CVICU or NTICU?

Ruby Vee, BSN · Feb 28, 2017

I have the rare opportunity to interview for both CVICU and NTICU at a level I trauma center. I have only worked in a step down unit and dialysis, but I am aspiring to work in critical care. Assuming I can hack it in intensive care, do you think there are certain personalities that thrive in cardiac vs NeuroTrauma ICU?

ICU tends to have "strong personalities". I've never worked in Neuro or Trauma ICU, but have done about thirty years of CVICU, SVSICU, SICU, CCU, CSICU -- cardiac, in it's various configurations at various hospitals. People say that if you can do cardiac surgery, you can do anything but I suspect that's equally true of Neuro, Trauma or Neuro/Trauma ICU.

Things to consider:

Are you more interested in neuro or cardiac? I never had much of an interest in neuro until recently but cardiac fascinates me.

Cardiac ICU (whether CCU (medical) or the surgical side will be predominately older folks. Unless you're working somewhere that does cutting edge cardiac surgery -- transplants, VADs, experimental procedures -- most folks will have their surgery, recover and go home. The places where they're doing a lot of research and trialing new new treatments, new surgical procedures, new devices will "make a lot of chrons." Nurse speak for patients not doing well and living out the rest of their days in the ICU -- I've taken care of folks still in ICU a year later. Of course, the only way to make a procedure routine and lifesaving is to go through the period when it's brand new and risky -- but you should know what you're getting into. There are a few younger folks with congenital defects -- some of whom will undertake new surgeries that might fix their problems . . . but mostly older folks.

NeuroTrauma ICU will have some older folks with CVAs or brain tumors, but will also have a lot of younger folks with issues that started shortly after they said "Hold my beer and watch this!", went through the threshing machine because their sleeve got caught, crashed their boat, their car, their motorcycle or whatever or were "standing on the corner minding my own business when some dude up and SHOT me." I floated to NeuroTrauma when I was a brand new ICU nurse, and it was full of guys younger than me who were permanently wrecked because of a few seconds of inattention or attention-seeking behavior. I couldn't do it. Others love it -- your milage will vary.

My husband says to do whichever specialty scares you more because that's the best way to get over being afraid. Maybe he's right; but then again maybe not. You can evaluate that advice for yourself.

Interview on both units. Which one "feels better" to you. Which manager seems fair and willing to work with you? Where to the team members seem to work better together? Even different ICUs in the same hospital have different cultures, let alone ICUs in different hospitals. Which culture do you like better? It seems silly, but does one have a better physical layout than the other? Some people absolutely cannot work in a place without windows. (None of them ever went to work in the OR, but you're not talking OR.) Others like bigger rooms and can tolerate the long hallways. Some like short hallways and can tolerate smaller rooms. One ICU might be in a newer part of the building; another might be scheduled to move into a brand new unit.

Interview wherever you can; choose the job after the interviews. Assuming you get more than one offer. Sometimes you have to work someplace for a year or two to decide whether it's for you or not. If that is true for you, consider that you'll be getting good experience to take to the specialty of your choice afterward.

MYSTICOOKIEBEAR · Mar 6, 2017

I am a Cardiac/Transplant ICU RN in a Top 10 hospital so I bet you can guess where I will tell you to go!

In my CTICU the MDs (residents, fellows, attendings) heavily rely on our input and our insight for the very critically ill patients. The patient populations, overall, have much more complex conditions than the Neuro/Surgical/Trauma ICU. In a CTICU/CVICU we primarily deal with a sick heart but might also have to deal with multiple sick organs as well. In a Neuro/Surgical/Trauma ICU more often than not there is one very big problem, but the rest of the organs are working pretty well.

I am very biased, but in my years on The Units, CTICU/CVICU training and experience will prepare you very well for entering other ICU specialties.