Why do unit nurses have bad reps?

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I will be transferring to ICU from general surg next week. When I told one of my co-workers (whom I respect) that I was going to the unit, she said "Just promise me you won't go up there and turn into a B***H." I asked around my unit and got the same type of response. I have not had many interactions with our ICU nurses, so I don't have much to go on, but my co-workers seem to think that unit nurses are holier-than-thou and that they all look down on "floor nurses", talking down to us. I realize that these are opinions, and are in all probabilty, stemming from isolated incidents, but I just wanted to get some perspective on what you all thought of this.

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".

My current hospital allows the floor nurses to have control and refuse to accept patients from ER, PACU, ICU, etc. during shift changes, lunch breaks, and other busy times at their discretion and it causes backups at times for our units but as a former floor nurse, I understand.

I wish that luxury was available to me back when I worked Med/Surg but my previous employer had a strict polcy that even if you were at lunch or off the floor, another nurse absolutely had to take report and accept any patient at any time from ER, PACU, ICU, etc.

I had many days where PACU and ER were coming up within minutes of each other. I would ask them to hold off because I just got 2 admits on top of it but they didn't seem to care. I felt as if they just wanted to dump their train wreck patients on me and run.

I think it's nice that my hospital allows the floor nurses to have some control over patients coming onto their units but I think they also abuse it and I've gotten some pretty lame reasons for not wanting to take my patients.

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I think its sad when hospitals allow some units to act like divas and expect other units to pick up what they throw their way..like enemas. This is bad management. :(

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Specializes in Critical Care.
I wish that luxury was available to me back when I worked Med/Surg but my previous employer had a strict polcy that even if you were at lunch or off the floor, another nurse absolutely had to take report and accept any patient at any time from ER, PACU, ICU, etc.

I had many days where PACU and ER were coming up within minutes of each other. I would ask them to hold off because I just got 2 admits on top of it but they didn't seem to care. I felt as if they just wanted to dump their train wreck patients on me and run.

What you are describing is known in management circles as throughput.

It's not that the ICU/PACU just wants to "dump and run". In the CCU I work in, once the order is given, I have 30min to empty the bed. Period. And normally, there is another patient on hold in the ER/Cath Lab/ PACU /Somewhere waiting on that bed.

About Critical Care personalities: ICU/CCU is not only detail oriented, it's got lots of bells and whistles that can be intimidating to a less motivated person. As such, critical care very often attracts an 'assertive' type of personality. Throw in big bonuses and a tad more hand holding from management, and it's easy to assume that YOU are important. (But you know what they say about assumptions.)

On the other side, critical care nurses quite often have tons more experience than other units. Lots of times, the floor units are learning grounds for nurses that intend to find what they want to do after they gain some experience. Critical Care is one of the high end specialty units; once there, nurses tend to stay there - and that means a higher ratio of experience.

I agree there is no need to be rude. But I also think alot of it is about perceptions - on both ends. An ICU nurse responds to the code, and 'takes over' - no rudeness is intended, but what is the floor nurse's 'perception'? An ICU nurse wants more information in report than you are giving: but that nurse is used to getting more information from the reports they normally receive. If they are questioning you about stuff that is beyond an 8 pt payload, it might not be intended as rude, just a normal expectation of a 2 pt nurse - but the perception could be otherwise. Generally speaking, when a patient is 'crashing', their care starts to enter an area where the critical care nurse is 'on his/her game'. Does that mean the floor nurse is a rock? Or is that just a perception?

I've worked both, I like ICU better, but I like the congeniality of the floors better. I am more guarded in ICU. I'm more protective of my pts (see the 'my biggest fear come true' thread - everybody thinks I'm coming off as what is being described in here, even if I don't)

Perceptions often times are based on reality. And often times they aren't.

~faith,

Timothy.

