Insight & advice on Critical care(ICU) VS. general Med-Surg floor?

nurse4theplanet, RN · Feb 28, 2007

I can definitely understand the part about being most interested in hands-on actions with clear results, as opposed to a very intimate relationship with a patient. (It's funny because just the other day I was talking about how I personally don't have a ton of interest in garnering social relationships with patients-- I mean it's not to say I'm cold/careless and don't want to talk at all, it's that it just won't really be my priority.) And from what I've learned, ICU and OR are pretty conducive to this preference, especially OR.

What would make you think that you will not form many social relationsips with your ICU patients? Even if you can't form a relationship with the patient, you have the family to connect with. These patients are critically ill and having a therapeutic relationship with their caregivers is very much a priority. Just because we focus intently on maintaing homeostasis and hemodynamic monitoring does not mean we are lax on the psychosocial areas of nursing in ICU. Anxiety, grief, fear, denial....are all very common responses to illness that our ICU pt's experience or that the family may be experiencing.

Alot of ICU patients have impaired communication r/t stroke, trauma, intubation, sedation, etc...this does not mean that their need for comfort and socialization is gone. Being alert and not being able to communicate verbally can be very frightening and the nurse must provide reassurance that their needs will be met, psychological support, and other ways to communicate nonverbally.

Death is common in the ICU, and the nurse must be emotionally prepared to deal with a grieving family. This takes very good psychosocial skills and use of therapeutic communication.

Some ICU pt's can remain on the unit for several weeks and you are with them constantly throughout your shift...you get to know them and their family members very intimately. They tell you their fears and look to you for hope and comfort. Please do not believe that forming social relationships is not a priority in critical care.

burn out · Mar 1, 2007

It sounds like you already have your mind made up. I wish I could say I agree. I started my first year of nursing on a med-surg unit until I could figure out where I wanted to go and believe me I have never regretted it. The skills that you learn that first year on med-surg are immeasurable and helped build my ICU skills on. Not just clinical stuff but how to manage care for 18 patients and meet all their needs , time management skill, delegation and trust of team members no where else but med-surg. Who said med-surg isn't a speacialty I have much respect for those nurses, I don't think I could do their job day after day.

RUcon08 · Mar 1, 2007

To asoldierswife, I wasn't trying to downplay the possibility of the psychosocial aspect in ICU, or say that it isnt present. But I just know that from what I've seen so far (which probably isn't very much at all), regular floor nursing like med-surg just hasn't caught my interest. And it just seems like the socialization is a bit different between that and critically ill patients.

DNurse08 · Mar 2, 2007

Thank you for all your advice. I'm going to try to get the ICU externship. I spoke with one of my friends who did it at the hospital that she externed at and she said that she for the most part acted as the nurse under a precepter and that she gained more confidence in her skills from it. I've worked as a CNA so I hope that the MS externship is not like that as well. I will have to look into that.

Where is the quote button??

From asoldierswife

"What would make you think that you will not form many social relationsips with your ICU patients? Even if you can't form a relationship with the patient, you have the family to connect with."

So obviously ICU nurses don't entirely connect with patients and do connect with the family. Personally, I am better at empathasizing than cheering someone on with a happy face. I'm like talking to families and explaining to them what the patient is going through. Death, I haven't witnessed enough death to really know how it will affect me.

In my MS clinicals, I felt like I had to put on a happy show for my patients and it was very uncomfortable for me because I didn't want to come off as uncaring because I'm a very caring person. The more I read this thread the more I feel like I want to be an ICU nurse.

MaryAnn_RN · Apr 9, 2008

So obviously ICU nurses don't entirely connect with patients and do connect with the family. Personally, I am better at empathasizing than cheering someone on with a happy face. I'm like talking to families and explaining to them what the patient is going through. Death, I haven't witnessed enough death to really know how it will affect me.
In my MS clinicals, I felt like I had to put on a happy show for my patients and it was very uncomfortable for me because I didn't want to come off as uncaring because I'm a very caring person. The more I read this thread the more I feel like I want to be an ICU nurse.

Try working a 7 till 7 shift with the same patient and their family. When you have been there for the pt all day, meeting and anticipating their every need - believe me - you will connect. Being able to build a therapeutic relationship with the patient and their family/significant others is one of the most rewarding aspects of working in ICU.