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?!

[TonyaM73, ASN, RN]

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.

Wow! You must be a joy to work with. Real morale booster!

In ICU when you are able to assess a pt every 15 minutes, I can almost buy that. Almost. On the floor when you see your pt every couple of hours because you have 6 more with discharges and admissions, that is a different story. Sometimes things just go wrong.

[Laurie52]

Wow! You must be a joy to work with. Real morale booster!

In ICU when you are able to assess a pt every 15 minutes, I can almost buy that. Almost. On the floor when you see your pt every couple of hours because you have 6 more with discharges and admissions, that is a different story. Sometimes things just go wrong.

Take a look at the failure to rescue data before your slam me. If it was your family member who died because something was overlooked, how happy would you be? For the vast majority of problems that patients are sent to an ICU for there is a window of time when someone could have interveened.

[TonyaM73, ASN, RN]

I actually did have a family member die because a very small downward trend was overlooked until it was too late. I also understand that it was a suble change that may not have been understood in the present, but was clear in hindsight.

I do understand striving to find and see every little detail, but to tell someone that "since you didn't pick up on this it is your fault this person died" is an awful burdon to put on someone.

[xtxrn, ASN, RN]

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.

Absolutely agree.....and people wonder why lawsuits are so common (and frivolous in many instances). It's always got to be someone's fault. Before current technology, when someone died due to illness, it was called a "natural death"...now it's "wrongful death".....Nuts, I say.....just plain nuts

When I worked neuro, sometimes the neuro ICU nurses would have to float up to the floor (and we went down there). I felt so badly for them; they were used to 2-3 patients (mid 80s) with monitors that let them know what was changing at the moment; we had 8, no monitors, and no pulse-ox back then. I remember one poor soul (really good natured about floating, but nervous). She sat on the floor in the hall between the doors of her patients, and charted there. She didn't want to be more than 10 feet from any door she had to account for. :) Fortunately, we assigned in blocks of rooms (sometimes we got lucky, sometimes not so much.... I liked the comas- get them repositioned and settled, all intake and outflow tubes in order, and NO CALL LIGHT ). But all private rooms, which was a real treat in the 80s.

The regular neuro floor nurses would all but trip over each other to go to the unit (neuro- not the others)... they were nice to us, and gave us people we couldn't do anything to- .... it was flip, flop, fold, feed, and fluff on a total gork who owed Glasgow points...did creep me out though, when someone bit it, and the vent was still on.....flatline with a rising chest.... (shivers thinking about it). They hadn't turned it off yet, waiting for the family.

With transfers, they were nice to us. Many had done their time on regular floors, and remembered it ..... so they knew what we were doing on the floors. If we had someone code (in 19 years working, I saw less than 10 codes....many close calls), they knew we only had the "general" info re: a blown carotid endart, or someone who's ICP was getting hinky. We'd give them the info we had, and they said "thank you". Nobody even registers in my memory re: being nasty (and the real duds are embedded in my thick head in any job I had-- the Hallmark store was one of the worst...all of those nifty, "heartfelt" cards, and a total jackwagon for a boss...that place inhaled sharply.... )

[Altra, BSN, RN]

Laurie52, I'm just asking ...

Are all your patients sick as crap? (they are ICU patients, after all) Do you really consider yourself so God-like that you have the ability to rescue them all? Is the life cycle of all living things on this planet suspended in a bubble around you, so that nothing in your presence dies?

WOW!

Can I send you all my house plants?

[xtxrn, ASN, RN]

take a look at the failure to rescue data before your slam me. if it was your family member who died because something was overlooked, how happy would you be? for the vast majority of problems that patients are sent to an icu for there is a window of time when someone could have interveened.

really?

the 'widow maker' ? severe icp changes? blown aaa? large pe? bad cva? meningitis that comes to the ed after a couple of days of symptoms, and dies in the ed (knew that person)? if the patient blows off getting help until it's too late, which staff member screwed up?

if you think you have that much control, you will have a really horrible career carrying all that baggage- or spreading it around...jmo :)

[nursenotamaid]

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 came here to say this. I tape tongue depressors on my beds routinely. Its an organizational fix.

[Laurie52]

Laurie52, I'm just asking ...

Are all your patients sick as crap? (they are ICU patients, after all) Do you really consider yourself so God-like that you have the ability to rescue them all? Is the life cycle of all living things on this planet suspended in a bubble around you, so that nothing in your presence dies?

WOW!

Can I send you all my house plants?

1. Many but not all my patients are "sick as crap".

2. No, I do not consider myself so God-like that I can resuce them all. I do, however, attempt to intervene so that they can either be allowed to die or so that we can do something to prevent a code.

3. Don't send me your houseplants. I cannot even keep a cactus alive.

4. I guess its not just ICU nurses who are rude.

[Altra, BSN, RN]

2. No, I do not consider myself so God-like that I can resuce them all. I do, however, attempt to intervene so that they can either be allowed to die or so that we can do something to prevent a code.

Ah, got it. You don't save them all, but you get to decide who is "allowed" to die and who is not. Still sounds like pretty awesome power ...

[TigerGalLE, BSN, RN]

Wow some of you guys... including the OP... are quite harsh.

Everyone has slow days. So maybe you did walk through the unit and see someone on their computer googling running shoes... But you probably haven't walked through the unit when there were 2 simultaneous codes, a 35 year old in DTs chewing through his IV tubing and ET tube at the same time, and no secretary or PCT. I've actually received transfer orders on a patient and sent them out with no AM meds or care given because I was so busy with my other patient who was bleeding out from an arterial GI bleed. I hurried and transferred them out without doing these things so the poor man could actually be cared for. Because he sure wasn't gonna get any care from me. It wasn't physically possible if my other patient was going to survive. Which he did by the way. I'm sure that floor nurse was just as mad as you are. But what can I do?? I'm only one person.

Crap happens. Everyone is busy, has bad days, and misses things. We could have this same argument with Nights vs Days, ER vs Floor, ER vs ICU, PACU vs Floor, PACU vs ICU, EMS vs ER....

I understand the need to vent. Which you did... Move on

[Laurie52]

Ah, got it. You don't save them all, but you get to decide who is "allowed" to die and who is not. Still sounds like pretty awesome power ...

I didn't say that I decided who is allowed to die or not. This is your interpertation of what I said. Are you going to tell me that you don't discuss code status with physicians and families?

[TonyaM73, ASN, RN]

TigerGalLE True! So true! We are all just human and are trying our best to care for all of our patients. Some people are better at it than others and some have more experience than others.

We also have to have our time to vent because we sure can't do it on the floor. (We have to be Applebee's hostesses on the floor for the surveys.) I get what the OP is saying. She was busy as all get out, then to have a pt go south, spend a bunch of time trying to take care of that person, get the orders done and then the ICU nurses be so ***** can send anyone over the edge.