ICU pay differential?

calivianya, BSN, RN · Feb 27, 2015

I'm curious if you think floor nurses are not responsible for their patients, don't have to know pathophysiology, never use specialized equipment, and don't provide education/communication to patients/family? If you do, you are seriously, seriously mistaken.

I don't think anyone is saying floor nurses don't do these things. But, it is indisputable that there is more equipment in an ICU patient's room, and it's not too bad to explain to patients and families that the pill or IV push drug you are giving is to lower the high blood pressure. They see an initial blood pressure, you give the medicine, they see the new blood pressure, and they understand.

The explaining of managing BP in the ICU is a little more complicated and counterintuitive. "Yes, the patient's blood pressure is okay on the monitor, but that's only because we have X, Y, and Z infusing," and then there is constantly re-educating when the family freaks because the BP drops a little, and you have to explain that's a good thing because you just turned down one of the drips and the BP is still above goal, so the drop in BP is okay. Family really gets hung up on systolic pressures in the 80s and they don't understand the concept that I don't really care about the systolic as long as that little number in parentheses next to the BP is above 65. "But the top number is 82 and that's SO LOW!!!" Some people try really hard to keep up with all their loved one's infusing drugs, and constantly get confused because there are so many, and you literally spend four or five hours of the shift explaining the same medications over and over again. I feel like that's not usually as big a problem on med/surg.

VANurse2010 · Mar 2, 2015

I don't think anyone is saying floor nurses don't do these things. But, it is indisputable that there is more equipment in an ICU patient's room, and it's not too bad to explain to patients and families that the pill or IV push drug you are giving is to lower the high blood pressure. They see an initial blood pressure, you give the medicine, they see the new blood pressure, and they understand.
The explaining of managing BP in the ICU is a little more complicated and counterintuitive. "Yes, the patient's blood pressure is okay on the monitor, but that's only because we have X, Y, and Z infusing," and then there is constantly re-educating when the family freaks because the BP drops a little, and you have to explain that's a good thing because you just turned down one of the drips and the BP is still above goal, so the drop in BP is okay. Family really gets hung up on systolic pressures in the 80s and they don't understand the concept that I don't really care about the systolic as long as that little number in parentheses next to the BP is above 65. "But the top number is 82 and that's SO LOW!!!" Some people try really hard to keep up with all their loved one's infusing drugs, and constantly get confused because there are so many, and you literally spend four or five hours of the shift explaining the same medications over and over again. I feel like that's not usually as big a problem on med/surg.

Just to let you know, I am a critical care nurse, and don't need a lecture on the distinction in the teaching required between the two. I am fully aware and experienced in both.

On the other hand, try to get a patient to understand the 3-4 new medications they are being discharged on; their new diagnosis of diabetes on discharge, or all their follow up. It's a different skill set to a degree, but not so simple and mechanical as is being presented in this thread.

francoml, ASN, RN · Mar 7, 2015

I am a rapid response nurse as well as an MICU nurse in a level one hospital I am CCRN certified and have my BSN. I run CRRT, and can place ultrasound guided PICC lines and PIVs. I can run codes and order diagnostics and interventions without consulting a doctor. I do not get any more pay. In fact medsurg nurses get a $2 differential. Financially fair? maybe not. Will I get into a top CRNA school because of these skills coupled with high grades? Absolutely. If you plan on being a bedside nurse long term than it is a big deal. If you are going into advanced practice then your ICU time is really just an extension of the class room and one long clinical rotation where you learn critical reasoning, advanced pathophysiology, and improve your dexterity with procedures. I look at it like I am getting paid to go to school everytime I go to work. Just my 2 cents

YanMinor · Mar 8, 2015

As a new grad, I've definitely noticed that our critical care nurses make the same amount as med-surg nurses. I don't think that it would be fair to pay one more than the other right out of nursing school. Although the skill set in ICUs is greater, there is also a greater demand for ICU jobs, so they don't have to pay as much.

However, I've been told that my pay will increase faster than that of a med-surg nurse. On top of advancing to a clinical nurse 2 position by the end of the year, I will also have completed my ACLS and CCRN, all of which come with a pay differential.

Bluebolt · Mar 9, 2015

I am a rapid response nurse as well as an MICU nurse in a level one hospital I am CCRN certified and have my BSN. I run CRRT, and can place ultrasound guided PICC lines and PIVs. I can run codes and order diagnostics and interventions without consulting a doctor. I do not get any more pay. In fact medsurg nurses get a $2 differential. Financially fair? maybe not. Will I get into a top CRNA school because of these skills coupled with high grades? Absolutely. If you plan on being a bedside nurse long term than it is a big deal. If you are going into advanced practice then your ICU time is really just an extension of the class room and one long clinical rotation where you learn critical reasoning, advanced pathophysiology, and improve your dexterity with procedures. I look at it like I am getting paid to go to school everytime I go to work. Just my 2 cents

This is a very true statement and a great perspective. I'm applying to a doctorate program for CRNA in a few months and never thought of my every day work like a clinical rotation. It sounds like a wonderful marketing tool for hospitals to get your focus off them compensating you for your advanced skill, certifications, responsibilities and efforts.

