Why do unit nurses have bad reps?

SheriLynnRN · Aug 5, 2005

I hope that I will be know as "the NICE ICU nurse as well." I got a chance to job shadow in the unit for 8 hrs and didn't experience any witchy stuff. They did all say that they think I will love it up there. A lot of you have metioned that unit nurses are very detail oriented, I am looking forward to the chance to develop that habit. Right now, it's impossible to give the kind if care I want to 7 or 8 pt, because if I gave perfect, wonderful care to one, I wouldn't be able to give the others ANY care. Having to make those kind of compromises is really crappy.

Long Term Care Columnist / Guide · Aug 5, 2005

I'm primarily a med/surg nurse, but I work ICU enough that I can see things from both sides (although there really shouldn't be 'sides' in nursing at all!), and often find myself explaining the ICU perspective to M/S, and vice-versa. I'm in "The Unit" at least once a week, and now I understand why the ICU nurses get so upset when we don't investigate telemetry problems quickly enough or give adequate report on a rapidly deteriorating patient (although we fail to do so mainly because we've got 4 or 5 other patients to deal with).

In fact, I've even been the tele nurse myself a few times, and I've gotten more than a little uptight when I have to call M/S more than once on a tele patient whose leads are off, or who was discharged and no one called ICU to let us know.

The OB floor is another area where the nurses are assumed to be really b****y, and even though I don't work there nearly as often as I do ICU, I've worked there enough in the past to know these folks are just like the rest of us. No, they couldn't handle a normal M/S load any more than the average ICU nurse, but that doesn't mean they're sitting up there on their rear ends eating bonbons and filing their nails. The truth of it is, most nurses are damn good at what they do, no matter what their specialty area.........this rivalry between departments is ridiculous, not to mention pointless and juvenile and not at all worthy of professional women and men.

And that's all I have to say about THAT.

jkaee · Aug 7, 2005

I'm primarily a med/surg nurse, but I work ICU enough that I can see things from both sides (although there really shouldn't be 'sides' in nursing at all!), and often find myself explaining the ICU perspective to M/S, and vice-versa. I'm in "The Unit" at least once a week, and now I understand why the ICU nurses get so upset when we don't investigate telemetry problems quickly enough or give adequate report on a rapidly deteriorating patient (although we fail to do so mainly because we've got 4 or 5 other patients to deal with).
In fact, I've even been the tele nurse myself a few times, and I've gotten more than a little uptight when I have to call M/S more than once on a tele patient whose leads are off, or who was discharged and no one called ICU to let us know.
The OB floor is another area where the nurses are assumed to be really b****y, and even though I don't work there nearly as often as I do ICU, I've worked there enough in the past to know these folks are just like the rest of us. No, they couldn't handle a normal M/S load any more than the average ICU nurse, but that doesn't mean they're sitting up there on their rear ends eating bonbons and filing their nails. The truth of it is, most nurses are damn good at what they do, no matter what their specialty area.........this rivalry between departments is ridiculous, not to mention pointless and juvenile and not at all worthy of professional women and men.
And that's all I have to say about THAT.

:yelclap:

GREAT POST!!

pricklypear · Aug 9, 2005

It seems you can never get away from it:
When I worked Med/Surg I always heard how LTC nurses don't know anything.
Then I moved to ICU and heard how the "floor nurses" are clueless.
Then I floated to SICU from my home MICU and constantly heard how MICU wasn't a "real" ICU like SICU is, only SICU and CVICU can take the "really sick" patients.
Then I moved to PACU, and apparantly from the feedback I got from my ICU and Med/Surg colleagues, PACU is the biggest prima donna of them all and I was going to end up like one of "them" if I stayed there because PACU nurses apparantly don't do anything because it's beneath them.
It's also an ICU overflow unit but apparantly I'm not a real ICU nurse anymore even though I can take their patients when they are full.
It doesn't matter where you work, somebody will always be more of a "real nurse" than you and someone will always be less than you.

Ain't that the truth!!:rotfl:

Anyway, to the OP - just don't ever forget what it was like to work on the floor. When it's you who's getting report on the crashing patient, be understanding and patient. When you're transferring one of your patients to the floor, try to tie up the loose ends since you probably have more time than the nurse receiving the patient does. I went to ICU after 3 years in tele, and I promised myself I would never have the attitude I saw regularly from some of the ICU nurses. We had several ICUs at my first hospital, and the nurses were kinder in MICU that any others for some reason. When we would get a patient from MICU, usually our 8th patient, the nurses would do things like "stop by" the shower on the way down, give the evening meds and anything else that needed to be done so we had less to do. I was always very impressed by that. The other ICU nurses were usually just plain rude when we would transfer a patient.

