Should ICU get more pay than floor nursing?!?

[francoml]

Okay so I don't want to come off as rude or biased but I am pretty confused as to how my facility can pay medsurg nurses an extra $3/hr over what they pay me!

I know they work very hard but I work in a large level one ICU and I make critical life altering decisions on a daily bases. I have far more autonomy and with that comes more risk to my license. Don't get me wrong I LOVE my job and LOVE my facility but how can a nurse get paid more to pass meds on the floor than I do in the ICU. And before anyone makes any comments about the "just passing meds" remark, I have worked a few shifts on the floor and that is just about all I did was pass meds!

Is it like this on y'all's unit or is this specific to my facility?

[Julius Seizure]

If you want nursing to be treated well,...you need to accept that better training should result in better pay. As it stands now,...a nurse is a nurse is a nurse. Just quit that thinking!

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

To add to this, there are absolutely reasons that some nurses expertise and training in their field of specialty should warrant higher compensation. Certifications and degrees. Show that you are a leader in your field. Get your CCRN certification. For other specialties, get the certification that pertains to that specialty.

If you want to be worth more to your company, you have to go above and beyond.

[Julius Seizure]

Well,...sorry to say,....despite your inferiority complex,....ICU nurses are better. More skills, more experience, more ability. Please let the whining stop and give me evidence to the contrary......

What about new grads (like me) who started out in the ICU? They didn't have 'more experience'. Should they be paid more?

[purplegal]

What about new grads (like me) who started out in the ICU? They didn't have 'more experience'. Should they be paid more?

Maybe you don't have more experience, but your job requires a greater deal of knowledge and skills than most other areas of nursing. Critical care nursing is more stressful in that you must be able to apply all those knowledge and skills within extremely short amounts of time, whereas other nurses generally have more time when their patients start deteriorating. Expansive knowledge, complex nursing skills and the ability to act quickly in stressful situations...if that doesn't warrant more compensation, I don't know what does.

[TicTok411]

Critical care does not require way more knowledge or skill. Heck, there are associate degree nurses working in these units. The nerve of these task master nurses thinking they have actual skill is beyond funny. Hospitals can plug in any med-surg nurse and in 12 weeks she will be an "expert". Plus nurses do not make decisions - they follow orders, check boxes and call a provider when told to. Wait is cleaning poo a specialized skill? Get real! If you gain a real degree or attain a certification then sure maybe a dollar more an hour otherwise get over yourself....

[Cowboyardee]

Here's something of a philosophical answer. Hope you'll forgive my meanderings.

Right off the bat, I don't really have an opinion as to whether ICU nurses should make more than med-surg nurses. That's for the market to figure out. If there aren't enough ICU nurses, or if hospitals want to make that particular specialty more competitive among applicants, then rates need to go up. If not, I guess not. ICU RNs are already a bit more marketable when applying for jobs or advanced schooling, and perhaps that's compensation enough. In my case, I like ICU work just because I think it is more interesting than med surg, having worked both.

To me, it's the underlying question that is more interesting: should ICU nurses be considered more valuable and more prestigious than med-surg nurses. I'm of two minds on the matter.

I'll admit I take a certain pride in working in intensive care, and even more in being good at it. And for the most part, I think that's a good thing. It serves a real purpose. There are often times where I'm assigning a patient to a nurse who has already had a busy day and isn't much in the mood for a heavier workload, and the nurse wants to know why the med-surg floor or the ED can't just solve some of their own problems and hold the patient a little longer rather than dumping on us. And often the best answer I can come up with at the time is this: we are the hospital's last line of defense, the unit that is expected to solve whatever problems come our way whatever they are. The nurse SHOULD take some pride in that. Taking some pride in what you do is often one of the best motivators there is to do good work, to keep working in less than ideal conditions, and to keep coming back and actually even enjoying your career. Taking pride in the nature of your work is a good thing.

