going back into med surg

JBMmom, MSN, NP · Oct 22, 2019

I work in the ICU and I pick up per diem shifts whenever I can on my old med-surg floor. I love the difference in the two work environments, and if I decided ICU wasn't for me anymore I would go back to med-surg in a minute. I don't think anyone will think anything about it, unless you make an issue of it. I don't think that by going to the ICU I "moved up", so going back to med-surg wouldn't be a step back. They are very different work environments and there are benefits and drawbacks to both. I think your coworkers will be thrilled to have someone with a critical care background on the unit, especially if patients have a change in status and might need a higher level of care. Good luck with your plans!

ThePrincessBride, MSN, RN, NP · Oct 22, 2019

ICU is overrated.

-Says ICU AND Med/Surg RN.

mmc51264, BSN, MSN, RN · Oct 22, 2019

I am an ortho med/surg nurse. I think it is about each one having different skill sets

To me, ICU, L&D, and Anesthesia are all the same: if it is boring, that means all is well, if it isn't-something bad is happening. I don't like that kind of stuff and I would get anxiety too!!

youngNurse722 · Oct 23, 2019

I am going through the same thing right now! I started in med-surg and absolutely loved it for 2 years. I thought I wanted more and enjoyed when my patients were crumping so thought I would enjoy ICU. Now, I only worked in ICU for a little over 6 months, so I can't say I gave it a long enough chance, but I don't think I enjoy it. I am having a hard time admitting to myself that I don't like though, because I wanted it so bad.

It really is overrated. It's absolutely grueling to me, unless you have a completely unstable crashing patient. Otherwise the tediousness and techy equipment (CRRT, balloon pumps etc) are just more tasks that ANYBODY can learn. It's completely different than i expected. I thought there would be constant adrenaline rushes and crashing patients. But most of the patients are stable - until they aren't. I've felt more adrenaline working on the floor having crashing patients with unstable BP's but no pressors to fix it, ect. In the ICU everything is right there, you can use pressors, vents, ect.

I also completely agree with the intense work environment. The competitiveness and superiority complexes drive me insane. Constant passive-aggressive attitudes and being looked down on because I was a "floor nurse" when I myself and many of the experienced floor nurses I worked with know just as much if not more than these ICU nurses (especially the new ones). Yes ICU nurses can code a patient better than a floor nurse and know about prisma, balloon pumps, impella pumps, ecmo and all that....but it is stuff ANYBODY can learn. It is a lot of tasking to me. And the whole ICU nurses are better than everybody concept needs to go! We all are great and have different challenges.

The med surg floor I worked on was like a family, we all got along, had fun and joked around. The ICU I work at is a lot of nurses who are all serious all the time and constantly have that competitive attitude. I think a big reason of why I hate the ICU so much is because of the work environment and people I work with. So I thought to myself about trying another ICU, but I think for the most part it is a general personality in ICU's and doubt it will be different anywhere I go.

ThePrincessBride, MSN, RN, NP · Oct 23, 2019

34 minutes ago, youngNurse722 said:
I am going through the same thing right now! I started in med-surg and absolutely loved it for 2 years. I thought I wanted more and enjoyed when my patients were crumping so thought I would enjoy ICU. Now, I only worked in ICU for a little over 6 months, so I can't say I gave it a long enough chance, but I don't think I enjoy it. I am having a hard time admitting to myself that I don't like though, because I wanted it so bad.
It really is overrated. It's absolutely grueling to me, unless you have a completely unstable crashing patient. Otherwise the tediousness and techy equipment (CRRT, balloon pumps etc) are just more tasks that ANYBODY can learn. It's completely different than i expected. I thought there would be constant adrenaline rushes and crashing patients. But most of the patients are stable - until they aren't. I've felt more adrenaline working on the floor having crashing patients with unstable BP's but no pressors to fix it, ect. In the ICU everything is right there, you can use pressors, vents, ect.
I also completely agree with the intense work environment. The competitiveness and superiority complexes drive me insane. Constant passive-aggressive attitudes and being looked down on because I was a "floor nurse" when I myself and many of the experienced floor nurses I worked with know just as much if not more than these ICU nurses (especially the new ones). Yes ICU nurses can code a patient better than a floor nurse and know about prisma, balloon pumps, impella pumps, ecmo and all that....but it is stuff ANYBODY can learn. It is a lot of tasking to me. And the whole ICU nurses are better than everybody concept needs to go! We all are great and have different challenges.
The med surg floor I worked on was like a family, we all got along, had fun and joked around. The ICU I work at is a lot of nurses who are all serious all the time and constantly have that competitive attitude. I think a big reason of why I hate the ICU so much is because of the work environment and people I work with. So I thought to myself about trying another ICU, but I think for the most part it is a general personality in ICU's and doubt it will be different anywhere I go.

Excellent post. This has been my experience as well before I transferred to a different NICU. Super cut-throat with so many witchy personalities and so unlike the chill, laid-back comrades of med-surg world.