It's just a whole different kind of world in the unit, and sometimes nurses forget what it was like to spread yourself thin on the floor. There's never an excuse to be a b****.

OjoRn · Aug 9, 2005

All I know is this:

When I got pulled to tele or m/s I realized that they were

experts in many areas and I was dumb as a box of rocks. I have

had patients say "you are an ICU nurse?" I wanted to say,

"oh yes and I am failing miserably without all my STUFF to tell

me what is going on, use a bp cuff? WHAT?" They had

better relations with some departments (eg: lab, pharmacy, xray etc)

than we did. I gave the nurses kudos to their managers and to anyone

who would listen. To have more than two/three patients is like

juggling jello balls blindfolded. I had no clue. One time I went to oncology

years ago and found arrythmias everywhere, an oncologist took my

steth off of my neck and said "chill out." When anyone floated

to my unit I always showed them around, made them feel comfortable and

thanked God we had another nurse to help us out. And I liked having someone

new to chat with (always a plus!)

OjoRn

LegalBeagle · Aug 9, 2005

It seems you can never get away from it:
When I worked Med/Surg I always heard how LTC nurses don't know anything.
Then I moved to ICU and heard how the "floor nurses" are clueless.
Then I floated to SICU from my home MICU and constantly heard how MICU wasn't a "real" ICU like SICU is, only SICU and CVICU can take the "really sick" patients.
Then I moved to PACU, and apparantly from the feedback I got from my ICU and Med/Surg colleagues, PACU is the biggest prima donna of them all and I was going to end up like one of "them" if I stayed there because PACU nurses apparantly don't do anything because it's beneath them.
It's also an ICU overflow unit but apparantly I'm not a real ICU nurse anymore even though I can take their patients when they are full.
It doesn't matter where you work, somebody will always be more of a "real nurse" than you and someone will always be less than you.

When are we all going to learn to get along before our petty differences and prejudices destroy our profession?

LegalBeagle · Aug 9, 2005

I'm primarily a med/surg nurse, but I work ICU enough that I can see things from both sides (although there really shouldn't be 'sides' in nursing at all!), and often find myself explaining the ICU perspective to M/S, and vice-versa. I'm in "The Unit" at least once a week, and now I understand why the ICU nurses get so upset when we don't investigate telemetry problems quickly enough or give adequate report on a rapidly deteriorating patient (although we fail to do so mainly because we've got 4 or 5 other patients to deal with).
In fact, I've even been the tele nurse myself a few times, and I've gotten more than a little uptight when I have to call M/S more than once on a tele patient whose leads are off, or who was discharged and no one called ICU to let us know.
The OB floor is another area where the nurses are assumed to be really b****y, and even though I don't work there nearly as often as I do ICU, I've worked there enough in the past to know these folks are just like the rest of us. No, they couldn't handle a normal M/S load any more than the average ICU nurse, but that doesn't mean they're sitting up there on their rear ends eating bonbons and filing their nails. The truth of it is, most nurses are damn good at what they do, no matter what their specialty area.........this rivalry between departments is ridiculous, not to mention pointless and juvenile and not at all worthy of professional women and men.
And that's all I have to say about THAT.

I couldn't have said it better myself! Especially the "pointless and juvenile and not at all worthy of professional women and men" part.

You have my profound admiration and respect! :yeahthat:

Zoomer · Aug 10, 2005

I hope that I will be know as "the NICE ICU nurse as well." I got a chance to job shadow in the unit for 8 hrs and didn't experience any witchy stuff. They did all say that they think I will love it up there. A lot of you have metioned that unit nurses are very detail oriented, I am looking forward to the chance to develop that habit. Right now, it's impossible to give the kind if care I want to 7 or 8 pt, because if I gave perfect, wonderful care to one, I wouldn't be able to give the others ANY care. Having to make those kind of compromises is really crappy.

I am sure you will do a SUPER job. I came to the ICU after 13 years of med-surg. My organizational skills came in very handy. I remember thinking that the ICU nurses were all snobs when I was a med-surg nurse too. It's just a different world. What I like about ICU is the control and the ability to know exactly whats going on with the patient. I also think that the doctors respect you more which is probably wrong, but they do get to know you better when they spend so much time with you.

Just remember to treat your former colleagues with respect as you do now. I often have to remember my med surg days when giving report to a floor nurse and have to stop myself from giving such a detailed report. I loved med surg for a long time because I liked the variety but patients are just too sick these days to be able to handle the nurse patient ratios.

You have made a good decision. :)

teeituptom, BSN, RN · Aug 10, 2005

The only Real Nurses are ER nurses, the rest are :rotfl: :angryfire

Marie_LPN, RN, LPN, RN · Aug 10, 2005

I thought this thread was serious.

pricklypear · Aug 11, 2005

I thought this thread was serious.

