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

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by marisatheresa marisatheresa (New Member) New Member

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Ruby Vee has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

11 Followers; 65 Articles; 170,062 Visitors; 13,908 Posts

I am sorry you feel put down. It is my frustration writ small (on here). I have never found a nurse to be interested in the types of things I am interested in. It was judgmental and not related to the OP, unfortunately.

So as to how it relates to the OP. It may be tangentially related to the OP and to my own question....that is....

do ICU nurses have to deal with the constant lack of respect from so many people that med-surg nurses, with their large case loads and, perhaps, greater number of forced interactions, have to deal with?

Do ICU nurses get more autonomy and respect is my basic question?

My assesment of nurses getting a heap of disrespect from all comers is based only on med-surg. would I find less of these things in the ICU?

I think some nurses deal with more disrespect than others. Perhaps ICU has something to do with it, but maybe not as much as you might think. I've found over the years that as people get to know you and to trust your judgement, knowledge base and work ethic, you get more respect. Getting to know the physicians,RTs, PTs, Pharmacists, etc. helps the respect factor as well. (Of course this assumes that you know your stuff, have your patients and your charts all in order, etc.)

Make an effort to get to know your colleagues -- not just their names, but some tidbit about them that you can chat briefly about when you encounter them at work. The pulmonologists likes to scuba dive, the RT loves to fish and the nephrologist has a nephew in China that she loves to show off. So when you say hello, ask about a new picture of the nephew, did the RT go fishing last weekend and were they biting and if the pulmonologists had any luck with finding a new dive partner. Or whatever. People who think you're nice will be more respectful.

I think ICU nurses get more respect partly because they have longer interactions with other members of the health care team, and thus have more of a chance to get to know one another. Part of it is perhaps the ICU mystique, where you know your patient more in-depth than a Med/Surg nurse ever can, and others assume you're smarter just because you can spout numbers at them all day.

Family members and patients disrespect ICU nurses, too. I've been in ICU for decades, so I don't know the relative ratios of respect/disrespect, but I will say this:

Years ago, when I injured my knee ice skating and could barely walk, the step down unit had just lost a monitor tech. Arrangements were made for me to cover their monitors for two weeks. The doctors all knew me, and some of the more senior nursing staff knew me, but the newer nurses and CNAs did not. I got a lot of disrespect and talking down to from the new nurses and CNAs. One time I paged a new nurse to tell her that her patient had just gone into A-Fib, and she disdainfully told me that I didn't know what I was talking about and that SHE would come out to the desk and set me straight. The cardiologist who happened to be in the nurse's station overheard the conversation and met her in her patient's room. "If Ruby says it's A fib, it's A Fib," he told her. The rest of my stint at the monitors went much more smoothly.

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8,255 Visitors; 412 Posts

Lol! That is what happens, anytime they float ICU nurse to our unit, they go crazy upon all their high skills. One punched out at 1020am instead of 730 when she floated to our unit.

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4,876 Visitors; 306 Posts

anytime they float ICU nurse to our unit, they go crazy upon all their high skills.

What on earth does that even mean?

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1 Follower; 11,954 Visitors; 1,319 Posts

As long as we're generalizing, CC nurses look down their noses at everyone, even each other.

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Kuriin has 2 years experience as a BSN, RN and specializes in Emergency.

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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 :twocents:

This is the most disrespectful post in this thread. I know this is an old post, too. This is one of the main reasons why I dislike giving ICU nurses report. Our RRT ICU nurses are some of the nicest people and they are the more down to earth nurses, too. I don't know what hospital you work in, but in our hospital, we never put in a 24G as that is useless to everyone. It's 22G or larger.

But, to your credit, I agree with the medical-surgical nursing being "task oriented". It is why I dislike nursing so much. I did not go into nursing school to do 07300 insulin/synthroid, 0800 breakfast, 0900 medications, etc. It is not fun.

I recommend you check your attitude out the door. Nursing a caring profession. Try being a little less douchey about it and guide the nurses to what you need.

