ICU is harder than Med/Surg?

youngRNstudent · Jun 11, 2004

Congradulations on graduating this summer! I will be graduating this december. This will probably create a bit of an uproar with some others on this forum but PLEASE PLEASE PLEASE do not think you have to "do time" in medsurg first. Many will tell you that you need the medsurg experience before going to ICU but this is not true. Sure it helps, but it is not necessary. Because of the shortage, most ICU's will train new grads and the new grads WILL SUCCEED. I know I do not want to work on the floor. If I can't get a spot in the ER, I will be going to the PICU, because I also am more interested in critical care and knowing a lot of detail about 1-2 patients.

MANY people will disagree with me. I think you should do whatever you want to do. If you choose medsurg just because you think you have to, you will end up getting stuck there. I have heard this from many nurses, they think they have to do med surg first and end up not being able to leave. If you are organized and confident that you can succeed in an ICU environment PLEASE do not think you have to go to med surg first.

Med surg is a good experience, but like you said it is not for everyone. Do what you really want to do, because with the shortage we have the opportunity to do that.

Tweety, BSN, RN · Jun 11, 2004

Agree with above. Choose the area you feel you really want to go in.

I've floated to ICU quite a few times and it's a whole different kind of "work" with a morecomplicated knowledge base needed.

Both areas have their challenges, I personally don't think one is harder than the other. The complicated nature of critical care is tempered by the fact the ratio is usually 2:1. As you said in med-surg you have to multi-task and be organized to manage the needs of many patients and not forget anything, chart more, etc.

Both are hard and honorable work IMO. :)

mattsmom81 · Jun 11, 2004

My advice is do your research and be particular about where you do your critical care internship, if you are determined to do this straight out of school. Not every facility is set up to mentor you in ICU right out of school. A large facility with a dedicated new grad internship with a solid critical care internship program with ongloing support is your best bet.

For every nurse who tells you they went right into critical care and 'did OK" , there are just as many who were thrown to the wolves, used as a pawn as a 'warm body' in ICU, left floundering ....in the wrong ICU this situation is stressful on the new grad AND experienced critical care staff.

In the ICU's I work in, there is not an adequate support system in place to accomodate a new grad's learning needs, thus a year experience in a stepdown or medsurg is a basic requirement to be considered for critical care...for good reason.

I'm not saying it can't be done, but please consider the facility carefully. Good luck to you. :)

snowboarderRN · Jun 12, 2004

I say go for it, I went straight into ICU from nursing school and had no problems going straight into ICU. It all depends on the type of nursing you like to do. The reason ICU nurses have a hard time on med surg is they are trained to critically think explain and fix problems, on med surg you don't have time to do that you just call the physician. Med surg nurses have great multi tasking, time effeciency skills, and patient interaction skills to name a few, but don't deal so well with the crashing, dying, high stress situations. Just my observation. Like mattsmom said, I would make sure you start out with a large ICU based critical care course upon starting ICU, GOOD LUCK!

LydiaNN · Jun 12, 2004

When I graduated, there was no nursing shortage, so hospitals really had the upper hand in placing you where they thought you belonged. I don't think anyone in my class got a job in the ICU right away. Med-surg was mandatory in those days. God, I hated it!!! It was definitely not for me. I hope you are able to get the position that you hope for- new grads definitely have the upper hand now!

CRNAStudent · Jun 14, 2004

I also don't think you have to work on the floor for a while before going to the ICU. I went straight to ICU upon graduation from nursing school, and I have been successful. I graduated last May (2003) and about half of my class started working in either the ER or ICU. I know that some hospitals require/prefer new grads to start in a less stressful environment, but I think the real determining factor in your success is how willing you are to put in the required work. Get yourself a good critical care book or two (my specialty is Cardiothoracic nursing and I have five CTICU books and one hemodynamics book), and be willing to go home and read up on the stuff you saw at work that day. ICU is not for people who are satisified with just "getting by" - as long as you are willing to put in the time and effort it takes, you will be successful! Good luck!

caroladybelle, BSN, RN · Jun 15, 2004

The reason ICU nurses have a hard time on med surg is they are trained to critically think explain and fix problems, on med surg you don't have time to do that you just call the physician. Med surg nurses have great multi tasking, time effeciency skills, and patient interaction skills to name a few, but don't deal so well with the crashing, dying, high stress situations.

Correction: Medsurg nurses frequently are required to think critically and fix their own problems...we do not "just call the physician". We are just required to do it with more patients.

Our patients crash and die, but we have to handle them as well as all the others on the floor. We merely have to assess without all the machines, bells and whistles to assist us. And we do not have nearly as much staff to handle the situation.

I do agree that all nurses have different skills for different areas, though.

Tweety, BSN, RN · Jun 15, 2004

I agree Carol. Even in our ICU they nurses have to call the doctor. ICU nurses have the time to micromanage their patients and their needs, becuase the patients are in critical condition and need frequent monitoring. It's hard to let go of that micromanagement and know what to let go of when ICU nurses work the floor after being in ICU for a long time.

Both jobs require critical thinking, time management and assessment skills. Both jobs are tough. Both are an art and a specialty.

My opinion, as I've already said, is one isn't harder than the other.

Med-Surg nursing can be the launching ground to many other specialities and one can never go wrong going to med-surg prior to a more specialized area like ICU.

But as mattsmom said, in order for the new grad to be successful in ICU there must be a good preceptorship and a culture of support. Our hospital has an ICU course, with seminars, etc. They've recently went online with the classroom portion of the course and I've taken parts of it and it's pretty good.

a_clay · Jun 18, 2004

My advice is do your research and be particular about where you do your critical care internship, if you are determined to do this straight out of school. Not every facility is set up to mentor you in ICU right out of school. A large facility with a dedicated new grad internship with a solid critical care internship program with ongloing support is your best bet.
For every nurse who tells you they went right into critical care and 'did OK" , there are just as many who were thrown to the wolves, used as a pawn as a 'warm body' in ICU, left floundering ....in the wrong ICU this situation is stressful on the new grad AND experienced critical care staff.
In the ICU's I work in, there is not an adequate support system in place to accomodate a new grad's learning needs, thus a year experience in a stepdown or medsurg is a basic requirement to be considered for critical care...for good reason.
I'm not saying it can't be done, but please consider the facility carefully. Good luck to you. :)

Mattsmom81,

Seems like I read from another post of yours that you are in the Dallas area, right? What hospitals in the Dallas area would fit the "a large facility with a dedicated new grad internship with a solid critical care internship program with ongloing support" criteria that you mentioned above? Do you know of any hospitals in Houston that would fit that criteria? I am a single woman with no kids and I am open to moving, if I need to, to get a solid ICU "foundation". Thanks in advance.

Amy