MICU vs SICU

meandragonbrett · Oct 1, 2011

It really doesn't matter when you break it all down. A critical care bed is a critical care bed......regardless of the name of the ICU above the door that enters the unit. I know at the facilities that I have worked at the surgeons did not want their patients in the MICU unless there were no SICU beds. The surgeons were familiar with the SICU nurses and had a very close working relationship and had a trust for the SICU nurses. It's all relative to the facility.

MICU tends to be acute exacerbation of chronic health problems (COPD, CHF, ESRD, etc.) mixed alone with acute illness (Pneumonia, DKA, Sepsis, ARDS, etc.).

SICU tends to have all of the underlying medical issues that the patients in MICU/CVICU have but those acute/chronic illness are general complicated by a surgical procedure and the body's stress response. The SICU nurse needs to be adept and managing the medical problems of the patient as well as caring for the fresh post-op surgical patient.

Typical patients seen in a Surgical ICU (Although can vary based on your hospital's critical care set up) include Carotid, AAA repairs, Fem/pop/aortic/tibial bypass, Ischemic bowel, abd compartment syndrome, lots of BIG belly surgeries, necrotizing fascitis, etc. Lots of septic, hypotensive, dry, clinically unstable patients at times and at other times they are stable as a rock. You just never know. Depending on your SICU you may have lots of vents, lots of swans, vasoactive gtts, sedation gtts, fluid resus, etc. Surgery critical care tends to do a *bit* more fluid resus than MICU but we don't drown our patients in LR/NS to the extent that we used to.....I can remember many of nights of literally pouring gallons of NS/LR into people until they were unrecognizable 12 hours later.

I say check out the ICUs, see where you feel like is the best fit for you....regardless of what the name of it is. Get in there and seek out the sickest patients, ask questions of the experienced RNs and of the docs......learn to be the BEST ICU RN that you possibly can be. Go to the unit that has the sicker and more unstable patients on a regular basis.

papawjohn · Oct 1, 2011

Brett has a good answer. I would only add that you should be thinking that you are going to work in both MICU and SICU sometime and in a CCU also. There are lots of things to learn from all the 'specialties' and to be the best nurse you can be you should experience them all before you lock yourself into one unit and plan to stay forever.

NCRNMDM, ASN, RN · Oct 1, 2011

Thank you! Those were really good responses, and it's great to get feedback from experienced nurses. I can't wait to begin work as an ICU RN, and, since there a lot of ICU jobs open to new grads in my area, I hope to start directly after I graduate. I think I'm most fascinated with SICU, but I would be willing to work in any critical care area that hired me. I do agree that working in more than one ICU would be a good plan, and I hope to have worked in at least two before I retire.

TraumaRN1983 · Oct 2, 2011

I am currently working in an SICU at a level one Trauma Center, where we also have an MICU that I have floated to a couple times. Brett already pointed out a lot of differences, which I would agree with. In my SICU we see a lot of cardiothoracic patients so we get a lot of pt's with swans and on multiple vasopressors, which I don't think the MICU sees quite as many of. The MICU patients tend to be more chronic. At my hospital you cannot get a job in any of our ICU's as a new grad. We have a great ICU internship program, which I think turns out some pretty great nurses. I myself started this job with just over 2 years of intermediate care experience and it was still pretty hard to adjust to the ICU setting. If you have any ICU internships in your area, I would highly advise them. Without that extra experience I think it would be very hard to start out in the ICU, especially SICU, as a brand new grad.

HazelLPN, LPN · Oct 5, 2011

I remember the old days when it was just "ICU"...and even before when critically ill patients were simply placed closest to the nurses station when there was no ICU!

When the ICU split into MICU and SICU in the 70s, I chose to go to MICU simply because I didn't care for some of the surgical attendings. However, thoes of us from the old days could freely work in both units if one was short staffed and we were equally comfortable working either.

I think a good critical care nurse can work in either. As a MICU nurse, you will still have complex dressing changes to do (no burns though....something that I much preferred to do the burn unit nurse if I had to do it at all). As an SICU nurse, many of your patients

also have medical issues.

I got burned out on MICU nursing...physcially and mentally...towards the end of my career. First, as said before, much of your population is chronic. Many are also obese/morbidly obese and can be physically challenging to manage...especially as one gets older. I felt like I was simply prolonging life and destroying my own body in the process......so I ended up cutting down my hours in MICU and reinventing myself...as a PICU/NICU nurse. The smaller patients were much easier on my body and kids often heal much faster and more completely than do adults.

