Why are ICU nurses so rude?

[wanderlustRN24]

OK, I have a bone to pick with some ICU nurses, but before I begin, let me just say that I know not all of you are mean to the "lower" telemetry nurses ALL of the time.......

It seems as if every time one of my patients clinically disintegrates and must be transferred to the ICU STAT, the nurses up there are SOOO RUDE!!! And it's not just one specific unit or one specific nurse, it's the CVICU and the MSICU (our 2 main ICU's), AND multiple different nurses. My goal on the floor is to get them up there STILL BREATHING as fast as I can so more advanced interventions can take place before the patient further declines. I generally give bedside report, write out the transfer orders, assist in any way that I can while I'm up there, and then rush back down to the floor to my OTHER 4 patients and likely a new admission on the way.

What's so funny is that these ICU nurses act like they are high and mighty and smarter than the telemetry nurses, but when I receive a downgraded patient from THEM, I notice ALL KINDS of (basic) mistakes made!! In charting, in meds, etc. And I wonder, how can such mistakes be made when they have 1 or 2 patients max?!?

For example, I received 2 transfers from ICU yesterday. The first one was on a heparin gtt, TPN, and lipids. Okay. The patient comes to the floor with the ICU nurse and their tech. The heparin gtt, TPN, and lipids were NOT ATTACHED TO A PUMP. The roller clamp was left wide open and the only thing clamping off these infusions was the square clamp that goes directly into the actual pump (unattached). AND these lines were connected to the patient's central line!!!! When I brought this up to the "ICU" nurse, she said because she didn't want us to "steal" one of their pumps! OMG. Seriously? We can trade a pump, this is about patient safety. At least clamp the rollers!!

Next one, a STEMI patient going for CABG the next day. Also on seizure precautions and fall precautions. The patient comes with a tongue depressor taped to the bed and with 3 side rails missing off the bed!!! First, we DO NOT place ANYTHING in a patient's mouth if they are having a seizure....is this nurse living in the dinosaur age with the tongue depressor?! Second, WHY does a patient on fall/seizure precautions (or any patient for that matter) have side rails missing off the bed?!?!?! Aieeee I was so mad!!

Furthermore, the documenting/transfer orders on both these patients was HORRENDOUS, with multiple things not accurate and/or missing.

To add it seems like when I have to go to the ICU for any reason, there are multiple nurses playing on their cell phones, surfing the internet, and chatting about whatever non-hospital related thing is going on in their lives. And what's REALLY FUNNY, is when they get floated down to the floor, they are flustered, can't get anything done, refuse to ever come to the floor again, can't handle the patient load, calling it unsafe yada yada yada.

So, back to the original question: Why are ICU nurses SO rude to telemetry nurses when we must transfer a patient up there?!

[wanderlustRN24]

To add, because the patient on the heparin gtt was not attached to the pump, I restarted the gtt from scratch including weighing the patient. When I weighed the patient, she was 10kg heavier than what the ICU nurse had documented!!! (Which btw, the ICU nurse used the weight from the ORIGINAL admission date instead of re-weighing the patient for a more accurate heparin gtt.) Basic stuff people!!

[diprifan]

We are so rude to you because you missed something clinically (Change in VS, urinary output, or mentation) that led to the patient decompensating, or directly led to it. We are also rude because you are picking at little things and not looking at the whole picture. YOU try to take care of two patients, one coding and one from an outlying hospital that needs multiple lines dropped for CRRT and central line access, and an A-Line that needs to be put in for titrating meds. Plus all of the q1hr items that we have to do. I'm sorry your 4 patients are needy and have a decent amount of interventions. But we get our butts handed to us also. The grass may not be greener. The square clamp keeps the iv line occluded when you take it off the pump, that is the point of it right? A lot of your complaints seem to be nurse/unit specific. Is there a way these can be addressed other than coming on a chat website and venting?

