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?

[amzyRN]

No, they shouldn't get paid more. ER nurses should get paid more (just kidding. I think in general nurses in all specialties deserve equal pay because all specialties are all hard in different ways. I have never done ICU nursing in an actual ICU but I've done floor and ER and ER is way more physical than the floors I've worked on and definitely requires more critical thinking because of the unpredictability and at times high acuity and volume. The inability to provide a safe environment at all times is stressful and draining, only to get a new patient (sometimes 2 or 3 at a time) with different problems requiring a whole new work up. New patient, new work up, running around trying to get it all done and get the patient out, oh no here comes that OD patient by ambulance got to get the room set up for intubation.

There are no lines yet, no tubes, no definitive diagnosis. In both floor and ICU those things are usually present: lines, tubes, meds stabilizing the patient already, working to maintail life, set ratio (in ICU anyway). Alot of ERs don't divert patients, but have to accomodate and if other units are full, the ER has to board patients and carry out the same duties other floors have to carry out, plus code patients and accomodate more patients who need their work ups done. I still don't think ER nurses should make more because the ICU and Floor nures do very valuable things even if it is not as physically taxing, the work is still invaluable.

[elkpark]

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".

But that same case can be made for nurses in any specialty. In any specialty, not everyone is suited for it or going to be good at it. Everything you wrote about your experience in MICU, the physicians respecting and seeking out your knowledge and opinions, your ability to anticipate needs and treatments, etc., applies to me in my specialty, and to plenty of other skilled, experienced nurses in their specialties. It's not about more "knowledge and skill," it's about different knowledge and skill.

[TicTok411]

TicTok411: Baloney! To be a good critical care nurse, it DOES require more knowledge and skill.

Skills can be taught and knowledge obtained by 90% of nursing graduates. You started as a newbie and had to learn the skills taught to you.

Obviously you're not one. You cannot make just anyone a good critical care nurse....it's not for everyone.

I was an ICU nurse for many years and taught critical care concepts.

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.

So on your days off what on earth do they do? They must call you at home for your valuable knowledge.

Our attending physicians ask for MY opinions and observations.

Did the patient poop? Can he eat? Is he passing gas? He is not asking you for treatment advise or if he should switch up antibiotic.

I can anticipate needs and treatments before orders are ever written.

So can a unit secretary

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".

​You can feed the patient, turn him, wipe up that poop. However, what is it you can do that does not require an order or is not specifically spelled our in a guideline or protocol? Nothing medical....

[Cowboyardee]

Skills can be taught and knowledge obtained by 90% of nursing graduates. You started as a newbie and had to learn the skills taught to you.

I was an ICU nurse for many years and taught critical care concepts.

So on your days off what on earth do they do? They must call you at home for your valuable knowledge.

Did the patient poop? Can he eat? Is he passing gas? He is not asking you for treatment advise or if he should switch up antibiotic.

So can a unit secretary

​You can feed the patient, turn him, wipe up that poop. However, what is it you can do that does not require an order or is not specifically spelled our in a guideline or protocol? Nothing medical....

Jeez, why is anyone 'liking' this? You really think bedside nurses employ no medical judgement of their own? This nonsense devalues everyone, not just ICU nurses.

Of course all hospitals are different, and your mileage may vary. Here is a typical day for me in my ICU:

I check assignments to make sure they're reasonable, huddle, get brief report on 15 or so patients from the night shift charge nurse, and then look after the sickest patients on our unit to make sure we haven't missed anything in the medical plan. I catch problems all the time doing this, from pressor orders that don't take into consideration the findings of the most recent echo, to sub-optimal ventilator settings per the most recent ABGs, to newly positive cultures or new sensitivity panels that have not yet been considered in the choice of antibiotics. I point these out to the bedside nurse (in case they haven't caught the same problems already) so that they can address them quickly and not wait until rounds.

I then take a quick look at the orders of all of our patients to fill out some audits and bookkeeping tools while simultaneously making sure that people who should have xrays, abgs, etc ordered do - and if they don't I have the bedside nurse get it ordered from a PA so it's ready by morning rounds. As the day continues, I give the intensivist an early heads up on how badly we need beds and my preliminary judgment on who are the best candidates for downgrade as well as the sickest patients so the intensivist can start rounding on them first. I am the first one called for advice when one of our nurses is having problems.

After the intensivist is done rounding and most orders go through a PA who is often not on the unit, I walk our less-experienced nurses through the relevant considerations in addressing any new medical issue to ensure that they give the PA solid information over the phone, which in turn helps ensure that the right intervention gets ordered, and I personally take it up with the PA or intensivist when the best intervention is not ordered. I make sure that patients are assigned to RNs with the patient's acuity and the RN's skill level in mind. I make sure that patients come and go from our ICU with an eye toward the overall acuity of our unit and of the patients waiting for beds, balanced against the needs of the facility. And then there's other stuff like running codes, stat teams, prepping the cath lab during STEMIs, making assignments, teaching procedures, bureaucratic duties, etc. Might have a patient of my own, depending on staffing.

The nurses under me... Well, the more experienced ones take the same kind of responsibility I do for their own patients, managing their plans of care, ensuring that the orders are correct and well justified, and helping less experienced nurses when they can. The newer and less experienced nurses, meanwhile, may not be independently monitoring the orders and overall plan of care for effectiveness, but are still prioritizing the needs of sick patients with multiple pathologies and judging which interventions to perform in which orders because neither the order sets nor the guidelines or protocols can effectively spell this out for complicated, sick patients. Hopefully, they do it right more often than not.

