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?!

[Horseshoe, BSN, RN]

I've worked ICU, stepdown, and tele. Having "only" 2 ICU patients doesn't make it any easier. You can still find yourself gasping for air to keep up, still have no lunch, no time to drink even a glass of water, and no bathroom break in 12 hours. When you have more patients, the acuity is lower, so your challenges have more to do with knowing how to prioritize and organize your time. The trouble hits when your house supervisor tries to increase your standard nurse/pt ratio, or you are assigned too many of the sicker patients on your unit. Or you are maxed out, and you get another admission. Yeah, ICU or tele, you work your butt off and frequently find yourself stretched over the limit.

We were lucky to have great CNAs. Even though it was "our" responsibility to know hour patients' vitals, they ALWAYS gave us a heads up if vitals were off. Thank GOD for those CNAs; couldn't have done my job without them.

[MunoRN, RN]

I started off in tele, moved to ICU, now do a mix of ICU, tele, ER (and infrequently cath lab, PACU).

When I was on tele I remember noticing how the ICU Nurse's workload always seemed to laxed; then when I moved to ICU I remember thinking how the tele Nurses seemed to just sit around. Doing both I've realized they're both just as busy, just in different ways. Hospital administrations are filled with people who's job it is to make sure every Nurse is equally overburdened, and they do that fairly well.

I think the tongue depressor example captures where much of the friction comes from pretty well, lack of understanding of what goes in the respective units often causes Nurses to jump to the conclusion that other floors are incompetent, even though they failed to acknowledge that they may not understand something nearly as well as they think they do.

[wooh, BSN, RN]

Hospital administrations are filled with people who's job it is to make sure every Nurse is equally overburdened, and they do that fairly well.

Bahaha! Truest statement in this thread!

[Horseshoe, BSN, RN]

Your post talks about ICU "dumping" sick patients for an emergency- most hospitals ICU beds stay full- why does anyone think an ICU nurse would be motivated to move out a less critical patient for a more critical patient? Hmmm ponder on that one. Which is more work for the ICU nurse?

Very good point! An ICU nurse would far rather keep a less sick, stable patient than have to do discharge work AND get a new admission who is probably very unstable and going to make the rest of her shift pretty crazy.

[Horseshoe, BSN, RN]

We think different. The tongue depressor on the side of the bed is for maintaining lines.

Interesting that the OP just assumed the tongue depressor was being used for seizures and that the ICU nurse was some kind of idiot.

I guess you don't know what you don't know, huh?

[Horseshoe, BSN, RN]

On the other hand you may have a sick pt still on the vent that weighs 300lbs with a swan and 2 quad pumps that needs to go to CT scan. They may also still have chest tubes. when you getback you may need to set up for new lines to be placed so you can run crrt. this pt may also end upon ecmo or a vad. then you may need to bronch them. and if you get them extubated some time in the day you inherit the joy of trying to get them to move their 300lb body from the bed to the chair. its end up with you and a couple of others dragging them. all in one shift.

in retrospect floor and icu nurses have bad days. respect each other quit being asses to each other.

One of the most stressful aspects of ICU nursing for me was when the patient needed to "travel." When a patient has to go out of the unit for a procedure, his nurse must go with him. This is a whole ordeal unto itself. Meanwhile, what's going on with your other patient? Well, another nurse has to pick up the slack for you and watch him, give meds if necessary, etc. The whole time you are gone you are stressing about that other patient and wondering what it's going to take to get caught up. I HATED HATED HATED traveling, even though, YES, it's part of the deal. It just always seemed that no matter how organized I tried to be, once I traveled with a patient, the rest of my day sucked.

[brai9284rn]

wow...at my hospital everyone generally gets along. I don't think I've ever heard bickering between floors like these comments, or I'm hard of hearing.

