ICU pay differential?

delphine22 · Oct 22, 2014

I will be starting a weekend option position on a tele unit, so I am excited to return to acute care.

Sounds like, after you are comfortable, PCCN might be a good option for you.

iluvgusgus · Oct 23, 2014

Your ICU doesn't require ACLS?? That is terrifying!

They only require it for nurses trained as charge nurses and there are frequently 2 or 3 nurses who frequently charge on staff as "stat" nurses helping with new admissions and codes as they arise. They are very experienced and I would trust them with my life over a new ICU nurse with an ACLS who has never ran a code. There is always the CCM team rounding in the hallway, there is always a team of RTs walking the halls in case of codes, So no, not so terrifying, but thanks for your input.

SionainnRN · Oct 23, 2014

They only require it for nurses trained as charge nurses and there are frequently 2 or 3 nurses who frequently charge on staff as "stat" nurses helping with new admissions and codes as they arise. They are very experienced and I would trust them with my life over a new ICU nurse with an ACLS who has never ran a code. There is always the CCM team rounding in the hallway, there is always a team of RTs walking the halls in case of codes, So no, not so terrifying, but thanks for your input.

No it is terrifying when only one or two people in the ICU have ACLS and know how to run a code. RTs don't run codes. And of course a new ICU nurse even with ACLS won't really know what's going on, but there's a huge difference between an ICU staffed with experienced nurses who all have ACLS and an ICU where only one or two people have it.

In my old ICU you had six months to get it if you were hired as a new grad and until then you couldn't transport pts or be left alone in the pod with them. We took our pts safety seriously and didn't rely on the hope that someone who knew something would be "walking the halls"!

And you're welcome! Always glad to give input on important topics.

ICUKeesh · Oct 27, 2014

While I agree that all nurses whether floor nurses or specialty are equally important-ICU nurses where I work are paid a little more than floor nurses. We had to complete critical care training and be ACLS certified as a requirement of course but there is a little (about $1-2/hr) pay differential.

jamielynn0802 · Nov 20, 2014

The hospital I work at we get a $3/hr differential for critical care and an extra $1/hr for having CCRN certification.

whofan, ADN, BSN, RN · Feb 7, 2015

no differentials here. you can earn a small pittance raise with a CCRN or other certifications, but not enough to pay for said certifications.

RNMeg · Feb 21, 2015

I'm surprised to read all these responses saying critical care nurses are not compensated extra where they work. Many specialty areas in my hospital are starting to get a $2-3/hour differential, including ED/OR/PACU/critical care. We do have a HUGE problem with RN retention, though, which is probably the reason for the "raise". Most hospitals in my town seem to offer this. For what it's worth, we're a nonunion state for nurses.

Mr. Murse · Feb 22, 2015

I felt like digging this thread up now that I'm a few months into critical care. After working 3 years on a GI surgical floor (which was a borderline step down unit most of the time) and now a few months in a neurosurgical ICU I definitely feel like critical care nurses deserve pay differentials. A lot of people responded rather defensively claiming it was no more responsibility than floor nursing and I disagree. It is not an indication of importance, because floor nurses are certainly as important in the patient care process, but rather stress and specialized knowledge.

I did a lot more task work on the floor, and it was often more physical, but in the unit I feel a lot more weight on my shoulders. Every patient in the unit could go downhill at any moment without any warning and you are the one to deal with it. On the floors, a patient goes downhill and you send them to the unit, in the unit a patient goes downhill and you have to figure it out, and that moment can come at any time without any warning. Besides the increased sense of stress because of the critical nature of the patients, there's also a lot of specialized knowledge required. Drains and other equipment, drips, etc......on top of all the usual knowledge floor nurses have.

All this is to say that my experience so far has confirmed my belief that critical care nurses (and other specialized nursing) do indeed deserve some kind of differential. I loved my experience as a floor nurse, and this is not to discredit them by any means because that's a tough job all around as well and I have all the respect in the world for those nurses too, but my job now is on a different level of nursing than where I was before.

My experience so far has also led me to believe new grads should not be hired into critical care. While there are exceptions where new grads do very well in the ICU, for the most part they lack foundational skills and senses that are more properly developed in less acute environments.

