MICU vs SICU

meandragonbrett · Oct 9, 2011

Everything in her unit seems very routine, and the nurses rarely deviate from their set protocols and standards. The patients are critical and very hands-on for the first day, and after that they are all well and up and about. It seems exciting in a way, and I know that you have to be very intelligent, but I think I would get bored of the monotony that the nurses face in that unit. Each day they hang the same drips, see the same surgeries, draw the same lab work, and follow the same protocol down to the letter as they did the day before.

Recovery of post-op surgical thoracic surgeries is very by the book. They follow a pathway and it's very boring for some. Many of us like the predictability and the comfort level of the same thing and knowing what is the normal course of care. Outside of your CV-Surgery population very little becomes routine with the patients in the other ICUs. You will see the same diagnoses and pathologies over and over but you will see different manifestations, clinical problems, and treatments with them all.

NCRNMDM, ASN, RN · Oct 10, 2011

Recovery of post-op surgical thoracic surgeries is very by the book. They follow a pathway and it's very boring for some. Many of us like the predictability and the comfort level of the same thing and knowing what is the normal course of care. Outside of your CV-Surgery population very little becomes routine with the patients in the other ICUs. You will see the same diagnoses and pathologies over and over but you will see different manifestations, clinical problems, and treatments with them all.

I'm glad to hear that my thoughts are actually based on fact. I always got the impression that thoracic recovery was very procedural and had the possibility of becoming pretty routine and boring. I'm glad to hear that other ICUs aren't routine and by the book, and that they tend to be more diverse and exciting. I like the idea of having to constantly adapt my nursing care and my thinking in order to provide the best care I possibly can for my patients. Part of the draw of critical care nursing, in my opinion, is the incredible knowledge base required, and the ability to be able to go with the flow and change nursing care and treatment based on the individual patient and their needs.

snifny1983 · Oct 17, 2011

I work in the SICU at my hospital and have also spent a few days on the medial ICU. I think that either place would be a fine place if you are wanting critical care. I think it depends on what type of patient you want. Do you want a person with a lot of dressing changes, hypovolemia/septic shock patients after a bowel perf, or do you want a pneumonia/COPD/DKA type of patient. I guess shadowing will be the only way that you can decide. As far as lines and drips go, I think you will see them in either unit. I know that at my hospital we see everything in all the ICU's except Swanz. It is no longer something that the MD's are using in our facility. Sad, but true. I would say that it is once a year that I will see a Swan. :crying2: I wish we were using them more b/c I think they would help us with some of our more difficult patients, but I can't make the MD's place them.

Hope this helps and good luck with your new role!!!

NCRNMDM, ASN, RN · Oct 17, 2011

I work in the SICU at my hospital and have also spent a few days on the medial ICU. I think that either place would be a fine place if you are wanting critical care. I think it depends on what type of patient you want. Do you want a person with a lot of dressing changes, hypovolemia/septic shock patients after a bowel perf, or do you want a pneumonia/COPD/DKA type of patient. I guess shadowing will be the only way that you can decide. As far as lines and drips go, I think you will see them in either unit. I know that at my hospital we see everything in all the ICU's except Swanz. It is no longer something that the MD's are using in our facility. Sad, but true. I would say that it is once a year that I will see a Swan. I wish we were using them more b/c I think they would help us with some of our more difficult patients, but I can't make the MD's place them.
Hope this helps and good luck with your new role!!!

I think I would rather work with the septic shock/hypovolemia patients who have undergone major surgeries. Does your SICU also take the trauma patients? Most hospitals in my area have combined their SICU with their TICU, and they have one large surgical/trauma ICU. I think this sounds like a very cool combination, but I would like to hear an opinion from someone who has actually done surgical/trauma ICU work. Also, in your SICU do you do a lot of ambulation and incentive spirometery, or is most of that done once the patient is in stable condition and on the step-down unit or surgical floor? Basically, my main question is this: what is a typical day like for you in surgical ICU? If you could give me a basic idea that would be immensely helpful. Thank you!

snifny1983 · Oct 20, 2011

My SICU is also the Trauma ICU. My hospital currently shares the Trauma service with another hospital in our city. We have it for 1 year and then it switches. Currenlty we do not have Trauma, but will take it back in January! We can not wait!! We love trauma and love taking care of the trauma patients. It brings a lot of "trauma drama" to the department, but I love every part of trauma. Some of it is very difficult, but I think in a way can make you a better person!

A typical day in my unit really just depends. Sometimes we have patients that are very sick and need a lot of one on one care and other times we have a patient that has had a major procedure, but does well after. Our hospital is very busy and sometimes we get IMC overflow. These patients still need close monitoring, but may not be as intense as a typical ICU patient. We do start ambulating our patients as soon as we can or at least get them up to the chair as soon as they can. We also do start IS with the patients as soon as we can because that would just increase the number of pneumonia patients if we did not start right away. Sometimes with our trach patients or chronic vents we also get them up to the chair. We had a recent meeting with our head Trauma MD and we are looking into ambulating patients that are on the vent! (if they can ambulate, depends on fractures ect. that they may have!)