OK, Marie. I read what you wrote, but somehow Klinger was saying it. His lips were moving and everything. I'm hallucinating.:rotfl:

caroladybelle, BSN, RN · Aug 11, 2005

After 30 years as a nurse I can tell you that there is definately that perception out there and it also applys to PACU and ER nurses. Some may have a chip on their shoulders, as do some med/surg nurses or nurses from any dept, but in general I think it's just an issue of depts that just don't understand the dynamics of other depts. We just don't understand unless we've walked in their shoes and them in ours.
With that said there are B****'s in every dept and in every profession! Don't worry about it too much.

I agree with this.

It also doesn't help when one manager brags on the "critical thinking" skills on her department, insinuating that no one else has any of those talents, etc.

It also has to do with how management treats staff in different departments. In one hospital (Florida - large elderly population) that I was in, the ER MDs routinely ordered "enemas until clear". But the ER would not do them, saying they were "too busy", but send them to the floor and want them back in 30 minutes completed. The final straw came when the ER was completely empty, but they sent a SHINGLES patient to peds for enemas until clear. Peds gets ticked because they shouldn't have shingles patients especially when not warned, and turfed it to ONCOLOGY. It was the 5th time in a month that the patient had been in for impaction and enemas until clear.

So let's contaminate two departments, two rooms and the corridor because one department does not believe that its nurses should be doing enemas until clear. And let's not force the MD to recognize that with the patient get reimpacted that often, maybe someone needs to have a discussion about bowel regimens. Since the ER nurses weren't having to do the enemas, they did not broach the topic with the MDs. Since the floor nurses did not have contact with the ER MD, he didn't have to address the problem.

When the onco manager forced the issue - the ER was more than equipped and staffed for this, since renovations, she took alot of heat because ER nurses are "too valuable" ...even if the ER is empty. She pushed anyway and the ER starting having do "some" of their enemas . About the time that a few patients made their routine repeatedly weekly visits for enemas, the orders started to change and a lot of the patients finally got the bowel regimens that they needed and ocasionally sent home with an enema kit, meds and instructions. About the third or fourth visit, the social worker starts having a long talk with the caregivers about proper care of their loved one.

Which is what should have been occuring in the first place.

Floor nurses are not permitted to decline to take report, whether they are caring for a patient, in shift report or eating for the only 15 minutes in the 12 hours that she is on duty. In many places the ER/ICU nurse is. ER/PACU/ICU time is considered expensive and their nurses' time is considered "more valuable". It may not be fair or right, but it is the way that things are. Just as MD satisfaction is valued more than nursing satisfaction...they are customers and we are employees.

We on the floor frequently have as detail oriented work in our own ways. I have traveled to ICU dozens of times to give chemo, just to find their nurses woefully ignorant of the issues involved in chemo. I've had calls to start Ida/ARA-C, find that the EF is 30% and no one has told the MD. The MD orders all the preprocedure tests and they call me up to give chemo before any of the necessary tests are done. They don't have the accurate I/O needed for giving Cisplatin. They haven't given any of the premeds, which do not require a chemo nurse. They skip doses of mesna or mannitol without talking to the oncologist, resulting in longterm problems. And when the counts crash about 7-10 days after chemo, they forget that this is normal.

THe following is a report that I have gotten:

Th ER tells me that the patient is being admitted with a fever. They have been in the ER for 5 hours, one of two cultures have been done, and they have just started the ABX (good luck getting another clean culture). They have had cancer (what type, I don't know...does it matter?) and have had chemo (what kind, when...two days ago,...two weeks ago or two years ago..does it make a difference?). Their WBCs are 2.0 (what is the ANC..why, does it matter??????). They have a port but it didn't get accessed or cultured. I just stuck them 4 times to get blood and an IV, man they had bad veins.

I transfer my 52 year old prostate Ca patient to the ICU for respiratory distress...he needs to be intubated. The distress has absolutely nothing to do with his cancer. I am greeted by, "Why the hell are they sending a CANCER PATIENT to the ICU". Frequently, followed by a , "Man, I would shoot myself if I got CANCER. Just tattoo DNR on my chest."

(Yeah, I just love the fact that I am merely a caretaker of the doomed and insist torturing them with "useless" chemo)

I receive that type of response probably at least 30%-50% of my transfers to the unit. And they wonder why the Oncos hate their patients going there. Getting beyond the stats that around 78% of cancer patients are going to be survivors. Especially prostate cancer.

We all have our specialties and should get recognition and respect for them. You don't like Onco/MS/Neuro/Ortho/Geriatrics/Nephro and I don't like ICU/PACU/ER. I'll try to respect your departments' idiocyncrasies and you try to respect mine.

And work to make everyone's job better.