[Ruby Vee, BSN]

as an icu nurse, i've always wondered why the telemetry nurses hid their empty beds so we couldn't transfer patients out. patients are discharged in the morning, but their names are still in the census until mid afternoon. i actually asked that once, and the reply was "we don't like to take transfers until the end of our shift. that way if we don't like the patient we don't have to spend much time with them."

really?

if you're saying that icu nurses everywhere are rude to you, it might have something to do with the way you address them, your body language, your tone, whatever. most of us are, i promise you, just as nice as telemetry nurses.

now the thing about the heparin drip is indeed a patient safety issue. as far as not wanting you to keep their pump -- there may be a valid reason for that. our pumps have icu algorithms programmed in -- allows us to program in epinephrine drips and such -- while the pumps on the telemetry unit does not have those algorithms.

i'm sure that if you nitpick anyone's care, you'll find lots of i's not dotted and t's not crossed. in fact, if i were looking i'm sure i could find things to criticize in your care as well.

now if yours was just a vent and you weren't expecting an answer, i apologize. carry on.

[wooh, BSN, RN]

Meh, probably just annoyed to be getting an admission. Like I am when I get an admit from ED or a transfer from another floor or PACU or one of the ICUs.

I think part of it though is if you feel like your "lesser" then you're going to feel like you're getting that attitude from the other nurse even if there's really not that vibe going on. I've noticed the more confident that I am with my own skills and knowledge, that it now takes a lot more to offend me than it used to take. I remember when it used to bug me when ICU nurses would expect the kind of report that you can give when you only have two patients from me when I was transferring one of my 6 or 7 or so patients. Now I just say, "don't know" and go on. If they feel "superior," fine. But I'm not going to ever let it make me feel "inferior."

[NickiLaughs, ADN, BSN, RN]

The square clamp is designed to occlude the IV line, it is a new advantage of these specific lines and the last time a spokesperson came by, they stated they designed them specifically as they are actually better at occluding the line than the roller clamp.

The reason the tongue depressor was taped to the side of the bed was to probably line up all the IVS without the 8 IV lines without them laying across multiple parts of the bed. It actually is a cheap fix to line it up and make the patient look more orderly. I highly doubt the tongue depressor was present for any other reason. I can't explain the missing side rails.

Most ICU's require the nurses to keep their pumps because many times our patients have 8 pumps each. It's probably not the individual, but a department policy.

And quite possibly, the pharmacy's rule is to base the patients med on their original admit weight. Patients can gain kilos of weight overnight that are the result of third spacing, and not true weight.

And no, I don't think I'm better than anyone, you tele nurses deal with call lights way more and demanding patients, honestly that can take up so much more time versus us sitting there monitoring a sedated vented patient. You've got one on me. :) Sorry there's such attitude and dislike between the different departments. Every department is necessary and fulfills a different role.

[Esme12, ASN, BSN, RN]

This argument has gone on before and will go on tomorrow. I agree there are certain cultures, in certain specialties that go above and beyond the usual competitive drives. I have noticed, however, a new elitist attitude in nursing as of late that coincides with the "my degree is higher and better than yours" or I have more initials behind my name that yours.......and then some nurses in general feeling the best way to feel better than one's self by putting others down.

The attitude of a unit depends a lot on the manager ( or hospital culture) and her tolerance to this kind of behavior. I have found the nurses the rudest to the floors are the one's bullied in their own unit. What you describe is poor nursing care and if I was the manager I would put a stop to it immediately. You can call how many pumps that are required in the room and return to the ICU with "their pumps". This particular "breed" of ICU nurse feels she is too busy to document those things as they are noted somewhere else...they have "better things" to do.

Honestly? ICU nurses don't like to float because they are really anal retentive and dislike changes...but that's how they avoid huge mistakes in the critical environment...habit and routine. They have lost the skill on managing more than 2 patients and they dislike them being ambulatory. Though few would admit it. They can handle 2 patients with many lines and tubes but are over whelmed by many patients and few tubes. I have openly admitted that I have lost the skill set to manage a 6-8 patient assignment on a short term intermittent basis which makes it unsafe in the sense I will probably forget something.....hopefully not an important something. I admire the skill of the "floor nurse".

