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]

Well said jls 189!

[MomRN0913]

I really hate when floor nurses must say "only 2 patients" I think there is a pretty good reasons we have "only" 2 patients, besides to give us more time to surf the internet.

Yes, this debate could go on. I believe sometimes they get ****** because nurses have called the Dr and said their patient needs a transfer to ICU, when in reality, they could handle the patient with a little more work. Or maybe when an intervention was ordered on the floor, it wasn't carried out, beacause the floor nurses were "waiting" for the ICU nurses to do it.

Whatever. I don't get mad or mean. I actually enjoyed fixing messes that came from the floors. Luckily in our hospital, we had very good relationships with the floor.

Oh, the tongue depressor thing. A per diem nurse at my hospital taught me that when you tape one to the bedside, you can use it as an anchor for all your drips lines, so they don't tangle and it is easier to differentiate which is which.

[anotherone, BSN, RN]

hehe. Sometimes it could have been caught quicker and fixed easier. Unfortunately, with ratios going the direction that they are, it's making it way harder to spend enough time with your patient on the floor to catch those subtle signs and symptoms. As a diehard M/S nurse, I take pride in the fact that I can keep my patients from needing to be transferred. And I've got a pretty good record with a few really good saves. But you can't stop every patient from circling the drain. Just like you can't stop every patient from going down the drain.

I don't know where everyone works but I work in a med surg floor in a major trauma center. We get patients that should have gone to a higher level of care to begin with or are very sick. If i pick up on a change in vitals or something very abnormal in my assessment, and the resident actually agrees and thinks the pt should be transfered to a higher level of care, how is that a failure on my part? It is actually a success. We can't do many drips on the floor i work at or monitor q15vitals, with 6 other patients.

[MomRN0913]

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.

Really?!? I don't even know what to say.

[anotherone, BSN, RN]

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.

Exactly. Of course you should know why any patient is on a heparin drip. but a last time they had a chest xray? NO IDEA for the most part. I cant remember the last x-rays on all 6 of them unless it was directly relevent. as in "oh by the way, yest or todays chest xray showed....."

[MunoRN, RN]

I still don't get the tongue depressor?

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

The tongue depressor is used to make a sort of hook by taping it to the upper part of the bed rail so it hangs over the downward curve. You can then bunch up your lines and hook them under the tongue depressor. I prefer the med cup technique, which holds the lines but still allows them to come free if they need more slack when the patient moves, there's also the blue tourniquet way of doing this.

I work ICU, tele, and ER so I can't really complain about anybody (or I'm free to bash everyone depending on how you look at it). I would say that all Nurses have both valid reasons to complain as well as many things they would benefit from understanding before complaining.

ICU Nurses can come off as snobby, although you'd be surprised how much respect we have for the floor Nurses, I remember something another ICU Nurse said when I first started there: "There's a special place in heaven for floor Nurses".

[anotherone, BSN, RN]

I don't understand the whole thought process between every rrt or icu transfer is a failure from a med surg/tele rn. yeah some are, i am sure. but not every intervention can be done on a med surg/tele floor.

[OpenHeartRN24]

I think that everyone just needs to try and get a long. I am a new nurse with only a year and 4 months experience, but I worked a M/S open heart step down unit and now I work CVICU. Floor nurses have it rough. Trying to take care of 4 to 6 pts that need to be walked at least 4 times a day. Discharge home, shower, take care of all of their families needs, admit new pts.

On the other hand ICU nurses have it rough to. we come to work in the morning get our assignment. one assignment could be to pts that need to go to the floor. in that case we needto walk both pts. which entails getting all chest tubes and foley into walking cart. all ivlines either disconnected or take the pumps with us. including telemetry monitors. they need to go back to bed and get their chest tubes pulled if possible. a line needs to be pulled. get the pt their meds and let them eat. REMEMBER THIS NEEDS TO BE DONE WITH ONE OR MAYBE TWO PTS. you also need to accomplish this by about 9am so you can come back and set up your room to admit a heart.

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.

[EDnursetobe]

I didn't read all the responses here because I'm lazy, but I thought I'd throw my 2 cents in :)

I don't think ICU nurses mean to be "rude". I think they are more thorough because they have less patients with higher acuity, so they usually see more of the whole picture.

And I don't think med/surg nurses aren't as good or whatnot, we just have a lot more patients so it's difficult to give as much attention to our patients, even though we want to.

[wooh, BSN, 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.

[wooh, BSN, 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.

And the primary person to blame for anyone who's a victim of failure to rescue? It would be the person that's decided staffing ratios and decided that the most important thing is customer service.

But if blaming the dumb lazy floor nurse makes things easier, well, don't worry. You're in the good company of that person that's deciding ratios and and to make the priority be customer service. He's blaming the nurses too.

[wooh, BSN, RN]

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

Not sure how that didn't get asterisks, but it's the perfect conclusion for this thread!