MICU vs SICU

JoyfulRN14, BSN, RN · Oct 28, 2011

My hospital is a little smaller that a big city hospital, we're a Level III trauma center (not higher mainly due to not being a teaching hospital, and not having 24 hour neuro coverage). We have a 21 bed M/S ICU and a separate CVICU (post CABG and vascular surgeries). I LOVE working in the MSICU it is such a great amount of variety and exciting and constantly learning new things. I've been doing it for 1.5 years now, and I still come across things ALL THE TIME that I've only barely heard of and have to research real quick after report (scleroderma anyone?)

Just wanted you to keep in mind that some smaller hospitals have their MICU and SICUs combined, and they can be great learning environments. I for one like the variety of having surgical and medical patients.

Some average patients so you can imagine a day....

(1)70 year old COPD exacerbation with pneumonia, resp failure in the ED and intubated down there. Will come up to the unit, be on a vent for a few days while they get some antibiotics, steroids, etc. And most likely do fine and be extubated. Usually within 24 hours of being extubated, they are eating a diet and shipped out to our stepdown ICU, sometimes med/surg unit if they are very stable

(2) 25 year old with acute severe pancreatitis d/t alcoholism.... lots of belly surgeries, wound vac, down to OR for abdominal washouts every other day, on a vent. On TPN and therefore an insulin drip, having to do blood sugars hourly.

(3) 60 year old with severe sepsis from pneumonia, also have multiple comorbidities (COPD, CHF, ESRD)... having to play the balancing act between their body's need for fluid d/t the processes happening from sepsis, vs. how weak their heart is d/t CHF and since their kidneys are shut down they are going to need extra dialysis to get off this fluid... oh but wait they are too unstable, they'll have to go on CRRT/SLED, which is a 1:1 patient.

(4) 18 year old kid who has multiple stab wounds in the abdomen, which perforated his bowel... causing him to become severely septic. And this sepsis/trauma patient will be handled completely differently than #3 with all the comorbidities. Fluid fluid fluid! Oh and crap you notice after a few days and a few surgeries (and a wound vac because of how big and swollen his intestines are) that there is fecal material in your wound vac! Call the surgeon... off to emergency surgery!

NCRNMDM, ASN, RN · Oct 31, 2011

My hospital is a little smaller that a big city hospital, we're a Level III trauma center (not higher mainly due to not being a teaching hospital, and not having 24 hour neuro coverage). We have a 21 bed M/S ICU and a separate CVICU (post CABG and vascular surgeries). I LOVE working in the MSICU it is such a great amount of variety and exciting and constantly learning new things. I've been doing it for 1.5 years now, and I still come across things ALL THE TIME that I've only barely heard of and have to research real quick after report (scleroderma anyone?)
Just wanted you to keep in mind that some smaller hospitals have their MICU and SICUs combined, and they can be great learning environments. I for one like the variety of having surgical and medical patients.
Some average patients so you can imagine a day....
(1)70 year old COPD exacerbation with pneumonia, resp failure in the ED and intubated down there. Will come up to the unit, be on a vent for a few days while they get some antibiotics, steroids, etc. And most likely do fine and be extubated. Usually within 24 hours of being extubated, they are eating a diet and shipped out to our stepdown ICU, sometimes med/surg unit if they are very stable
(2) 25 year old with acute severe pancreatitis d/t alcoholism.... lots of belly surgeries, wound vac, down to OR for abdominal washouts every other day, on a vent. On TPN and therefore an insulin drip, having to do blood sugars hourly.
(3) 60 year old with severe sepsis from pneumonia, also have multiple comorbidities (COPD, CHF, ESRD)... having to play the balancing act between their body's need for fluid d/t the processes happening from sepsis, vs. how weak their heart is d/t CHF and since their kidneys are shut down they are going to need extra dialysis to get off this fluid... oh but wait they are too unstable, they'll have to go on CRRT/SLED, which is a 1:1 patient.
(4) 18 year old kid who has multiple stab wounds in the abdomen, which perforated his bowel... causing him to become severely septic. And this sepsis/trauma patient will be handled completely differently than #3 with all the comorbidities. Fluid fluid fluid! Oh and crap you notice after a few days and a few surgeries (and a wound vac because of how big and swollen his intestines are) that there is fecal material in your wound vac! Call the surgeon... off to emergency surgery!

Thank you for the information. It does sound interesting to have a combined MICU and SICU, but I think most of the hospitals around here have them separated because they are larger level I trauma centers. All of the patients you listed sound great, and I really don't think I would hate to work in MICU either (I know I wouldn't turn a job opportunity down in MICU). However, I feel like I am the most interested in SICU, and that is where I would really love to work. It's my number one choice for an ICU, but I will not turn any learning opportunity down. Were you a new grad when you started in ICU, or did you have experience elsewhere prior to going to MSICU?

suetje · Dec 14, 2011

I am currently a nursing student, but I have a few questions regarding MICU vs. SICU. I know that I want to be an ICU nurse after I graduate from nursing school, and I am pretty sure that SICU is the ICU that I want to work in. I just had a few questions regarding both MICU and SICU. Some of the hospitals in my area hire new grads in both SICU and MICU, some hire new grads only in NSICU, NICU, and MICU. My first question is this: what is the main difference between MICU and SICU? I realize that the patient population is different, but do you use some of the same treatment methods? Is SICU more fluid based resuscitation where MICU is more pressor and vasoactive drugs? Does the typical SICU patient have more in the way of Swans and invasive lines? Do the MICU patients tend to be more chronic and long term, and do the SICU patients tend to be more acute and quick to leave the unit? Next, for those of you who work in SICU, do you think a new grad could come to work in the unit and be okay? Finally, are those of you who work in SICU happy with your jobs? Do you like your work environment, and if so, could you tell me a little about what it's like to work in SICU? Thank you!

Trust me, in our large teaching hospital, a lot of the patients in MICU are frequent flyers like quads that come in for repeated pneumonias, CF patients with issues, and those chronic medical patients that keep having problems. SICU is fresh people form OR, generally with NO VRE or MRSA (no gowning every time your turn around!!!) and more stimulation I think. I have been in SICU for about 30 years (yup- old!) but it is always challenging and not boring.

NCRNMDM, ASN, RN · Dec 14, 2011

I just found out that a large (800 plus bed) teaching hospital in my area has a new graduate program that places new graduate nurses in the critical care setting. I graduate in May of 2013, and I can apply to the program in February of 2013. The best applicants are called in for an interview with 72 hours, and then they are placed based on their preference, and the available jobs. This hospital is so large that it currently has about 20 jobs in MICU, STICU, and NSICU. I made contact with one of the directors of the new graduate program, and she informed me that it is common for new graduates to be placed in critical care units, and that it is very possible that I could be placed on one of these units, depending on my preferences and the current job openings at the time I apply. I plan to apply for this program, and I hope that I will be accepted. If I am called in for an interview, my preferences will be as follows:

Surgical Trauma ICU
Nuerosurgical ICU
Medical ICU