So I am taking a graduate level research class, and my textbook keeps talking about how there are all of these great care models shown to improve outcomes for patients that aren't being utilized in practice. I just keep thinking about how nurses NEVER have ANY time, and this is probably contributing greatly to the lack of research in practice. It seems like the problem is getting worse and in some cases practice is not only not evidence-based, it's not even safe. Then good nurses stop being nurses because expectations are impossible.
I guess I'm wondering if anyone has any ideas on how to improve staffing ratios? There is evidence out there that the role of the nurse as an educator is as important. How do nurses get the time they need to serve as effective clinicians?
I've read other posts with suggestions like, "cut the CEOs salary", which is a nice idea, but not likely to happen without some sort of catalyst. Does anyone know what the catalyst could be?
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
ICU was indeed part of my clinical experience in nursing school, Linda. ICU/CCU nurses are not that awful "special". They have an amazing skill set, but so do the rest of us.
You SAY you dislike the "infighting" in nursing, but out of the other side of your mouth, however, your words actually promote the very in-fighting you disdain.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
PS-----Linda, in all my years in OB, I never saw ONE ICU nurse who was floated to us (yep they floated when ICU was slow) that could hold her water in OB and was NOT scared out of her wits.
Something about women in labor scares many other nurses. If I had dollar for every time I heard "I don't know nothin' about birthin' babies" from the very ICU/CCU nurses you laud, I would be able to retire already.
They were unable to care for active labor patients and barely functioned with our stable postpartum moms. And BABIES??? FUGGEDABOUDIT. They would not touch them, to include starting IVs, which we did all the time.
NO----- ICU and CCU nurses CANNOT function everywhere else. Quit saying they can.
Specializes in OR, Nursing Professional Development.
In other words, ICU nurses can do everyone else's jobs, but everyone else cannot do, and are not trained, to do everyone else's jobs.
Wow. Just wow. For someone who is so adamant about nurses joining together, this speaks of someone who doesn't follow what she preaches. No, ICU nurses cannot do everyone else's jobs. Being an ICU nurse does not make one a master of all trades. I have to say, this statement right here caused me to lose a fair amount of respect for you. Reminds me quite a bit of political double speak.
Specializes in Critical care, tele, Medical-Surgical.
As a critical care nurse since 1980 and CCRN since 1986 I have had to tell a supervisor, "I would if I could, but I can't accept the responsibility for a pediatric patient, an L&D or postpartum woman, a group of oncology or orthopedic patients, mental health patients, outpatient surgery, PACU, or ER. There are overlapping competencies, but I have had neither the education nor recent experience for their care.
Medical-surgical and telemetry priorities are not the same as in ICU where I have only one or two patients. An ICU RN who has not worked med/surg for a few years does not have current competency.
All areas of nursing are specialized. A nurse who has been in a specialty for 5 or more years is likely an expert in that ares.
The ICU nurse who was once an expert medical-surgical RN is no longer expert when competency isn't current. New information and skills have not been learned and practiced.
Management may want to divide us, I won't fall for that one.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
I agree that nursing specialties are so much different and we all have something unique to offer to the table. During my bedside nurse years, I've worked in long term care, acute in-patient rehab, Med-Surg, ER, and ICU though ICU is my favorite. However, if we are going to push for billing as nurses, we will have to accept the fact that reimbursement will be different for each setting. The cost of providing care to an ICU patient is much higher than it is for a patient in Med-Surg. A perioperative patient might require more nursing manpower hours than a patient with community acquired pneumonia. That's the reality physicians face. Some physician specialties are huge revenue generators and though the rankings fluctuate from time to time, some of the highest paid physicians are intensivists, orthopedic surgeons, dermatologists, and other types of surgeons.
The point of my response, that caused so many individual to get their panties in a wad, was that nurses in different areas of the hospital, are providing a higher level of care, than in other areas. And yes, critical care nurses, provide a higher level of care that other areas of the hospital, the hospital is charging a higher cost to the patient, therfore I should be compensated as such.
Physicians who are in higher cost specialties, charge more than, say, a Physician who is in Family Practice. None of them get their knickers in a wad over other physicians charging more for their services.
IF I am providing a higher level of care to an ICU patient, than I should charge more than a nurse who works med surg., etc. The higher level of care is NOT being determined by ME, but by insurance companies, and therefore, the hospitals charges more for my services as an ICU nurse, than they charge for a med surg nurse. If they are charging more for my services, than I should be paid more. Period. There should be no discussion, or hand wringing, over it.
