Should ICU get more pay than floor nursing?!?

ChristineN, BSN, RN · Mar 31, 2014

How do you know med-surg nurses make more? Are you sure it isn't based on a med-surg nurse having more experience, certifications, more degrees, etc

Here.I.Stand, BSN, RN · Mar 31, 2014

I'm guessing the ones you discussed wages w/ have worked there longer, and are paid more for seniority, not for being med-surg nurses.

I'll also say as one who has worked more than "a few shifts" on the floor, if all you did was pass meds on your few shifts you had it easy.

The hardest place I've ever worked was the floor of an LTACH. A typical day could include 4-5 pts, all w/ complex wounds. M/W/F were vac change days, but Mondays was when the wound dr. rounded and thus when the WOCN did their changes. Soooo...that meant on Wed. and Fri, the floor RN had several vac changes. One could take 2 hours, if the pt had 4 stage IV pressure ulcers. Among other lengthy dressing changes I had personally were circumfrential burns to bilat LEs...big open belly w/ a Wound Manager covering all the packing...Fournier's gangrene of bilat groin...freak dental lab accident resulting in burns from the waist to the top of the head... Many of these pts were on ventilators. Many needed their meds crushed and had those teeeeeny little bore feeding tubes that are VERY easy to plug, so even the "med pass" could get complicated. TPN, enteral feeds, IV fluids. Admissions. Pts and families who had already been through the ringer, and the behaviors that accompany chronic critical illness. (This cannot be underestimated!! Think helicopter families and people acting out of frustration that you see in the ICU, and take that to the nth degree.) Multisystem physical effects of chronic critical illness. Pain. Lots and lots of pain. Routine and critical labs...no phlebotomists. Paper MD order entry and paper charting.

Now I work in the SICU of a busy urban Level 1 trauma center. I took a $4/hr pay cut to come here. It was well deserved.

inchii · Mar 31, 2014

There are easy days and bad days on any unit --I've worked both floor and ICU. It may be a different kind of busy, but it's still hard work :). Anyway, ChristineN is right. On the facilities I've worked, pay depends on the years of experience. You may get additional for certifications/education. And also include pay increases based on performance (yearly evaluation, hospital award, etc). :)

Pangea Reunited, ASN, RN · Mar 31, 2014

You got your "first truly critical patient" in november 2013 and you're wondering why there are people who make more than you do? It's not enough to make critical life altering decisions on a daily basis- the decisions you make have to be good ones, too. :wacky:

shermrn · Mar 31, 2014

Generally speaking, within the same facility, staff nurses with the same education, same experience, and working the same shift, should be paid the same rate regardless of which unit they work on. Of course variables exists such as maybe one nurse picked up the shift and is earning overtime, or one is from an agency and has a completely different contract with different benefits, etc. But the point is that, all other things being equal, working on a different unit shouldn't get you more or less pay. It may seem like med/surg nurses just pass meds, but they have a completely different set a variables to deal with than an ICU nurse. The med/surg nurse, perioperative nurse, L&D nurse, postpartum nurse, ICU nurse, etc. are all of equal value and importance.

If you really want to know which nurses should be complaining about wage differences it's those who work in LTC, sub acute facilities, and home care/hospice. Those jobs are brutally difficult and usually pay much less than what hospitals pay. You go on making your life and death decisions while others just pass meds. Being that I work in the NICU should I get paid less for just changing diapers and bottle feeding infants? Never mind that the infant I'm trying to get to take a bottle tonight is the same one I've been caring for over the last five months, who started out at 25 weeks and weighed less than 400 grams, had more IV meds and lines running that you can count on both hands, needed blood transfusions just to make up for what we had to take in order to check blood gasses, not to mention the overwhelming challenge of just getting oxygen into that little body. No big shot you don't get paid anymore for working ICU than the rest of us.

shermrn · Mar 31, 2014

Sorry to come off so harsh, the subject just hit a nerve.

meandragonbrett · Mar 31, 2014

Your autonomy is perceived autonomy and risk to your license is moot. There is nothing riskier about working in a critical care environment vs another specialty when you practice as a prudent nurse would.

You're still a young nurse and it is definitely showing.

Esme12, ASN, BSN, RN · Mar 31, 2014

Intent or not...like it or not....it was rude.

You are a new grad. I am not surprised that you make less than someone on the floor. What was their experience level? How long have they been at the facility? Most facilities will offer a differential for certifications like the CCRN....when you have enough time accrued to make you eligible to sit for the exam.

As a critical care nurse with 35 years experience I don't feel floor nurses have a lessor skill set they have a different skill set. I openly admit that after a lifetime in critical care I do not have the skill set any longer to be competent at floor nursing.

A floor nurse is no less skilled than you...they just have a different skill set.

**RosesrReder, BSN, MSN, RN** · Mar 31, 2014

OP, you seem bitter. Transfer to the floor

iluvgusgus · Mar 31, 2014

OP, I worked on the floor and I just transferred to the ICU and I did not get a raise. Instead, I get the opportunity to learn and be taught, while getting paid, how to work in critical care. This is a huge investment on the hospital's part and it really is a privilege and an honor to be entrusted with their critically ill pts. You will be happier if you adjust your attitude about it a little bit...Every RN you bump into is going to have a different pay rate, due to merit raises, how long they have been there, whether they were even eligible for a merit raise at their last evaluation etc. there are lots of factors. My hospital trains new grads in their ICUs and my preceptor happens to be one of those that was hired right out of school and ICU is all she has done. As a med/surg nurse, there have already been lots of knowledge I was able to contribute to her regarding chest tubes, wound care, policies, etc that I dealt with more on my floor. So dont knock floor nurses, if you floated to the floor, chances are they gave you the easiest assignment. Some days get down-right ridiculous,and the tasks, meds, pain meds, phone calls, dealing with family members, coordinating transport for 5 pts to go to different tests and procedures all day, calling the lab on 5 pts all day, contacting the dr on 5 pts all day, can seem overwhelming and humanly impossible to deal with sometimes. What if 3 of those 5 or 4 of those 5 pts were totals, and they also had cdiff, loose BMs all day, needed to be turned q 2, needed to have their feedings held one hr before and after dilantin all day, ripped out their IVs that they absolutely needed because they are on hep gtts, then you have family members calling you 3 or 4 times a shift on them for updates? There is a reason I transferred!

elkpark · Mar 31, 2014

Often, pay ranges (one specialty/location getting paid more than another) has nothing to do with how "hard" a particular specialty is vs. another, and is all about supply and demand. If the hospital has qualified applicants lined up wanting to work in the ICU and they can't staff the med surg floors, they are eventually going to increase the wages they are offering for the med surg positions to make those positions more appealing.