Generally, SICU patients are younger, but in both units you will still find that many of the patients are geriatric.

As a new nurse, you won't lose with either unit if you have a passion for critical care with the natural talent that I believe it takes to be a good one.

If I would have had to do my career all over again, I would have been a PICU nurse from day one. I liked adult critical care (most of the time) but I LOVED pediatric critical care (most of the time). Had I stoped doing adult earlier, maybe I would also have my original knee that needed replaced the month after my retirement and was the reason I had to retire from critical care nursing. The mind is still as sharp as ever, but the body sadly does not keep up with the mind.

Also consider PICU. You have to know everything, medical and surgical there. Most of the patients do get better....and when you're pushing 60 (oh to be 60 again!) you will probably have all of your original parts.

Best wishes to you in your career in nursing,

Mrs. H

NCRNMDM, ASN, RN · Oct 5, 2011

Thank you, HazelLPN! That was a great post. I had thought about PICU, but wasn't sure if it would be right for me. I do have a passion for critical care, I've wanted to be an ICU nurse since I was six, and I hope I will be good at it. I had thought about starting in an adult ICU just to gain experience and then possibly moving to PICU if I needed a change of scenery. Did you find PICU/NICU to be harder or equally as hard as the MICU/SICU? I always thought it would be ten times harder, and I was a bit frightened at the prospect of taking care of such critically ill children. But it is something that I am keeping in mind. Truth be told, I would work in any ICU: neurosurgical, burn, surgical, medical, pediatric, neonatal; I wouldn't refuse a job in any of the ICUs. I want to experience as much, and learn as much, as I can.

HazelLPN, LPN · Oct 6, 2011

Thank you, HazelLPN! That was a great post. I had thought about PICU, but wasn't sure if it would be right for me. I do have a passion for critical care, I've wanted to be an ICU nurse since I was six, and I hope I will be good at it. I had thought about starting in an adult ICU just to gain experience and then possibly moving to PICU if I needed a change of scenery. Did you find PICU/NICU to be harder or equally as hard as the MICU/SICU? I always thought it would be ten times harder, and I was a bit frightened at the prospect of taking care of such critically ill children. But it is something that I am keeping in mind. Truth be told, I would work in any ICU: neurosurgical, burn, surgical, medical, pediatric, neonatal; I wouldn't refuse a job in any of the ICUs. I want to experience as much, and learn as much, as I can.

The big thing that I had to get used to when I made the switch to PICU was that everything was based on weight and your norms are different. Kids can also compensate better than adults do before they crump. An adult, usually, will give you plenty of warning. They'll look like hell first before their vitals or labs start to give you the empirical evidence that your intuition has already told you. Generally, kids are not that easy to read...they keep you on your toes. You can literally walk out of the room with a PICU patient and they will look fine....vitals are fine...labs are fine...and then they rapidly decline without the all the warning signs that adults will give.

At the same time, kids are strong. You will see most of your patients get better. Some will have quality of life issues, but not the majority. Rarely did I feel like I was prolonging life of a person with a chronic illness who continued to make poor lifestyle choices like I did as a MICU nurse. NICU is its own thing. Very specialized. You don't have to know nearly as much as a PICU or adult ICU nurse in terms of variety, but you better know premies very well because there is so little room for error. Its a simple matter of mass and volume. I was more of a PICU nurse who moonlighted in the NICU, never a real NICU nurse. I was great with two stable vents or three feeder growers. The very tiny premies (23-24 weekers) and the complex chronics were not my cup of tea and I rarely took care of that population for the good of the patient and my license. They needed a real NICU nurse, not a PICU nurse who is adventerous. I also had some ethical issues in the NICU. We had great technology to save these babies, but there were oftentimes quality of life issues that were challenging for me...and the real NICU nurses as well. It was a nice change of pace, and I loved the staff that I worked with, but I would not have wanted to spend my entire career in the NICU.

We had plenty of new grads who did well in the PICU fresh out of school, so don't be afraid of it. The ones who did the best were naturally bright and talented, were passionate about critical care, and knew that they had a lot to learn and were not afraid to ask questions.

You could always test the waters of the PICU by working as an NA or a unit clerk or tech if you have a local childrens hosital. Some of our best nurses in the unit started out in these positions and were hired immediately after they graduated. Human connections are so important in the work word, but thats a speech for another time.

Best to you,

Mrs H.

