MICU is medical and SICU is surgical. Some people like post-op pts vs medical pts. I like SICU. We get all the traumas and post-op neurosurgical. It challenges me and I love it. The more invasive lines I get to play with, the happier I am.
I work in a general icu and prefer medical cases. We don't get traumas or neuro surgery because they go to their own units. We get a lot of general and CT surgery. I hate getting surgical patients out of bed and dealing with post-op pain that I am powerless to control. Plus, medical patho is generally more interesting to me.
I work primarily SICU, but float to MICU on occasion. We have a relatively small hospital with only an SICU and MICU. So our SICU gets pretty much everything from immediate post op CABGs to craniotomies. We also get our fair share of medical ICU on weekends or when MICU is full.
I think it depends largely on your personality and tastes. I'll try to compare the two a little. I imagine this varies largely from hospital to hospital depending on what types of surgeries are done and whether you have specialty units for your CABGs, neuro cases, etc. Also keep in mind that my experience is solely on night shift.
SICU- Post op protocols and routines are usually busy--drawing labs, up in AM, pulling lines, pain management, stressed families (especially with patients who have newly diagnosed problems).
- post op CABGs are busy--q15 min vitals, redrawing labs, frequent assessments, labile hemodynamics often requiring intervention, insulin drips requiring q1hr and sometimes more frequent CBG checks, EKGs, nighttime calls to surgeons (ours are usually hateful), vent weaning, pain management, up in AM, pulling art lines, SWANs, etc which are time consuming.
- "most" patients recover within a few days and are transferred out to a floor or long term acute care as neccessary, so you rarely deal with the same surgical patients for more than a few days.
- Still get a lot of medical patients if MICU can't take them (which happens often). At least 1/4 to 1/2 of our "SICU" patients are actually medical.
MICU - Medical cases like DKA, ETOH withdrawal, COPD exacerbation, MIs, strokes, etc. are common.
- Patients seem to stay longer due to multiple comorbidities, and fair share of frequent flyer DKA and ETOH W/D patients.
- patients tend to be on vents longer than SICU and they see more trachs.
- Our MICU takes our induced hypothermia protocol patients which are few and far between, but very busy and tend to be last ditch efforts.
- Families not as acutely stressed as SICU since medical issues more chronic in nature, however sometimes they can be just as difficult given that they are around for a longer period of time.
Both units have different types of stress, but I find that I usually have more downtime in MICU at night than SICU. I also am more likely to get out on time in MICU due to fewer AM routines than post op patients. Some people like having slow times where as others like to stay on the move.
I second the comment about SICU works harder. If everything else being the same (pay,etc), I would choose MiCU for actually being able to work hard without additional responsibilities piled on, get out in a timely manner, and not have to go thru extra hospital based course (no extra pay) just to do more work at the same pay.
Would anyone be able to comment on what the SICU work environment is like? I have heard from some that everyone prefers to be more independent in SICU whereas in MICU there is a lot more teamwork involved. I wasn't sure if this was how it is at my hospital specifically or at other SICU/MICUs as well.
Where I am, MICU is a general catch-all ICU, and usually gets respiratory failure, DKA, EtOH, ischemic strokes, septic shock, and chronic vent patients. We have 3 different SICUs- a CVSICU, which is CABGs, valve repairs, and complex coronary surgeries; a GISICU, which is open bellies and transplants, and an NSICU, which is neurosurgery and neurotrauma. I work in CV, and I really like it. I will say that the SICUs have things like bolts, swans, and a TON of invasive monitoring, whereas the MICU doesn't see as much. However, the MICU gets a broader spectrum of patient cases.
It all depends on which type of population you prefer!
In my Trauma/SICU we get a lot of closed head injuries which means bolts, paralytics, and frequent neuro checks. We're also the general surgical ICU (we have an 8 bed CV where all the hearts go) so we get lots of open bellies, complex wounds (no major burns though), chest surgeries (if there is no room in CV), and ortho. Lots and lots of ortho because of the traumas we get. We also get medical overflow if needed. Because of how complex trauma pts can be they tend to hang out long, get trachs and pegs, and have multiple, multiple surgeries and wounds. I've only been in SI for 6 months but I love it. CV and MI can get really boring to me even with the interesting patho, but there's not a ton of hands on work to do. I love getting my hands dirty with lots of wounds.
Back in the mid 1970s I was working in the ICU when we split into MICU and SICU and was given a choice which one to work in. I immediately went to MICU simply because I didn't care for some of the attitudes of the surgeons....still don't! I was able to float back forth easily and comfortably until I stopped taking care of adults.
The chronic MICU type patient that was constantly in and out of the hospital and would never get better did get me down on nursing. MICU wasn't always that way...no no...we had a great variety of patients in the beginning. During the early 1980s, it was especially rewarding for me to care for AIDS patients and provide comfort to those who many in society chose to throw away because of ignorance and bigotry. These chronic type patients seemed to become the norm during the mid/late 1980s. I felt like I was destroying my own body caring for these often very large patients while I was doing nothing except prolonging life...but doing little to help in the quality of lives. We did get the occasional OD, near drowning, some hem/onc and some very acute infectious diseases where you see the patient leave the hospital and get better, but most of the population is described by posters above...lots and lots of type II DM who just seemed unable to change their lifestyle so they could have a better quality of life.(one reason why I stopped making my fried chicken every Sunday...now we eat it only once a month!).
I eventually phased out working in the MICU and started picking up hours at the childrens hospital in their PICU as they were experiencing high acuity and census. It was the best thing that I ever did. It is extremely rewarding to see someone very very sick pull though and leave the hospital with few or no complications. Nobody does that better with than kids. If I would have had to do it all over again, I would have done PICU from the start. My old decrepit broken down body would probably be less broken down and decrepit had I stopped doing adult much sooner!
I know this is an old thread, but I just wanted to add my 2 cents for future readers with the same question:
I work in a MICU at a 500+ bed hospital with an MICU and SICU. Where I am, an ICU bed is an ICU bed. Medical patients go to the SICU, and Surgical patients go to the MICU. It's all based on bed availability, and we never seem to have any available beds. Our MICU sees everything from GSWs/TBIs to ARDS/DKA/Stroke. I think I like surgical/trauma patients a little better, since they generally tend to be a little healthier at baseline, but I would rather work with a pulmonologist/intensivist over a trauma surgeon any day of the week.
I can definitely see how working in a closed MICU with nothing but medical patients would get depressing after awhile. However, sometimes you just wanna go to work and not have to deal with the fast-paced trauma, and just do your job, and go home. This is why I like working with a mixed patient population. On a side note, the other day I had a surgical patient who has been in the unit since last September, so it's not always the medical patients who stay in the unit forever. Either way, you can't go wrong.
If you start off in a general SICU/MICU that isn't too specialized, switching back and forth won't be all the difficult as long as you have the basics of critical care down!