ICU or OR; pros and cons of both

Schuur451 · Jun 19, 2011

OR is very narrow in scope. Unless you go advanced practice, you'll probably only be a circulator. You work closely with the docs in some ways, but you won't learn much about disease management.

In ICU you are more indepedent, work closely with docs on a variety of patients, and learn more long-term management.You learn a lot more critical thinking (in my opinion), and learn more of what you need to move out of bedside care into a more independent role. Surgery, like OB tends to limit options if/when you get sick of it. If you want broad experience, go to a MICU or SICU. A SICU (surgical ICU) could be a good option for you if you're interested in surgery. Unless you want do surgery forever, I would not start there.

I guess I should disclose that I work in a CCU/MICU. So I'm a little biased :)

Editorial Team / Admin · Jun 20, 2011

Try to get a shadow day in both areas. Each is unique, and has many different aspects. It's hard to determine what may be a pro or a con to you. I look at call as a pro because it means extra money. You may look at call and see it as a con because basically you can't do anything/go anywhere outside of a time window of getting to the hospital.

My pros:

I only take call 2/8 weekends, and call on 2 holidays/year.

Call pay- guaranteed 2 hours of time & a half whether we're there for 2 hours or not (example: heart surgeon gets call that patient dumped 500cc into chest tube in 5 minutes. Calls heart team in while driving to evaluate patient. Gets to unit, finds it was just a "turn & dump" where the patient was turned and all the fluid that wan't quite within reach of the chest tube suddenly got to the chest tubes and the team gets to go home 10 minutes after arriving)

One patient at a time- and they're asleep! No call bells! No crazy family members!

Ultimate teamwork- we have a circulator, a second assist, and a scrub all from the OR plus a surgeon & PA from the surgeon's office plus anesthesia. Each plays an important part in the surgery.

When the patient starts heading south, you have all the parts required: anesthesia to manage the airway, circulator/additional anesthesia to give drugs, scrub person or PCA to do compressions, and circulator to document. We don't even involve the hospital code team in the OR, we do it ourselves.

Great view of real life anatomy. And I can tell you from experience that almost no one looks like those pretty pictures in the anatomy textbooks.

My cons:

There are a lot of people with, shall we say, strong personalities.

You WILL see people die, especially if you work in a trauma center. I still vividly remember my first patient death in the OR, even though it was over 5 years ago.

You will work with some surgeons that you wonder how the hell they got a license/privileges to operate. And then you will wonder how many cases have to go south before their privileges finally get yanked.

And to follow the previous poster's admitted bias, yes, I do work in the OR and most days I love it!

Schuur451 · Jun 20, 2011

Great post, Poetnyouknowit, I'm glad you gave a good surgical perspective.

And yes, one patient, who is asleep is a HUGE...let me say that again HUUUUGE!!!!! pro.

I'm just done working my weekend, and it was a doozy...