Should ICU get more pay than floor nursing?!?

Specialties MICU

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Okay so I don't want to come off as rude or biased but I am pretty confused as to how my facility can pay medsurg nurses an extra $3/hr over what they pay me!

I know they work very hard but I work in a large level one ICU and I make critical life altering decisions on a daily bases. I have far more autonomy and with that comes more risk to my license. Don't get me wrong I LOVE my job and LOVE my facility but how can a nurse get paid more to pass meds on the floor than I do in the ICU. And before anyone makes any comments about the "just passing meds" remark, I have worked a few shifts on the floor and that is just about all I did was pass meds!

Is it like this on y'all's unit or is this specific to my facility?

Specializes in Gerontology.

Floor nurses are also there 24/7

I think you missed the point of the post.

I think you missed the point of the post.

So, should the housekeeping people who work in the ICU get paid more than the housekeeping people in the rest of the hospital because the ICU brings in more revenue than other floors of the hospital? And do you know for a fact that your ICU is bringing in more revenue? In my experience, many of the cases who end up in ICU are people for whom the hospital ends up eating the bill. Just because the hospital charges "an arm and a leg for ICU care," that doesn't mean the hospital is getting paid "an arm and a leg." And the care costs more because it is more expensive to provide; the hospital isn't just charging more for the heck of it.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I've worked both the floor and the ICU. Considering that hospitals charge an arm and a leg for ICU care, and the ICU nurses are with the patient 24/7, I do think that ICU nurses should be paid a least a little more. I base this opinion on hospital revenue alone. Higher revenue = higher salary. The problem is that administrators and corporations bank top dollar $$$$(millions) while nurses get defensive and argue over an additional $2 dollars and hour.

I'm one of those California RNs that you hear about who makes 100k/year, and I still don't think any nurses are paid what they're worth. People come to hospitals for NURSING care. If that that weren't so, physicians would make rounds at home like the old days. Hospitals can't function without nurses. Period. All nurses deserve more pay. This is why I support nursing unions, regardless of my political beliefs.

I've worked at both unionized and non-unionized hospitals, and there's always a noticeable difference in working conditions and pay (in California at least)...

Why is it always some dude who works in ICU who thinks ICU ought to get more pay?

It has nothing at all to do with how much the hospital charges for ICU care, even though I think it stinks that nursing care is just part of the room charge. And Med Surg nurses spend their shift with their patients as well, even though they may have 8-10 of them. As for ICU nurses being with the patient 24/7, the longest I've ever spent at the bedside was 20 hours. I really hate to think you're spending 24 hours at a time with a patient, much less doing it 7 days a week.

Someone up thread mentioned that Med/Surg nurses make more where they work. It's supply and demand. When every nurse wants to work in ICU so they can get into anesthesia school at the earliest possible time, it's harder to staff the Med/Surg unit and Med/Surg may combat that difficulty with higher pay.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I think you missed the point of the post.

No, I think you did.

I just enjoy debate for the sake of debating. I honestly don't care either way. I don't mean to offend anyone. I'll be the first to say that med/surg is hard work. However, we're all entitled to an opinion. To the individual who asked if ICU housekeepers deserve more pay, I would have to respond by saying...touche. Additional training and certifications are not required by ICU housekeepers though, so I would say no. ICU housekeepers do not deserve more pay.

One thing I would like to poing out is that intensivists earn a higher salary than internists. Sadly, I think that your post reticently illustrates exactly how administration views both nursing and housekeeping: as an expense that can be cut.

Here is my rebuttal to all of your comments:

1) Who would come to the critical care section of a forum (an area of the site that critical care nurses obviously frequent) and expect critical care nurses to not state that they should get more pay? I'm sure if we went to the corrections/prison section of this website and asked them if they deserved to get paid more, they would more than likely say yes. I'm sure plenty of med/surg nurses feel that they're entitled to more pay, which I think is reasonable. If we asked ED nurses if they deserved to be paid more than ICU and med/surg nurses, the ED nurses that I know would respond with a resounding "YES!!"

2) I never implied that med/surg nurses weren't with their patients 24/7. Pointing out that med/surg nurses are with their patients 24/7 is pretty much stating the obvious.

