OR vs ICU

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Hello all,

I have been a med/surg RN for 2 1/2 years and would like to make a change to either OR or ICU. I know they're both very different. Nursing is a second career for me. I hope to experience many areas of nursing in my career (maybe I'll do both at some point), and will probably jump over to the management side in the long-term future (management background--old career). For now, I love nursing. While some days (and docs, and pts, and families, and mgrs) can be rough, I still believe I am making a positive difference in the lives of others.

I understand the amount of direct patient care required in the OR is not the same as the floor, but I think just being there and able to contribute to a smooth work flow is contributing positively to patient care. That said, if I find an area I absolutely fall in love with, I may never want to leave.

Any thoughts? Does one pay better than the other? Are jobs more plentiful in one area than another? If so, why? What about career opportunities for advancement? Thanks for your help.

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Specializes in ICU, Research, Corrections.

Well, one big difference in the specialties is family involvement. In the OR you

will have little family interaction. In the ICU you will have a ton of family issues.

That is a reason right there to pick the OR.

It seems there is a bigger demand for OR nurses to me. There is a demand for

both EXPERIENCED OR and ICU nurses. It may be tough to make a specialty

change right now.

There is no difference for career advancement. That being said, I think the OR is

slightly easier on your body than working ICU.

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Specializes in ICU.

Having never worked in OR (I have observed several times) but with lots of ICU experience, I think you'll have more autonomy in the ICU. While the attending is in charge of the whole ship, you're next in command and pretty much get to do things your own way. The challenges are much more diverse ranging from helping the cardiologist float a new Swan catheter to helping the family place kids of a dying mother into suitable housing. OR is 'sterile' in more ways than one.

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Both are good choices to experience the variety in nursing. While you are the only one who can make the decision about what is right for you at this time, I will share my thoughts as I have worked in both the OR and the ICU.

PAY - I know of no hospital that pays differently in the two units. My hospital pays a differential for certification and there are certifications available for both the OR and the ICU. You need to have 2 years experience in the specialty to be eligible to sit for the certification exams. The differential at our hospital is the same for both.

The OR - Immensely satisfying for those who would like to work in an area that is well-organized and, for the most part, predictable. You will get to know the individual doctors and their preferences. You will come to know what supplies will be needed for each procedure and you can prepare ahead of time. You will become familiar with the procedures so when you "scrub" you can, with some degree of certainty, predict what they will need next. Some hospitals have the OR nurses perform Peri-Operative Nursing (taking you to the patients hospital room for Pre-Op and Post-Op assessments) but most utilize OR nurses for the OR itself (and the immediate Holding areas) so the Pre-Op and Post-Op assessments are immediate + 1 hour rather than + 24 hours. There is tremendous opportunity to learn how surgeons think as there is usually alot of talk in the OR and the relationship with the doctors is, for the most part very friendly and you experience really working together. In most surgeries the patient monitoring will be done by the Anesthesiologist so you have time for lots of learning and socializing with the team during the surgery. When the procedure is done under local or Moderate Sedation, the Circulating Nurse is usually responsible for patient monitoring. You are usually focused on one patient at a time, although there are times when you will circulate between rooms or cover a Holding Area. Working in the OR you will learn alot about human anatomy. The down side - the instrument trays are very heavy.

The ICU - You will need to take a Critical Care course to work in the ICU. Most hospitals will register you in the course when you are hired and it will become part of your orientation. The ICU is immensely satisfying for those who like a fast-paced critical care environment where something new and different is happening with every patient every day. The patient/staff ratio is better than in a Med/Surg unit because of the intensive need for patient monitoring and the need to respond to the various events that occur in a critital care area. In this area there is almost always a physician present, often quite a few so "calling the doctor" is not the issue it is on a Med/Surg floor. Working in the ICU you learn alot about human physiology. The down side - there is constant sensory input so it can be mentally as well as physically tiring although, over time, you do become very familiar with most of the things that happen so it becomes like a normal work day.

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Having never worked in OR (I have observed several times) but with lots of ICU experience, I think you'll have more autonomy in the ICU. While the attending is in charge of the whole ship, you're next in command and pretty much get to do things your own way. The challenges are much more diverse ranging from helping the cardiologist float a new Swan catheter to helping the family place kids of a dying mother into suitable housing. OR is 'sterile' in more ways than one.