VANurse2010 · Feb 24, 2015

I felt like digging this thread up now that I'm a few months into critical care. After working 3 years on a GI surgical floor (which was a borderline step down unit most of the time) and now a few months in a neurosurgical ICU I definitely feel like critical care nurses deserve pay differentials. A lot of people responded rather defensively claiming it was no more responsibility than floor nursing and I disagree. It is not an indication of importance, because floor nurses are certainly as important in the patient care process, but rather stress and specialized knowledge.
I did a lot more task work on the floor, and it was often more physical, but in the unit I feel a lot more weight on my shoulders. Every patient in the unit could go downhill at any moment without any warning and you are the one to deal with it. On the floors, a patient goes downhill and you send them to the unit, in the unit a patient goes downhill and you have to figure it out, and that moment can come at any time without any warning. Besides the increased sense of stress because of the critical nature of the patients, there's also a lot of specialized knowledge required. Drains and other equipment, drips, etc......on top of all the usual knowledge floor nurses have.
All this is to say that my experience so far has confirmed my belief that critical care nurses (and other specialized nursing) do indeed deserve some kind of differential. I loved my experience as a floor nurse, and this is not to discredit them by any means because that's a tough job all around as well and I have all the respect in the world for those nurses too, but my job now is on a different level of nursing than where I was before.
My experience so far has also led me to believe new grads should not be hired into critical care. While there are exceptions where new grads do very well in the ICU, for the most part they lack foundational skills and senses that are more properly developed in less acute environments.

I've done both, and I think you're wrong.

Bluebolt · Feb 25, 2015

I felt like digging this thread up now that I'm a few months into critical care. After working 3 years on a GI surgical floor (which was a borderline step down unit most of the time) and now a few months in a neurosurgical ICU I definitely feel like critical care nurses deserve pay differentials. A lot of people responded rather defensively claiming it was no more responsibility than floor nursing and I disagree. It is not an indication of importance, because floor nurses are certainly as important in the patient care process, but rather stress and specialized knowledge.
I did a lot more task work on the floor, and it was often more physical, but in the unit I feel a lot more weight on my shoulders. Every patient in the unit could go downhill at any moment without any warning and you are the one to deal with it. On the floors, a patient goes downhill and you send them to the unit, in the unit a patient goes downhill and you have to figure it out, and that moment can come at any time without any warning. Besides the increased sense of stress because of the critical nature of the patients, there's also a lot of specialized knowledge required. Drains and other equipment, drips, etc......on top of all the usual knowledge floor nurses have.
All this is to say that my experience so far has confirmed my belief that critical care nurses (and other specialized nursing) do indeed deserve some kind of differential. I loved my experience as a floor nurse, and this is not to discredit them by any means because that's a tough job all around as well and I have all the respect in the world for those nurses too, but my job now is on a different level of nursing than where I was before.
My experience so far has also led me to believe new grads should not be hired into critical care. While there are exceptions where new grads do very well in the ICU, for the most part they lack foundational skills and senses that are more properly developed in less acute environments.

I've worked in multiple different ICU's, as a staff nurse and as a travel nurse. In Alabama there was a $2 an hour base pay increase if you worked Critical Care. If you did CVICU and received fresh open hearts you got another $5 an hour base pay increase. For a low paying state that usually starts RN's off on med surg at $18/hr this was an appreciated pay increase. Also if you got your CCRN you got a bonus check of $1000. Although I've been told by my friends still there that they are doing budget cuts and attempting to phase out the new hires getting the ICU pay differential.

In Connecticut it was a union hospital and I don't believe the pay was any different from one floor to another, even if you took open heart patients. Although the base pay was so high for staff nurses I couldn't imagine any extra pay bonuses. They all made $40+/hr. Plus the ICU got other cushy perks/benefits/respect, including frequent catered meals from residents and management.

In Georgia I don't believe they offered a specific ICU pay increase. Although if you work on the weekend there you got several $ more an hour. You also were required to do research and education improvement courses if you work ICU, be a leader, etc and by doing those things they gave you pay increases. So in a round-a-bout way by working in the ICU you did get paid more, but had to do research to get it. Also they paid more for the BSN and of course for the CCRN.

As for my opinion to your original post and subsequent posts. Yes, you are right about a pay differential or other benefits being offered to ICU trained nurses. You are required to have ACLS, BLS, PALS, TNCC, be certified in conscious sedation, be part of the code team, be proficient in the Critical Assessment Team who prevents floor patients from "going bad", take "on call" for the ICU, titrate drugs and be proficient in advanced hemodynamic monitoring, Ventilator Management, Coordinate 5 different physicians on a single case, spend lots of time educating and updating family meaning you have to be very well versed in everything happening (pathophysiology, labs, current vitals, MD's current opinions, plan of care for next 12 hours, etc.). You will be expected to manage machines and critical patients on machines like IABP, CRRT, ECMO. Manage Swann Ganz Catheters, CVP monitoring, Arterial Lines, ABG interpretation and interventions, assisting in intubation proficiently. Your assessments and reports will become more in depth and are more time consuming and "critical". There are more but I think you get the point.

Everything listed in the area above require extra training and knowledge. It also is not something you learn once and are done. Every year you have to do more re-training and online classes to certify yourself in your training and knowledge. They change and add machines, standard of practice, ICU policies, new titratable drugs, etc constantly and you have to keep educating yourself and staying ahead of the curve.

