transfuse 30 units of blood and 18 liters of fluid and the patient lives. You change dressings on patients with open chests or fasciotomies or open bellies. You have chest tubes dumping 400cc of frank blood and hour. And you have protocols that detail every move you make, you call a doctor for any of this stuff and you get yelled at. If you are upset because an ICU nurse was mean to you when she was getting report it was because she didnt want to hear the bs report you were giving and wanted to jump to the nitty gritty. If she wants to know labs its because we have a protocol that tells us we have to replace all their electrolytes and get them in a perfect balance. If she wants to know where the family is its because she plans to spend ungodly amounts of time updating them on the current plan of care and explaining the pathophysiology of whats gone on thus far. We dont have CNAs to do our work, they arent even allowed to empty our foleys or get a BS for us. Give the ICU nurse some slack... Im sure med surg nurses can have hell shifts and have to run their butts of but when every day is like i described to you and the easy shifts are few and far between you learn to ask what you want to know and get it over with quick so that you can get to what matters... saving lives.