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Are Critical Care Nurses a Bit Snobbish?

I have been a Registered Nurse for about 32 years and have a BSN and MS in Nursing Education and Maternal-Infant Nursing. I am also a Certified Diabetes Educator.

Although my graduate work was in OB, I have accrued many years experience in Med-Surg and Ortho (thanks to the United States Army Nurse Corps' approach to deciding where to place their officer nurses.)

About six months ago I took a position in a hospital as a Clinical Educator on a post-op Surg/Ortho unit. As I have interacted with the Clinical Educators from the other units in the hospital, I have observed something that has left me wondering.

Is it just me or do I detect a bit of "snobbish" behavior from the Critical Care educators...(and perhaps the other Critical Care leadership as well?)

On the one hand, the critical care nurses do have some additional knowledge and skills that they apply to up to two patients at a time...for which they receive many weeks/months of additional training...usually while receiving a pay check from the hospital.

On the other hand, the med-surg nurses with their own brand of specialized knowledge and skills manage from five to eight patients at a time...sometimes discharging most (or all) in one shift...only to fill the beds with new admissions before the shift ends. The patients on the med-surg floors are many times nearly as sick as the ones in the critical care units with the nurses attempting to provide competent care without the aid of all the technology available to the critical care nurses.

I know many critical care nurses who refuse to be pulled to the med-surg floor if the ICU census drops. They are intimidated by the numbers and are afraid to try the juggling act required on med-surg.

I really DO respect what every nurse does...and just wonder if I am being overly sensitive or if it is my imagination or if others have noticed similar "snobbish" behavior?

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20 Responses to “Are Critical Care Nurses a Bit Snobbish?”

  1. Kim Says:

    I think that is a pretty braod statement to make and apply to all critical care nurses. I am sure there are a few bad eggs in any department, but do not think it is a fair statement to say globally “critical care nurses are snobbish”.

    I was “warned” about the critical care nurses when I was working Med/Onc, but personally found those preconceived notions about ICU/CCU nurses to be untrue.

    I think truly for critical care nurses that have not functioned on a medical unit before, it is extremely intimidating to care for 5-8 patients, as this is a unique “skill set” in and of itself. Floating to another unit where one does not feel comfortable may cause a great amount of fear and anxiety for anyone. This is especially true for critical care nurses who may have never cared for more than 2 patients at a time. However I don’t think many med/surg nurses would truly feel comfortable floating to a critical care unit either. It is difficult for anyone to work outside their comfort zone.

    Sometimes critical care nurses are looked on poorly from code or near code situations where they are very direct in asking questions and /or obtaining information about the patient, but again realize they only have a matter of minutes to try to get as much info about the patient, the situation, and then to prevent a code from occurring, or stabilize a patient who is in a code situation. Sometimes these situations don’t lend themselves to time for friendly chit-chat, but rather quick and focused attention on the patient’s situation. I would hate to think that is the only basis on which a global personality statment is made.

    Each area / department has their own area of expertise and benefits that they bring to their specific patient groups. I think it would be far more beneficial to focus on the positives of each area rather than to globally label one department as “snobbish” when really they may just be different or have been trained in a different background with differing priorities given their typical daily patient scenarios. I promise you on any day, a med/surg unit could discharge twice as many patients in half the time of a critical care unit, but again it is based on what is common to that unit not based on which nurses are better, nicer, or less snobby:)

  2. ZBT Says:

    Perhaps I had never noticed the “qwirks” of the various departments until I have now had reason to interact on an almost daily basis with leadership from other departments. As I said in my original statement, I personally certainly have great respect for all nurses who DO have specialized knowledge and skills within their given area.

    I respect your comments and can only hope that most of our fellow nurses agree that looking on the positives will be more beneficial. Having been on the receiving end of some less than positive comments, I cannot help but agree.

  3. TheCannulator Says:

    Specialties that exert some degree of control or independent practice, like Midwives, Critical Care Nurses, Emergency Nurses and Nurse Practitioners do have to believe some of their own bull to do well they believe.