For you OP.....try not to drive yourself crazy as you will NEVER be able to change it by yourself.:hug: I would bring to my manager's attention the ICUs shortcomings and if necessary.....write them up or file an incident report. Check on the policy on the transferring of patients with gtts and lines without pumps and write an incident report. It won't make you friends but it will get administrations attention to make the ICU manager's behave or it may bring to light the shortcomings of certain staff. Personally from what you describe it's a culture thing and you need to focus on being the best nurse you can be and ignore their bad habit and behavior. Ask your manager to do a focus study and improvement process on the transfer of patients as this is also a JACHO (actually thie want to be JC again) win point and improve the process at the same time.

Feel better??:redpinkhe

[Double-Helix, BSN, RN]

We are so rude to you because you missed something clinically (Change in VS, urinary output, or mentation) that led to the patient decompensating, or directly led to it. We are also rude because you are picking at little things and not looking at the whole picture. YOU try to take care of two patients, one coding and one from an outlying hospital that needs multiple lines dropped for CRRT and central line access, and an A-Line that needs to be put in for titrating meds. Plus all of the q1hr items that we have to do. I'm sorry your 4 patients are needy and have a decent amount of interventions. But we get our butts handed to us also. The grass may not be greener. The square clamp keeps the iv line occluded when you take it off the pump, that is the point of it right? A lot of your complaints seem to be nurse/unit specific. Is there a way these can be addressed other than coming on a chat website and venting?

I agree that ICUs are busy and stressful places to work. There is a reason we only have two or three patients. Taking an emergency admission in the middle of the day can really mess up your shift. I'm sure floor nurses feel the same when they get a sick, unexpected admission. However, none of that is an excuse for rudeness to a co-worker.

I completely DISAGREE with your statement that the patients decompensate because the nurse missed something. That's just untrue and really does play into the "floor nurses are inferior" mentality. If its the nurse's fault that a patient needs to come to the ICU, then it must be your fault when the patient codes.

[ashleyisawesome, BSN, RN]

:sofahider ohno!

[wooh, BSN, RN]

I completely DISAGREE with your statement that the patients decompensate because the nurse missed something. That's just untrue and really does play into the "floor nurses are inferior" mentality. If its the nurse's fault that a patient needs to come to the ICU, then it must be your fault when the patient codes.

hehe. Sometimes it could have been caught quicker and fixed easier. Unfortunately, with ratios going the direction that they are, it's making it way harder to spend enough time with your patient on the floor to catch those subtle signs and symptoms. As a diehard M/S nurse, I take pride in the fact that I can keep my patients from needing to be transferred. And I've got a pretty good record with a few really good saves. But you can't stop every patient from circling the drain. Just like you can't stop every patient from going down the drain.

[wanderlustRN24]

Thank you wooh and NickiLaughs, I'm just venting, not trying to be mean. Your posts have enlightened me as to an explanation for these incidents. Who ever really wants a new admission, after all?!

@Ruby Vee, as far as my general attitude toward my co-nurses, I am kind and respectful. Incidents like these are things I have heard from multiple nurses, not just from my own experience.

@nursenick20, I have not done anything "directly" to make these people sicker than they are. Quite possibly they should have never come to the floor to begin with when they deserve a higher level of care.

[ShankR]

First of all, as an ICU nurse I respect telemetry and floor nurses... taking care of 6 patient's is a lot of work and I certainly don't think I am "better" than ANYone else... But I do have a different skill set and am better at doing certain things than you are - obviously this door swings both ways.

You have to realize what happens in the ICU on a regular basis. We get sick patients... REALLY sick patients. In a critical situation the last thing to worry about is documentation - that is why sometimes documentation isn't up to par. The first priority is to keep the patient alive - and stabilize. After this happens maybe we have a little time to chart - that is if we arent getting another critical patient or dealing with another critical situation in the hospital.

It really is a different kind of nursing - priorities are different.

We are under a lot of pressure - and I will admit we can be short, rude... whatever. It's not necessarily you, or anyone else. Take it in stride.