retention of nurses in open heart unit

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    Hello fellow nurses...I have a question for you all. I work in the cardiothoracic ICU at an area hospital. We are facing a very serious shortage of nurses in our unit. Many of us feel we should be compensated for the skills that are required of us to work in this unit. For example: a patient with an open chest who has a IABP and will soon be started on CVVH. Although all nurses regardless of where you work ,work hard and earn their salaries daily, do you think it is unrealistic to expect that you should be compensated more if a higher degree of skill and compentency is expected? This is not intended to offend any one. I am on a clinical ladder committee and I am trying to determine if we are being unrealistic in our request. I would appreciate any feedback you can send.
    If possible pay-scale examples would be very appricated.
  2. 11 Comments so far...

  3. 0
    No, I do not feel ICU nurses should receive more. When the ICU nurses in our hospital receive word that we have to float to med-surg, most of the nurses quiver and quake at the idea. Why? Because med-surg nursing requires it's own "high degree of skill and competency." There is a very serious shortage everywhere.

    from an ICU nurse.
  4. 0
    Another ICU Nurse here,
    My best friend works Med-Surg. She has several competencies I do not have. I would be lost on her floor. Everyday she does several things that I have never done, and can't do (don't have the certification). I have several competencies that she does not have, everday I do things that she has never done, or can not do. We work 2 floors apart and don't really have any idea what each other does in a days work....I love working in a speciality ICU, and I don't mind making the same amount as my friend, I think its appropriate. Money is not the only way to retain staff- how about a supportive working environment, with a decent manager (rare, but it can happen) While we do have a shortage at my hospital, there is not a shortage in the unit managed by my manager, in fact, we have a wait list to come work there. What's up with that? It surely isn't about the money.
  5. 0
    As a nurse fortunate to work with a fine, kind cardiac surgeon in a hospital where all our work is respected I think specialty certification whether Chemotherapy or CCRN should be financially rewarded. I only have to care for one patient on the IABP or CRRT.Safe staffing makes the difference. Some facilities actually want a nurse to care for an IABP patient AND a second! Very dangerous!
    Med-surg is very stressful for me even though with a few exceptions my skills are sufficient I don't have the skill to handle the volume of patients they do in med-surg.
    The nurse who is certified has proven skills for that area of nursing.
    I do think that the hospital should pay for the education of the nurses taking care of such unstable patients. None are being paid what we deserve. Another consideration should be whether the surgeons and other physicians are polite as they are 99% of the time in my hospital. That makes such a difference in the stress level and management deserves most of the credit.


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  6. 0
    As a seasoned critical care nurse including cardiothoracic skills, I realize that there are skills required for this type of nursing. There are also different skill sets for L&D nurses, Peds and Med/Surg nurses. I am not now in favor of, nor have I ever been in favor of extra pay based on the type of unit in which one works. I believe that one should be compensated for education, credentials and efforts that go above and beyond the routine. We all choose our work units and receive some type of compensated preparation to participate in those areas.

    Clinical ladders can be meaningful additions to programs that aim at retention. I would suggest, however, that you take caution that you design the ladder so it is accessible, achievable, open to all, and does not inadvertently cause hostilities among your core staff. Ladders, done well, are wonderful tools for supporting a nurse's desire to attain clinical excellence (the key). Poorly designed ladders can cause infighting because they reward favorites and promote mediocrity rather than excellence.

    Best regards and luck with your program

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    I work in a CV-ICU and care for similar patients like you descirbe. We are not compensated for working in ICU, but our hospital does compensate nurses for being certified. On our unit, we have a number of CCRNs, but we also have some nurses who are certified in gerontology. This is fine with me. Nurses in different areas have special skills that require knowledge that I don't have. I'd never make it on a Med Surg floor-I can't juggle the number and types of patients a Med-Surg nurse takes in stride; just as a Med-Surg nurse can't float into ICU and take a Pt. on an IABP with multi drips.
  8. 1
    I think a staff nurse is a staff nurse. Every nurse has their own special qualities to offer. If you pay an ICU nurse more, you are saying they are more valuable than a tele or med-surg nurse with a far greater load. I do believe a clinical ladder should be in place in every hospital, as it provides a foundation for advancement, a way that a nurse can control her profession. I think this is where the extra education comes in. CCRN, BSN, MSN, etc can all be taken into account. Also ACLS, PALS. Separating different units by giving only certain nurses raises will only cause animosity.
    linzellern likes this.
  9. 0
    we have had some success with retaining our nurses in our icu. we have had a unit manager who supports and encourages our clinical ladder program. Each ladder (level II and III0 will allow the nurse to gain $1.00 more and hour at the time their application is approved. that means while they are doing the extra work they are receiving their $1. If the work is not completed, they lose the $1 and can not reapply again the next year. this is all done at yearly review. We are a 19 bed unit.

    We also have shared governance and those nurses in that program feel since they are attending meetings, they may as well go for clinical ladders and get paid for all the work they are doing.

    therefore, clinical ladders is working throughout our hospital, and all nursing units are eligible. We are even piloting a program in our cardiovascular unit to help retain our techs there, who have skill and education in their field.
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    Our hospital gives "certification" pay--actually, it was negotiated by the union! Any national specialty certification is recognized: CCRN, L&D, Neonatal, Low-Risk OB, and I believe there is ceritification for Med-Surg and other floor specialties, like Ortho, Rehab. This is $100/month for 100%, pro-rated for part time.

    This is one way a hospital CAN recognize special skills.
  11. 0
    I used to work in a facility that paid us extra ($8/hr) to care for patients on CPS, VADs, Thoratec, TAH, back then these patients had 2 nurses carig for them. I think that this is no longer the case. I do not work at that facility any longer, but I am sure that the facility has done away with this extra pay. We also received extra for precepting new nurses...We never received extra for caring for IABP patients or CRRT patients.


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