Lost my temper at work :-(

One of our night time charge nurses just recently quit and in the mean time they're having random ICU nurses float out to cover the role. One in particular, M, has been charge two times when I was working on step down and both times he has very sarcastically, publicly, and nastily questioned my acuity assignments. He has this way about him that is sort of sarcastic joking --- like guys like to rib each other -- but has enough of an edge to it that really doesn't feel good. And I don't think it's appropriate in the work place.

The team I had last night was rough. I've had them two nights in a row and the first night was even busier. I only rated one of them as high acuity (there are options of low, medium, and high, with about 10-12 different levels of each of those based on criteria). The criteria for acuity levels are different on step down versus med surg versus ICU. So this temporary charge is probably not as familiar with the acuity levels for step down as he is for ICU -- but he does occasionally float out to step down when the census is high; all the ICU nurses do.

The criteria for which acuity and # you assign the patients are pretty straightforward. Things like isolation precautions, frequency of interventions, whether or not those interventions are effective, hemodynamic instability, active arrhythmia management, etc contribute to the rating.

So for my team last night I think I rated them as a medium, a lower level high, and a high. For various reasons, all following the prescribed acuity scale for step down.

And this same temporary charge nurse starts mouthing off at me about rating two of my patients high. Goes on about "well they might be high acuity for you, but for me they would be low," and basically making fun of me and questioning my judgment in front of two other nurses. At first I kept my cool. I said it was pretty straightforward what merited the acuity rating for each of my patients. I pointed out that I probably knew them better after spending two 12 hours shifts with them than he did after getting a *very* brief charge-to-charge shift report. He kept pushing and pushing, and I snapped and said, "F*** you." Up until that point it was unclear whether he was being a joking jerk (ribbing me) or serious, but it was starting to feel pretty serious. At this he was surprised, "Did you just say 'fuck you'?!"

I never swear at work. On night shift many nurses do. I'm mostly quiet and focused on the patients. This really struck a nerve with me (probably based on previous experiences at my old hospital) and I lost my temper. I'm really kind of mortified that I did. I hope this doesn't go any further. The other two nurses that he was poking fun at me in front of supported me, and also supported the concept that it is the bedside nurse who knows the patient best in terms of assigning acuity.

The day shift nurse that I handed off to yesterday morning told me at the end of the day that it was the worst team that she had ever had. It's *not* *just* *me*. She requested that one of the two most time-consuming be redistributed to another nurse, and ended up getting a whole new team today instead. (We split my team up for today's receiving nurse).

I feel sick to my stomach over the whole thing.

Have any other nurses had difficulty with charges questioning your acuity ratings?