Long story short, you are directly responsible for 2 patients whose bodies are actively trying to die (hence, Critical Care) and it is your responsibility to not just halt it, but turn them around. If the heart does stop beating, YOU are responsible for implementing an immediate code and YOU (with your friends) are responsible for bringing them back.

Eh, easy peasy. Why give $2/hr for something so simple?

It really just has to do with the hospitals trying to find a way to save every dime they can. If RN's are willing to put up with it, they'll do it. One hospital even took away the coffee creamers....

I say all that and add this addendum. My girlfriend is a Med/Surg RN on a busy 33 bed floor. While she doesn't have to deal with any of the things I listed above I think she has the worst end of the deal. While I do think it's important to reward your ICU nurses for all the extra training and responsibilities, that does not mean I think they should continue to treat Med/Surg so badly. The hospitals need to start tackling the horrible trenches that we call Med/Surg.

VANurse2010 · Feb 25, 2015

I've worked in multiple different ICU's, as a staff nurse and as a travel nurse. In Alabama there was a $2 an hour base pay increase if you worked Critical Care. If you did CVICU and received fresh open hearts you got another $5 an hour base pay increase. For a low paying state that usually starts RN's off on med surg at $18/hr this was an appreciated pay increase. Also if you got your CCRN you got a bonus check of $1000. Although I've been told by my friends still there that they are doing budget cuts and attempting to phase out the new hires getting the ICU pay differential.
In Connecticut it was a union hospital and I don't believe the pay was any different from one floor to another, even if you took open heart patients. Although the base pay was so high for staff nurses I couldn't imagine any extra pay bonuses. They all made $40+/hr. Plus the ICU got other cushy perks/benefits/respect, including frequent catered meals from residents and management.
In Georgia I don't believe they offered a specific ICU pay increase. Although if you work on the weekend there you got several $ more an hour. You also were required to do research and education improvement courses if you work ICU, be a leader, etc and by doing those things they gave you pay increases. So in a round-a-bout way by working in the ICU you did get paid more, but had to do research to get it. Also they paid more for the BSN and of course for the CCRN.
As for my opinion to your original post and subsequent posts. Yes, you are right about a pay differential or other benefits being offered to ICU trained nurses. You are required to have ACLS, BLS, PALS, TNCC, be certified in conscious sedation, be part of the code team, be proficient in the Critical Assessment Team who prevents floor patients from "going bad", take "on call" for the ICU, titrate drugs and be proficient in advanced hemodynamic monitoring, Ventilator Management, Coordinate 5 different physicians on a single case, spend lots of time educating and updating family meaning you have to be very well versed in everything happening (pathophysiology, labs, current vitals, MD's current opinions, plan of care for next 12 hours, etc.). You will be expected to manage machines and critical patients on machines like IABP, CRRT, ECMO. Manage Swann Ganz Catheters, CVP monitoring, Arterial Lines, ABG interpretation and interventions, assisting in intubation proficiently. Your assessments and reports will become more in depth and are more time consuming and "critical". There are more but I think you get the point.
Everything listed in the area above require extra training and knowledge. It also is not something you learn once and are done. Every year you have to do more re-training and online classes to certify yourself in your training and knowledge. They change and add machines, standard of practice, ICU policies, new titratable drugs, etc constantly and you have to keep educating yourself and staying ahead of the curve.
Long story short, you are directly responsible for 2 patients whose bodies are actively trying to die (hence, Critical Care) and it is your responsibility to not just halt it, but turn them around. If the heart does stop beating, YOU are responsible for implementing an immediate code and YOU (with your friends) are responsible for bringing them back.
Eh, easy peasy. Why give $2/hr for something so simple?
It really just has to do with the hospitals trying to find a way to save every dime they can. If RN's are willing to put up with it, they'll do it. One hospital even took away the coffee creamers....
I say all that and add this addendum. My girlfriend is a Med/Surg RN on a busy 33 bed floor. While she doesn't have to deal with any of the things I listed above I think she has the worst end of the deal. While I do think it's important to reward your ICU nurses for all the extra training and responsibilities, that does not mean I think they should continue to treat Med/Surg so badly. The hospitals need to start tackling the horrible trenches that we call Med/Surg.

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.

Bluebolt · Feb 27, 2015

VANurse2010, you have taken what I've said and put false words in my mouth. You've come up with a common entry level debater tactic of "If you're saying this is black, then you have to be saying this is white". All RN's are responsible for all the things you listed, it's core elements of being an RN. What the Intensive Care Unit does is takes all those roles and makes them more "Intense" so to speak. You are responsible for all those things, just more of it and in a more advanced fashion.

If you're attempting to argue that the ICU does not have more advanced machinery, advanced certifications, advanced family education on pathophysiology, advanced patient care you're simply delusional. I have no time to carry on conversation with a basis of delusion, especially when the catalyst is a fragile ego.