Then of course there's the other side: looking down on others for the nature of their work is not a good thing. Taking pride in working intensive care doesn't have to mean that med-surg RNs are to be scorned or derided, even if you feel as though you have a stronger skill set. One of my biggest problems with American culture in general is that we attach way too much value to what you do and not anywhere near enough value to how you do it. A doctor or a lawyer or a politician or an engineer are impressive and valuable by default, no matter whether they do a half decent job of their work; meanwhile, a teacher, a nurse, a waiter, a CNA - all less valuable by default, regardless of the quality of their work.

The fact of the matter is that a great nurse is hugely valuable to all who come into contact with her, while a terrible doctor is a drain on and danger to most of the people he comes across. So it goes with just about any other distinctions between classes and skillsets you want to investigate. Are ICU nurses better than med-surg nurses? Who cares. A good ICU nurse is a great thing, and so is a good med-surg nurse. If you think the prestige of some job and ability to look down on others for holding 'lesser' jobs is what's important, you are living a hollow life, in my not so humble opinion. You are a fool, educated or not.

Take some pride in what you do, do it well, and give respect to others who are good at what they do, regardless of its prestige or lack thereof.

Critical care does not require way more knowledge or skill. Heck, there are associate degree nurses working in these units. The nerve of these task master nurses thinking they have actual skill is beyond funny. Hospitals can plug in any med-surg nurse and in 12 weeks she will be an "expert". Plus nurses do not make decisions - they follow orders, check boxes and call a provider when told to. Wait is cleaning poo a specialized skill? Get real! If you gain a real degree or attain a certification then sure maybe a dollar more an hour otherwise get over yourself....

Exhibit A

[William2]

Critical care does not require way more knowledge or skill. Heck, there are associate degree nurses working in these units. The nerve of these task master nurses thinking they have actual skill is beyond funny. Hospitals can plug in any med-surg nurse and in 12 weeks she will be an "expert". Plus nurses do not make decisions - they follow orders, check boxes and call a provider when told to. Wait is cleaning poo a specialized skill? Get real! If you gain a real degree or attain a certification then sure maybe a dollar more an hour otherwise get over yourself....

ADN and BSN has nothing to do with skill or knowledge and ICU. You learn from the same material. What you retain is your own. BSN may spend more time on it than ADN school, but the end result is both are nurses capable of working ICU if they so choose. The secondary learning starts day one of that job and continues and accumulates through experience. The nurses with 35 years experience of critical care are experts in their field more so than a doc that has been there 5. This is evident in my place of work. How ignorant. Any nurse follows orders and checks boxes its part of the job done anywhere. Until you work ICU will you EVER understand.

Now you are just being a troll. Why are you even here?

[francoml, ASN, RN]

holy crap I started this thread years ago and people are still debating it... Kinda proud lol.

After years of experience I now believe that all acute care nurses (MS, ICU, ER, ect.) should start off getting paid the same. The caveat to that is we should be substantially compensated for the training and certifications we get. If I pass my CCRN that should be a few dollars extra, if I completed hours upon hours of specialty training in critical care competency I should be paid more. Learn to place PICC lines more pay, CRRT, therapeutic hypothermia, LVADS, ECMO more pay. ACLS, PALS, NRP, TNCC more pay.

Currently I have all of these certifications/training and with exception of my CCRN (+$1/hr) I am not compensated for any of these skills. Funny thing is the MS nurse with the same years at the hospital still gets +$3/hr more than me in differential pay for simply being a MS nurse.

I am all about MS being a difficult area, I have picked up there multiple times. They should be compensated if they get their specialty certs as well. THE THING IS... in no way should a MS nurse (or any nurse for that matter) get paid more than me with the same years at the facility with FAR LESS training, certifications, and liability.

