What is the best way to win the battle for unit differentials?

NPinWCH · Oct 11, 2006

I'm not sure I understand why you want a differential for working in a specific unit. Each unit has it's own set of advanced skills, what is it that your dept. does that is different from say ER, OB, or even Med/Surg?

I work OB, my skill set is different from yours...there is no way I could hop right into ICU and competently run a code or pick up on those little clues that mean my pt is going south, but then neither would you be able to step onto my unit and easily interpret a fetal heart rate strip or competently handle a shoulder dystocia. We take care of different pts, we both know the basics of nursing, but we have each added specialty skills that differ.

At our hospital you get a differentials for adding to your knowledge base. All RNs must have BLS, some depts require additional skills such as ACLS, PALS, or NRP you get an additional $.15 for each qualification and $.30 if you become an instructor with a max of $.45. It isn't much, but it's something and anyone in any department is eligible even if their dept doesn't require that certification.

I agree with your manager...unless the differential would be applicable to the other depts it would most likely alienate yours.

Tweety, BSN, RN · Oct 11, 2006

It might work if there is a shortage of ICU nurses vs. other departments.

I can see your manager's concerns, espeically with other units that require critical care skills like PACU and ER.

Good luck, if you feel you deserve it, then no harm in trying.

ZASHAGALKA, RN · Oct 11, 2006

Unity.

I worked at a non-union for profit hospital. The non-union not for profit across town 'market-adjusted' their ICU to a 3-5 dollar/hr raise. When we requested equal treatment, we were told, "The highway runs both ways".

At that time, the hospital I worked at had 14 total ICU F/T nurses.

One fine thursday evening, the nurse recruiter of the other hospital called the nurse recruiter of OUR hospital to ask what they had done to alienate all their ICU staff. Why? 9/14 employees had applied for f/t employment at the other hospital.

Friday we were given a desperate email not to do ANYTHING until a tues meeting. At that tuesday meeting: 5 dollar ICU differential.

Bingo.

~faith,

Timothy.

NeedyourhelpRN · Oct 12, 2006

I don't know about your hospital, but if an OB pt in our hospital goes "South," she goes to ICU. I just get tired of Med Surg floors saying they "can't take the patient because they don't do that kind of dressing change," or "we don't take chest tubes on this floor. We have expertise in many areas, that is my point. We have to know how to take care of everyone (with the exception of kids) If people want a critical care unit differential then they can make the extra effort, study all the material, and work in a unit.

bagladyrn, RN · Oct 12, 2006

I don't know about your hospital, but if an OB pt in our hospital goes "South," she goes to ICU. I just get tired of Med Surg floors saying they "can't take the patient because they don't do that kind of dressing change," or "we don't take chest tubes on this floor. We have expertise in many areas, that is my point. We have to know how to take care of everyone (with the exception of kids) If people want a critical care unit differential then they can make the extra effort, study all the material, and work in a unit.

Reading this post, if this is the reasoning you are projecting at work, I can see where your manager may think this would alienate others. Try rereading it and substituting the word OB or ER for ICU and see how you would feel.

Most places I've worked (many in 10 yrs of traveling and 14 yrs. before that) OB pts. who "head south" are only transferred to ICU for those areas we don't manage (vents, etc). The OB nurse generally comes along to manage the OB related parts of her treatment.

As for Med Surg nurses - how many ICU nurses do you know who can manage care on 7-10 pts. at a time? I know as an OB nurse I certainly couldn't! As a previous poster said, we all have a skill set we have developed and all are equally valuable.

ZASHAGALKA, RN · Oct 12, 2006

As for Med Surg nurses - how many ICU nurses do you know who can manage care on 7-10 pts. at a time? I know as an OB nurse I certainly couldn't! As a previous poster said, we all have a skill set we have developed and all are equally valuable.

NOBODY in acute nursing should be managing 7-10 pts.

I've done it before, but I'm wiser now.