The nature of the autonomy is different and the degree of autonomy in the ICU probably depends a great deal on your hospital. In my hospital, a teaching hospital, there is little opportunity to assist with procedures because there are so many intern/residents around who want to do it. It can sometimes be frustrating to even get to the patient to deliver care and the "autonomy" may be needed just to shoo them away. On the other hand, if you are observant and know your stuff you can often help the patient by making timely suggestions to the new docs (sometimes about meds and sometimes about psycho-social issues).

In the OR I experienced autonomy as a type of freedom in the work environment. You are the one who does the Pre-OP assessment and makes sure that the checklist is complete and that there is nothing amiss. You are the one who brings the patient into the room and talks to them as you settle them on the table. This is often a very important moment for the patient. There's really nothing to say about what procedure is being performed or how it is being performed and once the Anesthesiologist takes over they monitor all aspects of the patient's condition. The management of the OR suite can be challenging and it is the nurses responsibility to insure that all equipment and supplies are available and functional ahead of time. Seeing that the room is cleaned properly and quickly between procedures can require some tough management skills and a good relationship with staff.

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Thanks for the insights. It looks like I have a lot to think about.

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Specializes in Trauma Surgery, Nursing Management.

I work in the OR, and have worked both Med/Surg and PACU. While I loved the autonomy that I had as a PACU nurse, I was most drawn to the emphasis of technique in the OR. There are rigid guidelines that must be followed and so much to be aware of...from ensuring that the proper paperwork is completed (consent, H&P, lab work) to ensuring that the equipment/supplies/reps are in place, to holding the patient's hand during induction, to ensuring sterile technique is followed...the list is vast. You never have the same day twice, you are constantly learning new things, you get to SCRUB IN (my fave) and you get a free education as you listen to the surgeon explain the procedure to the resident. You oftentimes will have one on one time with the surgeons during closure, and this is when you can ask all the questions you want. If after induction I have questions regarding the specific drugs and gasses that were used, I can usually pose these questions to the anesthesia care provider and gain more knowledge about pharmacotherapeutics we use in the OR and their resulting physiological mechanisms.

I love the OR and cannot imagine doing anything else.

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The ICU can be great fun if you've got a good group of team plays and experienced nurses. It can get old quickly though. The intubating, the titrating, the transfusing 20-30 units of blood products everyday you work, and the families can all drain every ounce of your being.

If you want to learn LOTS about Resp, CV, and renal physiology and more than "Labetalol is a beta blocker" the ICU is the place you need to head to!

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Specializes in OR.

If you dont like working weekends or holidays then consider the OR!

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Specializes in Telemetry, Oncology, Progressive Care.

I would think that if you want to do OR that it would be a good idea to do ICU. At least that way you get experience with some of the additional monitoring that you don't see on the regular floors (i.e. intubated patients, invasive lines, etc.). I could be wrong, but, I would think it would be helpful. Plus, some ICUs do work as PACU during certain situations (not sure how common that is).

I've never done ICU or OR, but, this is just speculation on my part. Maybe an OR nurse can tell me if I'm wrong or not.

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Experience in the ICU is not particularly helpful in the OR. The nature of the nursing activities are worlds apart - ICU is focus patient monitoring at a high level while OR nursing involves very little patient monitoring. On the other hand, OR nursing can be very helpful in the ICU, actually a natural progression if you are in a Surgical ICU.

The comments about weekends and holidays are a valid point for someone who prefers a normal Monday-Friday schedule. You will, likely, need to do your share of coverage for weekends and holidays but it would be minimal coverage. You might also consider that most ICUs have 12-hour shifts so you maximize your time off without using vacation and personal time.

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OR vs. ICU update:

Yesterday was very busy. Had an interview at 0630 for an ICU position and then followed up with shadowing in the OR for a 4 hour Ortho surgery.

When I left the ICU interview, I was all excited and thought, "I'm going to love this job, and can't wait to get started on my CCRN!" Then... I went to the OR and thought, "Boy!, this is really fun!" Geez.....

I think I would like the automony the ICU can provide. (It's up to you to monitor your patient(s) and be aware of what systems are working well, and what is not, and adjust drips accordingly.) But.... I loved the teamwork I saw in the OR. Everybody together in a closed room working towards the same goal and each doing his/her part. I liked the pace (busy at times, slow at others). It seemed like the RN had to know so much.... where to get this, who to call, what forms to complete, answering doc's pages (a ton), charting screws and plates used (and wasted) during surgery....

I think my "heart" is with the OR, but my "head" is with the ICU.

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