Although its kinda of a moot point now because I am in ACNP school and will get a substantial pay raise when I finish :)

[MunoRN, RN]

It's supply and demand, night shift nurses don't get paid more because they are superior nurses, it's because extra pay is required to offset the fact that nurses don't generally like to work nights. The same is true for ICU vs floor nursing. I wouldn't willingly work on the floor for the same pay as I get as an ICU nurse, in fact I wouldn't switch to the floor for more money, at least not until you got into the range of $5 or more an hour increase.

[nursemaryck]

Ok so I've been on both sides....a PCT on a med/surg unit - alone with 36 beds; ICU nurse out of school, and I pick up time both in the ED and floors.

For starters, I don't care who you are, if you get floated anywhere, half of the trouble is you don't know where stuff is or that unit's specific procedures! If you had that down, anyone would feel more comfortable.

Secondly, I agree that a certain level of pay should be based on years of service/experience....however, an ICU nurse can float to a floor and operate (maybe like a fish out of water but he/she can do it as he/she had the knowledge base to do so) but a floor nurse cannot go to an ICU and function appropriately. Yes, I know floor nurses work hard with the crazy patient loads that hospital administrators think you should be able to handle and i applause you all for hanging in there and doing it! What you don't know is that while hospital administrators think you should be able to handle 4-8 patients a piece, they also think that ICU nurses should be able to take three critical patients with more and more machinery every day!

When I started in the MICU 10 years ago, we had titratable drips, vents, and the occasional balloon pump (which was supposed to be 1:1, yeah right) now we have more drips, IABP, impella, CRRT, LVADs and now we are learning ECMO! our patients are getting harder and more specialized. Therefore, I think base pay should be based on years of experience and hospital employment, but then, like a clinical advancement system, I think that for each specialized treatment one knows how to give, they should get paid more. There is no way all of the nurses in my ICU should be jumping ship for departments that care for 3-4 observation patients that are walkie-talkies, not have to work weekends, holidays, nights, AND get paid the same amount that I do while taking care of two critical care patients, being charge in the ICU, and the Early Nurse Intervention Team nurse to the whole hospital! We are currently in a mass exodus because our hospital doesn't see the experienced ICU nurses as valuable...they see a nurse is a nurse is a nurse. Why wouldn't someone want to go for an easier job and get paid the same. in fact, today we lost a nurse with 10 years critical care experience, 5 in our unit, to an outpatient surgical center, no nights/weekends/holidays....STARTING OUT at $4 more an hour than she makes in our ICU!!!!

If hospitals plan on keeping experienced ICU nurses, they are gonna have to start valuing their knowledge, skill, and hard work. Otherwise, god bless any ICU patients who get admitted to an ICU with an average experience of a nurse being 1 year! A nurse is not just a nurse, is not any nurse....

[nursemaryck]

TicTok411: Baloney! To be a good critical care nurse, it DOES require more knowledge and skill. Obviously you're not one. You cannot make just anyone a good critical care nurse....it's not for everyone. And I work in an MICU where we have resident MDs who look to me for my knowledge and skill to help guide them in their first and second years. Our attending physicians ask for MY opinions and observations. I can anticipate needs and treatments before orders are ever written. I am a damn good ICU nurse and it's not because I can "follow orders, check boxes, and call a provider when told to".

[KeepinitrealCCRN]

i agree that ICU requires more knowledge or maybe different knowledge. throw me on an oncology floor and i wouldn't have a clue whats going on. every type of nursing requires different skills and knowledge but i don't think any specialty should be paid more than another; pay should be based on years of experience and education/certs. i work in ICU because i enjoy it, find it challenging and learn new things all the time. i would not want to work at an "easier" job that is m-f 9-5 even if they paid me more.

[KeepinitrealCCRN]

i agree that ICU requires more knowledge or maybe different knowledge. throw me on an oncology floor and i wouldn't have a clue whats going on. every type of nursing requires different skills and knowledge but i don't think any specialty should be paid more than another; pay should be based on years of experience and education/certs. i work in ICU because i enjoy it, find it challenging and learn new things all the time. i would not want to work at an "easier" job that is m-f 9-5 even if they paid me more.