ICU vs Med Surg for New Grad?

TazziRN, RN · Apr 22, 2003

I'm an ER nurse, not ICU, but I have close contact with ICU because that's where a lot of my patients go. ICU would be less demanding in terms of being on your feet, since the nurse-patient ratio is much smaller, but how demanding a shift is will depend on how sick your patient is. On MedSurg you can have anywhere from 3-8 patients, if not more, and it can get pretty exhausting.

New CCU RN · Apr 22, 2003

Originally posted by TazziRN
I'm an ER nurse, not ICU, but I have close contact with ICU because that's where a lot of my patients go. ICU would be less demanding in terms of being on your feet, since the nurse-patient ratio is much smaller, but how demanding a shift is will depend on how sick your patient is. On MedSurg you can have anywhere from 3-8 patients, if not more, and it can get pretty exhausting.

Lower patient ratios (generally two patients) does NOT by any stretch of the imagination equate to less demanding. The reason why ICU's have lower patient ratios is because these patients require agressive, intensive care.

MANY SHIFTS GO BY THAT YOU WILL NOT SIT, WILL NOT EAT, AND WILL NOT PEE. An ICU is very physically demanding.

While, I am not saying that M/S isn;t bc it is also alot of running, please don't think that just because an ICU nurse has less patients, means that the nurse isn't running just as much.

I replied to this post also in the other forum but Tazzi your comments kinda struck a chord.

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Apr 22, 2003

I agree with you New CCU RN, that ICU shouldn't have an expectation of being less physical demanding than floor nursing. It is just as demanding.

jfpruitt- if you really have physical concerns you should investigate both places, perhaps talk to nurses from that institution. No facility is exactly the same. Perhaps the VA has more staff that allows for decreased physical demand. But I think that you will find that people here will pretty much tell you the same thing - that lifting, standing and physical activity is a good part of ALL nursing in the hospital and other settings.

I can tell you being a floor nurse I only make myself take my 30 minute break even though it will put me behind. There are days that I can work a 12 hour shift with no food, water, or bathroom break and have pulled up the same patient about 50 times. Other days I get my break, bathroom and have staff able to help. Some days are just better than others.

As for starting out in the CCU, I personally do not believe that grads should be starting out in CCU or any specialty area, but that is my opinion and definately another topic.

Hope this helps and that you find out the information that you are looking for.

Good Luck.

SmilingBluEyes · Apr 22, 2003

go for it. I started out in OB as a new grad, never having

"done time" in M/S (and no desire to), and did fine. Just ensure there is a very good orientation/'residency/ preceptorship for you or else you will get in trouble. That goes for M/S, also. Just cause many consider it a good place for new grads to go and learn, does NOT mean you do NOT need a darn good orientation/residency. M/S is a SPECIALTY IN AND OF ITSELF AND IT IS HIGH TIME WE RECOGNIZED THIS AS NURSES. Fact is, You can get into trouble in ANY area of nursing if you are not well-oriented. Don't go out "on your own" til you are somewhat comfortable with what is expected of you. BEST WISHES!!!!!

louloubell1 · Apr 22, 2003

Originally posted by New CCU RN
Lower patient ratios (generally two patients) does NOT by any stretch of the imagination equate to less demanding. The reason why ICU's have lower patient ratios is because these patients require agressive, intensive care.

MANY SHIFTS GO BY THAT YOU WILL NOT SIT, WILL NOT EAT, AND WILL NOT PEE. An ICU is very physically demanding.

While, I am not saying that M/S isn;t bc it is also alot of running, please don't think that just because an ICU nurse has less patients, means that the nurse isn't running just as much.

I replied to this post also in the other forum but Tazzi your comments kinda struck a chord.

I couldn't agree more! I have never worked med-surg, but I have the utmost respect for med surg nurses. I know they work their tails off, but don't think that ICU nursing isn't demanding and physically strenuous. I work my tail off in the course of my twelve hour shifts, & often go without time to sit down or eat, though I am usually able to squeeze in time to pee :). I work nights, and no, I don't believe that they are any less demanding than days are. We're talking about critically ill patients...just as sick at night as they are in the day. We make plenty of midnight roadtrips, admit just as many patients, AND we, the night shift at my facility, are responsible for all baths (which can be very time consuming and strenuous when you're talking about 250 lb patients with multiple dressing changes and that kind of thing). Add to that the fact that we have no support staff on nights so everything must be done by the RNs on the unit. Only the day shift in my unit has unit techs, a unit secretary, and PCAs able to assist with turning, bathing, getting up to the chair, etc.

I went straight to ICU as a new grad, and yes, I do understand the concerns that many people have re: new grads in critical care settings, but that's another thread and a heated debate in which I just don't want to participate. I love the choice I made to go into the ICU after graduating.