I disagree that all are equally 'valuable', from a staffing perspective. All are equally valuable skills, but the law of supply and demand doesn't look at the intrinsic value of a skill, but the relative rarity of its practitioners.

~faith,

Timothy.

caroladybelle, BSN, RN · Oct 12, 2006

I don't know about your hospital, but if an OB pt in our hospital goes "South," she goes to ICU. I just get tired of Med Surg floors saying they "can't take the patient because they don't do that kind of dressing change," or "we don't take chest tubes on this floor. We have expertise in many areas, that is my point. We have to know how to take care of everyone (with the exception of kids) If people want a critical care unit differential then they can make the extra effort, study all the material, and work in a unit.

Everyone is required to have skills in "diverse areas.

I personally don't like having to drag myself all over the hospital, because ICU/ER/OB nurses can't do chemo or in many cases, manage chemo, or access ports. But you know what, I do it. Of course that requires me to often be Oncology/chemo certified - something that requires a great deal of time, education, and CEUs. And I have to take my time out from caring for my 5-10 patients, with the diverse central lines, chest tubes, dressings to fungating (smelly) wounds, and verging on septic shock/RT failure patients (that the Onco doesn't want to move to the ICU and will do anything to keep from shifting to the ICU), to advise someone with two patients, and hang their chemo at the drop of a hat. And think that they should get paid more for their being in the ICU.

There are NO nurses these days that don't have specialized skills. And whether you like or not, medsurg requires special skills (different skills but special , none the less), and there is a major shortage in many areas of the Country of Med/Surg.

All nurses should be paid well, and have a workable ratio. You get fewer patients and that is a "perk" that MS nurses don't get. You don't think that you get paid "fairly" for ICU....maybe you should work a year or two on M/S and see how much "easier" it is.

If you want to argue that you get paid extra for education or certification, or being passed on special skills, that is quite legit.. But don't try the "divisive"...I'm better because I'm ICU and should get paid more. That merely divides nurses when we should be uniting them

rn/writer, RN · Oct 12, 2006

Many hospitals offer a differential for critical care areas.

llg, PhD, RN · Oct 12, 2006

My hospital has a differential (that includes the ICU's) NOT because the nurses in those areas are in any way "better," but because those positions have been historically hard to fill. When we instituted the differential, we made it clear that it was not because we thought those nurses were "smarter, better, or worked harder." We made it clear that it was a simply case of supply and demand.

At the same time, we instituted recruitment bonuses for those units and even a temporary transfer bonus for nurses who transferred into the "critical demand" units. That's what we called them -- "critical demand" units. That way, nurses on other units could get a piece of the action by recruiting a friend into one of those units.

Also, it was simultaneously announced that some of those bonuses would be taken away once the staffing stabilized and the "critical demand" for nurses in those areas was satisfied (though the basic differential has remained). We also simultaneously gave a small raise to everyone to ease the pain to the rest of the staff. By announcing a whole package of increased wages and bonuses for everyone, it softened the news that a few units were getting more than others -- and gave everyone a chance to earn something extra through the recruitment bonus.

llg

OC_An Khe · Oct 12, 2006

I have been in crtical care nursing for over a quarter of a century. I have nevner found differentials (based on being employed in a specific unit only) to be effective in the long run for retention or recruitment. Better to raise base compensation/benefits and provide adequate staffing ratios.

ZASHAGALKA, RN · Oct 12, 2006

I have been in crtical care nursing for over a quarter of a century. I have nevner found differentials (based on being employed in a specific unit only) to be effective in the long run for retention or recruitment. Better to raise base compensation/benefits and provide adequate staffing ratios.

It's not like Administrations are known for being smart when it comes to retaining nurses. But, as long as they are going to be penny wise and dollar foolish, I'm all for throwing those dollars my way. . .

If TPTB were truly wise, there would BE no shortage and we would all be making much less. But not only are they NOT that wise, it's endemic and epidemic that my salary must go up.

~faith,

Timothy.