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After being in ICU for a while I can say why these nurses think this about us. ICU and floor nursing are totally different. I personally have respect for the "good" floor nurses out there, because I could never do what they do. Too many patients not enough time. Anyway, I think the reason we are seen this way is because we are for the most part very thorough in everything, more direct in our personalities. We don't waste a lot of time on BS...we just get to the point. When we go in to run a code we may upset folks who don't known what they are doing. And I am sorry every nurse in the hospital should be able to know when they need to do compressions, bag and put a monitor on. This is all I ask that is done when I am around. Everything else they just need to be able to follow directions being called out.

Some critical care nurses do think they are hot stuff though and need to get off their high horse! I realize that I can learn something from everyone usually no matter what area they work in or their experience.

Just my .02

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Specializes in ER, ICU, L&D, OR.
My current hospital allows the floor nurses to have control and refuse to accept patients from ER, PACU, ICU, etc. during shift changes, lunch breaks, and other busy times at their discretion and it causes backups at times for our units but as a former floor nurse, I understand.

I wish that luxury was available to me back when I worked Med/Surg but my previous employer had a strict polcy that even if you were at lunch or off the floor, another nurse absolutely had to take report and accept any patient at any time from ER, PACU, ICU, etc.

I had many days where PACU and ER were coming up within minutes of each other. I would ask them to hold off because I just got 2 admits on top of it but they didn't seem to care. I felt as if they just wanted to dump their train wreck patients on me and run.

I think it's nice that my hospital allows the floor nurses to have some control over patients coming onto their units but I think they also abuse it and I've gotten some pretty lame reasons for not wanting to take my patients.

While the ER has no control over the patients coming into their area, Can we tell that 57 yo with chest pain and cold and clammy and sob to wait, we are too busy. No we stack patients all over the place. Yes we get 2 and 3 and more patients all at the same time. They come in we take care of them. It isnt always neat and organized. But it gets done.

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Specializes in Med-Surg.
While the ER has no control over the patients coming into their area, Can we tell that 57 yo with chest pain and cold and clammy and sob to wait, we are too busy. No we stack patients all over the place. Yes we get 2 and 3 and more patients all at the same time. They come in we take care of them. It isnt always neat and organized. But it gets done.

That's the oldest argument in the world that ER nurses use. "We can't tell the ambulances we're to busy and come back later". Doesn't phase me a bit. Sorry.

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Specializes in Med-Surg.
My current hospital allows the floor nurses to have control and refuse to accept patients from ER, PACU, ICU, etc. during shift changes, lunch breaks, and other busy times at their discretion and it causes backups at times for our units but as a former floor nurse, I understand.

I wish that luxury was available to me back when I worked Med/Surg but my previous employer had a strict polcy that even if you were at lunch or off the floor, another nurse absolutely had to take report and accept any patient at any time from ER, PACU, ICU, etc.

I had many days where PACU and ER were coming up within minutes of each other. I would ask them to hold off because I just got 2 admits on top of it but they didn't seem to care. I felt as if they just wanted to dump their train wreck patients on me and run.

I think it's nice that my hospital allows the floor nurses to have some control over patients coming onto their units but I think they also abuse it and I've gotten some pretty lame reasons for not wanting to take my patients.

Our policy is not to obstruct transfers, no matter what time, no matter what is going on. But it's not about patient safety, it's about the ER making money for administration. If the ER gets too backed up and they go on divert then each ambulance that goes by is a loss of revenue.

Also, if the PACU patients get stacked up, it makes the surgeons made and they consider doing surgery at one of the money of hospitals that suck up to them, which again causes a money problem.

I just surrender to the policy and no matter what always take report and take the patient, no matter how inconvient or unsafe. We gotta work together, both between units and within the units. :)

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I will be transferring to ICU from general surg next week. When I told one of my co-workers (whom I respect) that I was going to the unit, she said "Just promise me you won't go up there and turn into a B***H." I asked around my unit and got the same type of response. I have not had many interactions with our ICU nurses, so I don't have much to go on, but my co-workers seem to think that unit nurses are holier-than-thou and that they all look down on "floor nurses", talking down to us. I realize that these are opinions, and are in all probabilty, stemming from isolated incidents, but I just wanted to get some perspective on what you all thought of this.