[MiaNursingStudent]

As a med-tele nurse (a brand new one at that) I won't lie that as a nursing student I loved ICU. I was obsessed with neuro trauma ICU and interned on that unit for 9 months!!! If you would've told me that when I graduated I would work med-tele..... I would've laughed at you because I honestly believed that I was above that. So in all fairness-- that high and mighty attitude is in all of us or else this wouldn't even be a topic of conversation. In my honest opinion, 2 ICU patients per nurse is like 5 med-tele patients per nurse....... The kicker is when staffing sucks butt and puts 8 med-tele patients to 1 nurse. We are all busy, every unit, every nurse--- in our own way... We are also rude in our own way, but we are all caring people- unless you got into nursing for some other crazy reason. People have bad days. It just happens.

I will say though..... I picked my unit not bc I am remotely even interested in medical-telemetry, but because I would rather be the only Type A personality on a Type B unit. I love the cohesiveness on my unit.... This is just my unit that I speak for, but we function as a "lets all help eachother out and get through these 12 hours as a functioning group while having some laughs" instead of an "every nurse for themself" mentality.

But med-surg nurses..... Admit it, ICU nurses have it rough even with 2 patients, because their patients are always trying to die on them and since they have the ability to make decisions first and ask doctors later- they have more liability/stress if their patient croaks.

But ICU nurses.... Admit it, med-surg nurses have it rough with 5-8 patients who are always calling for pain meds, the second we discharge 3 patients there are 4 more patients in line to be admitted. And the charting..... omg. The charting.... and what's worse is when 6 out of your 8 patients are in isolation.

Whoever said "at least get BLS" to the med tele nurses. That was a rude comment. What do you think we have?!!?! It's a requirement at my hospital that ALL nurses have BLS. If your hospital doesn't require it of all nurses- what does that say about your facility? And FYI--- most of our med tele nurses are also ACLS and PALS certified. We all got into nursing to take care of people and we seem to all be very catty to eachother-- I wonder why that is? We should be supporting every unit in nursing bc no one unit can function independently without the other units.

CAN'T WE ALL JUST GET ALONG?!?

[MiaNursingStudent]

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.

This! This nurse nailed it. ICU nurses are very very very organized when it comes to lines. I a million times prefer patients intubated, sedated, and restrained (but that might be bc I came from a medical examiner's office), but the admits/discharge/call lights for lemon-lime Shasta/pharmacy thinking that when we ask for abx STAT that we mean in 8 hours.......

Every nurse has it rough. And like Nicki said (and my hats off to you for putting it so concise and eloquently) but every department is necessary and fulfills a different role.

[MiaNursingStudent]

funny story: while working in icu one night a nurse on the floor called back and asked for a rapid response because he thought he heard atrial fib when assessing heart sounds. hahaha what exactly does afib sound like? irregularly irregular? lol

Bahahhajjajaj!!! This totally made me lol. Before I graduated from nursing school I was all about neuro trauma ICU or cvicu then one day my bf woke up at 5 am and said his heart felt weird (I brushed it off as him having a nightmare or the weird surge of catecholamines in the morning thing..... But I wasn't really concerned bc he has neuro issues- Grade 5 AVM- not cardiac issues) but to make him feel better I did a cardiac assessment and apparently he saw the fear on my face and asked what was up. My response was "I'm almost 100% sure you're in afib with rapid ventricular response" and he said "what the hell does that mean?!?" And of course I was all flustered and responded with "you have no P-wave and we probably need to get you on a calcium channel blocker and if this gets any worse I might get to shock you!!!" Needless to say we just called 911, lol.

BUT. As a med-tele nurse I had a patient who was neurologically declining and no longer responding to painful stimuli (including a sternal rub), she was satting at 78% with 10L O2 nonrebreather mask, and her EEG (that i had to beg the doc for) showed seizure activity... the doctor was furious that I asked for transfer orders to an ICU (she finally came and assessed the pt herself after I paged her 4 times) and agreed the pt had to go to a neuro ICU-- when I transferred her there and gave report to the ICU nurse it was like the pt snapped out of it and was ok. I think the ICU nurse and I were equally frustrated at the situation...... Not eachother.

But the "hearing afib" story made my night- so thanks!

[Kricket, RN]

Just a heads up… the tongue depressor is for  organizing and separating IV lines, not for seizure precautions…