    Let’s not get all warm and fuzzy about it so that we don’t upset anyone. Instead of thinking the sun shines out of your backside because of your skill set, be thankful you have been given the opportunity to practice in the environment you do with the skill set you have.

    As both a RN with a Crit Care certificate and a Paramedic I get to see snobbery from both sides. ER Nurse who think they know my pre-hopsital role when the closest they have been to an ambulance case is the triage desk (amazing lack of insight) yet they are able to criticise my care or lack thereof.

    there are trauma Centres here who are so far up themselves their tonsils hurt just bewcasue they got a TV series and the newest department. Where as the next level down ER’s have far more overall compassion and commonsense than they do hands down. And I trained at this Trauma Hospital long before the little pats appeared as an RN and I turned out a nice guy!!

    The only difference between ICU nurses and Rottweilers is lipstick! was a famous joke told here. I became a Crit CAre RN but still performed basic nursing skills. I still jabbered with the orderlies and the cleaners and those often overlooked in hospitals. I love going to general wards.

    Looking after little old ladies in my ambulance who just need a cuddle and cu of tea are just as rewarding as the 6 car MVA. It’s all about perspective.

    If you start to believe your own bulldust you will one day crash and burn. You are only as good as the next cocky SOB on your shift……

  4. laura Says:

    perhaps the more specialized we become in our nursing practice the more “snobbish” we might appear to be. i know for a fact that my 1 pound patients strike fear in the best of floor nurses and the ER treats us like conquering heroes when they call us to try to start a line on a screaming, sweaty chubby baby/toddler after they tried in vain…but then again i haven’t touched an adult patient in 18 years so i know a floor nurse could wipe the floor with me while juggling their full patient load with one hand tied behind their back…which is why i am glad that i don’t have to float.

  5. A Critical Care RN Says:

    As my name says, I’m a critical care RN. I’m relatively new to it having worked only one year in it. Our training is pretty much the same training that is offered to anyone else in the hospital, we have a preceptorship (at my hospital it’s the same amount of time as any other department, 3 months), ACLS, PALS, and foundation courses (same thing, other departments get them focused in their area). While there is the perception that we only get 2 patients at a time, it’s not true. I have had 2 patients, gotten a third because patients have to go somewhere and it’s not the ER job to hold them, sent one to the floor and then admitted another. That’s four patients in one night with at least two being really unstable enough to be admitted to ICU. The paperwork isn’t any better (on a night like the one described above, I might spend an hour to an hour and a half after my shift catching up on it). We’re the ones that have to call the surgeon 3-4 times in the middle of the night because a patient has received 8 units of blood and is still not stabilized. We get yelled at all the time. At my hospital the chain of command for emergencies on the floor is that if an emergency presents, a rapid response team is called which involves ICU staff (usually the charge nurse which now has to stabilize this patient AND find room in a possibly full ICU), and the floor charge nurse who has to call the attending. Are we snobbish? No, we’re usually stressed out and really have the best intentions in helping out but may come off as abrupt. At the end of the day we care about the patient and not about what other people think of us. I’ve had plenty of patients brought down from the floor who are unstable and everyone is freaking out, the patient is stressed and the staff is stressed. We bring a new insight into an emergency that might of been overlooked. At my hospital, our floor patients are no where near as sick as the ICU patients and if they are, then they pass the buck to us which we are happy to take. Leadership is under a lot of stress too because they have to run a department in an efficient manner often dealing with all the situations that arise. Upper management has to run a department that is losing money in the most efficient way possible. So that’s my soap box. I apologize if there seems to be snobbery but we really mean the best for everyone.

  6. Rachel Says:

    I think nurses are also groomed by the doctors they work with. Personally I landed in the Neuro ICU so mostly I deal with neurosurgeons. There is an expectation from them that if a certain person hesitates on answering his or her orientation questions we recognize this as a significant difference and at 3 in the morning get the ball rolling for an emergency craniotomy. We hear the doctors reminding us how critical our perceptions are and we see the results of it on a daily basis, good or bad. And we have to teach new medical residents on a monthly basis on how the brain needs to be treated.

