Should ICU get more pay than floor nursing?!?

Harveyslake · Oct 9, 2016

Sigh,........you just cannot teach someone the answer if they don't even understand the question. Yes,...all nurses have skills and are necessary. By not recognizing the greater depth and breadth of skills more highly trained and experienced nurses possess, you cheapen the whole profession by buying into the administrative dogma that a nurse is a nurse is a nurse when in fact not all nurses are created equal. Critical care nurse have more ability. Period. To take care of a much wider and diverse type of patient population. A floor nurse simply does not. The fact that floor nurses have more patients to take care of is a moot point. It is meaningless. By that logic, the CNA's should be paid more than anyone because they are responsible for more patients than the RN. Sheesh! By making the argument that ICU nurses only have 2 patients and a floor nurse has 8 totally demonstrates a complete lack of understanding of what taking care of a real ICU patient entails. I give more meds to my 2 patients in a shift than a floor nurse give to their 8. If my pressor IV bag runs dry, my patient dies, almost immediately. That doesn't happen on the floor if your normal saline running at 75 ml/HR runs dry. Come walk in my shoes and see if your opinion changes?

Susie2310 · Oct 9, 2016

Sigh,........you just cannot teach someone the answer if they don't even understand the question. Yes,...all nurses have skills and are necessary. By not recognizing the greater depth and breadth of skills more highly trained and experienced nurses possess, you cheapen the whole profession by buying into the administrative dogma that a nurse is a nurse is a nurse when in fact not all nurses are created equal. Critical care nurse have more ability. Period. To take care of a much wider and diverse type of patient population. A floor nurse simply does not. The fact that floor nurses have more patients to take care of is a moot point. It is meaningless. By that logic, the CNA's should be paid more than anyone because they are responsible for more patients than the RN. Sheesh! By making the argument that ICU nurses only have 2 patients and a floor nurse has 8 totally demonstrates a complete lack of understanding of what taking care of a real ICU patient entails. I give more meds to my 2 patients in a shift than a floor nurse give to their 8. If my pressor IV bag runs dry, my patient dies, almost immediately. That doesn't happen on the floor if your normal saline running at 75 ml/HR runs dry. Come walk in my shoes and see if your opinion changes?

Do you know how sick patients on med-surg often are today? Nurses on med-surg don't just have stable patients, at least not in my area. I posted on another thread that my relative with severe sepsis received care on a med-surg unit, not an ICU, and they were febrile, hypotensive, tachycardic, tachypneic, in acute renal failure, with other symptoms specific to the source of infection. And they weren't on a monitor. And there weren't enough nurses or aides, so I helped as much as I could. Try taking a full load of patients on med-surg with ICU level patients without ICU patient ratios and without monitoring devices.

Harveyslake · Oct 9, 2016

Do you know how sick patients on med-surg often are today? Nurses on med-surg don't just have stable patients, at least not in my area. I posted on another thread that my relative with severe sepsis received care on a med-surg unit, not an ICU, and they were febrile, hypotensive, tachycardic, tachypneic, in acute renal failure, with other symptoms specific to the source of infection. And they weren't on a monitor. And there weren't enough nurses or aides, so I helped as much as I could. Try taking a full load of patients on med-surg with ICU level patients without ICU patient ratios and without monitoring devices.

Im sorry for your relatives Illness. However, they were not, from your post, requiring anything that amounts to the need for ICU level care. Hats off to the M/S nurses, however! Why wasn't an RRT called if they were so unstable? That's my main question.

Harveyslake · Oct 9, 2016

For what it's worth,...on several occasions in my trauma/neuro ICU I had a patient that was not a 1:1 patient, or a 2:1 patient but a 3:1 patient. That is, 3 nurses assigned to one patient. They were so sick/injured and deteriorating so quickly that even 3 nurses had difficulty keeping up with what was happening to 1 patient. We all ran out butts off for 12 straight hours, without a break. Coding hourly, blood products like you've never seen before, electrolyte replacements, bedside surgery. More coding. Placing ICP monitoring continuous cardiac output monitoring, CRRT. paralytics, vent with nitric oxide, every pressor known and then some. The patient survived. I slept for 18 straight hours when I got home. We all got paid the same that a floor nurse earns. What's wrong with this picture??? The Docs took us all out for a very nice dinner as a thank you for saving THEIR patient. I guess that make up for everything.

Susie2310 · Oct 10, 2016

Im sorry for your relatives Illness. However, they were not, from your post, requiring anything that amounts to the need for ICU level care.

I grant you that I didn't post any information such as age, co-morbidities, medical history, labs, other current symptoms, and assessment information. The purpose of my post was to make the point that my family member required an intensity of nursing care that the med-surg unit was not staffed to provide, a situation that is not unique on med-surg units. Whether you consider my family member should have been in the ICU or not is not important to me. You are insistent that ICU nurses perform at a higher level than med-surg nurses; I am telling you that med-surg nurses deal with very sick, unstable patients too; and these nurses have to have very good assessment skills as they don't have the benefit of all the monitoring equipment of the ICU, and they don't have the much more favorable patient ratios of the ICU.

