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]

All the pumps are programmed exactly the same way in the adult hospital where I work. Administration did that years ago to streamline the transfer of patients.

[wanderlustRN24]

Thanks Ashley, PICU RN and ShankR. I am very thankful to have the ICU nurses when my patients go bad!

Nurses as a whole should respect each other more :) We all have tough jobs and it takes a lot of grit to be a good nurse!

[Esme12, ASN, BSN, RN]

We are so rude to you because you missed something clinically (Change in VS, urinary output, or mention) 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?

.

Ouch.......and you wonder why she wants to know why ICU nurses bite. That was a bit harsh.

I have been both an ICU nurse, an ED nurse, a Cath lab nurse, a flight nurse, and a Cardiac Anesthesia NUrse (wet nurse to cardiac anesthesia fellows amongst other responsibilities) and have dealt with many many transfers in and out of hospitals and units. The same can be said for the ICU nurse that she is picking at little things and not looking at the whole picture when she points out another shortcomings. There are ways to teach someone about what is the right thing to do, without being nasty or rude.

The "floor nurse" can say the same for you.....to paraphrase you...."You try taking care of 4 patients each of them with 4 lines a piece 2 with active chest pain and EKG changes, prepping another for his urgent cath while trying to transfer another off telemetry to get the ED admit on nitro and heparin for a total of 5 patients and now I have to transfer the chest pain to the unit because now he's in CHF with a positive trop, which gives me another empty bed to receive the ICU transfer out to take my patient in....:uhoh3:" The floor nurses get their "butts handed to them also" and probably get their butts handed them on a plate for not clamping the IV tubing with the roller clamp, which is probably the policy anyhow.

I know this will get me flamed:sofahider but if her job was so simplistic why do you mind floating so much and enjoying a break for the day? We need to start respecting each other as the professionals and specialists that we are. "Floor nurses" have certain skill sets that are unique to their area of expertice and although different than yours are just as unique and specialized.

I say this with the upmost respect and kindness unique to my 32 years of critical care medicine....:hug:

[Altra, BSN, RN]

Off the top of my head ...

Pump: I often disconnect non-essential gtts from a pump before transport -- it's one less item to contend with. (and yes, Heparin is nonessential for the length of time that it takes to get from one unit to another) The "square" clamp actually does occlude the line better than the roller clamp, unless you force the roller so far that no human is likely to ever get it "unrolled" again.

Side rails: probably removed to get the gigantic ICU bed out of the room -- taking them off gives you an extra 3 inches or so that can make the difference. Yes, these should have been replaced prior to leaving the unit, but perhaps the nurse knows from previous experience that they don't fit well to get into the rooms on your unit either.

Tongue depressor: as another poster pointed out ... this is a cheap, quick way to gather all those lines off to one side of the bed. For a while we had some disposable foam thingies with little indentations designed for this purpose, but the adhesive would never adhere to the bed side rails.

Rudeness? Well, this is relative. But as another poster mentioned ... if an ICU nurse feels "superior" to you, that bad karma is on him/her. But no one can make you feel inferior unless you allow yourself to feel that way.

I will say that I have met a few nurses (from various specialty practice areas) who seem to regard any deterioration in a patient's condition as the personal fault of someone, somewhere. This is unrealistic, unproductive, and unprofessional. It does reflect the culture of the society at large, but it is a shame when health care practitioners can't use their education and experience to grasp the reality that illness/injury are not always someone else's fault.

[meandragonbrett]

ICU RNs have a different skill set than a non-ICU nurse and our priorities are often times different. Just because you see us using our phones or talking doesn't mean that the ICU RN is not actively titrating 3-4 gtts to manage sedation, analgesia, HR, Cardiac output, urine output, etc. It's just a different kind of nursing. ICU nurses tend to be short and to the point and many times those that don't work in that department are somewhat taken aback by the abruptness......I would say it's generally nothing personal. I wouldn't worry about your ICU nurses.....to Hell with them! :)

[frumpter]

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?!

I tape a tongue depressor to the side of the bed to organize all my 1,234,862 lines on. It looks much more orderly and keeps them from getting all tangled up. Most of the nurses in my ICU do this. As for the rest, there are bad apples in every bunch. Ignore it and move on.

[himilayaneyes]

Like all nurses, ICU nurses aren't happy when we get an admission or a transfer. I have worked both as a tele nurse and an ICU nurse and know that neither unit wants more patients unless there's the threat of being floated. I can say that some ICU nurses are peeved when receiving patients from a different floor b/c they may feel that delayed interventions or signs/symptoms missed that led to the patient's decompensation. Not the nurses fault if the patient decompensates, they came to the hospital for a reason. As far as iv pumps, we never take our pumps to the floor as our pumps have ICU algorithms programmed into them which are needed for the titration of various medications. Regarding the heparin gtt, if the iv line was clamped, I personally don't see the problem. As far as the weight of the patient on the heparin gtt, you have to go by facility policy. My facility policy states that all medications are based on the admission weight...so if the patient gains 10lbs during their stay, we still use the admission weight for all medications. Being rude is never acceptable, whether it is from an icu nurse or tele nurse, however, take it all in stride. If you did your job to the best of your ability, why do you care what some other nurse thinks?

P.S. I used to think what are those ICU nurses doing with only 1 to 2 patients...it's something you can't understand until you do it. Tele and ICU nursing are two completely different types of nursing. Tele is task oriented (e.g., what meds to pass next). ICU involves taking a comprehensive look at the patient. One really sick patient can feel like caring for 6 patients or worse, especially with the standard q1hr charting or sometimes q15 minute charting depending on the situation.

[Esme12, ASN, BSN, RN]

no one can make you feel inferior without your consent. eleanor roosevelt, 'this is my story,' 1937

us diplomat & reformer (1884 - 1962)

[ThePrincessBride, MSN, RN, NP]

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?

Sorry, still doesn't mean that you have a "right" to be rude to someone.

[Laurie52]

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.

I have worked ICU for a very long time. Yes, I tell my orientees that if their patient codes and it is not an acute MI or a PE, then, yes, it is your fault. You have missed something along the way.

[TonyaM73, ASN, RN]

I, for the most part love our ICU nurses. They are helpful as all get out! Every nurse on my floor tried to get a line on one of my patients a while back and no one could get it. I finally called down to the ICU and asked if someone had a little time if they could come up and try. (This guy was only going to be in the hospital another day and we didn't want to get a PICC in him for just 24 hours.) She was on my floor in about 15 minutes, smiling, and asked where he was. It took her a few tries to get him, but she finally did.

Needless to say, I thanked her profusely!

[kool-aide, RN]

I agree with Esme, if it's something that has truly endangered the pts, talk to the ICU charge nurse and file an incident report. In my hospital, incident reports are electronic and are reviewed by the nurse manager. Pts come first.