[stanquim]

Hello all, I have question...I want to know something about Trauma vs Med-Surg ICU....is there anybody here that has worked both, or knows a lot about both...which one do you consider a more challenging place to work, I know in trauma, there is not a lot of medecine involved, but which one is a more challenging place to work, any feedback appreciated.

[Reno1978]

I work in a Med-Surg ICU and I find it challenging. The patient population is quite varied, I learn a lot about many chronic illnesses and interventions, etc.

I did a rotation through our Trauma ICU in school, and I found it to be more fast paced when fresh traumas arrive, more emphasis on neuro insults (we have lots of outdoor recreation and skiing around here), and a much younger patient population. Personally, it really hit home for me to see patients my age whose lives were cut short or permanently altered because of trauma...that was very challenging for me to come to terms with, much less trying to help family members come to terms with severe, sudden, unexpected life altering events.

As far as the basic nursing care, there are some obvious differences, but much of it is very similar. It all boils down to what interests you most. It's all quite fascinating, in my opinion.

[RNperdiem]

Where I work there is a Medical ICU and a Surgical ICU, and the surgical takes the trauma patients.
I have floated to all the ICU's (CCU, neuro, burns) including MICU.
The basics of nursing are the same in all ICU's-assessments, meds, vital signs and ventilators.
I find MICU patients to be generally older and more chronically ill. The younger patients often have CF.
SICU/trauma patients are varied, especially since surgical patients like liver transplant patients, vascular surgery patients and complex plastic surgery patients are mixed in.
I'm not sure what you mean by there being less medicine involved. Everyone in ICU gets meds.
While not getting into stereotypes, medical service docs are generally more laid back and approachable than the surgeons(at least until surgeons get to know you well).
Trauma is a more challenging place to work, but not by much.

[cruel shoes]

As a new grad with an obsession for critical care, I took my first job in an MSICU over the Trauma ICU at an urban Level 1 trauma center where I completed my senior preceptorship. I thought Trauma would be the culmination of my year spent pursuing critical care, including two preceptorships in MSICUs. In trauma, I found myself knee-deep in 2.5 hour long dressing changes, open thoracotomies and fasciotomies, packing pts up for trips to CT/IR/etc in the middle of the night, neuro checks on EVDs/bolts, and the possibility that a peds or burn pt might roll in at any moment (neither of which I was remotely prepared for). Despite the fact this facility offered a 6 month orientation period for new grads, I opted for the more manageable MSICU pt population. To this day, when a major MVA or other horrific mauling/attack/accident is announced on the local news, I silently thank my creator that I am not on my way into a shift at that hospital.

[cruel shoes]

PS I forgot to mention the fun of turning/bathing/cleaning crani patients with no bone flaps! M/SICU are units where this might be the exception. Trauma is where this, the exception, can be every shift. I find the stress of a level 1 Trauma ICU x10 that of a busy M/SICU

[koyeh]

I've worked 23 years in nursing and have done trauma, SICU and now MSICU. What I've learned is that there are challenges at all of them. What makes the biggest difference is who you work with. If your a tight crew and help each other out the job is more manageble and a lot less stressful. If the Doc's have the "God Complex" you can have a bad day until they learn to respect your nursing. So pick an ICU that holds your interest, the grass is always greener on the other side.

[pebbles]

Where I work, the trauma pt's go to the SICU, so I guess I get the best of both worlds. I did work in a step-down that was "just" trauma though.

Honestly, you can be running and busy with all types of surgical and trauma pt's, and the challenges are about the same. A newly admitted trauma has a lot of uncertainty in terms of injuries and stability, but that doesn't last for very long. After the first day, the person is usually stabilised and you know what's going on with them and how to manage it. There can also be a lot of uncertainty in surgical pt's of all kinds, esp when they are first admitted to ICU, decomepensating, etc.

Keep in mind that "trauma" can happen to people of all ages, and with all kinds of medical histories, so that can keep you hopping too.

When you decide which one to take a job in, it might be possible to pick up shifts in the other and get the best of both worlds. It'd suck to develop SICU skills and knowledge and leave out the trauma part, but that's just my opinion.

[nursejill155]

I work in the SICU, we take the traumas but we also get MICU pt as overflow. It depends what you are looking for in a job. MICU usually are chronic pt or "repeat offenders" they don't always get better since they are chronic pts. SICU, is very different, the docs are different and the pts tend to be very different. We take open heart pts, and any other surgery pt who needs ICU care, I like it. Be prepared if you go into trauma, it can be emotionally taxing when the young people come in and cannot be saved. They both are busy, and both are challenging, it just depends what you want. Hope that helps.

[RNFELICITY]

What I like about a medical ICU is that the patients tend to have multi-organ dysfunction and you really get your work-out trying to follow the labs and stuff. Plus, you can get an aged person in with pneumonia and the next thing you know, they can't breathe and they are intubated and lo and behold because of stress and other cardiac issues they have an MI and holy crap their B/P bottomed out after intubation and now they have some ATN. Look at all the systems involved there and you really have to be on your toes.

[cardiacRN2006]

Originally Posted by RNFELICITY

Plus, you can get an aged person in with pneumonia and the next thing you know, they can't breathe and they are intubated and lo and behold because of stress and other cardiac issues they have an MI and holy crap their B/P bottomed out after intubation and now they have some ATN.

This is why I love MSICU! A mixed bag of everything...