Attn Icu & Er Nurses:what's You Opinion Of Med-surg Nurses?

erezebet · Aug 11, 2002

I was a med-surg RN not long ago and I recently transferred hospitals to get into an ICU. The reason I did this was because the supervisor discouraged me from applying for an ICU job. Unfortunately, the ICU's at my hospital were taking new grads and passing up experienced nurses from my neuro-step down unit who were applying for the same position. I was outraged and some people told me that its harder to staff the more "difficult" floors because of high turnover and thats the real reason I was "discouraged" from ICU. Instead, the supervisor made me feel I wasn't good enough to work in an ICU and that is just not true. I strongly agree that ICU nurses do have a demeaning attitude toward floor nurses. I am not sure why that is. Personally, I think its because ICU nurses know more information and feel like they can do a medsurg nurse's job, but a medsurg nurse could not do an ICU nurse's job. Same senario as with nursing assistants.....we can do what they do, but they can not perform our job duties. Its petty and stupid but will always be there. Don't let anyone tell you you are not good enough to work in an ICU. I am glad I had med-surg experience and I am a better nurse for my past experience. I love the ICU and would not return to the floor for anything!

Fgr8Out · Aug 11, 2002

Originally posted by erezebet
Personally, I think its because ICU nurses know more information and feel like they can do a medsurg nurse's job, but a medsurg nurse could not do an ICU nurse's job. Same senario as with nursing assistants.....we can do what they do, but they can not perform our job duties. Its petty and stupid but will always be there. Don't let anyone tell you you are not good enough to work in an ICU. I am glad I had med-surg experience and I am a better nurse for my past experience. I love the ICU and would not return to the floor for anything!

I agree with your post, for the most part... however, (and this is NOT meant to start an argument with anyone :kiss just my own personal observation), while an ICU nurse might think "they can do a medsurg nurse's job"... just watch their faces when/if one is asked to float to a med/surg floor.... Our numbers are very often too overwhelming when compared to the ratio in ICU.... Plus, as I've read somewhere else on this site... many Med/surg patient's are very close to ICU status anyway.

But I get your point, in that med/surg Nurses may not have the experience or training to handle those specifics that make ICU "critical care"... Each area of Nursing is it's own "Specialty" and deserves recognition as such....

Personally, I like when I'm floated to ICU... I'm given 2 patient's who are generally ready to transfer out or to a different level of care... quite often anticipating transfer to my own floor. I actually get to spend TIME with them in ICU....

Gotta love every Nurse in every Specialty for the contributions each and everyone makes to our Profession :)

cmggriff · Aug 11, 2002

Med/Surg nurses are the greatest. You guys do the job I cannot do. I've been a nurse for 18 years now every bit of it at the bedside. Almost all of those years hae been in ICU's and ER's. I hate routines. I love not knowing what will happen next. When I have worked a floor long enough to get a routine I got lax and then I made some hideous mistake. Critical Care and ER nurses are different from each other and from Med/Surg nurses. Not better, not smarter, just different. Viva la difference. Gary

nimbex, RN · Aug 11, 2002

med/surg... 15 years... you've seen AlOT! Your prioritization and delegation skills are unmatched! YOU'VE BEEN READY!

I've never worked med surg and can't do it... After learning advanced and anal assessment skills... can't do less than I know for each patient... I'd try to treat each one as an ICU pt. and flounder at the mere numbers assigned to me.

Plus no monitor, A-line, swan... how the heck can I know what's going on!!!!!

But YOU DO! With out the monitors and fancy equipment, you assessment skills by now must be superb!

These are the assets that you bring, many of them.

Sure you will be required to learn so much.. be prepared; rhythms, pathophysiology is an absolute must, hemodynamics and advanced theory such as ABG's, the shock states, DIC, MI's, multisystem organ failure, GI bleed's, trauma ect.

The ICU must help prepare you with hands on and courses but you must keep learning and reading every day. My saying to new grads is.."I can teach a monkey to shoot hemodynamics... it takes a critical care nures to know what the numbers mean and how to treat... "

Realize there is nowhere to send the patient.... it's yours when they go bad and tag... you're it!

Now with 15 years in, you're beyond ready... if you want it... don't settle for less

Attitudes.. yeah we have them. The attitude to do right by the patient. Because we know what to do when and how. Yes, we even debate therapy with docs's. Many an ICU nurse forgets that others just don't know. (No hard feelings meant, we just sometimes can't understand that you don't know what we do ) if you transfer a code and start talking about peg feedings while we've just intubated, have no pressure... it's not a priority to us.

So I say do it.