Harveyslake · Oct 10, 2016

I grant you that I didn't post any information such as age, co-morbidities, medical history, labs, other current symptoms, and assessment information. The purpose of my post was to make the point that my family member required an intensity of nursing care that the med-surg unit was not staffed to provide, a situation that is not unique on med-surg units. Whether you consider my family member should have been in the ICU or not is not important to me. You are insistent that ICU nurses perform at a higher level than med-surg nurses; I am telling you that med-surg nurses deal with very sick, unstable patients too; and these nurses have to have very good assessment skills as they don't have the benefit of all the monitoring equipment of the ICU, and they don't have the much more favorable patient ratios of the ICU.[/quote
Kudos to the M/S nurses taking care of unstable patients without monitoring equipment. In my hospital the M/S nurses call an RRT if the patient hiccups or farts. "I need a Unit bed, STAT!" is what I hear.

Here.I.Stand, BSN, RN · Oct 14, 2016

Yes,...all nurses have skills and are necessary. By not recognizing the greater depth and breadth of skills more highly trained and experienced nurses possess, you cheapen the whole profession

By recognizing that L&D nurses have greater breadth and depth of knowledge and more highly trained on the birthing process than an ICU nurses are? Birth can result in DIC, emboli (amniotic fluid), and hemorrhage for the woman; and brain injuries (probably more anoxic, sometimes traumatic) for the newborn. Complications that can happen with...trauma?

By recognizing that psych nurses have greater breadth and depth of knowledge and are more highly trained about mental illness than ICU nurses are? Unmanaged mental illness can cause death, in the form of suicide or homicide. Said death is just slower than death by trauma.

By recognizing that public health nurses have greater breadth and depth of knowledge and are more highly trained in nursing on a community and systems level and in epidemiology than ICU nurses are? How many deaths do those nurses help prevent, by way of community outreach and education, way before they would come to us?

By recognizing that LTC and clinic nurses have greater breadth and depth of knowledge and are more highly trained on the management of chronic diseases than ICU nurses are? Chronic illnesses take WAY more lives in this country than accidents do (per the CDC).

I am not arguing that a nurse is a nurse is a nurse. To the contrary I am arguing that each specialty has different areas of expertise and training-- and that critical care is not on a special level of importance.

I say that as an experienced ICU RN, and if my opinion cheapens our profession in the minds of some...I am comfortable with that.

BrandonLPN, LPN · Oct 15, 2016

Kudos to the M/S nurses taking care of unstable patients without monitoring equipment. In my hospital the M/S nurses call an RRT if the patient hiccups or farts. "I need a Unit bed, STAT!" is what I hear.

Comments like this aren't exactly bolstering your argument that ICU nurses are more educated and professional than floor nurses....

Here.I.Stand, BSN, RN · Oct 15, 2016

Kudos to the M/S nurses taking care of unstable patients without monitoring equipment. In my hospital the M/S nurses call an RRT if the patient hiccups or farts. "I need a Unit bed, STAT!" is what I hear
Comments like this aren't exactly bolstering your argument that ICU nurses are more educated and professional than floor nurses....

Right...not cool to mock colleagues for using an evidence-based intervention.

On the flip side, I have received pts from the floor after a RR, who should have had a code called. We make judgment calls, and I would rather see someone err on the side of caution.

Harveyslake · Oct 23, 2016

So,....if every new graduate is told to get a good foundation on a Med/Surg floor, does that not indicate that Med/Surg nursing is where neophytes belong? It is the entry level position for nursing. How in all things holy can you defend a newbie being paid the same as an experienced critical care nurse? It happens all the time, unfortunately because "they who are not us" want a nurse is a nurse, is a nurse mantra to prevail. Stop selling yourselves short. Recognize that specialty training should result in specialty pay. This is rarely the case.

Editorial Team / Admin · Oct 23, 2016

So,....if every new graduate is told to get a good foundation on a Med/Surg floor, does that not indicate that Med/Surg nursing is where neophytes belong? It is the entry level position for nursing. How in all things holy can you defend a newbie being paid the same as an experienced critical care nurse? It happens all the time, unfortunately because "they who are not us" want a nurse is a nurse, is a nurse mantra to prevail. Stop selling yourselves short. Recognize that specialty training should result in specialty pay. This is rarely the case.

No one has said that at all. You're reading words that aren't there. What is being said is that every nurse works in a specialty; why should any specialty be deemed "better" and thus "more deserving" than others?

The requirement of med/surg for new nurses has long gone by the wayside. Many new grads are accepted into positions in all fields of nursing; therefore, med/surg is no longer where "neophytes" belong.

Harveyslake · Oct 23, 2016

Sigh,.......