In an attempt to study the basis for conflict and tension surrounding decision making in ICU settings, a questionnaire was used to examine staff attitudes in a newly opened medical ICU in four major areas: (1) ethical issues; (2) decision-making process; (3) communications; and (4) emotional reactions of staff. All of the 36 house officers and 32 of 34 nurses (all RNs) completed the questionnaire. Results showed there was no monolithic nursing as opposed to physician position on any issue. Futhermore, professional role exerted a more profound influence on attitudes than gender or religious background. There was remarkable agreement between physician and nurse groups on ethical issues. However, nurses were less satisfied with the decision-making process and communication in the medical ICU and were more aware than physicians of their own and other's emotional reactions. The results suggested four ways to reduce tension in the medical ICU: (1) frankly recognize the inevitability of conflict and tension in a system where physicians have ultimate authority; (2) avoid perpetuating stereotypes; (3) maximize the continuity of physician care; and (4) maximize communication between and within professional groups.