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?!
Quite the lively discussion here... I actually read the whole thing (I usually give up and move on after 3 pages, how is that for an attention span?)
But I really felt compelled to say that I laughed out loud at this poster, after 5 pages of ICU nurses defending their tongue depressor orginization method:
I still don't get the tongue depressor?
Is that a way to organize drips? By taping it to the depressor?
Pretty sure that was tongue-in-cheek, but pretty funny either way you look at it
I have a lot of respect for the ICU nurses I come across. There was one week when the CVICU had two transplants, one patient received a TOTAL artificial heart (i.e. they removed his heart and implanted a pump to bridge him to a transplant), plus 3-4 ECMO patients. You did not catch me complaining that week when they pushed their CABG/valve replacements over to us when they had only been off pressors for a couple hours. Did I recognize my patient is at risk for decompensating? Absolutely, which is why I keep an extra close eye on him. Did I understand why you were annoyed because I couldn't get his blood pressure up, despite several fluid boluses, then I had to transfer him back to you because he is symptomatic and has low UOP? Definitely, to you this is an easy patient. All he needs is a cardiac drip that we can't give on the floor. But ICU nurses need to remember that even if I might be able to care for this patient, my hands are tied by unit policy and patient load. I am usually okay with taking a little attitude from someone as long as it does not affect patient care.
I have never had an issue with icu nurses doing direct transport from our CVOR. I spent 18 months at my last job taking 3-4 cabg/valve patients a day up to sicu from my OR and there was always mutual respect. I help them and respect them, they do the same in return.... It's a two way street....
I did icu for a year. Night shift was great, as we were all new rns who worked together. When I went to day shift I found myself back in junior high with gossip, cliques, and head games. The manager was horribly ineffective I'm type A, but I'm not viscous, so I just couldn't give it right back to them. I moved on to the ER where I feel supported and respected daily. I will never work icu again because of that experience.
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?!
We think different. The tongue depressor on the side of the bed is for maintaining lines. I would not want your job because I could not give good care. Of all the floors most ICU nurses think highly of telemetry nurses. We just don't let blanket rules keep us from taking calculated risks to get the patient better
The most frustrating thing for an ICU Nurse is to respond to a CODE and BASIC LIFE SUPPORT is not occurring. Yep generates an ICU Nurse bewilderment and eye rolling at a minimum. So advice to the med-surg nurse. Could be your momma- learn BLS at a minimum.
Your post talks about ICU "dumping" sick patients for an emergency- most hospitals ICU beds stay full- why does anyone think an ICU nurse would be motivated to move out a less critical patient for a more critical patient? Hmmm ponder on that one. Which is more work for the ICU nurse?
I do not think ICU nurses think floor nurses are "lazy or dumb" the work/priorities/skill sets are different. All are needed and all need to strive to provide the best care possible.
Actually although kind of rude and feeding into the original post. Literature does support there are subtle changes missed long before a patient arrests- MOST of the time it should not occur outside of the ICU or be a shock. Implementation of MEWS scoring/Rapid Response Teams etc... were developed just because of this fact!!
Floor nurses review your vital signs/O2 Sats/Urine output-make sure if a tech is taking the VS they are correct, look for trends you will see the changes. Yesterdays ICU pt is todays Med-Surg patient.
Actually although kind of rude and feeding into the original post. Literature does support there are subtle changes missed long before a patient arrests- MOST of the time it should not occur outside of the ICU or be a shock. Implementation of MEWS scoring/Rapid Response Teams etc... were developed just because of this fact!!
Floor nurses review your vital signs/O2 Sats/Urine output-make sure if a tech is taking the VS they are correct, look for trends you will see the changes. Yesterdays ICU pt is todays Med-Surg patient.
This. I've had ONE patient code on me in 6 and a half years. One. That was dumped on me by day shift with a report of "Her BP and sats have been down all day every time she gets out of bed. We put her on BR c BRP." as I'm looking in the window of her room & see her walking to the BR unassisted & without her O2. Five minutes later, RT tells me she "refused" her tx. (We had just finished report & I had two high priority patients. This one & a very sick RSV.) Walk in the room to find her dangling off the bed & agonal gasping respirations. ER doc said she had a "lot of pus" in her airway that made it hard for him to see to put in an et.
I did have to apologize to one patient. I promised her a good night's sleep. That all changed when I did her vitals. She bought herself a trip to the ICU.
Floor nurses review your vital signs/O2 Sats/Urine output-make sure if a tech is taking the VS they are correct, look for trends you will see the changes. Yesterdays ICU pt is todays Med-Surg patient.
Or instead, "Administration, review your staffing so floor nurses have time to review their vital signs/O2 sats/urine output...and so on..."
It's a little tough to catch signs of impending crumpdom when you have WAY more than two patients.
Or instead, "Administration, review your staffing so floor nurses have time to review their vital signs/O2 sats/urine output...and so on..."
It's a little tough to catch signs of impending crumpdom when you have WAY more than two patients.
Yes to this.
I've worked both ICU and floor and the floor was much harder on me because of the level of acuity plus the ratio of nurse to patient.
I have worked with ICU nurses to this day who talk about themselves (individuals not generalizing all ICU nurses) as if they were above the floor nurses. I won't tolerate those attitudes.
A nurse is a nurse, we all work together as a team.
Or instead, "Administration, review your staffing so floor nurses have time to review their vital signs/O2 sats/urine output...and so on..."
It's a little tough to catch signs of impending crumpdom when you have WAY more than two patients.
True. But that's why nurses are paid for their critical thinking skills. Prioritization. If I have 6-8 patients, 3 or 4 might be going home tomorrow, 2 might be mostly stable and 1 or 2 might be getting sicker. It's incumbent upon me to be diligent over all of them, but I shouldn't be caught unawares that one of my sicker patients decides to crump out on me.
Been there,done that, ASN, RN
7,241 Posts
Why.. because ICU nurses are special!
They know more than lowly med-surg nurses. ..the residents and (most of the time) the attendings!
They are also busier and saving more more lives than all of the above put together.
I have worked in the ICU, stepdown ICU and all the way around these settings.
Some ICU nurses feel they are the bomb.. for reasons that I will never be able to fathom.