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1 Follower; 11,954 Visitors; 1,319 Posts

This is the most disrespectful post in this thread. I know this is an old post, too. This is one of the main reasons why I dislike giving ICU nurses report. Our RRT ICU nurses are some of the nicest people and they are the more down to earth nurses, too. I don't know what hospital you work in, but in our hospital, we never put in a 24G as that is useless to everyone. It's 22G or larger.

But, to your credit, I agree with the medical-surgical nursing being "task oriented". It is why I dislike nursing so much. I did not go into nursing school to do 07300 insulin/synthroid, 0800 breakfast, 0900 medications, etc. It is not fun.

I recommend you check your attitude out the door. Nursing a caring profession. Try being a little less douchey about it and guide the nurses to what you need.

Don't be too hard on the dude/Dudette ... the person is just recycling the crap they get from CRNA's and doctors. It all rolls down hill.

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209 Visitors; 2 Posts

I have mad respect for most of the med-surg nurses where I work. I know when I get pulled up there from time to time it bugs me that I cant endulge myself as much in the patients hx and can't always have a grasp of their status in view like I'm use to. Plus I have to ask where some of the most simplest supplies are located which always sets me back and makes me feel time management incompetent a lot of the time. Of course I feel that way often times as of recent in my unit on weekends we have no unit secretary so if the census is 4 pts 1-2 it's just 2 of us down there- phone feels like it's constantly ringing in unison with the monitors- along with our door buzzers to let family in. If I need to transport a patient I have to call for assistance (wait for a tech on the floor to be available and come down) and wait for supervisor to come sit down there so there are at least 2 nurses present. This is usually as the floor is showing up with my new pt that has deteriorated upstairs with my patient I need to transfer up still there waiting on help for transfer. Always having nonimportant interruptions interfering in middle of care. Makes my head want to explode sometimes- got to talk with my manager with changing something but we know that'll do a lot :p- okay. Venting complete. Thank you

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Trauma_drama14 has 3 years experience as a BSN, LPN, RN and specializes in Medical-Surgical Critical Care.

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Wow, it seems like there is a lot of "looking down" from M/S to CC and CC to M/S. I was going to write a rant for both sides because I have worked both in the past two years, but to be honest with you I don't feel like it would relevant to say anything about it really. Listen, we all are nurses in the long run, so we really need to respect each other.

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tcvnurse has 15 years experience and specializes in Thoracic Cardiovasc ICU Med-Surg.

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What healthcare assistants? I do my acuuchecks, empty my foleys, mark off my chest tubes, document my I/O's, my own oral care, my own temps. I ask for help from techs with turns and clean ups and walking the patients.

Exactly WHAT do you think we're delegating? In my experience, (and yes I worked for many years in med surge, as well as cardiac step down) it's the BAD floor nurses that delegate all the 'clean ups' to the techs. The GOOD floor nurses ask for help, don't expect others to do their work.

These arguments are just so stupid. Floor nurses hate the ED. ED hates the ICU. CVICU hates the MICU etc etc etc (Actually we don't hate the MICU we just think it's boring down there)

To be a good nurse you have to show up, and give a damn. Everything else is cake.

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CCU BSN RN has 7 years experience and specializes in CICU, Telemetry.

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Have worked in both scenarios.

What ICU nurses should keep in mind: Sometimes the floor nurse understands perfectly that if someone had intervened 3 days ago, we would not be transferring them to you. We asked the MD to put them on pressors 3 days ago because of their end stage CHF and severe hypotension. They had us treat with fluid. Now they're flashing. Or they had us ignore the hypotension, now they need dialysis from renal failure from hypoperfusion. They had a lot of VT and I wanted extended lytes with a Mag, because they hadn't been done in days. MD won't give me the order. Can't do it.

Flash forward to ICU, I'm no longer dealing with a hospitalist who is covering 50+ patients overnight and literally doesn't even know why they're in the hospital. I'm working with CCU residents and mid levels who are right there to discuss my concerns. I have protocols to draw and replete labs, I don't need anyone to order jack. I magically have a central line and a foley and an arterial line to give me a wealth of information. When the floor RN asked for the foley, she was told it would cause a CAUTI so even though the creatinine bumped from 0.7 to 6.2 in 2 days, and the patient is incontinent/probably oliguric, she can't get the order. In the unit we're allowed to treat first, clarify orders later a lot of the time. It's necessary for our patient population.

