culture of surgical ICU

[klimasr]

I'm a new manager to a surgical ICU, medical ICU and step-down unit. I can assure you (and the staff will attest to this) that the "culture" in the medical unit is very different than that of the surgical unit. My personal observation is that in "general" the medical ICU nurses are "thinkers" & the surgical ICU nurses are "doers". I may have staff voluntarily engage in a confidential personality profile to compare the units & gain a greater understanding of the differences between these two cultures.

Hmmmm.

[barb o]

First off, let me congratulate you for having the nerve to say you are management--but then, you are new and probably don't know better than to admit your status. Or, perhaps you work in one of the few places in the world where staff nurses are actually taken seriously and are seen as valuable members of the health care team--are are treated as such.

Having worked in both medical and surgical areas and with both species of physicians, I would agree that there are differences in approach, but you'll be selling yourself short if you categorize nurses as either thinkers or doers. The best nurses you will have are able to do both. For example, you cannot care for a post-operative patient without understanding the recovery process and the implications of your nursing interventions--it's not as simple as doing what the doctor orders. Nor can you care for a patient with severe medical problems without anticipating interventional therapy and preparing for it in a timely fashion.

If you will be doing a research paper that will look at defining nursing personalities for some particular purpose, that's fine. It may also come in useful when you are interviewing new staff to know how they think and work. And, please, please, please do not forget that your staff nurses deserve respect and support from you. They are the ones at the frontlines and without nurses who can only do one thing at a time, the patients will suffer.

[TanaLisa]

Let me say that sicu nurses are both doers and thinkers at the same time. We have to be or who would let the physicians know when their patients have to go back to the OR?!

[LBauer007]

You are so brave to actually say that SICU nurses are doers, and MICU nurses are thinkers. I wont take anything away from my MICU coleges but, at least were I work The MICU RNs don' think as fast or are as on top of things that happen to the acutely ill Surgical or trauma patient. We have a neuro surgeon who refuses to have his patients on the MICU unit because he doesn't have the same confidence in them as he does us. The MICU nurses often float to the SICU and feel that they are over worked or that we are dumping on them they don't realize that this is what we do every day. MICU nurses are great at what they do. But I will take a gunshot wound to the head any day over a MI or CHf patient anyday of the week.

[NROSRGN]

I disagree with the original posters...SICU nurses are definitely thinkers AND doers

[This message has been edited by NROSRGN (edited March 17, 2001).]

[mdslabod]

I have worked in both units and in Burn ICU among other places. Seems to me that we acclamate ourselves to whatever the enviroment requires.

Sounds strange but it's true.

There is a competition among critical care units.

The "thinkers vs the doers" thing just fosters that competiton.

MicheleRN

[prmenrs, RN]

That is a very thought-provoking comment--and does reflect on the medicine vs surgery MD differences, and the RN's ability to adapt to his/her environ.

Now. See if your colleague for the NICU will do the same profile and what that manager comes up with--let me know!

[KRVRN, BSN, RN]

Good lord now the ICU nurses are differentiating themselves! Please please please don't start mentioning whose an ADN and whose a BSN!

[Stormy]

Please use caution in your comparisons between the units for which you are responsible. In doing so, you will create a no win situation. I have worked with someone in the past who did just that. She was not able to gain respect from either area that she was responsible for, and her staff were generally unhappy.

Respect your staff in all areas for their knowledge in their specialty.

Good luck!

[booklady]

For pete's sake, this is the most ridiculous discussion I've ever read, including the ADN vs BSN controversy. I've done every type of ICU nursing for 28 years, including management and educator positions, and I don't have a clue what you're talking about. The ICU I'm in now recovers neurosurgery,(ICP's etc), Cardiovascular Surgery (IABP's, complex drips and hemodynamics routine), we do CVVHD,(run by the nurses), we get GI bleeds, sepsis with MODS, post-codes from the floor, you name it, everything except PEDS. Two-thirds of our staff can competently take care of everything that rolls through the door. So are we thinkers are doers? I promise you, we are both!

[SICU Queen]

OH MY... You don't want to start that ol' SI vs. MI war...

I have a very good friend who works in the MI at my hospital, and we always laugh because she doesn't like my unit and I don't like hers. I'd rather recover a CABG or have a trauma patient over an MI or overdose ANYDAY, but my friend says "A drain isn't a drain unless it drains, and I don't care!"

Honestly though, the environments are totally different a lot of the time, but I've found that the nurses in BOTH units are doers AND thinkers. You cannot properly care for a critically ill patient without being able to do both of these things.

I have found though, that some of the MI nurses at my hospital are completely unaware of how much ass-busting can go into taking care of a critically-ill post-op patient, and they rag us about our staffing constantly. It's not my fault that our surgeons stomp their feet about making sure we have proper staffing and their cardiologists don't...

Just my two cents...

Kim

[pebbles, BSN, RN]

could it be a hospital-specific difference? The medicine wards in my hospital have a very "academic" feel - the nurses are thinkers, but don't actually touch patients. (They "manage patient care"...) Similar in ICU's, too. But I think that's just because of our hospitals culture and how management has evolved, hiring practices, etc....

There are a lot of factors that lead to the "culture" that is formed on a unit. Being as you are new to this management position, try to spend some time getting to know those factors, as well as understanding how the nurses on the units work. Different styles of action or communication don't mean that one is less of a doer or that one is less of a thinker...