CTICU vs Neuro ICU

[CVVH, MSN, RN]

Basically, I'm approaching a year in my first job as an RN, and thinking of next steps. I'm on a neuro stepdown unit, and would like to transfer to an ICU in the near future. In nursing school I loved cardiac, worked for a couple years as a tech on a telemetry unit, and did all of my adult clinicals on cardiac units, including a CTICU. When I applied for jobs, the cardiac units at my hospital didn't have openings at the time, nor did the two ICUs that hired new grads. I got a job in a SICU at another hospital, but for various reasons turned it down, and took a neuro stepdown job at my hospital.

Almost a year later, I definitely enjoy neuro, and am doing stroke-related research right now. My unit is great, but I love "technology" and "devices", so I'm still interested in the ICUs, though I'm trying to figure out which one. I still do think about CTICU, as it seems to have the most technologies and devices out of all the ICUs (the CTICU at my hospital does heart/lung transplants, ECMO, VADs, artificial hearts, IABP, etc). ECMO also sounds very interesting to me, and all of the ICUs have ECMO, except Neuro ICU (though its mostly found in CTICU and MICU).

Interestingly, the Neuro ICU recently started taking VAD patients that stroke, so the RNs there have relatively recently been trained on them. The neuro ICU also does multimodality brain monitoring, though when I asked one of the nurses about it recently, she said they don't do it as much these days, and its become more for research purposes.

Another thing I think about is marketability and further opportunities. I may be wrong, but I feel that cardiac experience would go further as far as opportunities outside of the ICU (cath lab, EP lab, etc) or hospital, and that cardiac is more...."accessible" than neuro for RNs and APNs, as far as being able to carve out roles. In the future I think I'd like to do ACNP, though I don't plan on applying for a couple years (I plan on staying at the bedside and doing the clinical ladder, committees, etc), so that may change. Also, it seems that there are more opportunities for APNs in cardiac nursing than neuro, at least in my area.

TLDR: I'm a neuro stepdown RN, almost one year down, originally wanted CTICU, doing neuro, like neuro, still think about cardiac, not sure what to do.

I definitely need to shadow in both to see what they're like, but thought I'd ask here as well. Thanks!

[airborneinf82, BSN]

I agree you should definitely shadow in each if you can and talk to the nurses about what they like and more importantly what they don't like.

I personally have worked a majority of my experience in Trauma/Surgical ICUs but for the past few years I have worked both Trauma and CVICU as our hospital has both those ICUs under the same management and the ability to work both units at times. Having worked trauma I have worked with many neuro patients and I do like many aspects of neuro, but personally there are many things I don't like with it.

Working in the CVICU I have really rounded out my nursing understanding. Obviously the cardiac picture dictates a lot of what goes on with the body. I really have enjoyed learning and understanding more about hemodynamics and the heart. And you are right that the CVICU is very device heavy. We do everything your CTICU would do minus transplants. We have a very robust ECMO program as well which has been a very unique learning experience.

Personally I have loved learning all the various devices and taking care of those complex patients. CVICU sees some very sick and very complex patients and you can find yourself with a myriad of various drips going. If technology/devices and really micromanaging drips to optimize hemodynamics is what you are looking for, then the CTICU would be perfect for you. Someone people just really love neuro and wouldn't trade it for the world. It definitely is a different world so it really depends what you want to get out of your experience.

[CVVH, MSN, RN]

I agree you should definitely shadow in each if you can and talk to the nurses about what they like and more importantly what they don't like.

I personally have worked a majority of my experience in Trauma/Surgical ICUs but for the past few years I have worked both Trauma and CVICU as our hospital has both those ICUs under the same management and the ability to work both units at times. Having worked trauma I have worked with many neuro patients and I do like many aspects of neuro, but personally there are many things I don't like with it.

Working in the CVICU I have really rounded out my nursing understanding. Obviously the cardiac picture dictates a lot of what goes on with the body. I really have enjoyed learning and understanding more about hemodynamics and the heart. And you are right that the CVICU is very device heavy. We do everything your CTICU would do minus transplants. We have a very robust ECMO program as well which has been a very unique learning experience.

Personally I have loved learning all the various devices and taking care of those complex patients. CVICU sees some very sick and very complex patients and you can find yourself with a myriad of various drips going. If technology/devices and really micromanaging drips to optimize hemodynamics is what you are looking for, then the CTICU would be perfect for you. Someone people just really love neuro and wouldn't trade it for the world. It definitely is a different world so it really depends what you want to get out of your experience.

Thanks for the reply!

Cardiac has always been my interest, however I've come to love neuro as well. I think I've found a middle ground between the two by my interest in stroke (I do research related to stroke and I'm planning on getting stroke certified (SCRN) by the end of the year). At the same time, I'm very interested in heart/lung transplants, and working in a high technology/device area, and CTICU seems to fit the bill.

Another option I've recently thought of is applying to transfer to CTICU then I could always do per diem at another hospital on a neuro unit.

[ghillbert, MSN, NP]

YOu'd have to try CTICU and see how you like it. The specialties are both acutely challenging, just in different ways. I have worked trauma ICU and CTICU and I am totally a cardiac person. I love mechanical circulatory support devices and acute hemodynamic management in post-op cardiac patients. I think either is marketable, just depends on your interest. There are excellent ICU ACNP roles in both neurocritical care and cardiothoracic critical care (actually, more so independently in neuroICU because the nature of CTICU often requires a physician to be present eg. for device insertion or chest reopening).

[CVVH, MSN, RN]

YOu'd have to try CTICU and see how you like it. The specialties are both acutely challenging, just in different ways. I have worked trauma ICU and CTICU and I am totally a cardiac person. I love mechanical circulatory support devices and acute hemodynamic management in post-op cardiac patients. I think either is marketable, just depends on your interest. There are excellent ICU ACNP roles in both neurocritical care and cardiothoracic critical care (actually, more so independently in neuroICU because the nature of CTICU often requires a physician to be present eg. for device insertion or chest reopening).

Thanks for the tips. Yeah the mechanical circulatory support devices sounds pretty fascinating. I really want to work in a setting that is high technology. My hospital is having a CT surgery/ECMO conference soon, so I'm going to attend that to hear a bit about what goes on in the CVICU.

That makes sense to me about independence and ACNPs. Interestingly, at my hospital we don't have NPs in the Neuro ICU (there are PAs), while the CVICU has ACNPs (the unit is split in two, with one managed by ACNPs in an "attending" role, though these are the less complicated patients (I believe they're termed "fast track"), while the other has the traditional medical team, though NPs are on those as well). We do have a neurohospitalist NP service, however their patients are on the neurology and neurosurgery stepdown units. Another hospital in my area is pretty progressive, and they have ACNPs doing both cardiac caths (I believe diagnostic for the most part though at least one is trained to do interventions as well) and diagnostic cerebral angiograms (NPs also assist on interventions). They also have NPs in the Neuro ICU. So there are many NP opportunities in both fields in my area now that I think about it.

I'm going to shadow in both units soon and find out about potential opportunities in the near future, as well as attend the CT/ECMO conference.