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?!

[MassED, BSN, RN]

oh I could go on and ON about how ICU nurses treat the ER nurses when delivering our patients to them! Different situations, different priorities, different settings, etc. Different responsibilities. Mostly "comes in without a known diagnosis in ED" in ICU "mostly known diagnosis and MOST work has been done."

How about we treated ABC, not that normal potassium that you replace PRN for whatever... how about their sats were in the 80's on Bipap and bp was 60/40 and we're handling that? How dare you ask me about nonemergent stuff when we're dealing with the present crisis???

But of course there are oodles of threads on this very topic....

[nursenotamaid]

Here is the truth, although tele nursing and ICU nursing are different worlds - ICU nurses *generally speaking* DO know more than your average tele nurse. We have gads more training, much, much more additional training in patho-physiology, pharmacology, different devices. We don't just get orders from MDs and see them in passing, we work WITH them constantly. We get shown the CT and MRIs... Most of us have been in the OR to *see* the procedures being done. My first ICU wouldn't let you take open hearts until you were at the head of the bed with anesthesia in the OR for 10 OR cases and you had to passed off by anesthesia to be allowed to admit these patients to the ICU.

Do I know more? A lot of times, YES.

Do I get snippy when I come to a code you called on the unit and no one has initiated CPR? YES.

Do I get annoyed when I'm coming down for your RRT and you can't tell me why the patient is on a heparin gtt? Or what their usual o2 requirements are? How their neuro exam was last time you saw them? YES. These are things you should know and these are things I *need* to know when I come down to your unit to try to help you out.

When I ask you questions and you say "I don't know", I do get frustrated. WHY don't you know? Its more frustrating when you act like its not a big deal that you don't know. I'm not talking about the nurses who ask you if the patient has a knee surgery 10 years ago, but when I ask what ATB they are on, when the last time they had a CXR done, etc... and you just say "I don't know" - you have just added onto the list of things I have to do while I try to reverse the wheels on crashing patient. And that is, ultimately, what we do when that patient gets to us. We look at where they are, where they *WERE* (which is where you come in), and what can I do to reverse this process.

Do I play on my cell at work? Hell yes. Sometimes, you have the time to. You also are so much better staffed with smaller ratios, you are working with your friends - so there is a lot of chatter. And we don't work alone, at all. ICU nursing is VERY much a team effort, and when it is a total team effort, you get to have more down time. I will say this though - you come up and spend a day with me when I have 2 crashing patients and judge me then.

Its issues like the tongue depressor that drive me nuts. Because you *didn't know* what we do that for, you assume its the "stupid ICU nurse" and go on your merry way. You *don't* know what happens behind those doors.

Would I have trouble coming down to a tele unit? Yes, for a bit. I don't like it. I used to work tele, I hated it. I felt ineffective and when I left tele and came into the ICU, I learned all about just how much I *DIDN'T* know. Food for thought.

Flame away...

[MassED, BSN, 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.

no, not the nurse's fault. Unless, of course, it was something you SHOULD have seen (like the obvious: cyanosis, hyperkalemia, hypotensive, etc.) Why would you say that? Of course you're supposed to know what's going on with your patient, but you are not responsible for finding the cause/problems with your patient - if you do (and we know most nurses, or good ones, DO) but the PHYSICIAN should be finding the culprit - not the nurse... unless, of course, you have MD behind your RN..... don't be nasty to your orientee. I'm sure they're internally shrugging when you say that, anyway.

[netglow, ASN, 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?

:yeah:Awsome! Well played.

[ChristineN, BSN, 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, a little harsh. So the 8weeker I coded with no prior history of seizures that had his very first grand mal seizure which ended up requiring intubation and a ICU transfer was my fault. Good to know.

[wanderlustRN24]

here is the truth, although tele nursing and icu nursing are different worlds - icu nurses *generally speaking* do know more than your average tele nurse. we have gads more training, much, much more additional training in patho-physiology, pharmacology, different devices. we don't just get orders from mds and see them in passing, we work with them constantly. we get shown the ct and mris... most of us have been in the or to *see* the procedures being done. my first icu wouldn't let you take open hearts until you were at the head of the bed with anesthesia in the or for 10 or cases and you had to passed off by anesthesia to be allowed to admit these patients to the icu.

do i know more? a lot of times, yes.

do i get snippy when i come to a code you called on the unit and no one has initiated cpr? yes.

do i get annoyed when i'm coming down for your rrt and you can't tell me why the patient is on a heparin gtt? or what their usual o2 requirements are? how their neuro exam was last time you saw them? yes. these are things you should know and these are things i *need* to know when i come down to your unit to try to help you out.

