Differences between Medical-Surgical Nursing and ICU Nursing

Nurses often wonder if the grass is greener on the other side. Usually, medical-surgical nurses wonder this, especially if they haven’t tried any other specialties since they graduated from nursing school. Inevitably, at some point, a nurse has to wonder what else they could be doing.

I worked a med-surg acute care floor directly out of nursing school. To be exact, it was telemetry, which was considered a non-critical discipline in my hospital. I had a nice mixture of both telemetry and other general patients, and I learned a lot in my three and a half years working on this floor.

However, I always wanted to work intensive care. There was just something about the patients, the equipment and the prestige that always interested me. I decided to transfer to our medical ICU to fulfil my dream and see what it was all about.

Unfortunately, it was more than I could handle. I lasted exactly three months. It was very different from telemetry. My experiences are indicative of the hospital I worked in, but if you’ve ever wondered what the difference is between Medical-Surgical Nursing and ICU, here are a few points I personally experienced that you may not have considered.

Ratio of Patients

For medical-surgical nurses who are used to having five to eight patients per shift, the idea of “only” having two patients can make them swoon in jealousy. It isn’t quite like that. Yes, the ICU nurse has two patients – sometimes three – but those patients take up so much time that you are running from the start of the shift to the end. In some cases, med-surg nurses encounter patients that need q2h assessments. In the ICU, both patients need q2h assessments and charting immediately after they are done.

While it is true that much of the information is now electronically charted automatically, it still can’t measure the reflexes, the pupil dilation, and other data that only a registered nurse can assess. It doesn’t do to only perform a focused assessment, either. These q2h assessments are usually head to toe.

Every nurse knows that they get interrupted, and ICU nurses are no exception. Running to an emergency is just as vital as it is anywhere in the hospital, probably more so for ICU nurses. The problem is catching up with those q2h assessments, giving all IV push medications, adjusting feeding tubes, watching the vent and drawing blood from a central line. Two patients can be just as stressful as eight on a med-surg floor.


On a med-surg floor, you may have IV pumps, sequential compression devices, telemetry boxes, continuous motion machines and other more or less standard equipment of the nursing profession. This is just not so in the ICU. For starters, learning how to operate the ventilator could take up an entire nursing school class. It is complex, temperamental and absolutely necessary to know how to work correctly. All of the metrics that are supplied have particular meaning and the settings are vitally important to how your patient fares. In some hospitals, respiratory therapists take care of the bulk of vent maintenance, but the RN still needs to know what everything means.

Other equipment includes bedside dialysis, aortic balloon pumps and banks of IV pumps. You have to know which medication increases blood pressure, which lowers it and what settings are going to manifest that in your patient. Again, the nurse has to know how to work all of these machines without the help of others.

In some hospitals, med-surg nurses can call on technicians to handle many problems. For instance, some facilities have IV nurses who can assist with pumps and rounding respiratory therapists who can give breathing treatments. Although this is certainly not true of all hospitals, med-surg nurses get help on occasion due to high ratios. Unfortunately, even many overextended med-surg nurses don’t always have this perk where they work. ICU nurses often have to do everything, too, and at a much more stressful level.


Although it seems rather obvious that the patients in the intensive care unit require more intense care, it isn’t until you’ve actually experienced that intensity that you realise how stressful it can be. Many floor nurses understand the intensity and stress of a code, but that doesn’t match the constant stress of the ICU. For instance, doctors are almost always available on the unit. It usually isn’t a case of calling a doctor so much as walking up to one and asking for an order. If they are not present, extenders usually are, such as CRNPs and PAs. This is because of the constantly shifting nature of the ICU patient.

It may also surprise floor nurses to know that many surgical procedures are done at the bedside and require the nurse’s participation. For instance, a surgeon needs to insert a femoral line under sterile conditions. Instead of taking the patient to the OR, the surgeon will insert the line at the bedside, using the assigned nurse to assist with the intricacies of the procedure. Other procedures are also done at the bedside, including opening up a CABG patient’s sternal incision on the spot to save a life.

In the end, intense things happen in the ICU, and the nurse has to be ready for them. They are not superior in any way, but experience an entirely different world than med-surg nurses.

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