    I wouldn’t say we’re cocky because of this, but I would say we have learned to speak quicker and louder and clearer then others. I can only speak from this particular unit, but I’m guessing there are others that are of a similar situation.

  7. KMJ Says:

    I agree with Kim, that is a pretty broad statement to make about critical care nurses. I am a critical care nurse and like any area, there are always a few bad apples but you don’t base the entire bushel on those couple where you are currently at. I work in a very open ICU/CCU and we get pulled to the Med/Surg, OB, Nursery, and ER and do take 6 to 8 patients (I personally love it) but there are some who would rather not due to being out of their “comfort zone”. Everyone has one and some are smaller than others. It does not by any means make them a snob.

  8. dgfuller Says:

    I worked a surgical/vascular unit for 3 years before transfering to the cardiac care unit 6 years ago. I work night shift on weekends, and generally I am one of the most senior nurses. We are often referred to as the “God Squad” or the “Cowboys” of the hospital. In return, I have VERY limited knowledge of ortho, maternal child, and chemo. I still have no quam calling on other departments for help.

    When I worked the floor, I was overjoyed when the code team came to my rescue and I could always count on the unit nurses to give me a second opinion on a difficult patient. Now that I am on the other side, I get a lot more backlash and attitude than thanks. Most comments are centered around poor staffing, difficult patients, “we have more patients on the floor,” and other poor pitiful me comments. When I receive such backlash, my simple response is “Why did you call me if you did not want my help?”

    My theory, we are all adults and should not wear our heart on our sleeves. My focus is ALWAYS the patient and what is best for him or her. How much of this “snobbish” behavior is someone getting his or her ego bruised? We should all put on our big girl panities and focus on the patient instead of grooming egos. That is what nursing is about, providing and caring for a patient while maintaining yourself as a professional. There is no room egos.

  9. Jackie, CCRN Says:

    I have worked in several hospitals from as far east as Virgina and as far west as Honolulu. My husband was in the military. I have worked in many critical care units. There are nice people everywhere you work and there are “Snobs”. The ICU has its share. For the most part ICU nurses are good people. AND, for the most part, most ICU nurses hate to be pulled to the floor. They are used to working with one or two patients and getting pulled to the floor requires that they change their entire routine to fit the routine of the floor. As nurses we all get into a routine for performing the tasks that we must perform for the day. When you get thrown into a different environment, it is VERY difficult to switch to a whole organizational skill set at the drop of a hat. Even nurses who have worked on a med-surg unit or some other type of “floor” nursing, have difficulty switching back after they adopt the new routine of the ICU. Sometimes they are viewed as being difficult, snobbish, or even lazy because of this. I think it is more being thrown out of their element. It causes anxiety, can cause the nurse to be very stressed and frustrated. They may come off as being a little short even. It is not that they are not good nurses or that their ego is bruised. They have been asked to do something that, in general, is a VERY hard, and uncomfortable thing for them to do. For me the anxiety is compounded by the fact that people do look to you as being somewhat of an expert because you take care of critical patients. It makes you feel like they may be looking to you to perform on the floor in the same effective manner that you perform in the ICU. Not easily done. When I have been pulled to the floor I feel like a fish out of water. I hate it. If you get an ICU nurse to the floor to help out, be aware that they may be very anxious about being there. They don’t know everyone, they don’t know where your supplies are, your charting is different, your unit routine is different, the meds are located in a different place, the patients are assessed at different times than what they are used to. You have to look to them like they are a completely new nurse to your environment. Try to give them a lighter assignment (Not pampering them, just being kind). Try to kind of take them under your wing and show them where things are, ask if you can help them, and most of all…. Be happy that you have some help… otherwise, you might be taking care of the extra patients yourself!! We all want to take good care of our patients. AND, I TOTALLY RESPECT WHAT THE FLOOR NURSE DOES. I WOULDN’T WANT TO DO THAT JUGGLING ACT ON A DAILY BASIS. I’m thankful that there are nurses who can!!! Thank God there are nurses who like virtually every area of nursing.

