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?!
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
i can understand the feeling that the original poster will never understand. someone who entitles a thread "why are icu nurses so rude?" and then goes on to pick apart the care they deliver with easily refuted examples is not the poster child for learning and understanding. she's already made the assumption that icu nurses are rude and then jumped to the conclusion that icu nurses not only aren't perfect (which is true, but then no one is) and proceeded to pick apart the care that was given, proving that she has no understanding of those aspects of care. yes, people can learn if someone attempts to teach them -- but first they have to be willing to learn, and the original post did not strike me as coming from someone who was ready and willing to learn about the way icu nurses do things and the rationale for doing it that way.
patience and understanding are well and good, but i find it hard to patiently teach and be understanding of the ignorance of someone who is perpetually on the attack. i'm not, after all, perfect.
ruby vee....we both know how many icu nurses talk about those "dumb floor nurses" and when they respond to codes or get that patient from the floor passively (or actively) attack the floor nurses and roll their eyes, sigh and in general treat the rest of the entire hospital as beneath them....i mean really doesn't everyone know how hard icu nurses work? i feel really bad for the floors these days and how short they are.....but i also know that they also don't have the same sense of emergency or responsibility that we had when we started. i really think that the finger pointing needs to stop and it needs to start somewhere....so i choose for it to be me.
i have seen many icu nurses "dump" patients up on the floors because they have an "emergency" they need to make room for and i have seen the floor do some pretty naasty dumps on the icu that i could choke them for being so lazy and blind. i also realize that some iv's are "non-essential" to have on a pump but for the floor they are essential to be on a pump. when i work icu i make sure there are enough pumps before i bring the patient even if i need to call for them myself because i feel it's dangerous to leave certain free hanging iv's unattended on the floor because god only knows when they'll get to them. i just think that when we start recognizing how hard the other guy works too......we'll all be far better off as a whole.
but then again i'm guilty of middle child syndrome.......always trying to make peace...lol :redpinkhe
Ruby Vee....we both know how many ICU nurses talk about those "dumb floor nurses" and when they respond to codes or get that patient from the floor passively (or actively) attack the floor nurses and roll their eyes, sigh and in general treat the rest of the entire hospital as beneath them....I mean really doesn't everyone know how hard ICU nurses work? I feel really bad for the floors these days and how short they are.....but I also know that they also don't have the same sense of emergency or responsibility that we had when we started. I really think that the finger pointing needs to stop and it needs to start somewhere....so I choose for it to be me.
I have seen many ICU nurses "dump" patients up on the floors because they have an "Emergency" they need to make room for and I have seen the floor do some pretty naasty dumps on the ICU that I could choke them for being so lazy and blind. I also realize that some IV's are "non-essential" to have on a pump but for the floor they are essential to be on a pump. When I work ICU I make sure there are enough pumps before I bring the patient even if I need to call for them myself because I feel it's dangerous to leave certain free hanging IV's unattended on the floor because God only knows when they'll get to them. I just think that when we start recognizing how hard the other guy works too......we'll ALL be far better off as a whole.
But then again I'm guilty of middle child syndrome.......always trying to make peace...LOL :redpinkhe
I have NEVER referred to someone as a 'dumb floor nurse' and never heard any of my colleagues do this either... Just saying :-)
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Well as 32 years in critical care.....I have heard "those dumb floor nurses" or even comment on "How can those floor nurses be so dumb". I'm just saying we need to be kinder to one another.
Ruby Vee, I know you would NEVER say that about anyone..((HUGS)) I know you are better than that..:)
well as 32 years in critical care.....i have heard "those dumb floor nurses" or even comment on "how can those floor nurses be so dumb". i'm just saying we need to be kinder to one another.
ruby vee, i know you would never say that about anyone..((hugs)) i know you are better than that..:)
i've heard it several times! lol sometimes it's warranted.....lol but not in all cases.
funny story: while working in icu one night a nurse on the floor called back and asked for a rapid response because he thought he heard atrial fib when assessing heart sounds. hahaha what exactly does afib sound like? irregularly irregular? lol
The pump issue is crazy!!! We are not allowed to take meds off the pump. we take their pump, settings intact, and give them one of ours. It helps avoid major issues.
Nowadays everywhere is a hard place to work. Tele, where I worked it, was a mixture of post procedure and "everybody has a heart" patients. The post cath and post stent patients could very easily have a retroperitoneal bleed if they had a certain doc do their cath... so you're q15 and q 30 min. groin and pulse checks on one or two patients, one who got off bed rest and is pre-CABG for the next morning, a CHF frequent flyer, and god knows what for your admission. The docs hate it when they have an RP bleed, so they are rude to you but if you monitor the trend, it speaks for itself. The OR picks your chart apart when you send your CABG to preop. The frequent flyer complains to your manager if she can't have a liter of coke and a big mac for her evening snack. You are lucky if your admission isn't dead or nearly so.
"Everybody has a heart" attitude from admitting docs eared us all kinds of interesting admits. Like the dude whose admitting diagnosis was cardiac tamponade. Really? What in blazes are we going to do with THAT on telemetry?! I'll tell you what, he went to ICU in less than thirty minutes, that's what. Or the guy with an actively dissecting aortic arch, who went straight back downstairs to the OR (diagnosis chest pain). Or the guy who was blue when he rolled up, the last note in the ER said "pt's lips are blue, gave him a popsicle and transferred to tele"- that guy was in ICU in about 15 and intubated prettymuch right afterwards. And there is always the classic cardizem drip, who happened to get IV metoprolol in the ER and has some unexpected asystole on arrival. When I transferred those guys, no one was rude to me. They were pretty glad to see that the patients didn't spend too much time on the floor. But then there are others...
