What is the best way to win the battle for unit differentials?

JenSICU_CCRN · Oct 12, 2006

I work in an ICU at a Magnet Hospital in Michigan (newly awarded). We want a unit differential, any ideas how to present the topic? Our manager does not think we deserve it- he thinks it would "stir" things up in the hospital and alienate the ICU nurses....anyone have any ideas?
thanks
--We have 7 openings, we always work short, no retention.

What I want to know also...is how did your hospital achieve magnet status if you are so understaffed? We have a magnet hospital in WV (Ruby Memorial) and people would cut of their arms to work there.

Jenny

banditrn · Oct 12, 2006

I spent 10 years at our hospitals ICU, and never felt I deserved any special differential. While I had to maintain certain certifications, etc., my working conditions were also much better than on the general floors.

lyceeboo · Oct 12, 2006

What floor refused a chest tube or dressing change??????

If you're Magnet & have that many ICU openings then your best argument is supply & demand. Some nurses on the other units & floors will be ticked but I think it helps us all when nurses fight for what they're worth.

I've only worked med/surg/ortho and to be honest I thought the RN's on the units were making more. Maybe it wasn't a unit diff after all. Maybe they were making more on average because of yrs of experience. I recently had someone tell me that hospitals pay Psych nurses less than med/surg. Don't know if that's true either.

When I worked med/surg noc and an ICU nurse would float to our floor the nurses would always be miffed because most ICU nurses would take no more than 4 pts. (We usually had a load of 8-9 on 7p-7a shift.) It never bugged me because I applaud anyone who has the guts to fight an abusive situation.

Good luck. If you have such poor retention, they'll have to approve the diff.

NPinWCH · Oct 13, 2006

I don't know about your hospital, but if an OB pt in our hospital goes "South," she goes to ICU. I just get tired of Med Surg floors saying they "can't take the patient because they don't do that kind of dressing change," or "we don't take chest tubes on this floor. We have expertise in many areas, that is my point. We have to know how to take care of everyone (with the exception of kids) If people want a critical care unit differential then they can make the extra effort, study all the material, and work in a unit.

You make it sound like the only nurses with expertise in many areas are ICU nurses. On my unit most of us have expertise in several areas also. While off the top of my head I may not remember every nuance of cardiac enzymes or the protocol for every drug you give on a daily basis I, and the other RNs I work with, can take care of pt's that have just about every problem you see PLUS they are pregnant.

Where I work where do they send a pregnant pt with a BP of 220/130, hgb of 4, Panic Ca or K with arrythmias, chest tube, central line, DIC, horrible MRSA infection that require packing q 12 hr? To ICU? No to OB...Why? Because it's easier for us to take care of these horribly sick patients than to send them to the unit and try to take care of them alongside of another nurse who looks down her nose at us 'baby rockers', while saying the same kinds of things you stated: "we can't take an OB pt because we don't know how to assess them" "what if she goes into labor?" "What if her water breaks?"or after she's delivered "we can't take her because we can't allow her baby in the unit" or "what am I supposed to do with her...she's breast feeding and pumping and ...".

ER sends them to us quicker than we can blink, just the other day ER sent a squad directly to us pt's complaint? "I can't breath!" Spo2 of 85% on 10L. Pt had been in a car accident 2 days prior, had been evaluated and sent home, no obvious bleeding, but the OB triage nurse picked up on the subtle signs of an abruption from the FHR tracing and assessment. We had 2 IVs running just as the pt crashed, full code, emergency c-section. Baby born with apgars 2/4/8 and was also a full code. Not only did we save that mom, but also that baby. Where did these pts return after OR? Both of them to us. 2 Critically sick pts to our dept, not ICU. Baby needed dopamine and a vent. It took the childrens hospital almost 6 hours to arrive (we don't have a NICU) so we cared for that baby until then. When they arrived, all they had to do was pack her up and leave. We already had her stabilized.

You have skills...so do I, so does med/surg and ER. Our ICU and med/surg is fully staffed, OB, ER and OR are severely understaffed. So based on the supply/demand model those units should receive differentials. The problem with that is the unit that is last year our unit was fully staffed and so was OR and ER. It was ICU and med/surg who were struggling.

I want any nurse that cares for me or my family to be an expert in her field, whether that be ICU, ER, med/surg, OB, or out pt chemo...I also want any of those nurses to ask other depts for advice if they need it. What I don't want is the OB/Med-surg/ER nurses to be resentful of ICU or any other unit because they make more $$.

Why is this starting to remind me of the old associate vs bachelor debate?

Debbie RN, BSN