  10. Victor Says:

    I COMPLETELY agree with the above post. I’m a critical care nurse and was pulled to a different ICU and was STILL extremely uncomfortable and anxious just because it was out of my “comfort zone” and the patients were completely different than what I was used to. I can’t imagine how stressful my day would be if I ever got pulled to the floor and have to take care of 8 patients- NIGHTMARE..

  11. SRE Says:

    From a student point of view, I would say that ICU nurses are way less snobbish than med/surg floor nurses. Initially I was assigned to Med/surg floors and the nurses were so unwelcoming it was beyond snobbish, as I progressed into higher acuity floors the nurses kept getting nicer and nicer. In fact, my whole final semester has been spent in the Med ICU, Neuro ICU, Surgical ICU, CTICU and all of the nurses have been so willing to get me hands on experience that I am convinced I want to work as an ICU nurse.

    In general, from my point of view, floor nurses feel like they are underappreciated and have this attitude to prove themselves as better than the ICU nurses. I also found them to be more unhappy with their jobs than the ICU nurses. In fact, I always asked this question to every nurse I worked with, Are you happy with your job? All of the ICU nurses responded with “I wouldn’t dream of doing anything else”, I only received this response form one Floor nurse, sad but true.

    To close, I don’t think ICU nurses are snobbish just happier. Unfortunately when the med/surg nurses see that, they interpret it as snobbish. I mean, heaven forbid that there are nurses out there who are not working just for the money.

  12. Billy Says:

    I’m a last semester nursing student— not much experience I know—but from what I have seen from clinical rotations,my job, and my professors; most nurses seem to be miserable snobs–not all of them—just most of the nurses I’ve met at the hospital–at my job—at school. I do agree with one the respondents–usually the more skilled or educated the nurse the greater the snobbery–they often pride themselves in their consumate professionalism—unfortunately consumate professionals are often consumate jerks who have chosen to define professionalism in the context of nursing as a well pressed uniform and an obvious facade of sincerity when dealing with their patients. Nurses have long resented physicians for their condescending attitudes and it seems as though, in an ironic twist, that while passively and successfully combating those attitudes nurses themselves have adopted the very dispositions they could hardly stand.I’ll try to hold out.

  13. nursingaround Says:

    generally they’re a mixed bunch like every other ward/unit. They do usually have a lot more knowledge than the regular ward nurses, but whenever I’ve helped out in the unit they’ve always been helpful. But… they don’t tolerate incompetence or plain stupidity. They really can’t afford to get it wrong, so if you’re blundering around in a unit, not pulling your weight, watch-out, and rightly so.

  14. Caring ICU RN Says:

    There are good and bad in every group. I have found that it is difficult for one to survive in an ICU setting if you are not an A type personality. I respect all fields of nursing. Everyone has their own job duties, judging from school clinical experience on several med-surge units, the patients at our facility in the ICU are much sicker. At times there are bed back-ups which keeps stable patients in the ICU longer, but that is a gift! There are times where patients have 12 or more drips running at the same time. Just figuring out what is compatable is a chore in itself. The charting is a nightmare, patients do get discharged, and you never know what is coming through the door if you have an admission. When it comes to education, the initial training at our facility was much more extensive for critical care areas. We may only have two patients, but we are constantly getting new orders, speaking with physicians and residents to fix unexpected problems, and hanging/monitoring more IV drips on one patient than most floor nurses see in all five of their patients in a day. As I said, this does not go for every patient, but most. To make matters even more stressful….time management becomes a trainwreck when your patient goes down the tubes. We can’t send them to the ICU, we are it….last stop. And you better know everything about your patient, as they physicians depend on you for the answers so they can make their decisions. The same complaints stand for night shift and day shift, adults vs. peds, clinic vs. impatient…..the attitudes affect all areas of nursing =-) Everyone who loves what they do want to be the best nurse out there.

