med surge vs ICU

Snowbird17 · Nov 28, 2012

In a nutshell, ICU is where patients go if they are very sick. The floor (medsurg) provides basic nursing care. ICU nurses need to be well versed in caring for critical patients, titrating vaso-active drips and working a kazillion pieces of equipment. However, they generally only have a couple of patients to care for. The Med-surg nurse has to be adept in caring for many patients, frequent admissions and discharges, and more assisting the patient with ADLs.They really are night and day. I would rather care for a coding patient, than have 6 or 7 "stable, floor" patients.

Did you not rotate through an ICU in school? ICU is not floor nursing. Floor nursing can be called medsurg, surgical, medical, ortho, neuro, GYN the list goes on. It is basically for stable patients. The names can be divided by sub-specialty. ICU, IMCU, PACU, and ER are considered critical care areas in most facilities.

If your patient "goes bad", in other words, becomes more ill, vitals become unstable, they need any aggressive airway or blood pressure management, they go to the ICU. The inverse applies. When a patient stabilizes and is well on the road to recovery they transfer to the floor for management.

Susie2310 · Nov 29, 2012

Snowbird17, no offense; your reply is well-intentioned but a little simplistic. Med-surg patients are certainly not always basically stable (you referred to having "6 or 7 stable, floor patients", and said the floor is basically for stable patients). Just this year a family member of mine was fighting for his life on a med-surg unit with acute renal failure and sepsis. Fortunately after multiple fluid boluses and antibiotics his kidneys began to work again.

I trained as a nurse 17 years ago, and there were unstable patients on med-surg then, just as today.

To the OP, I suggest reading the med-surg and neuro forums.

Snowbird17 · Nov 30, 2012

Like I said, in a nutshell. No offense taken, however, I would venture that our definition of stable differs.

If a patient becomes critically unstable, and cannot easily/quickly be stabilized, I would bet that the majority of doctors would transfer them to a higher level of care. No one fights for their life in med-surg! If they are that sick, they need to be moved to an acute area immediately. That is why there are rapid response teams and code yellows, to prevent such things. And why there are ICUs and IMCUs. We put septic patients that are even remotely tittering in our unit so that they can be closely monitored. Otherwise, they end up in an IMCU. Should a truly septic, patient remain on the floor to the point of instability- someone is dropping the ball big time.

Susie2310 · Nov 30, 2012

Like I said, in a nutshell. No offense taken, however, I would venture that our definition of stable differs.
If a patient becomes critically unstable, and cannot easily/quickly be stabilized, I would bet that the majority of doctors would transfer them to a higher level of care. No one fights for their life in med-surg! If they are that sick, they need to be moved to an acute area immediately. That is why there are rapid response teams and code yellows, to prevent such things. And why there are ICUs and IMCUs. We put septic patients that are even remotely tittering in our unit so that they can be closely monitored. Otherwise, they end up in an IMCU. Should a truly septic, patient remain on the floor to the point of instability- someone is dropping the ball big time.

I am happy to hear that septic patients in your facility are transferred to your unit. My husband was seriously ill with sepsis and acute renal failure, systolic BP 80/?, pulse around 120 if I recall, labs showing SIRS. He did indeed fight for his life in med-surg, sorry to contradict your ideas with reality. I was by his bedside. I am trained in emergency nursing and am an experienced nurse, so I think I may talk about my husband's unstable condition with credibility. It would be nice if the practice you described happened everywhere, but the fact is it doesn't. I wish all patients in the US were as fortunate as the ones you describe.

Snowbird17 · Nov 30, 2012

Regardless, Glad he improved quickly! I would have to think having you to advocate for him was very much am important factor in that.

OP- I hope you have some insight into the differences in the two units.

Here is a nifty little article that provides much insight into the ICU patient...

http://www.learnicu.org/docs/guidelines/admissiondischargetriage.pdf

I can tell you these are followed for the most part with discretion from the docs!

Hope this helps!

Susie2310 · Nov 30, 2012

Regardless, Glad he improved quickly! I would have to think having you to advocate for him was very much am important factor in that.
OP- I hope you have some insight into the differences in the two units.
Here is a nifty little article that provides much insight into the ICU patient...
http://www.learnicu.org/docs/guidelines/admissiondischargetriage.pdf
I can tell you these are followed for the most part with discretion from the docs!
Hope this helps!

