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.

[geekgolightly, BSN, RN]

uhh, happens all the time where I work. Lord knows how they get away with it, because insurance is going to look at that and say, "You're kidding, right? We're not paying for this pt to be in ICU overnight for being slightly difficult to arouse at 0230 after 10mg of Ambien!" The docs don't care. They still get paid no matter where the pt is. It's the hospital that gets shafted. We had a pt transferred down for the sole purpose of getting Bipap (which can be done on the floor), who's gasses didn't even indicate the need for it. This was apparently precipitated by a personal vendetta between the doc and the floor over an incident earlier that day.

Every one of those pts who are improperly placed in ICU represents a percentage of a raise that I won't get this year. Not to mention less care for the true ICU patients since we are now busy with people an their call light all night wanting sandwiches and ice cream.

sounds like you have a bad system in place, too. it would never happen in my hospital.

and the docs get in trouble if a patient doesn't follow the DRG's. I've heard them b&^&*(ing about how a patient is gonna get them in trouble with the Med Director for going off the DRG time for their particular ailment.

maybe that is what's missing in your hospital. do you know if the docs get fussed at for patients hanging around in ICU or MedSurg when they should be gone?

[pricklypear]

I think my hospital operates in a bubble. I don't think the docs get fussed at about anything. Which doesn't make sense to me when the hospital eats the cost of non-ICU pts in ICU. The last hospital I worked at was a large one, and they didn't put up with stuff like this. Every effort was made to ensure that a pt being transferred to ICU was really in need of ICU care.

[RN34TX]

This is turning into a different thread than just ICU nurse attitude, but I have to chime in on this as well because it took me by surprise as well when I moved to ICU.

I worked Med/Surg in different states around the country for years and in each and every hospital I've worked at, I was NEVER EVER:

1. Allowed to tell the ER/ICU/PACU that a nurse was at lunch. If the receiving nurse was indeed at lunch, whoever was supposed to be monitoring that nurses patients was to take report and receive the patient.

2. Allowed to decline patients at shift change. Patients rolled in at all hours, period.

3. Demand that floor orders get started in their ICU/PACU prior to transferring to the floor or demand that the giving nurse calls the MD to clarify any orders that I didn't like as the Med/Surg nurse. Once the patient was on my floor, that all became my problem alone.

4. Sit at the desk reading a book or hide all together when I saw ICU/PACU/ER rolling in with my patient. I was to stop what I was doing and go in and help with transferring this patient to the bed. The PCT/CNA was to do the same.

In addition to the above, a clean room alone was also not enough. The bed covers were to be pulled back with every piece of equipment like O2 or suction was to be in place and ready before that patient ever came up.

My manager would be getting a call and I'd be written up if any of these things were not to the ICU/ER/PACU nurse's satisfaction in every hospital I worked as a Med/Surg nurse.

I must have been always working for the wrong hospitals because obviously that standard doesn't apply everywhere and certainly doesn't apply at my current employer now that I'm on the other end of it.

I'm actually appalled at how I often get treated by the floor nurses when I bring patients up to them, or at least try to bring patients up to them before I get hit with a brick wall of excuses.

It's insulting that after all the years I've put in as a floor nurse, that this is how many of them now treat me.

I've brought this up before and have heard every excuse in the book here about how overworked Med/Surg floor nurses are and to not take their attitudes personally. Baloney.

It's funny how if I'm overworked in ICU or PACU and am anything less than sugar sweet to the floor nurses, I suddenly get labeled as having a prima donna complex and that I think I'm better than they are because I work in critical care.

If I don't have every possible thing done that could get done in my unit by the time I transfer the patient to the floor (and believe me, I do try, but it's not always possible), I'm labeled a lazy, arrogant ICU nurse who thinks they're too good to do grunt work.

It's not about inflated egos and who's a better nurse, it's about respect for each other as professional RN's and LPN's period no matter which area we work.

[Tweety, BSN, RN]

It's funny how if I'm overworked in ICU or PACU and am anything less than sugar sweet to the floor nurses, I suddenly get labeled as having a prima donna complex and that I think I'm better than they are because I work in critical care.

