Should nurses get paid according to specialty?

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Specializes in Critical Care.

Physicians are paid differently according to their speciality. We know that specialities such as cardiology and neurology can make considerably more than others.

So why do we pay all nurses the same?

Should ICU nurses titrating vasoactive drips, performing conscious sedation for GI procedures, stabilizing traumas, running IABPs, ECMOs, and recovering fresh hearts make more for the amount of autonomy and risk they face?

I am not siding with one side or the other.

YOU tell me what you think.

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Good Lord, no. There are aspects of every facet of nursing that are challenging in their own right, and worthy of appropriate compensation, regardless of perceived skill level/lack thereof. Also, as I always tell my patients when they are apologizing profusely for "making a mess" or for me "having to see/touch/smell that," I signed up for my job and my specialty of choice voluntarily. No one forced me. About the only case that I could see being made for extra compensation being paid for specialty would be trauma/flight nursing, because of the extra risk involved and the highly specialized level of care. However, again, they chose that line of work, and no one forced them either.

I could never be a school nurse or a PICU nurse or a camp nurse or an ER nurse or work in LTC. God bless them all, because I would surely shrivel up and die in those specialties. Many nurses feel the same about my area of specialty.

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You get "paid" more in ICU by having 1-2 patients instead of 7-8. :up:

I do think nurses with experience in everything (or complicated things) can often negotiate a better pay rate, but it doesn't make sense to me to break it down by specialty. And even "hard" specialties have "easy" days. Would anyone be OK with being paid less on the days when they have a lighter assignment? I wouldn't.

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Specializes in Critical Care.
You get "paid" more in ICU by having 1-2 patients instead of 7-8. :up:

I do think nurses with experience in everything (or complicated things) can often negotiate a better pay rate, but it doesn't make sense to me to break it down by specialty. And even "hard" specialties have "easy" days. Would anyone be OK with being paid less on the days when they have a lighter assignment? I wouldn't.

If you believe that two patients "only" is a lighter assignment then you are far removed from the reality of critical care. These two patients require extra time and attention. I cannot articulate in words how extremely time consuming two ICU patients can be.

It is a fine attention to detail. Drawing labs every 1 to 2 hours, and continuously replacing or adjusting fluid and electrolytes. Titrating your vasoactive drips every 5 to 10 to 30 minutes and vital signs accordingly documented. Hourly titrations of of ventilator settings. Sometimes one nurse is not enough, sometimes it takes 2 or 3 other nurses to step in and keep the patients afloat. Sometimes 1 patient is so time consuming that the charge has to take over meds/tasks of the second patient (however you must assess them).

So just imagine all these hourly or even half-hourly adjustments and multiply them by two. Times that by all the typical things such as routine meds, every 2 hour turns, bed baths, explosive code browns, code blues the unit may experience.

You MAY want to rethink your thoughts on two patients.

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Specializes in Critical Care.
Good Lord, no. There are aspects of every facet of nursing that are challenging in their own right, and worthy of appropriate compensation, regardless of perceived skill level/lack thereof. Also, as I always tell my patients when they are apologizing profusely for "making a mess" or for me "having to see/touch/smell that," I signed up for my job and my specialty of choice voluntarily. No one forced me. About the only case that I could see being made for extra compensation being paid for specialty would be trauma/flight nursing, because of the extra risk involved and the highly specialized level of care. However, again, they chose that line of work, and no one forced them either.

I could never be a school nurse or a PICU nurse or a camp nurse or an ER nurse or work in LTC. God bless them all, because I would surely shrivel up and die in those specialties. Many nurses feel the same about my area of specialty.

EVERYONE chooses their path voluntarily. Some doctors do cardio, others pulm, others choose surgery. Nurses that choose other specialties should also be compensated accordingly.

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Specializes in Oncology.

We have a $2.50/HR critical care differential for our ICU nurses and a $2/hr differential for our step down unit nurses. I think it's ridiculous. Our ICU nurses are highly trained and experts at what they do, but every unit in my hospital is specialized in some way and has highly trained nurses who are experts in what they do. Our ICU nurses work hard taking care of 1 or 2 patients, but other nurses are working hard taking care of 4 or 5 times as many patients.

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Specializes in Critical Care.
We have a $2.50/HR critical care differential for our ICU nurses and a $2/hr differential for our step down unit nurses. I think it's ridiculous. Our ICU nurses are highly trained and experts at what they do, but every unit in my hospital is specialized in some way and has highly trained nurses who are experts in what they do. Our ICU nurses work hard taking care of 1 or 2 patients, but other nurses are working hard taking care of 4 or 5 times as many patients.

It goes beyond hard work. Nursing needs to stop focusing on this thing called "hard work". Because all I can imagine is someone whom is physically overworked. More tasks and physical work aren't necessarily reasons for compensation.

ICU nurses have specialized training. ICU nurses can get floated to a medsurg unit and manage. Although they may feel overwhelmed by tasks, after tasks... NOTHING on a medsurg unit is above the level of competency of an ICU nurse.

A medical surgical nurse cannot manage STEMI/CABG/IABP/ECMO/Transplant/Organ donors/CRRT/Impella/LVAD... these things take education, training, and extra liability and SHOULD result in extra pay.

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Come to my front porch and I'll show you what you can't do.

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Specializes in Critical Care.
Come to my front porch and I'll show you what you can't do.

Libby, this is an open discussion. Care to elaborate? I'm genuinely interested.

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Step down off the pedestal. ICU nurses should not be paid more.

Medical floors can be just as stressful with less support than the ICU caters to.

Physicians pay scales are structured differently than RN's. Look into how physicians are reimbursed; HR often dominates RN wages with little wiggle room.

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Specializes in Critical Care.
Step down off the pedestal. ICU nurses should not be paid more.

Medical floors can be just as stressful with less support than the ICU caters to.

Physicians pay scales are structured differently than RN's. Look into how physicians are reimbursed; HR often dominates RN wages with little wiggle room.

ICUman, I'm not on a pedestal.

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I am not siding with one side or the other.

Then why are you being argumentative and nasty with every person in this thread? You obviously think you deserve to be paid more than other nurses. Your ICU training does no good on a labor & delivery unit; they are specialized and take on responsibilities just like you. The same can be said about nearly every aspect of nursing. If you want to be paid more for your choices you should CHOOSE a different profession.

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