EC1234 · Apr 23, 2003

Well, I think in Med-Surg you're guaranteed to be on your feet almost everyday you come in to work. But in the ICU you may or may not depending on your pt workload. I did a year of precepting in the ICU and from what I've witnessed, yeah there were some nurses who didn't get the luck of the draw and ended up w/ "heavy" pts, but for the most part nurses were sitting around chatting and monitoring at the nurses station (in addition to giving meds, turning pts, documenting, but they only have 2 pts!). I am a new grad and started in Tele, and let me tell you, I am getting a lot of experience here! It's a great place to start!

New CCU RN · Apr 23, 2003

Originally posted by EC1234
Well, I think in Med-Surg you're guaranteed to be on your feet almost everyday you come in to work. But in the ICU you may or may not depending on your pt workload. I did a year of precepting in the ICU and from what I've witnessed, yeah there were some nurses who didn't get the luck of the draw and ended up w/ "heavy" pts, but for the most part nurses were sitting around chatting and monitoring at the nurses station (in addition to giving meds, turning pts, documenting, but they only have 2 pts!). I am a new grad and started in Tele, and let me tell you, I am getting a lot of experience here! It's a great place to start!

I will reiterate what I said before, ICU is physically demanding. So is M/S...so is every unit in a hospital. Nursing is a physically demanding field.

Maybe once every three months we will have a decrease in patient load and have one of those days that you can sit around. Being that you were doing an internship I am assuming you weren't there full time to really witness what happens day to day in the unit.

It's not just "heavy patients" its hemodynamically unstable patients, its train wrecks that you get from the floor without even a report being called, its patients that roll up to the unit from the ER coding, maxed out on pressors, bleeding from every oriface saturating the bed, families that don't understand why resucitating grandma for another 50 minutes is futile when you have been doing it the last hour, it is anticipating what is going to happen next, its the floor nurses giving you a hard time bc they are getting an admit and refusing to take report ignorant to the fact that there is a code waiting to come down, you run in the ICU....you are keeping people alive .... and that doesn't involve much sitting around chatting turning your patients q2hr.

Before you knock it and say something ignorant like....they only have two patients why don't you come down to the ICU and work as a nurse and see what it is reallly like.... :eek: It is things like q5 min vitals, titrating 8 different drips, swan numbers q1hr, abgs q4 or even more often sometimes, labs anywhere from q2-q12, running a balloon pump that is keeping someone's heart pumping, running cvvh, etc...

SmilingBluEyes · Apr 23, 2003

sigh, debates wherever you turn.....

i say let the new grad go where her heart takes her. with enough determination and drive and a measure of smarts, she will succeed. can we drop the "easiest unit" debate that is ensuing here?

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Apr 23, 2003

I didn't think there was a debate going on. I agree though, that she needs to do whatever her gut is telling her. Like I said, the best information is going to come from the nurses in the units that she is interested in.

TheLionessRN, RN · Apr 23, 2003

The VA I worked at had almost constant "unit diversion" because there never were empty beds. The sickest patients are in there all the time. I work in the ER and can tell you that I am aware that while I get them fresh, it is to the ICU/CCU that the patient will ultimately go, and have to be cared for.

I did not think a new grad had any business in the unit when I graduated. I do, however know enough about the VA system to know that every skill that is needed will be covered, every policy will be gone over and classroom time will be more than you ever wanted in your life. I personally would want to jump right in if that is where the action is....but be prepared for physically demanding days they seem like they will never end.

OrthoNutter · Apr 23, 2003

Originally posted by jfpruitt
I am graduating in May and was recently interviewed at a local VA hospital. They currently have 2 openings. One is in Med-Surg and the other in ICU. The Med-Surg position is about a 6-8 week orientation whereas the ICU position is much longer with classroom orientation alone about 6 weeks. I am a new grad and have always thought ICU would be a great place to go however, I have a few health concerns that keeps me from debating floor nursing. Can someone out there that started in ICU tell me about their decision and how they like it now? As far as physical labor, how physically demanding is the ICU verses Med Surg?? Will I be on my feet all shift in ICU? Or Med Surg? Is the evening's less physically demanding in the ICU? Thanks.

I went to ICU straight out from graduating. Spent the first six months of my nursing career bewildered, confused and utterly lost. I was supposed to have a 6-8wk introductory period as well but they were short-staffed and to management, a body was a body so we got thrown in the thick of it. My time management skills, which were used to a 6-8pt load went right out the window in my time there (I'm sorry if this offends ICU nurses, but it is a lot easier to for me to co-ordinate care for 1-2 very very sick pts than for 6-8 less sick pts). ICU terrified me but I'm proud to say I survived my stint there and still go back occasionally, when staffing needs necessitate it. I'm MUCH happier where I am now though (ortho, in case you hadn't gotten that).