I just think it's worth acknowledging that part of the problem is ICU nurses assuming that floor nurses have the same support of MDs who are familiar with the patient nearby, and the same support of protocols. They're often at the mercy of what they can get a provider to order. As a floor nurse, the only time I could even get a hospitalist to come see a patient was when I used the phrase 'breathing like he needs to be intubated'

My 2 cents.

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Ruby Vee has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

11 Followers; 65 Articles; 170,062 Visitors; 13,908 Posts

Have worked in both scenarios.

What ICU nurses should keep in mind: Sometimes the floor nurse understands perfectly that if someone had intervened 3 days ago, we would not be transferring them to you. We asked the MD to put them on pressors 3 days ago because of their end stage CHF and severe hypotension. They had us treat with fluid. Now they're flashing. Or they had us ignore the hypotension, now they need dialysis from renal failure from hypoperfusion. They had a lot of VT and I wanted extended lytes with a Mag, because they hadn't been done in days. MD won't give me the order. Can't do it.

Flash forward to ICU, I'm no longer dealing with a hospitalist who is covering 50+ patients overnight and literally doesn't even know why they're in the hospital. I'm working with CCU residents and mid levels who are right there to discuss my concerns. I have protocols to draw and replete labs, I don't need anyone to order jack. I magically have a central line and a foley and an arterial line to give me a wealth of information. When the floor RN asked for the foley, she was told it would cause a CAUTI so even though the creatinine bumped from 0.7 to 6.2 in 2 days, and the patient is incontinent/probably oliguric, she can't get the order. In the unit we're allowed to treat first, clarify orders later a lot of the time. It's necessary for our patient population.

I just think it's worth acknowledging that part of the problem is ICU nurses assuming that floor nurses have the same support of MDs who are familiar with the patient nearby, and the same support of protocols. They're often at the mercy of what they can get a provider to order. As a floor nurse, the only time I could even get a hospitalist to come see a patient was when I used the phrase 'breathing like he needs to be intubated'

My 2 cents.

And your two cents has accurately described a very real problem.

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I come from 5 years as a float pool nurse that worked the floor and later cross trained to ER. I now work in ICU but am still a "baby" ;). The one pervasive theme I noticed was that each department vies against the others. It's probably an innate us vs them kind of think. Each department has their own specialty knowledge, with their own ways of doing things that works best for that department. obviously this can set the stage for irritation and miscommunication, especially when something is quickly happening. That being said, there are always the stereotypical Us vs Them groups we all know : ER vs ICU, ICU vs Floor, Floor vs ER.... Totally different areas of nursing with different priorities. Working all three areas has helped me see this in ways I didn't understand before. When I worked floor, I would get so frustrated with ER and the report I would get. It was really not a whole lot I could work with. Or having to talk to a different nurse who knew nothing about the patient because the primary nurse was unavailable. There would only be so much I could find in the ER report too, so it would be frustrating not knowing what was coming. Lines were messed up, things needing to be done, etc... and when you're running with 6 patients on days and drowning, it was the last thing you needed.. Yet when I also worked in ER, my mind was blown by the total chaos all the time. Lots of patients per nurse. You have absolutely no clue what's walking in the door to you. Continuous codes, traumas, combative patients, etc...everyone running! The primary goal was to get them stable and up to the floor, where they would get more thorough attention and care. Eye opening for sure!! Would then work the next shift on the floor, and would have to change my nurse think to adapt to that unit now. So many needs for so many patients, making it hard to know as much as I would have liked about their whole admission. And since it's impossible to monitor your 4+ patients so closely on the floor in addition to q4 vitals only, a patient can deteriorate quickly without staff knowing for some time. At this point I would want my patient out of there and to the unit, knowing our floor couldn't do anything more at this point and it's now beyond my scope. Plus I would have multiple other patients that needed me.... giving report to ICU was always intense for me. Especially since in those situations it's a rapid transfer and I wouldn't know numbers off the top of my head or extreme details that I didn't need on the floor. I don't think it's right for an ICU nurse to give you heat during report; it's not right no matter what department the transfer is hapson

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