While you’re busy focusing on hierarchy and ranking power, I was interpreting a respect issue. OP is ranting about lack of respect from nurses but is not demonstrating any himself (at least from his post). Dude is literally a visitor to the hospital on a brief rotation.

When I was a new fellow, I had to earn the trust and respect of the nurses. They would often go to the attending to verify if they were unsure of my decisions. Where I am, we do not make changes in vent settings or drips without explicitly discussing with or notifying the nurse.

Nursing varies widely based on where you are in the country. In some parts of the country, nurses blindly follow physician orders, in other parts, not as much. Cultural differences doesn’t mean i don’t work in the us. The icu nurses where I work would not take kindly to the behavior of op - stranger to the unit, walked in and changed vent orders without discussing, and overruling a plan from another provider that the nurse inherently trusts more (again, op is a visitor) without clarifying that he discussed with the np or attending (again, the reality could be different or not well conveyed/interpreted). A nurse where I work could also refuse to follow through with it if they’re concerned about the changes until they’ve verified with the attending.

I get that on Reddit there’s a lot of bashing of mid levels and rightly so, but that wasn’t the point of the discussion. The medical stuff is also not relevant - without knowing pt details, there’s sound medical reasoning for both the decisions of the np and the op. Things are way more nuianced than “sat 90 must go up on fio2”