Why do unit nurses have bad reps?

[SheriLynnRN]

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.

[RN34TX]

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.

Very good points. The biggest problem is that too often each dept does what's most convenient for them and don't think of the other units as their colleagues.

I never worked ER so much of it is a mystery to me but I really do still try to be considerate to the floor nurses with patient transfers because I remember what it was like.

In ICU I often get report from the ER sometimes more than 6 hours before the patient finally arrives there. On top of that the report was often of the "I just got here I don't really know this patient" variety. Why this happens so frequently and why the previous nurse who does know the patient couldn't have called and talked to me for 3 minutes is a mystery.

I asked an agency nurse on my unit who does work ER why so long of a wait to get a patient unless it's after 5am. If it's after 5am I hardly ever wait, I get report and the patient is up her in a matter of minutes. The ER often brings 2-3 or more at a time between 5 and 7am. This nurse explained to me that it's because that's a less busy time for the ER and that they are pressured to empty it out before shift change.

That might be convenient for them but getting slammed with new admits toward the end of my shift because patient transfers are timed at the ER's convenience is very inconsiderate.

Now in PACU I too realize what it's like to get pressured to open up my slots to keep the OR from getting backed up but experience in other areas has taught me that it's not always all about what's best for the PACU and OR, other people are trying their best to manage their units as well and sometimes the floors just can't take patients just to keep us running smooth and happy.

I always ask because sometimes the floors are ok with it, but I never pressure anyone to take fresh post-ops from PACU at shift change. It's inconsiderate, most of the time unnecessary, and can be unsafe.

[mattsmom81]

As an old ICU nurse (and an ER and medsurg nurse before that) I know the special problems each of these areas have to work with...and I try hard to not get a 'diva' attitude in ICU.

If I tell ER I cannot take that patient right now its because I'm in an emergency situation in another room and really cannot break away. I try to call them back ASAP. I don't abuse this privilege tho...and will often offer to come down and get the patient later if possible to make up for it, or help them out in another way. I recognize that ER nurse likely has 6 or 7 patients and that ICU patient is monopolizing their energy and holding a room up (likely with a waiting room full of people).

Same with medsurg...if I'm having a slow night I offer to come up and resite some IV's or do some admission interviews for them. I don't give them a hard time if they don't know the last PTT...I try to remember when I was that frazzled medsurg nurse scared to death cuz his/her patient was going bad. But then I'm known as the 'nice' ICU nurse and I have a good relationship with most nurses I've worked with through the years.

I think its sad we've gotten so burned in our jobs that we forget to be nice to one another.

I think if more nurses worked each others' units (and shifts) we wouldn't feel so justified in judging each other, personally.

[Tweety, BSN, RN]

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

I've seen both sides of it Tom and can go tit for tat on each and every one of your thoughts and then some. I'm not going there, and still not buying it. :)

[Marie_LPN, RN, LPN, RN]

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

And that could be said about anyone at anytime, it's not exclusive to the floor nurses:rolleyes:

[Marie_LPN, RN, LPN, RN]

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

I agree!

[TypicalFish]

This is why nurses lack the political power that we should have; power that would make HUGE changes in America's healthcare system; we could, if we could get past who's better, who b***hier, who has a harder job, what degree makes a better nurse, and just sheer pettiness and discord, WE COULD RULE THE WORLD (or at least the healthcare part of it) and make some AWESOME changes. But as it is, we will continue to gripe about those "witches" from ICU, PACU, ED or those "terrible" floor nurses, who got break and who didn't,what so-and-so said, or did or didn't do, and we will continue to get what we we now have......

[bluesky, BSN, RN]

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.

In my SICU, we get pts primarily from the trauma center and the OR or CVVR, and the occasional surgical floor car-wreck. There is absolutely NO WAY we could ever say "I'm on break" to some hotshot surgeon are you CRAZY!!!! We have 4 managers on our a*sses at all times to assure that we transfer our pts out within 1/2 of expected ETA and take pts when they arrive. Our OR doesn't play. Do you really think we're going to pick up the phone and be like ... "hey, you know that heart transplant or balloon pump you were talking about... well it will have to wait until my smoke break is over" HA! I haven't heard a single nurse call anyone ever to say don't come- ever. Every once and a while we get very assertive about getting some transfers out when the unit is full and we need to liberate some beds to admit some sick pts.

I mean sure we have some serious diva-bit*h back stabbing egotists...

[CEP10492]

In the facility where I work it's not necessarily the unit one comes from that gives them an alternate ego, it's generally just the person. The ICU in my facility has 6 nurses, of those 6 only one has ever talked down to me or flat out ignored me, even though I'm charge on med-surg. She's relatively new to the facility and I've been there for 6 years, but I started as a CNA and worked my way up to RN. Which could be why she acts as she does towards me. I don't let it bother me, because everyone else is polite and knows I am competent at my job.

[AlexandraRN]

It is so sad that some nurses feel that they need to be rude or demean other nurses. Why? Does this somehow make them feel more important or somehow better than the rest? We are all working for the same purpose and that is for the good of our patients. I wish we could find other ways to boost our self esteem, putting down your co-workers says alot about who you are as a person!

[Schoolnursetrish39]

Exactly right...

[sayitgirl]

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.

Okay I just wanted to jump in and give an outlook from the patient's family perspective. I lost my son about a year ago to a long illness. He was admitted to ICU three times over a year and my experience with the nursing staff was not good.

They took good care of my son, but they forgot that he also had another part of his life, he was someone's son. They were so wrapped up in taking care of the "patient", they would not let him be a human being. I cannot tell you how many times I had to ask if someone would let me come in earlier to sit by his bedside or explain to me what is going on. They were usually short, and too busy to talk to me. It did not matter that I traveled an hour to get there,...they told me that they would never get any work done....it did not occur to them that maybe it would help the patient feel better to have family there. What would it have hurt. After the experience of my child dieing in ICU I never wanted to work in the unit. I sent a letter in to the nursing director explaining how I was treated in an effort that the next family not have to go through what I did. This was at a large well known teaching hospital.

:stone So please remember to treat the whole person, there are nurses out there that are insensitive and cold to families and patients. Usually because they are overworked. But what is more important, the paycheck or the patient? Why are we nurses today?

[busykim]

I have only worked at one hospital in the ER, but I have heard nurses say that we "dump" patients on them at shift change. In our facility that is not the case, once we have orders from the admitting Dr. we fax for a bed, admitting has up to one hour to get us one, then once a room is assigned we must call report and have the patient out of the ER within 15 minutes. All the while everything is timed on the computer. This is all done to keep the busy ER moving. There is no way we could orchestrate and hold patients just to "dump" them at shift change to inconvenience other RN's/ I sometimes think that a "exchange program" for day- would be a good thing between different areas of the hospital to try to understand each others perspectives. I think most all of us are hard working and judge each other too harshly. Just my observation :) Kim