ICU nurses have to be very detail oriented & they are often dealing with crises. We often need meds, labs, etc very quickly & don't have time to say please or thank you until the crisis is over. Unit clerks & people we work with daily understand this. Most of us are polite, most of the time!

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Specializes in ER, ICU, L&D, OR.
That's the oldest argument in the world that ER nurses use. "We can't tell the ambulances we're to busy and come back later". Doesn't phase me a bit. Sorry.

Yes thats old and so am I

but also old are floor nurses who off the floor on smoke breaks, lunch breaks.

or say they are still in report, which means they are having coffee and donuts

or say they are in the middle of a code brown

Or the bed isnt clean yet, when housekeeping reports it clean over an hour ago

or they ask can you hold it untill the next shift. Ive had such a rough day.

or you cant bring the patient untill you fax report, but the fax isnt working, and when I send maintenace up there it seems to have been accidentally unplugged, amazing how that happens so often

Or the charge nurse says, I havent assigned that patient yet, and youve already called 3 times

and thats only a few of the excuses floor nurses have

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Im new to all of thise i keep reading about all the work in the hospital but havent come across any topics about private clinics and i was wondering if any of you guy's worked both & the pro's & con's. Im still far away from being either but i am curious...

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sorry i put thise in the wrong section... oopps sorry

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Specializes in Oncology/Haemetology/HIV.

but also old are floor nurses who off the floor on smoke breaks, lunch breaks.

or say they are still in report, which means they are having coffee and donuts

or say they are in the middle of a code brown

Or the bed isnt clean yet, when housekeeping reports it clean over an hour ago

or they ask can you hold it untill the next shift. Ive had such a rough day.

or you cant bring the patient untill you fax report, but the fax isnt working, and when I send maintenace up there it seems to have been accidentally unplugged, amazing how that happens so often

Or the charge nurse says, I havent assigned that patient yet, and youve already called 3 times

and thats only a few of the excuses floor nurses have

Unfortunately, many of these same excuses and others are used by the ICU and ER.

The ER staff that send up the a patient (former employee dying of cancer) filthy, shivering in wet sheets at shift change - despite the ER being almost empty. The excuse...the patient was large and would take several people to change and they wanted to clear the board before shift change. There were plenty of staffers down there more than enough to change the patient. Yet they sent the patient dirty, at shift change to a unit that had only two nightshift nurses and no other staff on it. Approximately two weeks later, the same thing occurred with the addition of someone in the ER having perfed the portacath by using the wrong needle. The family raised complete H%^& with administration. After that, we had the additional duty to access all portacathes in the ER as they couldn't be trusted to do it right.

I have called the ICU any number of times to give report...repeatedly, to get the"nurse is busy", the "nurse is at lunch", etc.

I have called the ER numerous times to get clarification on report (patient admitted with ARF but nothing whatsoever documented about the oozing shingles over 50% of their body...admitted to a nonisolation oncology room with a roommate) , to find "the nurse is at lunch/dinner/on a break.

I have also been on floors that had a fax machine that has been pumping out faxes right and left...working just fine...yet no report whatsoever from the ER on four separate admissions.

Our favorite excuses on the floor are when the patient has been in the ER either less than 30 minutes or over 12 hours (when nothing has been done for the last 9 hours), and yet the staff conveniently wait until shift change to send the patient. The excuse of, "I want to get off duty on time" when they have basically screwed over the floor nurses chance of doing the same is always so appreciated.

And just because says that it has been cleaned, does not mean that it has been cleaned. Or just because admissions says there is an empty bed does not mean that it is true. I have had enough supervisors/ER charge?ADONs come up to the floor to find out that indeed that bed was filled or that room was still filthy and never cleaned.

Trust me Tom, for every little thing that you put against floor nurses, we can also say about ICU/ER nurses.

We all need to stop the petty squabbling about trivial stuff and all start working together for the good of ALL nurses.

And stop putting down one group as having an attitude or another not paying attention to detail.

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