Thanks. He spent the entire year recovering. Please don't be so quick to tell other people they don't know what they are talking about.

Snowbird17 · Nov 30, 2012

You're welcome. This is a forum for opinions and experience. I shared mine, you shared yours. NO where did I say you didn't know what your were talking about. Getting the last word in is not very useful for this OP. I will continue to share, like now. Obviously, your personal experience was very influential in your thoughts of the floor. My experiences have left me with a different thought. Let's not hijack anymore of this person's inquisitive post. Like I said, glad your husband improved. Neither of us is wrong, and I am pretty sure we both are competent in our thoughts.

turnforthenurse, MSN, NP · Nov 30, 2012

ICU nurses typically have 2 patients, some are 1:1s, though..such as those on ECMO or CVVH. Those one or two ICU patients can be the equivalent to 6 or 7 patients on a med-surg floor - ICU patients can be THAT sick. There are patients diagnosed with sepsis and other conditions that can be unstable on a med-surg floor...but they typically stay there unless 1) they need more monitoring (telemetry and/or hemodynamic monitoring) 2) they need to be intubated or 3) they need vasopressors or vasodilators which cannot be given on a med-surg unit. Sometimes there are patients that are relatively stable but have the chance to become very unstable at any time and the docs will choose to admit them to ICU. Any patient can become unstable, however. Patients admitted with DKA and HHNKS needing an insulin drip will probably go to ICU first because they need more frequent monitoring, not to mention FREQUENT blood sugar checks (Q30min-Q1H) which would be extremely difficult to manage if a nurse were to have 6 or 7 patients on a med-surg floor. The fresh STEMIs go straight to ICU because they are unstable and could go into cardiogenic shock.

Susie2310 · Nov 30, 2012

Snowbird, your words "Like I said, in a nutshell. No offense taken, however, I would venture that our definition of stable differs" were dismissive. Please go back and read your first reply to me. Then read your next reply to me. No, your actual words did not say I didn't know what I was talking about but the language of your post conveyed that.

You may wish to present a certain view of the ICU and Med-Surg to the OP, and you are free to do so. I am surprised that you apparently have not experienced unstable patients on a medical-surgical unit, but I do not know the extent of your nursing experience.

littlepeopleRNICU · Dec 1, 2012

I think what we can all gather from this post is that it really varies from facility-to-facility. I used to work on a telemetry floor and sometimes had up to 6 patients. We loved 4, no more than 5, but 6 was not uncommon. Our patients also had a primarily renal background, but we did get some overflow of patients that were just med-tele. Frankly, a large majority of my patients were sick as snot. We had very brittle people who went downhill at the drop of a pin frequently...but the majority of them were not knocking on deaths door at all times. We could do certain levels of some drips- cardizem, insulin, nitro, etc. However, we could not do all, and for most, we could not titrate.(They mainly only liked us to titrate insulin and heparin drips.)

And my floor was more the exception to the rule at my hospital...the other floors could not do those drips, only the telemetry units, but we were still considered med-surg. What got you a ticket to ICU on my floor were things like not being able to keep your sats up without more than a NC or Venti mask. If you needed anything else continuously(with the exception of our sleep apneas who wore their PAPs throughout the night), you were transferred off. Also, if you required titration of the previously said drips or more than our limit, you were transferred off. After codes, you were always transferred off.

It really just depends on the hospital and even unit-to-unit standards/expertise in that same facility. So, what I would do is ask to shadow different areas in the hospital, speak to staff and managers, and ask the recruiter was the level of care really means to each unit before making your decision.

Anoetos, BSN, RN · Dec 1, 2012

Most larger hospitals also have units for patients who are between regular medical-surgical care and intensive care. These progressive care units usually have nurse : patient ratios between those of a MedSurg unit and the ICU. They're often called "step-downs".

In our case about half our patients are on their way out of the MICU, the other half are EC admits with multiple system issues and of generally higher acuity. Their placement is often dependent on a baroque algorithm involving the kinds and amounts of meds they need and the opinion of the attending physician.