If that where the case, and you wanted to make more money, then you would obtain employment as an ICU nurse, it is that simple. When doctors want to make more money than their present specialty allows, then they obtain a residency in a certain specialty, and charge more money.
The same way, CNA's, or LPN/LVN, can make more money if they go back to school and become RNS.
I think this discussion has gone a little off the rails. It is not a matter of which area of specialization is more skilled than the other but which ones are more labor intensive. It may take three nurses working together with a physician to stabilize a patient. The flight teams, CVICU, Trauma codes, cath lab team, high risk OB patients, PICU pts, emergent dialysis situations - and probably many more - fit the description of unstable and labor intensive.
These services are very expensive and the number of man hours per patient are, could be, or should be billed accordingly.
I do get pulled to ER, stepdown and once or twice even to OB just to do tasks. You would never see a PACU, ED or L&D nurse be floated everywhere the way that ICU and M/S nurses are in some institutions. I go with a positive attitude and jump in and try to be helpful where I can. But we are not interchangeable. No one can be well versed in everything.
It is not my forte and I will never trade places with the Med Surg RNs team of 6 pts for my one or two unstable patients who require constant assessment and intervention. The total man hours of care though are probably about the same for both specialities and both are equally valuable as income generators.
Whether as an FTE or as a temporary contract worker, the payscale (or bill rate for a travel nurse) is based on speciality & certifications and I am certain that I am paid significantly more than nurses who have not chosen to pursue a career in Critical Care.
Specializes in Critical care, tele, Medical-Surgical.
If I float from ICU to med-surg I am usually assigned five patients. Providing safe, therapeutic, effective nursing care to a higher volume of patients is a competency for which I'm no longer current. Sometimes I have to stay over (on the clock). Currently competent med-surg nurses would complete their documentation on time with the same staffing and acuity.
So I am taking a graduate level research class, and my textbook keeps talking about how there are all of these great care models shown to improve outcomes for patients that aren't being utilized in practice.
Could you share more about these care models that improve outcomes?
The point of my response, that caused so many individual to get their panties in a wad, was that nurses in different areas of the hospital, are providing a higher level of care, than in other areas. And yes, critical care nurses, provide a higher level of care that other areas of the hospital, the hospital is charging a higher cost to the patient, therfore I should be compensated as such.
Physicians who are in higher cost specialties, charge more than, say, a Physician who is in Family Practice. None of them get their knickers in a wad over other physicians charging more for their services.
IF I am providing a higher level of care to an ICU patient, than I should charge more than a nurse who works med surg., etc. The higher level of care is NOT being determined by ME, but by insurance companies, and therefore, the hospitals charges more for my services as an ICU nurse, than they charge for a med surg nurse. If they are charging more for my services, than I should be paid more. Period. There should be no discussion, or hand wringing, over it.
If that where the case, and you wanted to make more money, then you would obtain employment as an ICU nurse, it is that simple. When doctors want to make more money than their present specialty allows, then they obtain a residency in a certain specialty, and charge more money.
The same way, CNA's, or LPN/LVN, can make more money if they go back to school and become RNS.
THAT was my point.
Lindarn, RN, BSN, CCRN (ret)
Somewhere in the PACNW
I don't believe that was your point the first time around. Let me remind you of one of your quotes: "Areas of nursing like critical care should have a higher pay scale than med surge. Sorry folks. The skill set a nurse brings to critical care is far and above what ER, Med Surg, OB, Dialysis does."
You obviously are way out of touch as to what nurses in other areas do. I think others have covered that, so let me respond to the direction you are now taking.
I hate to burst your bubble, but the ICU costs more because there are more resources devoted to it. Not because of the level of care you provide as one nurse.
On the ICU, there are many more nurses per patient population, MD's and NP's always close by. Pharmacists on the unit. More RT's per patient population. Etc. It costs more to run an ICU. The nurses may or may not be more skilled.
As a med-surg nurse, I have 4-5 patients. Many of them teetering towards heading to the ICU, depending on my care to keep them out of that high-cost area. The MD only rounds once per 24 hours. Medications are seldom available stat. One actually has to go into the room to put eyeballs on the patient.
Take away the additional resources in the ICU, then what do you have. An ICU nurse with 1-2 patients as compared to a med-surge RN with 4-5 patients. The hospital is charging 4 or 5 patients for my care as opposed to your 1 or 2. Using your logic, it seems that the med-surg nurse should be paid more.