3) There are obviously a lot of different variables that affect profit and loss. At my hospital, ICU does bring in quite a bit of revenue. Likely because our boss rides us about not being wasteful with resources. Also, our physicians do a good job of justifying ICU level of care to medicare, transferring patients to subacute rehabs ASAP, downgrading asap and/or convincing the family that palliative care is the best option. No family? Ethics consult is put in QUICK to evaluate quality of life. Our intensivist pay is affected by our unit's revenue. No revenue? No bonus.

4) If a patient's crashing, who does the med/surg nurse call for a higher level of care? Me. The ICU/RRT nurse to evaluate and see if the patient meets ICU criteria. Patient needs an IV and nobody else can get it? Call ICU. Patient's about to code? Call ICU. Patient codes? We need ICU. Patient is VIP and the family is too high maintenance? Put them in the ICU.

5) I've worked med/surg. It's hard work that requires good time management and a lot of patience. I'm glad there are nurses that enjoy it. I got burned out by it, so I went from med/surg--> tele--> intermediate care --> ICU. It's not like I've only worked ICU and I'm claiming that ICU nurses should get paid more. The floors are very stressful. While I'm not as physically exhausted working in ICU, the stress is at a different level since there are different stressors, in my opinion.

Out of curiosity, why do you guys/gals think so many hospitals pay ICU and ER nurses a critical care differential?

Also, a couple of salary sites state that ICU/critical care salaries are 5-7% higher than the average RN salary. Why is this?

Are individuals who have worked both the floors and ICU the only ones that are able to deliver an unbiased response to the OP's question?

Specializes in Anesthesia.
Out of curiosity, why do you guys/gals think so many hospitals pay ICU and ER nurses a critical care differential?

One hospital that I work for pays us a whopping $2.00/hr critical care differential, which comes out to an extra 4k/year. My per diem gig pays staff pays critical care nurses (ICU, ER, and PACU) an extra 7k/year. Progressive care is paid a slightly lower differential, and med/surg and tele do not receive differentials at all. I'm not saying it's right, but that's just the way it is.

I like Harveyslake's analogy in a prior post that compares the worth of a smart phone vs a simple cell phone and a short order cook vs a gourmet chef. I think it's spot on. I've had nights in ICU where I've been busier than I ever was working on the floor. The stress that comes along with helping other units with rapid response, being the hospital's IV start team, and cleaning up the rest of the hospital's mess makes working the floor not so bad. From my experience, taking care of 5 patients in no way compares to the stress of having multiple family members breathing down your neck while taking care of their family member who is maxed out on 5 pressors and is barely hanging on by a thread. There's just no comparison.

Then again, where I live we have patient ratios where med/surg tops out at 5, tele 4, PCU 3, and ICU 2. If you live in a state that gives you 8 patients then I suggest you move or change specialties because that sounds like horrid working conditions.

I didn't read all the posts before me but I can say that when I was in ICU and had to float to the med/surg units I worked SO MUCH harder on those shifts. Our med/surg nurses got paid slightly more than we did in ICU because no one wanted to work out there. The extra $1.50/hr or whatever it was wasn't worth it for me or my friends to transfer.

Specializes in Unit Nurse.

I worked a busy med/surg floor for 6 years. I actually transferred to the units for a break. While there are days that I am extremely busy, I have days where I have a lot of down time. Which is something I never had on our med/surg floor. The majority of the ICU nurses, no matter the type of ICU, where I work will tell you quick like they don't wont to go to the floor. It's too hectic up there. So OP until you truly have worked both sides of the fence and not just been floated a few times, and the charge nurse probably taking it easy on you by giving you the easy patients on the floor, so that you actually may come back. I don't want to hear it. ICU nursing can be extremely stress full but so can floor nursing. As far as the money goes, our hospital pays differentials to work certain areas that they have trouble keeping staffed, with our med/surg department having the highest differential.

Specializes in MedSurg, OR, Cardiac step down.

I get an extra $3/hr for my dept in neurosurgery. Only one other OR gets that, also. If anyone else doesn't like it-they are welcome to come work with us..there is a reason we get it..

a nurse is a nurse is a nurse what department you work in is nothing more than geography. What is cause for higher rate are working off shifts, certification, years of experience and education. An RN is not specialized because they work in a certain department and have been oriented to the area as any other nurse can walk thru the doors and do the exact same job with equivalent training.

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