The difference between Med-Surg nurses and ICU nurses

Nurses General Nursing

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Has anybody else noticed this, or is it just me? The ICU nurses seem a TON more laid back, and the Med-Surg nurses seem very ancy (aka anal). I know not every nurse in these areas is not like this, but in general, this is what I have noticed. For example, in nursing school I always felt like the Med-Surg nurses were very hawk-like and made sure I was doing everything by the book. But when I got to the ICU, I literally had nurse after nurse say things like "well, you do the best that you can do, and that's all you can do." And then they would let me go do procedures/give meds to the patients! This strikes me as odd because in an area such as ICU, I would think they would be very anal and hawk-like, and in med-surg they would be a lot more lax. Maybe this is just my experience....

Specializes in NPD; Administration; M/S; Critical Care.

As one who worked critical care nursing for a while, I have to say that critical care nurses encounter code situations as their routine, so they get very comfortable in mixing the appropriate IV medication to combat serious arrhythmias, titrating those meds to the patient's rhythm and vital signs, on a moment's notice. There is more autonomy in ICU because there is not enough time to call the MD for those issues. The MD is called after the fact and alerted to the situation, and standing orders for these type of situations are typical. I also had to take a critical care course, in order to be able to perform safely in ICU.

My thoughts are that ICU nurses receive more in-depth department-specific training than I did while a Med/Surg nurse. It's simply the nature of the job. So, that would produce a nurse with confidence in his/her ability to perform in such situations. Perhaps that's why critical care nurses become more "laid back": they are very confident in their ability to successfully perform in critical situations.

I would also add that I routinely had 3 patients in ICU. 12 hours always turned into 14, since there was so much patient care involved that there was never time for paperwork until after giving report!

Hope this helps,

UnitRN01

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Hmm, anyone see the potential for an ICU vs M/S mud toss? ;)

I actually have noticed this tendency myself. And you know what we say? Those of us on med-surg tend to say "the ICU nurses that float here can't handle our patient load (4-5 days, 5-7 eves, 8-10 nights); they're lost with that many to remember. They miss doing stuff". The ICU nurses tend to say "the med-surg nurses don't have to keep 1-2 critical patients from coding every day. They don't have to know as much as we do".

The med-surg nurses DO tend to be more nit-picky over the details (so we CAN make sure we don't miss dressings, meds, etc on a patient overload). And the ICU nurses DO tend to be more laid-back; RRT activity is more common on their floor than ours. OTOH, lol, our job is to make sure we don't HAVE RRT activity :)

But you know what? SWITCH those two nurses, and you might have something entirely different (in my opinion). When those ICU nurses float to my med-surg floor, they are frequently harried and behind-the-8-ball; getting report from them can be a nightmare of "I don't know, I didn't get to that yet". And when some of our med-surg nurses float to ICU, they frequently look at us like "why are you worrying over those details?? It's no big deal...."

Interesting that it goes on elsewhere, too!

Oh, no mud-slinging from me!!! I do not, in any way, think that critical care nurses are "better" than floor nurses, but that the personality is different. I agree that many CC nurses cannot handle a full MS load, I know I couldn't.

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Specializes in Almost everywhere.

My take is this...

The ICU at the facility I work at contains nurses with many years of experience, and if it is that they only have a few years experience, they are exceptionally good nurses. I have seen several float to MS where I work and very easily keep up with all of their pts and then some. I have also seen several who cannot keep up and are there charting late.

The MS unit I work on, you can find all kinds of wonderful nurses, however, you would be lucky to find many with at least a year under their belt and you bet they are antsy. However, you can find a few (very few) like myself who have been doing it for almost 20 years and not be antsy one bit. I feel a person's experience and what they do and don't do routinely make a big difference.

If you can see where I'm coming from, that's just my 2 cents.

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I've done a short time in both environments, and I just have to say the assignments are just very different. In the ICU, it's more technical, less "people" work, and more thinking about the patho and all the critical conditions. Whereas in med-surg, it's all about managing care -- meds, PT/OT, tests, admits, discharges, and managing so many more details. It's a LOT about managing PEOPLE.

I've seen great fabulous nurses in both environments, and the experienced floor nurses are no less knowledgeable.

I can't decide which I like best. There are days when I'd like to go back to the ICU and just do pure ICU nursing and not have to deal with the people. Then there are days where I'd be lost without the people and all their funny little idiosyncrasies and watching them get better until their discharge.

Don't assume every nurse on the floor is a certain personality type -- many of us new grads are just getting our nursing legs so we CAN make it to the ICU at some point.

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Specializes in Cardiac Nursing, ICU.

It just really depends on who you ask. My experience has been that there are icu nurses who are anal, control-freaks and there are some who are laid back. It just all depends on what you think is "laid back". What I mean by this comment is, that icu nurses are used to seeing low BP, low CI, with climbing SVR's etc...so they may not get excited because it's the norm...it doesn't mean however that they're are laid back. I am an icu nurse (newbie) and let me tell you (there is nothing "laid back" about my personality) it just may seem that way because I don't fret over certain things that a floor nurse might consider a problem. As for details, I believe an icu is very detailed-oriented, you have to know the patient. I believe that the floor nurse is task-oriented (gotta give this med, dsg, transfer, admission, pt. has a test to be done OMG)...The icu nurse is constantly asking, is my patient stable enough to do/recieve this/that. What's my MAP, pt. vp with breakthrough A-Fib, just had a MAZE procedure...should I start...A-fib protocol...maybe not, don't want to block pt. down more. I mean there is soooooo much info to take in and be aware of. Not saying that the floor nurse doesn't....but maybe not as much....because of the patient load, you can't and some tend to be more task-oriented. I hope this makes sense...