For example, the cardiologist who learned not to be sarcastic with me. Instead of giving good orders he said "put 'em in ICU because you can't handle them" Ok sir I will do just that. All I wanted was labs and an xray for a CHF'er on a renal dose dopamine drip. Geesh. But yes I will obey orders. Or the dude whose BP wouldn't stay up for crap and when his foley was removed, after ICU got him, he magically became right as rain. That was just weird and I don't blame them for not enjoying it. And there was one cardiologist who preferred to see into the future and transfer people who might have a problem, that would be ok if they actually had one so for her transfers people always looked at me funny. I can't make the doc do it my way, I have to do it her way.
I don't actually have a lot of trouble with the floor, from the other side of the fence. ER can occasionally mess up my day by not bringing the chart (with admit orders) with the patient, or by bringing me a dude with a saddle embolus, without O2 during the transfer. I really dislike getting people who are dead, that really isn't fun, and if you work in OR you should know that people can and do die everywhere, even the OR. From the floor, well my unit has learned to transfer BEFORE shift change so I don't have to **** 'em off trying to send a patient during report or right afterwards. And some of 'em seem to think I have the ability to start IV's when really they are better at it than me, but we can all practice I guess. I'm just glad I have my job and hope I don't make theirs any harder than it has to be. It's all work, not too many folks have it easy no matter what you think you see.
The tongue depressor taped to the bed was most likely to keep all the IV tubing, etc... in place. We typically do that. But yep, there are BOTH ICU and Tele or Floor nurses who think they know it all and are better than you. Trust. I float everywhere and there's always a few nurses I really can't stand.
In response to "wanderlust24" comments ....Although I do not have an understanding of the patients course of stay, I am curious to know if the ICU nurse was using the patient's original (dry) weight to dose heparin because they patient may have sustained extra vascular volume overload as a consequence of a complicated course of stay. In that case, the ICU nurse was thinking critically in using the patient's original weight and not the weight related to the fluid overloaded status. Not quite "basic stuff people"...theres literature out there on this method if youre interested in learning about it.
There does seem to be this ICU vs floor nurse unspoken battle, and ICU vs ER nurse, etc. (well clearly spoken here lol). You're probably right. You probably have encountered some "high and mighty" ICU nurses who think they're better than floor nurses, but it's not really fair to generalize. I have been an ICU nurse for not even a year yet, but I don't hear my co-workers speaking badly about the floor nurses. We're generally pretty busy taking care of our patients, helping someone who has a patient who has become unstable, or who has a new admission, or just cleaning poop and bathing our patients to talk about such petty things.
Each floor has their own unique challenges. Are there good and bad nurses on every floor? Probably. All seem to be caring and safe on my floor, good team players, so I am happy where I am. The heparin drip issue you mention is a patient safety issue, but it's not fair to generalize and say that ICU nurses are unsafe and don't know anything about their patients from these few examples, and your one isolated experience. I may not be the most experienced nurse out there, but you can bet that I am safe, and thorough. I know my patients' lab trends, plan of care, family situation, PMH/PSH, current assessment, what they ate for breakfast yesterday, kidding on that one lol, and the nurses on my unit seem to know these things, as well. I get along well with the floor nurses when I transfer my patient, and we're mutually respectful, help them if they need it. Not quite sure why that is so difficult. And, this is an old post lol
I feel really bad for the floors these days and how short they are.....but I also know that they also don't have the same sense of emergency or responsibility that we had when we started. I really think that the finger pointing needs to stop and it needs to start somewhere....so I choose for it to be me.
I also realize that some IV's are "non-essential" to have on a pump but for the floor they are essential to be on a pump. When I work ICU I make sure there are enough pumps before I bring the patient even if I need to call for them myself because I feel it's dangerous to leave certain free hanging IV's unattended on the floor because God only knows when they'll get to them. I just think that when we start recognizing how hard the other guy works too......we'll ALL be far better off as a whole.
I'm guilty of middle child syndrome...
....always trying to make peace...LOL :redpinkhe
Esme12, ASN, BSN, RN
20,908 Posts
ruby vee....we both know how many icu nurses talk about those "dumb floor nurses" and when they respond to codes or get that patient from the floor passively (or actively) attack the floor nurses and roll their eyes, sigh and in general treat the rest of the entire hospital as beneath them....i mean really doesn't everyone know how hard icu nurses work?
i feel really bad for the floors these days and how short they are.....but i also know that they also don't have the same sense of emergency or responsibility that we had when we started. i really think that the finger pointing needs to stop and it needs to start somewhere....so i choose for it to be me.
i have seen many icu nurses "dump" patients up on the floors because they have an "emergency" they need to make room for and i have seen the floor do some pretty naasty dumps on the icu that i could choke them for being so lazy and blind.
i also realize that some iv's are "non-essential" to have on a pump but for the floor they are essential to be on a pump. when i work icu i make sure there are enough pumps before i bring the patient even if i need to call for them myself because i feel it's dangerous to leave certain free hanging iv's unattended on the floor because god only knows when they'll get to them. i just think that when we start recognizing how hard the other guy works too......we'll all be far better off as a whole.
but then again
i'm guilty of middle child syndrome...
....always trying to make peace...lol :redpinkhe