Nursing is a great job because it’s a large tent. There are jobs for nurses both in and out of hospitals. I can’t speak for out of hospital nursing because I don’t have any experience whatsoever, but in hospital there is a hierarchy, and it’s the same in nearly every hospital, to the point that memes are made about this.
Nursing has a definite pecking order. Let me say that each nursing specialty is needed, but some nurses do have a more strenuous pathway than others. Remember that nursing is filled with mostly women (about 65% female) and women are some catty, backstabbing bitches. It makes for some very cat-like behavior, and not in a good way. No, in a “mean girls” way. The bullying and competition is pretty fierce. Women are simply vindictive, conniving bitches.
You have your inpatient nursing- medical/surgical (called med-surge), and these nurses staff the oberservation and general patient floors. Generally, med-surge nurses care for the least complicated patients, and they tend to be the least skilled nurses in the hospital. I’m sure that will piss some people off, but that’s just how it is. Because the patients are low acuity, nurse/patient ratios are 1:6 or sometimes as high as 1:8.
A step up from that is cardiology, oncology, wound care, those sorts of specialties. Nurses in these areas are very good within their specialty, but don’t generally know a whole lot outside of it. Again, they are needed, and a great example is that I suck at wound care, so not slamming anyone. The nurses in this area are usually ratioed at 1:4 or 1:5.
Above the general floor nurses are your step down units- PCU, CVPCU, those kinds of units. These nurses handle patients that are more complicated and require more care. For that reason, ratios are usually 1:3 or 1:4.
The next level up in the inpatient nurses packing order is the ICU. The nurses in this unit generally consider themselves to be the cream of the crop. There is a bit of a superiority complex here, and a good bit of it is well deserved. ICU nurses are well known for being very detail oriented and for having OCD. Every IV line is carefully labeled with color coded stickers. The ICU nurse knows everything there is to know about the patient: the name of his kids, his dog, his favorite color. They have time for that, because the nurse patient ratios are frequently 1:1 or 1:2, so they spend the entire 36 hour workweek with 1 or 2 patients.
Then there are outpatient nurses. PACU (post anesthesia care unit) nurses take care of patients who have just come out of surgery. After that the patient either gets admitted to an inpatient unit, or goes home. Also surgical nurses, endoscopy nurses, and the like. The nurses here are fairly specialized, and most of them work M-F 9-5 jobs. Other nurses refer to these types as “princess” and the shifts they work are called “princess shifts.”
The emergency department. The nurses here are known as being “cowboys” who don’t follow the rigid rules the rest of the hospital’s nurses have to follow. They have one overriding goal- stabilize a patient, then send them to an inpatient unit. Everything else- bathing the patient, changing their clothes, and other nursing tasks just don’t get done. ED nurses also tend to think of themselves as being the best of the best, and act like those routine tasks are beneath them. For this reason, inpatient nurses generally don’t like ED nurses.
If anything goes wrong in an inpatient nurse’s area, the nurse will initiate a “rapid response” or “CAT” call, and the response team will come to help them out. Some hospitals use ICU nurses as the response team, other hospitals use ED nurses.
As you can imagine, the rivalry between ICU and ED nurses can be rather intense, med-surge nurses feel (or are looked down upon) as being inferior, and the entire hospital feels like it is at war with one unit, shift, or zone being at war with all of the others. Some temporary alliances are formed, mostly when one unit teams up with another to take a third unit down a peg or two.
Yes, nursing is filled with a bunch of infighting that is mostly caused by having several hundred women in the same building, all wearing the same outfit, and about 1 in 5 of them is menstruating at any given time. It’s like being in a building full of rabid honey badgers.
All shift long, it’s “day shift is lazy,” or “Night shift didn’t do anything last night,” then you hear “Med-surge nurses are idiots,” or “Those ICU nurses are stuck up bitches,” and the old reliable “The ED nurses didn’t even bathe this patient and put him in a gown before they sent him up.”
Older nurses take great pleasure in screwing with younger ones, for no other reason than flexing their pecking order muscles. It’s so bad that every nurse hears an old adage while they are in school: “Nurses eat their young,” meaning that the level of bullying of new nurses by old ones sends many a young nurse off to cry in the bathroom.
It’s especially difficult when you are a man that just doesn’t like playing those kinds of bullshit power struggle games, and also has the nasty habit of calling things like you see them. It’s been a difficult skill to learn, biting my tongue. I still struggle with it frequently. I’m old enough that I don’t play those games, and I tell people to fuck off. That’s when your attacker then plays the victim card and uses their victim status as a weapon.
My first experience with this was in nursing school, when a fellow student began bitching at me and calling me stupid, and I told her to shut the fuck up. I almost got kicked out of school after she went to the instructors and told them I was racist and sexist. For the rest of school, that woman (who also happened to be black) organized a “Hate on Divemedic” club amongst the other students and staff members of her own demographic.
If you get the feeling that I don’t like most women in the workplace, you would be correct. They spend more time setting up tribes, posturing, backstabbing, and putting on makeup than they do actually caring for patients. There is a lot less of that kind of bullshit in the ED, simply because we are too busy to have time for that shit. Let there be some down time, and the ED starts with it too.
It’s exhausting.
I got a message from a reader who is a nurse, talking about my last work post. The gist of it was “be careful making enemies of HR and training folks, they will screw you over.” You know what, that is 100% correct, nurses like that will find a way to get back at you. The difference now is that I am close enough to retirement that I just don’t care.