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Specializes in ICU.
I've done a short time in both environments, and I just have to say the assignments are just very different. In the ICU, it's more technical, less "people" work, and more thinking about the patho and all the critical conditions. Whereas in med-surg, it's all about managing care -- meds, PT/OT, tests, admits, discharges, and managing so many more details. It's a LOT about managing PEOPLE.

I've seen great fabulous nurses in both environments, and the experienced floor nurses are no less knowledgeable.

I can't decide which I like best. There are days when I'd like to go back to the ICU and just do pure ICU nursing and not have to deal with the people. Then there are days where I'd be lost without the people and all their funny little idiosyncrasies and watching them get better until their discharge.

Don't assume every nurse on the floor is a certain personality type -- many of us new grads are just getting our nursing legs so we CAN make it to the ICU at some point.

Well said. I have almost a year of medsurg under my belt and have been thinking a lot about ICU. It seems much more peaceful in the ICU than on my floor. Is that so, or is that an illusion?

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Specializes in Trauma ICU, Surgical ICU, Medical ICU.
Well said. I have almost a year of medsurg under my belt and have been thinking a lot about ICU. It seems much more peaceful in the ICU than on my floor. Is that so, or is that an illusion?

It really depends on where you are. We have had simultaneous codes some nights where everyone is busy because acuity is so high and we've had days where half of our 16 bed unit ISNT on vents (thats good for us, we usually only have 2 or 3 walky talkies). However you really just get used to intubating people, adding BP meds, codes, etc. I am already pretty used to it and I have only been in my ICU for year. My personal experience is that some ICU nurses are CRAZY anal and some are very laid back. The difference is like night and day when certain people are working. We have ICU nurses who have been on our floor for 30+ years and they tend to be the most anal (only from my experience) but I guess they've seen what can go wrong if you arent super vigilant. I really think its kind of half and half. Whats so good about ICU though is many nurses wont be 'as busy' and can really help out when you get admissions (which IMO is FAR worse because you often have to intubate, get lines in, go to MRI/CT, start bp meds sometimes, draw blood cultures, start sedation, etc) and we get admissions at all times of night and day. Plus the families are really upset when pts get admitted to ICU because their loved ones look totally different with a big tube in their mouth and on a vent, so you have to deal with that too. You REALLY need help to get all that done in a timely manner. I dont think I could ever do M/S though, I am one of those laid back types and I'd probably get eaten alive lol!

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Specializes in CCU,ICU,ER retired.
Hmm, anyone see the potential for an ICU vs M/S mud toss? ;)

I actually have noticed this tendency myself. And you know what we say? Those of us on med-surg tend to say "the ICU nurses that float here can't handle our patient load (4-5 days, 5-7 eves, 8-10 nights); they're lost with that many to remember. They miss doing stuff". The ICU nurses tend to say "the med-surg nurses don't have to keep 1-2 critical patients from coding every day. They don't have to know as much as we do".

The med-surg nurses DO tend to be more nit-picky over the details (so we CAN make sure we don't miss dressings, meds, etc on a patient overload). And the ICU nurses DO tend to be more laid-back; RRT activity is more common on their floor than ours. OTOH, lol, our job is to make sure we don't HAVE RRT activity :)

But you know what? SWITCH those two nurses, and you might have something entirely different (in my opinion). When those ICU nurses float to my med-surg floor, they are frequently harried and behind-the-8-ball; getting report from them can be a nightmare of "I don't know, I didn't get to that yet". And when some of our med-surg nurses float to ICU, they frequently look at us like "why are you worrying over those details?? It's no big deal...."

Interesting that it goes on elsewhere, too!

I found that since we do head to toe assessments every couple of hours, we tend to do that on the m/s and it just threw me way behind. Another thing was we realize that sometimes we can put every iota of knowledge we have into keeping a patient alive and they still die. I don't fear death like I did when I was young. I know that everybody will die eventually. It is just that way and nothing will change that. That doesn't mean I won't do all I can to extend that life,because I do. I think that if it is your time to go, you go. If it isn't then you have us to make sure you stay. So all in all we accept what happens. I think that is one of the reasons we are so laid back.

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Specializes in Staff nurse.

God bless us all!! We are all there for the patient, regardless of what floor/unit/department. We can all learn from each other and help each other. I particularly appreciate our SWAT team, aka as Rapid Response Team, who we can call when we just want another opinion of our pt. when something just doesn't seem right.

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Specializes in ICU.

One difference I've noticed is how we deal with unresponsiveness. On the floor, they page the doctor, draw labs, checks vitals, check blood sugars, give Narcan. Once they are on the unit, we apply noxious stimuli until they miraculously come out of it when they can't take it anymore. We're meaner! :devil: Not that it happens all that often, but it is pretty funny when it does. And I've seen some Oscar-winning performances.

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