Meanwhile the med-surg nurses we eventually send our patients to prioritize the needs of 5-7 relatively sick and often demanding patients, and discern which assessment findings out of the hundreds of little checks they do throughout their day require further intervention or additional orders to address. Hopefully they get them right too. Like us (and even more so, in truth) they don't have a physician hovering over them to make their decisions for them, and their protocols do not cover the myriad of medical decisions they have to make in a day.

The point: You do ALL nurses a disservice by painting ICU nurses or anyone else in the field as a butt-wiper who doesn't make decisions or use judgment. IYou put your ignorance and arrogance on display. It's lame. Don't do it.

[JellyDonut]

Jeez, why is anyone 'liking' this? You really think bedside nurses employ no medical judgement of their own? This nonsense devalues everyone, not just ICU nurses.

Of course all hospitals are different, and your mileage may vary. Here is a typical day for me in my ICU:

I check assignments to make sure they're reasonable, huddle, get brief report on 15 or so patients from the night shift charge nurse, and then look after the sickest patients on our unit to make sure we haven't missed anything in the medical plan. I catch problems all the time doing this, from pressor orders that don't take into consideration the findings of the most recent echo, to sub-optimal ventilator settings per the most recent ABGs, to newly positive cultures or new sensitivity panels that have not yet been considered in the choice of antibiotics. I point these out to the bedside nurse (in case they haven't caught the same problems already) so that they can address them quickly and not wait until rounds.

I then take a quick look at the orders of all of our patients to fill out some audits and bookkeeping tools while simultaneously making sure that people who should have xrays, abgs, etc ordered do - and if they don't I have the bedside nurse get it ordered from a PA so it's ready by morning rounds. As the day continues, I give the intensivist an early heads up on how badly we need beds and my preliminary judgment on who are the best candidates for downgrade as well as the sickest patients so the intensivist can start rounding on them first. I am the first one called for advice when one of our nurses is having problems.

After the intensivist is done rounding and most orders go through a PA who is often not on the unit, I walk our less-experienced nurses through the relevant considerations in addressing any new medical issue to ensure that they give the PA solid information over the phone, which in turn helps ensure that the right intervention gets ordered, and I personally take it up with the PA or intensivist when the best intervention is not ordered. I make sure that patients are assigned to RNs with the patient's acuity and the RN's skill level in mind. I make sure that patients come and go from our ICU with an eye toward the overall acuity of our unit and of the patients waiting for beds, balanced against the needs of the facility. And then there's other stuff like running codes, stat teams, prepping the cath lab during STEMIs, making assignments, teaching procedures, bureaucratic duties, etc. Might have a patient of my own, depending on staffing.

The nurses under me... Well, the more experienced ones take the same kind of responsibility I do for their own patients, managing their plans of care, ensuring that the orders are correct and well justified, and helping less experienced nurses when they can. The newer and less experienced nurses, meanwhile, may not be independently monitoring the orders and overall plan of care for effectiveness, but are still prioritizing the needs of sick patients with multiple pathologies and judging which interventions to perform in which orders because neither the order sets nor the guidelines or protocols can effectively spell this out for complicated, sick patients. Hopefully, they do it right more often than not.

Meanwhile the med-surg nurses we eventually send our patients to prioritize the needs of 5-7 relatively sick and often demanding patients, and discern which assessment findings out of the hundreds of little checks they do throughout their day require further intervention or additional orders to address. Hopefully they get them right too. Like us (and even more so, in truth) they don't have a physician hovering over them to make their decisions for them, and their protocols do not cover the myriad of medical decisions they have to make in a day.

The point: You do ALL nurses a disservice by painting ICU nurses or anyone else in the field as a butt-wiper who doesn't make decisions or use judgment. IYou put your ignorance and arrogance on display. It's lame. Don't do it.

You may not like what I said, but it is just true. I was an ICU nurse for many years and started out where we did make decisions and start medications then informed the providers of what we did. That does not happen anymore. It is a role of checking boxes and asking permission. Don't believe me than ask a nurse who worked in the ICU 20 years ago....

[KeepinitrealCCRN]

i do a lot of the same as Cowboyardee mentioned. where i work we make a lot of decisions or recommendations. we always have a resident on the floor (usually 2nd year) and they are very overwhelmed. most of the nurses have more experience than the residents in the ICU and we end up making a lot of decisions especially in an emergency when the attending is not there yet. without having those critical thinking skills and knowledge we would not be able to do that and a lot of the times the residents will not know what to do or will say to do something which is not appropriate.

[Cowboyardee]

You may not like what I said, but it is just true. I was an ICU nurse for many years and started out where we did make decisions and start medications then informed the providers of what we did. That does not happen anymore. It is a role of checking boxes and asking permission. Don't believe me than ask a nurse who worked in the ICU 20 years ago....

I don't recall you making any comments in this thread. Or replying to them. Is your other screenname tictok411? Can't imagine why you'd have two...

Anyway, care to address any of what I actually wrote in the comment you quoted rather than just repeating the same tired insults? How much of what i wrote sounds like checking boxes to you? Or do you use the quote function in lieu of actually reading the comment you're quoting?

[brownbook]

I haven't read every thread.

I floated to every unit in a smaller county hospital. My home base was med/surg then ICU. We had vents, art lines, swan ganz, the usual variety of drips, etc. After about a year of ICU it all became very routine and easy. Never more than two patients, give me a break! I could NEVER function again on med/surg and care for 8 to how ever many patients, (I forget what the average staffing ratio was).

Anyway if any nurse deserves more pay it's L&D. What is more important than bringing a healthy baby into the world? I floated to L&D, it can be the busiest scariest place a nurse can work.