You have everything to GAIN

carol

RyanRN · Aug 11, 2002

Med-Surg Nurses are sent from heaven!

When I worked med-surg I DID feel that critical care nurses had the 'attitude'. Later when I went to critical care I found that thinking was of my OWN making. I felt inferior and had absolutely, positively NO reason to feel that way. Although we are able to be more detailed focused you guys juggle 6 millions patients and things a day! That's a gift.

On the rare occasion we are floated to med-surg ( and yes we are) I am scared out of my wits! You guys should DEMAND the respect from the docs and let them know, on a daily basis if necessary, how SPECIALIZED your nursing abilities are. We are all in this together.

Furball · Aug 11, 2002

I used to think ICU nurses had an upturned nose attitude until I had to call CVICU to have a nurse come and troubleshoot an external pacer for me. She was great explaining her thought process to me and fixed the problem. No condescension there at all. I must've felt inferior and then transferred those bad feelings onto them.

After 5 years on a post cardiothoracic tele unit I'm scheduled to start in ICU next week! Can't wait! :)

MQ Edna · Aug 11, 2002

Med Surg nurses are great ...on Med Surg.

Med Surg is it's own specialty like most places. If a medsurg nurse wants to go to ICU they need a critical care course.

Experienced topnotch Med Surg nurses can turn into great ICU nurses with the appropriate education. And I'd rather get a good Med Surg nurse to work with me than a new grad anyday.

l.rae · Aug 11, 2002

Originally posted by cmggriff
Med/Surg nurses are the greatest. You guys do the job I cannot do. I've been a nurse for 18 years now every bit of it at the bedside. Almost all of those years hae been in ICU's and ER's. I hate routines. I love not knowing what will happen next. When I have worked a floor long enough to get a routine I got lax and then I made some hideous mistake. Critical Care and ER nurses are different from each other and from Med/Surg nurses. Not better, not smarter, just different. Viva la difference. Gary

OH sO TRUE..and well stated....ER is a whole different culture in and of itself....l had an opportunity to do critical care or ER...l chose ER cause l know l will never be floated to a medsurge floor....guess we all have our different preferences...thank goodness...and that is as it should be.....l teach a session in our ER residency program that we have about twice a year at the facility where we work.......and l touch on these differences that you speak of .....nursing is done from a totally different perspective in the ER than in ICU or MED/SURG.....all are a necessary piece in the recovery of our patients.....all are equally important...........LR

nimbex, RN · Aug 11, 2002

Cath, I'm in NC too, IF you had submitted a resume for our CCU/CSICU, we'd snatch you up so fast your head would spin

THen the manager and I would give each other a big Knowing we're lucky to have gotten you

norinradd · Aug 12, 2002

You are right about your feelings. When I worked ICU, Med/Surg nurses were looked down upon with only a few exceptions. The way a pt was transfered to us or the lack of knowledge of the reporting nurse led to a lot of miscommunications. However, we had all worked in that area before going into the unit and some of our opinions were based on working side to side with some of these nurses. Some ICU nurses had forgoten what it was like to manage the loads that you do and that you have limitations of resources. They forget that the doctors are not as quick to return calls or give aggesive orders or that maybe you wouldn't be allowed to do them if he did.

Please keep trying. I only have one strong opinion about ICU. New grads do not belong there. They need to be challenged on a Med/Surg floor. Our ICU is mostly staffed with new nurses and agency(who may or may not have ICU experience). They have all of the additude but not the skills to back it up. There is so much relearning to do just out of school, it shouldn't be done in an ICU. ER likes to recruit from ICU because they believe the nurses have already proven to have good critical thinking skills and will acclimate easier into this enviroment. Unfortunately these areas require a certain level of confidence (arrogance) to work so close to the doctors and gain their respect.

I now work Onc which is off of a Med hall and fully respect Med/Surg nurses. My hospital is an enigma, most of the stronger nurses work Med/Surg.

Jen911 · Aug 12, 2002

Okay, I'll throw my two cents in here. I'm an ER RN, still green, been there a year and a half, have built myself about 1/2 way up the seniority pole in the ER. Work in one of the smaller ER's for our city, 18 bed ER, 7 bed Fast Track.

We occasionally hire a new grad, maybe once a year. We LOVE experienced RN's.... Not particularly from any unit. We have a complete skill mix. I work night shift, and on my shift we have RN's with backgrounds from Neuro/Onc/ENT (me).. MSIC, CV, CVICU, CSIC, MedSurg, and old die-hard ER nurses... now if we could just get a psych nurse, we'd be SET! I think our mix of skills is what makes our shift work so well together. If one person isn't so proficient at a skill, another person will be, for example medi-ports...everyone knows I'm willing to access them when I'm working. I don't do so well with pedi stuff, so I just go find one of the nurses who's worked peds when I need them... It's all plain and simple, you need that mix.

