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?!
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.
I wouldn't be so quick to judge. The mountains of charting and meds on 5-6 patients takes away from your patients. You can't be at the bedside of 5 unstable or potentially unstable patients. Easy to say someone missed something clinically when you have 2 patients. You aren't missing things 'clinically' when you have 2 patients.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
delrionurse said:
I wouldn't be so quick to judge. The mountains of charting and meds on 5-6 patients takes away from your patients. You can't be at the bedside of 5 unstable or potentially unstable patients. Easy to say someone missed something clinically when you have 2 patients. You aren't missing things 'clinically' when you have 2 patients.
"Quick to judge" anyone? Have you ever *tried* taking care of two critically ill ICU patients? Honestly, I had more downtime taking care of 15 floor patients.
As an ICU nurse, when a sick patient is transferred into the unit, my first and biggest concern is the patient. I try to be as kind as possible to the transferring nurse, but the patient comes first and if you're meandering through a lengthy "report" about how much he ate for breakfast last week rather than a short, focused report about what's happening now, I may be abrupt. Even if your report is perfectly adequate and the patient suddenly coughs out his ET tube, goes into V-tach or V-fib or begins to flail around like a hooked trout, I may turn away from you to deal with the patient.
We can all learn from one another, support one another and put the patient first.
"Quick to judge" anyone? Have you ever *tried* taking care of two critically ill ICU patients? Honestly, I had more downtime taking care of 15 floor patients.
I am not sure what you mean by 'tried', and implying that people haven't taken care of critically ill patients. which I have with a 6:1 ratio, in the ER with no respect for the nurses, SVTs, trauma 1's, CPR in progress, all at the same time, so I get it. 'You' are not the only one who's taken care of critically ill patients. This is why I don't work in a hospital anymore, most ER's (and hospitals for that matter) are not well run and I refuse to put myself in that position. There is no respect in hospitals for nurses time. They assume, 'the nurse can take it'. Have you ever seen a nurse manager or charge nurse advocate for the nurse (which in turn advocates for patient safety)? I have not.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
delrionurse said:
I am not sure what you mean by 'tried', and implying that people haven't taken care of critically ill patients. which I have with a 6:1 ratio, in the ER with no respect for the nurses, SVTs, trauma 1's, CPR in progress, all at the same time, so I get it. 'You' are not the only one who's taken care of critically ill patients. This is why I don't work in a hospital anymore, most ER's (and hospitals for that matter) are not well run and I refuse to put myself in that position. There is no respect in hospitals for nurses time. They assume, 'the nurse can take it'. Have you ever seen a nurse manager or charge nurse advocate for the nurse (which in turn advocates for patient safety)? I have not.
I was responding to the post I quoted.
The person implied that caring for two critically ill ICU patients was less work or less stressful or less something than caring for 6 floor patients. I don't think she has an idea what kind of patients we routinely take care of in ICU.
I don't think I'm the only one who has ever taken care of critically ill patients, but I am probably one of the few who has done so for over 40 years. I have also taken care of floor patients -- 1:5 ratio, 1:10 or 1:15 and everything in between. I get it. I get the difference between caring for 1-2 ICU patients and 5-6 floor patients, and I get that they require very different priorities, skill sets and planning/organization.
My point was that the poster said we ICU nurses shouldn't judge floor nurses and assume that they've missed something. Floor nurses shouldn't judge ICU nurses and assume that because of our ratios, we should never miss something clinically either. We should not be judging each other; we all work together. Evidently I didn't make that point very well.
delrionurse
245 Posts
I wouldn't be so quick to judge. The mountains of charting and meds on 5-6 patients takes away from your patients. You can't be at the bedside of 5 unstable or potentially unstable patients. Easy to say someone missed something clinically when you have 2 patients. You aren't missing things 'clinically' when you have 2 patients.