Level 1 Trauma ICU vs Community MICU

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Specializes in ICU, Critical Care RN.

Level One Trauma Critical Care Nurse here. Have a decision to make and need some advice.

Currently work in a 21 bed, highly specialized ICU in large hospital. Pros - professional staff, good hospital mission, focus on continuous education and cutting edge technology, friendly staff and coworkers, great medical benefits. Cons - pay rate low (making 2/3 of my previous salary, but wanted the experience). Can't alter hours or switch positions for one year and I'm only 7 months in. I have a really long commute, but would for any Level One Trauma hospital near me. Working overnights.

Have job opportunity at a smaller hospital - larger than a community hospital, but nowhere near as big as Level One Trauma Center. ICU is 14 bed Medical ICU. Commute is cut in half, pay rate better. Will see more variety here, but nothing as critical as the floor I'm currently on because they ship them out to the Level 1 Trauma. Option for per diem or full time and option for days/nights. Cons - Medical Insurance expensive.

Other factors. Until recently, thought I would like to pursue CRNA. Now, probably not my life goal. Probably will focus on NP in the near future.

Curious what others might do in this circumstance. Not entirely sure what future goals are, just want to get at least one year of ICU experience in for now, have flexibility in schedule, and make more $$.

I would miss the people and the hospital I currently work in, but I'm not in love with the specialty area I am in, and would have to wait several more months before having the opportunity to apply to another floor. And at that point, I would probably like to try the MICU. It's also hard on my family to make the 12 hour shift into a 16 hour day with commute time, but this isn't a deal breaker.

Advice?

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Have you shadowed on the MICU near you? If not, I'd suggest requesting a few hours on that unit ASAP and making your decision with that information. The unit culture matters a lot.

Also, leaving a job before you've been there at least a year is always a little dicey and may burn some bridges, so sticking it out for a few more months might be a good idea on that basis alone.

As someone who's worked both in level 1 trauma centers in big teaching hospitals and a community MICU (though, in fairness, a relatively large one), I can tell you that I think medical ICUs and community hospitals get a bad rap as far as experience and resume-building is concerned. Medical ICUs expose you to a tremendous range and depth of pathophysiology, if you pay attention and take seriously your responsibility to learn your assignment. Likewise, community hospital ICUs often wind up offering a nurse who has proven his or her competence a degree of functional autonomy that you'll almost never find at a big academic center.

There are some caveats though. For one, you won't learn all that much if your new unit gives you 3 or 4 patients every shift. The ratio matters a lot. For another, you'll likely have to be inquisitive and seek out learning opportunities in a community MICU, rather than just absorbing lessons passively.

Outside of that, you may ultimately be surprised to find how similar other ICUs are to trauma ICUs. The psycho-social aspects of trauma nursing are more distinctive than the medical experience, if that makes sense.

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Specializes in ICU, Critical Care RN.

Thank you for your advice. Makes sense. I'm hopeful to stay on at the Level 1 Trauma Center, if they will allow me to reduce my hours. I just don't know if that would be an option.

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