I definitely think the place to start is on a floor somewhere, at least get your feet wet and learn the basics... Then start looking at ER or ICU's. But if you decide on the ER, there's one thing you're going to have difficulty with, and everyone says it's the same...it's chaos, and everything you've taught yourself about neatness and routine flies out the window!

Yeah, we can be confident, maybe a bit over-confident, okay, I guess I MIGHT be able to squeeze in a bit of arrogance every once in a while, too *wink*. But I wouldn't trade my ER job for the world. Once you're there, you'll gain more confidence than you ever thought you had. I was quiet when I started there, now I can yell out with a code like the best of 'em.

Give it a try, heck, come apply in MY emergency room!

Anaclaire · Aug 12, 2002

My opinion of Med/Surg nurses is that of deep respect. The ability to care for so many patients and all their related treatments at once is not much short of a miracle. These can be some of the most difficult and exhausting patients to deal with.

I've never worked Med/Surg. I worked on a telemetry unit for heart patients who were in the "diagnosing" phase of care (preps for open heart surgery, angiogram candidates, etc.) We would often receive some Med/Surg overflow patients so I did get to see some of the involved work they required.

I found my happiness in a Neotatal Intensive Care Unit after spending 6 years on a Mother-Baby Unit. Now, a Mother-Baby Unit is not a Med/Surg floor by any stretch of the imagination, however, it was a floor where we were assigned 4 to 6 couplets (Moms and their babies) and a few antepartum patients who were too ill to go home but not ill enough to stay in Labor & Delivery. I think folks would be surprised how many diverse ailments these Mom's can have... along with antepartum and postpartum routine needs as well as complications, we saw everything from asthma, strokes, sickle cell, auto accidents, traction, extravasiated c/section wounds requiring complicated sterile dressing changes, deaf and blind patients, paraplegics, underlying heart disorders, oh I could go on an on.

Anyway, I wanted to go to the NICU to work after I felt I had learned all I could on the Mother-Baby Unit and was feeling bored rather than excited to go to work. Over the years I had formed a good relationship with our NICU nurses. I always tried to give a thorough report when transferring a baby to them and have done all I was supposed to for the baby first, when calling them to help us start an IV or assess a "sick" baby I'd always be super nice to them and treat them with respect. I also accepted admissions from them with a smile even though I was busy myself. I was in awe of them for no other reason than they were critical care nurses. I believe I also tended to talk myself into feeling inadequate around them. I think my interactions with them over the years was the beginning of my "proving myself" to them.

I let a few of them know that I was thinking of applying for a NICU position and was received nicely by most of them. A few required that I "prove" myself over the first few months. I later found out that when our manager was considering hiring someone from another area of our hospital she would often hint around for our "opinions" of how we felt this person might fit into our unit.

There were certainly the "snobby" NICU nurses who acted like they were better than the rest. Some of us are full of ourselves whether we are nurses, accountants, lawyers, or whatever. Such is life.

My transition to the intensive care unit from the floor was smooth for the most part. There was a lot to learn and I enjoyed it so much! Now, after working on a floor and in a unit, I believe that each is difficult in it's own way. On the floor you have sooo many patients and every minute is spent organizing and running around like a chicken with their head cut off; in the unit you may have one to three patients (sometimes 4) but they are generally very busy ones with lots of medications and care to be given and evaluations to be made on a moment by moment basis, that every minute of your time is taken. Also, you never know when a crash will happen so you must always be on your toes and caught up with your patients needs. When on the floor, the patients we had who we thought would crash were sent off to an intensive care unit because we wouldn't be safe with those patients along with the heavy load already.

I don't know why you are receiving signs that the unit doesn't want you to work there. It's a mystery because your skills would only be an asset. Shucks, I bet you would even be able to teach the unit nurses a thing or too. My floor experience made me better at helping the NICU moms breastfeed their babies and set up the electric breast pumps, and I seemed to have a deeper understanding of what their pregnancy and delivery entailed as compared to my fellow nurses who had never worked with the same population as me. They would often complement me on my bedside manner with the parents and would ask for help with breastfeeding and other such things. It made me feel good and it helped them understand how important each person is for their knowledge. We all have something to contribute.

I say apply for a unit job. If not in your present hospital then maybe in another one where you aren't known. Maybe you, like me, are reading the unit nurses "confidence" as "snobbiness".

Sorry I wrote so much. I'm awful about that!!! :rolleyes:

Warmly,

Anaclaire