I'm trying to make a point here, not de-value what an ICU nurse does. I have come across many brilliant ones. And I have worked with many brilliant med-surge nurses. You can't tell me a experienced med-surge nurse who has continued to develop their skill-set by becoming certified, attending conferences, continuing ed, etc. is any less valuable then any ICU nurse.
Pay should be based on experience and skill, not by title.
And why are doctors paid more? Because they have more education and training than, say Family Medicine Physicians.
I wish that I had a nickel for every physician who told me that he/she, transferred their patient to the ICU, because the floor nurses don't know how to care for their patients, when they become more complex.
Physicians are paid base on their specialty, which often require more education and training that is not provided for in their basic medical education.
ICU nurses take training classes, that can take up to 6 months. ICU skills, are NOT taught in nursing school.- titrating drips, reading monitors, Swan Ganz Catheters, Hemodynamic calculations, CVVHD,etc. The same with dialysis.
Med Surg skills are taught in nursing school. Physicians charge more for their additional educational education, and training. Neurosurgeons, charge more than neurologists, Cardiac Surgeons, charge more than cardiologists, etc. WHY is it not the same in nursing??
Because nurses need to validate their self worth and self esteem by perpetuating the lie, that nurses are all the same, with our skill sets, when we are not. Higher skilled, trained skills, should be paid more than basic nursing skills, learned in nursing skills.
Having more patients to care for, is a matter of learning to prioritize your workload for the day. Learning to delegate to lesser trained personnel, etc. They are skills that are taught in a basic sense in nursing school. Titrating vasactive drips, while weaning someone off of the IAPB, is not taught in nursing school.
I stand by my original statements that nursing should be paid based on their education and training, not by, "well, we are all the same".
We sometimes had floor nurses float to ICU to work as "functional". nurses. They may not be able to take critical ICU patients, but they can help with baths, hanging IVs, giving medication, etc. We welcomed any help we received, regardless where it came from.
An experienced Med surge nurse who attends conferences, continuing ed, is still not qualified to care for a critically ill ICU patient. They are developing and improving on their already gained med surge skills and knowledge base, not learning new skills. The hospitals and insurance companies are the ones who make the decision to charge more the ICU care, than med surge care. They pay more because their is more bedside care, in addition to all of the bell and whistles of being a patient in ICU. Just like they pay more for a Specialty Physician, or Surgeons, than a Family Practice physician. They are paid because of experience, skill,education, and title. We should be too.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
WELL SAID!!!!! Thank you.
I don't believe that was your point the first time around. Let me remind you of one of your quotes: "Areas of nursing like critical care should have a higher pay scale than med surge. Sorry folks. The skill set a nurse brings to critical care is far and above what ER, Med Surg, OB, Dialysis does."
You obviously are way out of touch as to what nurses in other areas do. I think others have covered that, so let me respond to the direction you are now taking.
I hate to burst your bubble, but the ICU costs more because there are more resources devoted to it. Not because of the level of care you provide as one nurse.
On the ICU, there are many more nurses per patient population, MD's and NP's always close by. Pharmacists on the unit. More RT's per patient population. Etc. It costs more to run an ICU. The nurses may or may not be more skilled.
As a med-surg nurse, I have 4-5 patients. Many of them teetering towards heading to the ICU, depending on my care to keep them out of that high-cost area. The MD only rounds once per 24 hours. Medications are seldom available stat. One actually has to go into the room to put eyeballs on the patient.
Take away the additional resources in the ICU, then what do you have. An ICU nurse with 1-2 patients as compared to a med-surge RN with 4-5 patients. The hospital is charging 4 or 5 patients for my care as opposed to your 1 or 2. Using your logic, it seems that the med-surg nurse should be paid more.
I'm trying to make a point here, not de-value what an ICU nurse does. I have come across many brilliant ones. And I have worked with many brilliant med-surge nurses. You can't tell me a experienced med-surge nurse who has continued to develop their skill-set by becoming certified, attending conferences, continuing ed, etc. is any less valuable then any ICU nurse.
Pay should be based on experience and skill, not by title.
SmilingBluEyes
20,964 Posts
ICU was indeed part of my clinical experience in nursing school, Linda. ICU/CCU nurses are not that awful "special". They have an amazing skill set, but so do the rest of us.
You SAY you dislike the "infighting" in nursing, but out of the other side of your mouth, however, your words actually promote the very in-fighting you disdain.
Interesting.