The SICU is a very crazy and fast paced unit, but I have learned a lot and seem to learn something new everyday! Sounds like SICU/Trauma ICU would be an excellent fit for you if Sepsis/hypovolemic shock type patiens is what you are interested in!

Good luck!

NCRNMDM, ASN, RN · Oct 20, 2011

My SICU is also the Trauma ICU. My hospital currently shares the Trauma service with another hospital in our city. We have it for 1 year and then it switches. Currenlty we do not have Trauma, but will take it back in January! We can not wait!! We love trauma and love taking care of the trauma patients. It brings a lot of "trauma drama" to the department, but I love every part of trauma. Some of it is very difficult, but I think in a way can make you a better person!
A typical day in my unit really just depends. Sometimes we have patients that are very sick and need a lot of one on one care and other times we have a patient that has had a major procedure, but does well after. Our hospital is very busy and sometimes we get IMC overflow. These patients still need close monitoring, but may not be as intense as a typical ICU patient. We do start ambulating our patients as soon as we can or at least get them up to the chair as soon as they can. We also do start IS with the patients as soon as we can because that would just increase the number of pneumonia patients if we did not start right away. Sometimes with our trach patients or chronic vents we also get them up to the chair. We had a recent meeting with our head Trauma MD and we are looking into ambulating patients that are on the vent! (if they can ambulate, depends on fractures ect. that they may have!)
The SICU is a very crazy and fast paced unit, but I have learned a lot and seem to learn something new everyday! Sounds like SICU/Trauma ICU would be an excellent fit for you if Sepsis/hypovolemic shock type patiens is what you are interested in!
Good luck!

Thank you so much for taking the time to answer my question! It was very helpful to hear from someone who has first hand experience. I've done some work in the ED, but I got tired of it, and after nursing school I know I want to work in ICU. I figured that surgical/trauma ICU would be pretty close to the ED without all the negative aspects. After reading your post, I feel like this is true, and I'm certain that SICU is where I want to work.

snifny1983 · Oct 20, 2011

glad I could help! Good luck and hope you enjoy your choice! Remember, nursing is great in the fact that we can go anywhere we want to work! Lots of options open to us!

NCRNMDM, ASN, RN · Oct 21, 2011

glad I could help! Good luck and hope you enjoy your choice! Remember, nursing is great in the fact that we can go anywhere we want to work! Lots of options open to us!

This is very true; that's part of the beauty of nursing. Did you start out in the ICU setting as a new graduate? In my area a lot of ICU positions are open to new graduates, but I've heard a lot of people tell me that, as a new graduate nurse, I won't have what it takes to function in the ICU. I feel like with a good orientation I could do it. I would be scared to death, and I would hardly be able to believe that I was lucky enough to get an ICU job straight out of school, but I think I would be able to function.

snifny1983 · Oct 21, 2011

I did not start out in ICU. I started in a cardiac step down unit and then the PACU. The PACU was where I got a lot of experience to help me in the ICU setting. It is funny, most ICU nurses eventually end up in PACU. At least at my hospital! I know there are several new grads that start in the ICU and do just fine. There is a lot of mixed emotions with new grads being in the ICU, but I say as long as you have a good orientation and do not act like you know everything (because nobody does) then you will be just fine!

NCRNMDM, ASN, RN · Oct 23, 2011

I did not start out in ICU. I started in a cardiac step down unit and then the PACU. The PACU was where I got a lot of experience to help me in the ICU setting. It is funny, most ICU nurses eventually end up in PACU. At least at my hospital! I know there are several new grads that start in the ICU and do just fine. There is a lot of mixed emotions with new grads being in the ICU, but I say as long as you have a good orientation and do not act like you know everything (because nobody does) then you will be just fine!

Thank you! I've known of new grads that started in ICU and did well also. I know that I don't know everything, I'm far from that, and I have a ton to learn. And I realize that working in the unit isn't something to take lightly; it's a serious job where you are forced to make life and death decisions, and it's a field of nursing that requires a lot of skill. I feel like I have the intellectual capability to learn the things I need to learn in order to be an effective and skilled ICU nurse, and I think that, provided a thorough orientation, I would be a good nurse. I'm not trying to sound cocky, I just feel that I could do it. I know that it will be hard, and I know that I will often be overwhelmed and feel as though I know nothing, but I think I can get past these things and go on to become a good ICU nurse.

snifny1983 · Oct 23, 2011

I think you are going to be great! You have the right attitude and seem to know what you what! Good luck! Let me know how it goes in the future. If you think of any other questions, please feel free to post!

NCRNMDM, ASN, RN · Oct 23, 2011

I think you are going to be great! You have the right attitude and seem to know what you what! Good luck! Let me know how it goes in the future. If you think of any other questions, please feel free to post!

Thank you so much! You've been really helpful, and I'm glad you've had the patience to answer all my questions. I'm glad to hear from someone with experience that they think I can do it. I will be sure to make a post as soon as I graduate nursing school and get a job (hopefully it will be in an ICU).