And I definitely agree about ICU being very task-oriented despite the claims of using more critical thinking skills. While ICU nurses may have more complicated procedures, I have noticed that med-surg (and LTC/SNF nurses) nurses tend to have some of the best assessment skills because there are fewer, if any, monitors/machinery/devices available.

Both groups are valuable but I get tired of the ridiculous disrespect that is shown to the med-surg RNs.

youngNurse722 · Oct 23, 2019

1 hour ago, ThePrincessBride said:
Excellent post. This has been my experience as well before I transferred to a different NICU. Super cut-throat with so many witchy personalities and so unlike the chill, laid-back comrades of med-surg world.
And I definitely agree about ICU being very task-oriented despite the claims of using more critical thinking skills. While ICU nurses may have more complicated procedures, I have noticed that med-surg (and LTC/SNF nurses) nurses tend to have some of the best assessment skills because there are fewer, if any, monitors/machinery/devices available.
Both groups are valuable but I get tired of the ridiculous disrespect that is shown to the med-surg RNs.

Yes I am glad someone agrees and I'm not alone in this. I also feel like I did way more critical thinking on the floor. I feel like on the floor you kind of are alone and have to push doctors. Where on ICU the doctors are there and making all the decisions and you are just completing tasks for them. and I agree with the assessment skills too, from working med surg you see 6 patients and automatically know which one just from looking at them from the door is going to be your sickest patient that shift, you don't have time to sit there and do thorough assessments every 4 hours on each patient, you just learn to assess from looking at them, vitals and knowing what's going on with the patient. I think ICU nurses who have never worked the floor would be surprised at how sick some of the patients are and all the work we do up there.

So you did transfer to a different NICU and have a better experience there with the coworkers? Because I feel like I could enjoy ICU and I do want the experience for resume/schooling purposes, but I just can't stand being around those personalities all the time. The people you work with really do make a big difference.

ThePrincessBride, MSN, RN, NP · Oct 24, 2019

21 hours ago, youngNurse722 said:
Yes I am glad someone agrees and I'm not alone in this. I also feel like I did way more critical thinking on the floor. I feel like on the floor you kind of are alone and have to push doctors. Where on ICU the doctors are there and making all the decisions and you are just completing tasks for them. and I agree with the assessment skills too, from working med surg you see 6 patients and automatically know which one just from looking at them from the door is going to be your sickest patient that shift, you don't have time to sit there and do thorough assessments every 4 hours on each patient, you just learn to assess from looking at them, vitals and knowing what's going on with the patient. I think ICU nurses who have never worked the floor would be surprised at how sick some of the patients are and all the work we do up there.
So you did transfer to a different NICU and have a better experience there with the coworkers? Because I feel like I could enjoy ICU and I do want the experience for resume/schooling purposes, but I just can't stand being around those personalities all the time. The people you work with really do make a big difference.

I transferred from a bigger NICU in a better part of the neighborhood to a smaller inner city NICU. I have noticed the larger the institution is, the less personable and more competitive it becomes. Do you work in a larger ICU from a magnet hospital? Those can be some of the worst places to work for. Talking amongst other ICU nurses, it seems that smaller hospitals are much more supportive and inviting.

PeakRN · Oct 24, 2019

Now that you have a ton of experience have you thought about something like float pool?

adventure_rn, MSN, NP · Oct 26, 2019

I think it's fascinating how the NICU tangent has unfolded...

OP, I had a related experience (ironically also in NICU). My background had been in lower-acuity NICUs, which functioned more-or-less as 'baby med-surg' with the occasional critically-ill patient. I loved it, but I felt like I needed higher acuity ICU experience to become a stronger nurse. I left NICU for a super-high-acuity pediatric cardiac ICU (constant ECMO, CRRT, beside surgery, etc.) I learned a tremendous amount, but I had terrible anxiety and quickly became burnt out due to our huge volume of tragic cases.

I, too, was nervous about the return (I even made a post about it over the summer, lol), but all of my worries were for nothing. Being back has been like a breath of fresh air.

What I mean to say is: you do you. If going back to med-surg will make you happy, then go for it. Different nursing specialties work better or worse for different people, and there's no shame in transitioning from one role to another until you find your niche. The diversity of nursing specialties is part of what makes the field so amazing.

On 10/22/2019 at 8:00 AM, cwilliams032 said:
I'm wondering how this will look if I applied, maybe as if I couldn't handle the unit or something?

I honestly don't think anybody will judge you. If anything, it will probably earn you some street cred (i.e. if a floor patient has an RRT or is coding, people may look to you as a leader in a crisis because you've seen that side of nursing before). I think that people will recognize your experience as an asset and not as some personal failing.

As an aside: people may be curious about why you left ICU, so I would have some kind of response prepared so you're not caught off guard in case they ask (i.e. you were feeling burnt out by the acuity, etc.) Like I said, I don't think they'll be judging you, but sometimes people can be nosy. (When people ask why I left peds cardiac ICU, I have no qualms telling them that I was tired of watching kids die long, drawn-out ECMO deaths on a regular basis, and I wanted to be back in the NICU where most kids get better and go home; so far, everyone seems to understand.)

Best of luck!