ICU vs Med-Surg Nursing: Which One Should You Pick?

a med-surg room and an ICU room
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Are you just graduating from nursing school, or looking for a new focus for your career?

You should know that medical-surgical nursing, and ICU nursing both offer a rich variety of opportunities and options for giving back to those around you.

So if you’re deciding between ICU vs med-surg nursing, consider the following differences as you make this important choice.

*Disclosure: This article on ICU vs med surg nursing may contain affiliate links. If you click and make a purchase, I may receive a commission. For more info, please see my disclaimer.

What is Medical-Surgical Nursing?

Medical-Surgical nursing (med-surg nursing) also referred to as floor nursing is a nursing specialty that deals with patients with a wide range of illnesses and disorders. These patients could be dealing with either acute or chronic conditions.

What is Intensive Care Unit Nursing?

ICU nursing or critical care nursing is a nursing specialty that focuses on patients who are critically ill. This could be either because of a severe illness or trauma. It could also be because of surgical or procedural intervention.

Medical-Surgical Nursing vs Critical Care Nursing

Now that we’ve laid a little bit of the groundwork of what each specialty is, let’s start comparing the two.

Job Duty Differences and Similarities

While all nurses have certain similarities in what they do each day, each specialty has job duties that are specific to it.

For example, both med-surg nurses and intensive care unit, or ICU, nurses will perform the following duties during each shift:

  • Monitor patient vital signs
  • Complete regular patient assessments
  • Provide medications, oxygen, and other therapies
  • Communicate with doctors and the patient’s family members
  • Delegate care to certified nursing assistants
  • Admit new patients
  • Provide patient education

However, because patients in the intensive care unit or critical care unit are typically sicker and often in far less stable condition than are those on the med-surg floor, nurses in the ICU must perform more frequent assessments and therapies.

They also frequently admit patients from the ER or from the floor but rarely discharge patients home.

Apply to ICU or Med-Surg Nursing Jobs

If you know which nursing job you want, you can start applying to those jobs in your area on our nursing job board.

Another key job duty of the ICU nurse is the management of unstable conditions using specialty therapies, equipment, and medications.

Intravenous medications are frequently used on this unit and must be regularly titrated to maintain appropriate vital signs.

Nurses in both specialty areas are required to look closely at physicians’ orders, ensuring that lab work, procedures and medications are used as prescribed.

This will also require the nurse to work closely with other health care professionals, including respiratory therapists and social workers, to create patient-centric care plans.

In addition, med-surg and ICU nurses also care for the patient’s overall needs, which could include feeding, grooming and bathing.

In both departments, certified nursing assistants are also available to help with these needs, and the registered nurse will delegate tasks as appropriate.

Daily Work Flow

The med-surg nurse usually sees far more patients coming and going over a typical shift than the ICU nurse does.

Patients are frequently admitted to the floor, and some may only stay for a few hours or overnight before being discharged. Some nurses admit and discharge multiple patients during every shift.

On the other hand, ICU nurses often care for the same patients for multiple days.

According to one study of over 30,000 patients, the average length of stay in the ICU was over three days. However, some patients may stay for weeks or even months if they’re in very critical condition or have serious disease processes.

Besides the obvious difference in patient turnover, nurses may also see differences in the pace of their work between different units.

While the med-surg nurse must juggle less acute concerns for multiple patients, the ICU nurse usually juggles far more serious issues for only one or two patients at a time.

Because of the high number of patients on the med-surg floor, the nurse here must usually spend a larger amount of time than the ICU nurse does in educating patients and family members and answering their questions. This is especially important at discharge.

On the other hand, the ICU nurse usually spends more time talking with doctors and relaying concerns about the patient as well as his overall health status.

The nurse in this unit must be able to work quickly and in stressful circumstances while responding immediately to clues that the patient is deteriorating.

Both nurses spend much time charting during every shift. ➜Related Article: Tips on Improving Your Charting

The ICU nurse must chart assessments every four hours and vital signs every hour or more.

The med-surg nurse usually only performs complete assessments every eight hours but must chart on half a dozen or more patients at a time.

Work shifts range from 8 to 12 hours for both types of nurses, but ICU nurses are more apt to work 12-hour shifts to provide greater continuity of care.

In addition, many nurses often switch between day, evening, and night shifts on a rotating.

Types of Patients

A medical-surgical nurse can see all types of patients depending on the floor on which she works, and she may care for patients with all types of diagnoses over the course of her shift.

Some of the health concerns most frequently seen on these floors include the following:

  • Pneumonia
  • Diabetes
  • Congestive heart failure
  • Sepsis or infection
  • Renal failure
  • Joint replacement
  • Bowel obstruction
  • Dehydration
  • Urinary tract infection

Patients on a med-surg floor certainly require much hands-on care, but they’re usually far more stable than are the patients found in the ICU.

Although some of the same disease processes may be at work, ICU patients may also have some of the following attributes.

  • Unresolved pain
  • Unresolved bleeding
  • Uncontrolled high blood pressure
  • Uncontrolled hyperglycemia or hypoglycemia
  • Recent myocardial infarction
  • Stroke
  • Traumatic brain injury
  • Physical trauma from serious injuries
  • Severe respiratory issues
  • Organ failure
  • Post-open heart surgery

Patient Ratios

Because the patients in the intensive care unit are in such critical condition and are not yet stable, nurses must be at the bedside frequently and will find that they have quite a bit of charting for each patient.

Therefore, the ICU nurse usually has no more than two patients.

In some instances, the ICU nurse may have only one patient or may be teamed up with another registered nurse to care for a single patient together.