Point well taken. We really don't know what is going on with each other and we don't respect it. I'm labeled lazy and putting up brick walls of excuses (rather than being genuinely busy with my other seven patients) if I don't drop what I'm doing to the beck and call of the critical care and ER nurse. And so it continues.

[geekgolightly, BSN, RN]

It's funny how if I'm overworked in ICU or PACU and am anything less than sugar sweet to the floor nurses, I suddenly get labeled as having a prima donna complex and that I think I'm better than they are because I work in critical care.

no one should disrepect you. im sorry that they do. when i get a load of haughty attitude from an ICU nurse, im nice back. i try and divert the emphasis of who knows what into whats best for the patient while trying to convey that im here for the nurse, not the enemy and if the hint isn't taken, i blithely ignore their attitude and get off the phone as quickly as possible. i figure that i have a better chance of knowing my patient by reading the chart myself if someone is going to be that cocky.

you will get labeled as having a prima donna complex or haughty or rude if you act that way. always put out what you want to receive. if that particular nurse is being awful, being awful back only relfects on you and your abilities to handle situations.

[RN34TX]

no one should disrepect you. im sorry that they do. when i get a load of haughty attitude from an ICU nurse, im nice back. i try and divert the emphasis of who knows what into whats best for the patient while trying to convey that im here for the nurse, not the enemy and if the hint isn't taken, i blithely ignore their attitude and get off the phone as quickly as possible. i figure that i have a better chance of knowing my patient by reading the chart myself if someone is going to be that cocky.

you will get labeled as having a prima donna complex or haughty or rude if you act that way. always put out what you want to receive. if that particular nurse is being awful, being awful back only relfects on you and your abilities to handle situations.

I never said that I was awful back to them. In fact, my colleagues believe that I allow the floor nurses to walk all over me.

By sugar sweet, I meant things like trying to pull a large patient into bed by myself even though the staff is sitting at the desk laughing and gossiping, but I don't dare ask for help to avoid the "rolling eyes" and floor staff acting put off by my asking. Or hanging as many meds and drawing as many labs as I can that are due on the floor orders to avoid any work on the receiving nurse's part so that he/she only needs to take vitals and assess.

It's backfired on me because they've come to expect it and get annoyed if everything isn't done this way all of the time. They don't understand that it's just not always possible.

It's interesting how this is the second time someone only used the second part of my bold phrase where I was only referring to myself as being overworked and anything less than gushing with kindness and courtesy.

Conveniently, the first part of it when I was talking about the floor nurses constantly being excused for their rude behavior because they are so overworked was overlooked, and once again, I should just let it roll off and walk on egg shells around the floor nurses being careful to not upset them too much.

So much for any recognition for my years as a Med/Surg nurse.

[geekgolightly, BSN, RN]

honestly, i haven't seen a floor nurse act that way to any ICU nurse. if that happens in your hospital, do you have a nursing practice council wherein you could get some sort of policy change? that;s uncalled for. the floor nurse should help with transfer. i don't understnad why that happens to you that they sit at the desk "laughing and rolling their eyes" while you are struggling. it's unconscionable, and should be addressed. you aren;t being sugary sweet when yuou accept that behavior, you are being a martyr.

[RN34TX]

honestly, i haven't seen a floor nurse act that way to any ICU nurse. if that happens in your hospital, do you have a nursing practice council wherein you could get some sort of policy change? that;s uncalled for. the floor nurse should help with transfer. i don't understnad why that happens to you that they sit at the desk "laughing and rolling their eyes" while you are struggling. it's unconscionable, and should be addressed. you aren;t being sugary sweet when yuou accept that behavior, you are being a martyr.

I've never seen it either until working here. And like I stated earlier, I've worked around the country. If only I'd done my Med/Surg days here, but then I probably would have just become a bad nurse working with that crew.

It's not every floor and I apologize for any generalizing that all of them are that way.

But it's rampant enough on specific units run by specific managers who let those nurses run wild with supervision that would be described as minimal at best on a good day.

Just the other day, I dropped off a patient on one of these units, and as I was walking by the nurse's station I heard the unit clerk tell an RN that ER was on the phone wanting to give report and send a patient. She laughed and said "Tell them I'm at lunch."

Everyone laughed because she had already eaten lunch earlier and already gave ER a previous excuse for not taking report.

So sad to see our fellow "professional" RN's at work.