when i ask you questions and you say "i don't know", i do get frustrated. why don't you know? its more frustrating when you act like its not a big deal that you don't know. i'm not talking about the nurses who ask you if the patient has a knee surgery 10 years ago, but when i ask what atb they are on, when the last time they had a cxr done, etc... and you just say "i don't know" - you have just added onto the list of things i have to do while i try to reverse the wheels on crashing patient. and that is, ultimately, what we do when that patient gets to us. we look at where they are, where they *were* (which is where you come in), and what can i do to reverse this process.

do i play on my cell at work? hell yes. sometimes, you have the time to. you also are so much better staffed with smaller ratios, you are working with your friends - so there is a lot of chatter. and we don't work alone, at all. icu nursing is very much a team effort, and when it is a total team effort, you get to have more down time. i will say this though - you come up and spend a day with me when i have 2 crashing patients and judge me then.

its issues like the tongue depressor that drive me nuts. because you *didn't know* what we do that for, you assume its the "stupid icu nurse" and go on your merry way. you *don't* know what happens behind those doors.

would i have trouble coming down to a tele unit? yes, for a bit. i don't like it. i used to work tele, i hated it. i felt ineffective and when i left tele and came into the icu, i learned all about just how much i *didn't* know. food for thought.

flame away...

interesting that you say this because in this particular case the patient's original diagnosis was gi bleed. so the first thing i asked the icu nurse was why the patient was on a heparin gtt. she could not tell me anything other than the bleeding had resolved.

sorry i didn't know what the tongue depressor was used for, now i do. thanks. we are all very busy in our different ways and mutual respect from both sides is important to make our jobs a better place to work. i have no doubt that working in the icu can be crazy, overwhelming, and insane at times but it can be that way on the floor as well. it irks me when some people view tele nursing as "just passing meds" when we do so much more. but you understand that since you have worked the floor.

anyway, have a great day.

[Mulan]

Sometimes you get a crap report, and sometimes you don't know what questions to even ask during report because the report was so crap.

Then when the **** hits the fan you are left holding the empty bag.

Garbage in, garbage out, but that is really for another thread.

[MassED, BSN, RN]

Interesting that you say this because in this particular case the patient's original diagnosis was GI Bleed. So the first thing I asked the ICU nurse was why the patient was on a heparin gtt. She could not tell me anything other than the bleeding had resolved.

Sorry I didn't know what the tongue depressor was used for, now I do. Thanks. We are all very busy in our different ways and mutual respect from both sides is important to make our jobs a better place to work. I have no doubt that working in the ICU can be crazy, overwhelming, and insane at times but it can be that way on the floor as well. It irks me when some people view tele nursing as "just passing meds" when we do SO MUCH MORE. But you understand that since you have worked the floor.

Anyway, have a great day.

I still don't get the tongue depressor?

Is that a way to organize drips? By taping it to the depressor?

[golflinda2214]

another case of "nurses eating their young" When will it ever stop?

[OCNRN63, 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.

Or maybe they should have been in ICU from the get-go.

[jls189]

first of all, nursenick20, you are just rude. icu nurses like you give the rest of us a bad name.

nursing is hard enough without having to deal with rude nurses. i was a tele nurse for 7 years and been an icu for 8 years. i have worked at big teaching hospitals and smaller community hospitals in micu, sicu, cvicu, and ccu. i have seen this one too many times. it's totally uncalled for. when i was a tele nurse, i would see patients get transferred out, and they were a total mess....like they hadn't been bathed in a week. i have had patients code and the icu nurse's would mumble to each other that we were stupid and it should have been caught earlier. i have seen many icu nurses treat tele/floor nurses like crap. i, however, haven't ever done that. no one is perfect....even an icu nurse like nursenick20. yes, as an icu nurse we know more than a floor nurse, but we are not better. when i go to a code or a rapid response, i always thank the nurses for calling or tell them "good job" and "good call".

laurie52: get a clue. things happen and some of them unfortunate.

and to you icu nurse out there complaining b/c you get an admission that screws up your day, get over it. if you don't want admissions, then you are in the wrong field. you don't go to the icu b/c it's gonna be easy. it can be hard work.

i find that working with a bunch of women is the problem. put a bunch of women together, and you get a bunch of cackling hens....and yes, i am a woman. we are complainers adn like to talk aout people behind their back. sad! sad! sad! of course, i am generalizing. i know we aren't all like this.

esme12: i love this post.

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

us diplomat & reformer (1884 - 1962)

[wanderlustRN24]

Right on, jls189!! :):)