This is usually the case for incredibly unstable patients or for those attached to numerous types of high-intensity equipment.

On the other hand, the med-surg nurse will have a higher nurse-to-patient ratio. On a progressive care floor or step-down unit, the nurse may only have four patients at a time.

However, the majority of floor nurses have from 5 to 11 patients during a shift. Nurse-to-patient ratios often go up at nighttime when med-surg patients require less hands-on care.

Work Intensity

Because of the instability of patient health in the intensive care unit, this nursing specialty can often feel stressful.

Nurses must organize their time expertly to find enough minutes to assess patients, deal with equipment, speak with doctors, and order medications from the pharmacy.

In addition, ICU nurses are usually allowed to work a bit more independently than med-surg nurses do.

While this autonomy can be a great experience, it does leave these nurses feeling that much of the patient care and in-the-minute decisions fall on their shoulders.

In hospitals where ICUs are broken up into different sections, you may find that certain areas are a bit lower in intensity. High-acuity ICUs will see the sickest patients, and nurses will be on their feet most of their shifts.

Of course, work on a med-surg floor is still intense simply because of the high number of patients there.

Nurses must have amazing time management skills to juggle well over half a dozen patients at a time while also charting and delegating tasks to certified nursing assistants.

Although nurses here must occasionally manage codes, high stress is usually intermittent rather than constant.

Equipment Differences

Med-surg nurses must know how to operate the following equipment quickly and accurately.

While ICU nurses will frequently see all of this equipment, they must also know how to use the most intricate and newest equipment available.

In fact, these nurses frequently earn continuing education credits for taking educational classes on specialty equipment, such as the following:

  • Renal dialysis machines
  • Aortic balloon pumps
  • Arterial lines
  • Bedside monitors
  • Temporary pacing wires
  • Ventilators
  • Electrocardiogram machines
  • Intracranial pressure monitor
  • Nasogastric tubes
  • Shunts
  • Chest tubes

Apply to ICU or Med-Surg Nursing Jobs

If you know which nursing job you want, you can start applying to those jobs in your area on our nursing job board.

Specialties

Both med-surg and ICU nurses can further specialize in their fields.

They may choose to take continuing education to earn certificates, such as the Certified Medical-Surgical Registered Nurse (CMSRN) credential or the Critical Care Nurse (CCRN) certification.

Med-surg nurses could also specialize in one of the following areas:

  • Oncology
  • Orthopedics
  • Post-surgical
  • Telemetry

ICU nurses may choose to specialize in the following areas.

  • Cardiac care
  • Neurological care
  • Trauma
  • Transplant
  • Medical care
  • Surgical care

Pro-Tip
If you want to learn more about all the other different types of nurses and specialties check out the linked article.

Typical Salaries

Salaries for all nurses vary based on their years of experience, area of the country and specific nursing facility.

However, overall, ICU nurses make a bit more money than their med-surg peers do and often find that their salaries increase more frequently over their years in the field.

On average, most ICU nurses with some experience make over $40 per hour across the country.

The states with the highest salaries include New York, Massachusetts, Washington, and New Hampshire, reflecting the high cost of living in these areas.

The national average for all ICU nurses is nearly $66,000 per year.

The annual salary for a med-surg nurse is a bit lower than that with an average of approximately $62,000 per year.

However, nurses in all specialty areas have great opportunities for advancement with plenty of new jobs opening up all the time.

According to the U.S. Bureau of Labor Statistics, registered nursing jobs are expected to increase 12 percent by 2028 with over 200,000 jobs opening up every year on average.

Personality Differences

All nurses have general personality similarities, such as the spirit of compassion and mercy that gives them the impetus to care for those who are suffering.

Med-surg nurses are highly skilled professionals who are able to multi-task, have very good interpersonal skills, and are able to roll with the punches.

They’re also usually highly creative, open and work well in teams.

On the other hand, ICU nurses must love challenges and must be able to appreciate a fast-paced and somewhat stressful environment where plenty of troubleshooting is needed.

They must be leaders in their fields and must be able to work independently much of the time.

These nurses must also be detail-oriented, driven individuals who have great critical thinking skills.

Pro-Tip
Something else to keep in mind is that some nurses are drawn to one versus the other based on the level of patient interaction.

What I mean is many times (not always) in the ICU your patients are going to be in critical condition that requires sedation so many times you’re just focused on the care of the patient with minimal interaction with the patient.

By the time the patient is getting better and getting to the point where you might be having conversations with the patient, they’re transferred to step-down or med-surg.

All of this to say some nurses thrive on those conversations and some nurses would rather just focus on the patient care without the conversations.

Neither personality/preference is wrong. But both are needed.

Final Thoughts

Hopefully, you found this comparison article helpful.

As you can see both med-surg and ICU nursing can serve as stepping stones to a variety of other careers in the field of health care.

Which option most interests you? Comment below with your thoughts, or apply for a job in either career on our job board today.

Frequently Asked Questions

Here are some frequently asked questions related to comparing medical surgical nursing and ICU nursing.

How is ICU different from Med Surg?

Med surg is a broad nursing specialty where the patients are dealing with acute and chronic illnesses. Med-surg patient conditions at times are stable. ICU nurses are dealing with patients who have acute critical illnesses who require constant monitoring and intervention.

Do ICU nurses make more than Med-Surg nurses?

On average ICU nurses will make more than med-surg nurses. It should also be noted that the job outlook for both critical care nurses and medical-surgical nurses are very good.

How many patients do med-surg nurses have?

A medical-surgical nurse may have 5-7 patients depending on the facility or patient acuity. It’s not unheard of for a med-surg nurse to have even more patients than that under their care.

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