Critical Care Differential

lindarn · May 16, 2005

The hospital that i work at has been buzzing about the potential for differentials for ICU nurses. During nursing school i worked as a nurse aid in a cardiac care unit for post CABGS and the like. I thought that we worked hard and had a lot of responsibility, i thought we should be paid more. That is until i did clinicals on the oncology floor (that is tuff stuff) and in L&D (gross gross gross) and PSYC ( i fit in too well) and realived that every branch of nursing is specialized in its own way and really i think that pay should be the same. I also think we should all be paid more but that is a different thread

Sorry folks. I disagree. I wish that I had a nickel for every time a phyician left his patient in the ICU because he knew that the floors nurses did not know how to care for the patient. Also, the average non icu nurse has no idea the depth of knowledge that one needs to be an ICU nurse. A while back we had a dialysis nurse who would come up to our ICU to dialyze an ICU patient in renal failure. She decided to accept an opening in the ICU, because she thought that all ICU nurses do is sit and watch the monitor, and chart V/S off of it.

She was in for a rude awakening when she had to take a critical patient to CAT Scan. The patient coded in the CAT Scan unit, and she had to run the code from there. She also had a rude awakening with the day to day workload in the ICU, and the level of care that we provide. she left after 6 months and went back to dialysis, where she did not have to work as hard.

We have had nurses float to the ICU from the step down unit, where they have monitors and drips. They are only there as helpers, and are overwhelmed by even the simple tasks that we ask them to do. I also started out in a stepdown/telemetry unit, and thought that orientation to the ICU would be a piece of cake. What was a mistake! Step down/telemetry IS NOT ICU. The vast amount of knowledge that we need to posess to work in ICU is overwhelming, and I am sorry, there is not another area of the hospital, with the exception of nurse anesthesia, that comes close.

Dialysis has some of the problems that we encounter in the ICU, but they are only there for the dialysis, not the rest of the patient. In the ICU where I used to work, the nurses would do the dialysis, and ALSO take care of the ICU patient, and have another patient to care for besides. Please don't tell me that an ICU nurse should not be compensated for that leval of expertise and vastly higher workload. That is a slap in the face to the advanced level of knowledge and expertise that we posess. That is not duplicated anyplace in the hospital. Your work load, knowledge and expertise are not even close to that of a critical care nurse. Yes, the ER gets busy and has critical patients from accidents, heart attacks, etc, but that is not every patient, and you are not making interventions,following standing orders, and the patients orders, based on the patients constantly changing conditions. You may be busy, but your patients are not going to die if they don't get a bath.This lack of reward for my knowledge and expertise led me out of the hospital where I do Legal Nurse Consulting, and charge for my education, knowledge, and expertise. When nurses start to appreciate the advanced knowlege that other nurses posess, don't try to receive a reward for something that they haven't earned, we will finally be able to move forward. This is the same reason that nurses with BSN's don't make more than nurses with diplomas and ADN's. All othe profession make more money when they earn a higher degree and receive more training. Nursing is the only one that does not reward higher education. That is the one big reason that BSN's leave the bedside. They are not rewarded for their education, and move to areas where there education is rewarded. It is riduculous. If you need to validate your self- worth and self importance, improve your education, become certified in your specialty, and learn a special skill like we have, and then tell me that you want make more money. In other words, earn it.

Lindarn, RN, BSN, CCRN

If you need to validate your self worth and self importance by thinking that you deserve a differential for only working hard, you are very mistaken. I take a large risk professionally, by working in ICU, far more that med surg nurses. and yes, we sork jsut as hard. I pay a higher premium for my malpractice insurance becasue of that. Physicians who practice in highly trained specialties, like neuro surgery, heart surgery orthopedics, charger a high fee because of their speciallized training. I expect and deserve to be compensated more for my much higher level of knowledge and expertise that a floor nurse. Sorry ER nurses. Er nurses are dangerous in the ICU because they think that they know it, and they really don't. Yes, they are more highly trained than the floor nurses, but since they don't do critical care all the time, and have NOT been trained in ICU nursing as we have, and no, you do not really know how to work safely in the ICU, no you do not deserve to have the differentail that critical care nurses have or should have. Just go work in the ICU by yourself, and take care of a balloon pump, CVVHD Swan Ganz catheter, and titrate multiple vasoactive drips, all at the same time, and tell me that you deserve the same pay as an ICU nurse. In your dreams! There also has to be a comprehension of the physiology behind what we are doing to be able to work effectively in the ICU. That is a much higher leval of competance that any other area of the hospital. Even OR nursing, is a technical skill. There isn't much intervention available in the OR. The surgeon is the captain of the ship there.