You're right that the ICU is essentially required clinical rotations for those seeking CRNA. Although what about all those other nurses (at least half of the ICU nurses) who do not plan to go past their BSN? They are left working their whole careers with extra work and no compensation.

MOSTLYHAPPYRN · Mar 10, 2015

After having thought about this topic some more, with the input of everyone here, I think that it does make sense to pay a more specialized person more money.

I don't want to work in those extremely stressful ICU positions and I'm glad there are those who do, so by all means, get paid more, you use more skills, you have more certifications, and you are more specialized! I appreciate this opportunity to get to hear from so many other nurses, good topic for thought.

Mostly happy RN

Susie2310 · Mar 10, 2015

I agree that ICU requires specialized training/knowledge/competencies, but this is also true of the ER, L&D, and other specialty units. In some facilities the ER requires ACLS, PALS, TNCC, with CEN preferred. Med-surg, while not necessarily requiring specialized training, still requires abilities that are not demanded on other units. With all the different specialities requiring different, specialized training, and different abilities, it makes no sense to me to say that ICU nurses should be paid more. ICU nurses do valuable work, and nurses who work in other areas do equally valuable work.

ashleebaby02 · Mar 17, 2015

What about Med surg certified nurses? We run our butts off and deserve the same pay as anyone else.

Editorial Team / Admin · Mar 17, 2015

This whole "I work such and such specialty; I should be paid more" is yet another way that nurses fall divided rather than stand united. Instead of saying such things, why not fight for higher pay across the board? In general, nurses aren't paid what they are worth, but to say one specialty is better than another doesn't do us any good.

MOSTLYHAPPYRN · Mar 18, 2015

What about Med surg certified nurses? We run our butts off and deserve the same pay as anyone else.

At my hospital if you are certified you do get a pretty good annual bonus. But it was earned by taking additional courses , etc. Their additional initiative to become more advances in their practice was rewarded monetarily. Similarly to how more specialized doctors earn more that less specialized ones. Just my opinion. I think....

Mostly happy RN

francoml, ASN, RN · Mar 20, 2015

I would like to say something on behalf of all the medsurg nurses out there. Being an ICU nurse and rapid response I too used to be on the side of we (ICU/RRT) should get paid more. I used to think that I was in one of the elite nursing fields and better than medsurg nurses.

Now that I have more experience, I see how wrong I was. Sure I can teach about advanced hemodynamics off a PA cath, I can manage critically ill patients on CRRT, I understand how to use different pressors/inotropes to maximize cardiac output, and I can use ultrasound to place difficult lines just to name a few. The thing is, all these things are done by using invasive monitoring. I see now that it is easy (with a lot of study) to see how your patient is doing when you have an art line, PA cath, and biz monitor. It is a true art to be able to treat a patient and recognize a de-compensating patient using only your eyes and non invasive monitoring while still being responsible for 5 other patients. This is a skill that many ICU nurses do not have as we are so dependent on our monitors. It wasn't until I worked rapid response that I was forced to learn how to use my eyes and ears more than my coveted invasive monitoring.

To be an excellent ICU nurse it takes experience, lots of study, and confidence in yourself. Thing is, medsurg takes these same skills. Many times the difference between a patient coding on the floor and getting better is nothing more than the nursing intuition that develops from treating patients without knowing every single aspect of their physical status.

So simply put, I now view medsurg as a specialty and have much more respect for them. It takes a very intuitive and vigilant person to recognize signs of distress before it become a full blown emergency. While I am not one of the people who thinks you need to work MS before going to the ICU, there are certain skill sets that MS nurses have that ICU nurses should learn to utilize. Much love to all the MS nurses out there! Don't let anyone talk down to you and have pride in your skills!

Dranger · Apr 2, 2015

Wow. I have worked tele, PCU, some ED and ICU. In my opinion critical care or any specialty area like ED deserves more pay. Sure I had 6 patients in tele but I also had a CNA and didn't have to be near as vigilant as I do in the ICU. The sheer amount of detail with a real ICU and 2 patients vs 6 in m/s doesn't even compare. Sure I ran around more in tele but I am mentally exhausted after an ICU shift. Plus in many ICUs you don't have a handy pulmonologist in your back pocket so when you page them at 3am you know your stuff backwards and forwards. On tele I could page the hospitalist frequently like it was no big deal...On tele some nurses would just coast through without REALLY knowing what was going on. You can't do that in ICU. With a lick of sense you can tell if someone is going down hill in tele but many nurses I met barely reviewed CNA vitals or labs unless they were critical and lab called.

OP I can see where you are coming from. Both areas are difficult in their own way but the difficulty is just different.