  15. Megan Says:

    I wonder if the distribution of snobbishness differs from hospital to hospital. This is just based on the different observations I’m reading here. You gotta figure that every ICU, Med-Surg or ER environment is different in every hospital…it all comes down to the individuals working there. No two nursing teams are exactly alike just like no two people are exactly alike. Plus all it takes is one bad apple to spoil everyone’s good mood or a small gaggle of gossipers to give us all a bad name.

    I’m a nursing student now, but I did clinicals as a phlebotomy student and the ICU nurses at my local hospital were very kind and supportive..even to a phlebotomy student like me (the lowest of the low on the totem pole). I do plan on becoming an ICU or NICU nurse because I fell in love with ICU during those clinicals..and I plan on being respectful and unsnobby to everyone while I do it. There’s enough stress in hospitals already without all the meanness.

  16. andrea Says:

    I believe each of us is a bit overwhelmed when we are ‘floated’ to a different environment. Floor nursing can be overwhelming just because of the assignment load compared to a Unit. Also, just finding supplies on different floors or Units is an issue for some folks. Seems that we give an impression of unwillingness (and we are) when moved from our comfort zone. My own experience is that we do react to how we are perceived. I’ve actually been awed by the skills of some of the Unit nurses, but realized they were ‘over the top’ when applied on a floor. We med/surg nurses are the work horses of any hospital. We are the worker bees. We don’t get as much acknowledgement as the Units, but we hang in there and get it done. And, there are snobs everywhere. Usually it’s the folks who are a bit insecure and allow their status to be their identity.

  17. Amy Says:

    I wouldn’t say more snobbish, but I must admit that every time I call report from the ED to take a patient to the ICU, I make sure all my i’s are dotted and t’s are crossed because I know that I’ll get yelled at if anything is out of place. One of our ED nurses got written up because her patient had filled his depends in the elevator on the way to ICU, and this was after we cleaned him up right before they left, but the receiving nurse was REALLY upset about it. But I’ll admit we have our fair share of snobs in the ED department too 🙂

  18. buttons Says:

    Wow, I think some nurses are snobbish regardless of their speciality.

    I am being serious… Snobbish, too cute, I do not get my hands dirty syndrome, I do not do adls and my butt dont stink attitude…those type of nurses right?

    Some of those nurses are in every unit, management and everywhere…..

    I believe every speciality has their strengths and weakens. There are some specialities that are similar and a nurse will be able to function easily in the other speciality.

    I am a firm believer in nurses should be rotated out of their units every year. Nurses need to be well-rounded in their education and their skills. Many nurses have forgotten their skills and this is unacceptable. This will eliminate the reduction of skills and understanding of every speciality. In addition, it will prevent burn out as well.

    Therefore, some of the snobbish nurses will be coming down to earth real quick or the reality will be reaching up and pulling them to earth. (I wanted to say “a kick in the butt” will bring them down” but someone would take me serious and say I was enforcing physical abuse/violence.) A figure of speech…..

  19. Sukie Says:

    A good ICU nurse is also called The Barracuda. They look over every little detail of their patients and are very protective of them. (Former ICU nurse) The behavior/personality is ingrained. Hard to adjust to another level.

  20. bob Says:

    Having worked a number of years on tele and med surg taking care of 6-9 patients and then transfering to ICU, I agree there are ICU nurses who are often are critical of med surg / tele nurses. Wishful thinking, but it would be a much better working environment if we all gave eah other more respect. Most tele, med surg, ER, and ICU nurses are under a great deal of stress. We all need to be considerate of each other.Maybe try working in these other areas before you critisize these nurses. As far as Im concerned, hospital management / bean counters create impossible demands on nurses. Intentional understaffing for the purpose of saving a buck to make themselves look good. And if department managers don’t play the game, they are out. Someone else with dubious morals will be right there to take the job. Nurses need to work together to promote better working environments. Unions like they have in California would solve alot of these problems. Problem is, nurses just can’t seem to agree on much. It’s easier to blame the other guy in the other department. Amen

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