KSnow2332 · Oct 7, 2011

I work in MICU at my hospital. The main differences between our units are that SI tends to get more of the neuro patients. Bolts, ICP, Brain stem injuries, CVA, etc. In MI we get, as others have said, the exacerbation of the chronic illness patients. COPD, CHF, DKA, etc. That is not to say there is no overflow. SI does get some ODs or Resp Failure every now and again, and we can get some surgery patients. Although if it is a neuro patient, critical like CVA on a mannitol drip, SI will always get them. I think a unit job for a new grad can be either a good or a bad thing. It really depends on your unit, your hospital, and your confidence in your skills. I have seen new nurses come into the unit since I started and some have done very well. I have seen others who have struggled with some basic things I learned when working on the floor, like time management. We have a 2:1 ratio here most of the time. Rarely will we get a 3:1, and on those times when you get that triple, time management is your best friend. It is easy to get caught up in caring for your patients in the unit. They are critical, need a lot of one on one time, and I even find myself in a room sometimes an hour or so caring for just one. When you have a vent and drips that need titrated is where your skills come into play. Nursing skills, learned skills, and just the skills you pick up over time of taking care of people. It is easy to feel like you have too much to do sometimes, and not enough time. And like I said, I worked on a floor where our ratio was on a good night 6:1 but more often than not 7:1. I still feel sometimes with my 2 patients like there just isn't enough time, and that's normal.

Although I am not an SI nurse I do love my ICU job. I wouldn't trade it or the experience I have gotten for anything. We do float to SI a lot, our units are run by one manager and we are one floor apart, and every time I have floated there I have loved it too. So if you think SI is for you I say go for it. The experience you will learn is great and you will always be learning new things. Just remember you need to have confidence in yourself, your skills, and your team members....and never be afraid to ask a question. If you don't ask, you can never learn the answer! Good Luck!

sethmctenn · Oct 9, 2011

There is a lot of variation from hospital to hospital in how they assign their patients. We don't have a neuro ICU but most of the neuro cases come to our MICU rather than SICU. When you start going down this path, I would choose whichever ICU has the manager you feel best about. Be sure to ask how long your orientation will be and what extra training they will provide. Will you be with one preceptor or a different one each day? Whichever unit will provide you the best orientation will likely be the best place to go.

NCRNMDM, ASN, RN · Oct 9, 2011

Thank you to everyone, these answers are just the type I was looking for. My mom works in a CVRU/CVICU that takes mostly post-open heart and vascular surgeries, but it's so specialized that it's hard to tell how other ICUs would be just by visiting it. I've been in her unit before, and 99% of the time they are taking care of cardiac or vascular surgery patients, with a rare overflow from SICU or MICU. Their unit has a high turnover rate, and most of the patients are out of the unit by the third day post-op. They are on the vent for one full day, then they are up walking on the second day, and by lunch or dinner on the third day they are on the step down unit. Everything in her unit seems very routine, and the nurses rarely deviate from their set protocols and standards. The patients are critical and very hands-on for the first day, and after that they are all well and up and about. It seems exciting in a way, and I know that you have to be very intelligent, but I think I would get bored of the monotony that the nurses face in that unit. Each day they hang the same drips, see the same surgeries, draw the same lab work, and follow the same protocol down to the letter as they did the day before. I would love to find an ICU where things are a bit more exciting and chaotic. I know that every ICU is going to have some monotony to it, but I think a unit where you see varied, and very critical and challenging patients would best suit me. I want to work in a unit where I am constantly learning new things, always expanding my horizons, and really caring for the most critically ill in the hospital.

NCRNMDM, ASN, RN · Oct 9, 2011

The big thing that I had to get used to when I made the switch to PICU was that everything was based on weight and your norms are different. Kids can also compensate better than adults do before they crump. An adult, usually, will give you plenty of warning. They'll look like hell first before their vitals or labs start to give you the empirical evidence that your intuition has already told you. Generally, kids are not that easy to read...they keep you on your toes. You can literally walk out of the room with a PICU patient and they will look fine....vitals are fine...labs are fine...and then they rapidly decline without the all the warning signs that adults will give.
At the same time, kids are strong. You will see most of your patients get better. Some will have quality of life issues, but not the majority. Rarely did I feel like I was prolonging life of a person with a chronic illness who continued to make poor lifestyle choices like I did as a MICU nurse. NICU is its own thing. Very specialized. You don't have to know nearly as much as a PICU or adult ICU nurse in terms of variety, but you better know premies very well because there is so little room for error. Its a simple matter of mass and volume. I was more of a PICU nurse who moonlighted in the NICU, never a real NICU nurse. I was great with two stable vents or three feeder growers. The very tiny premies (23-24 weekers) and the complex chronics were not my cup of tea and I rarely took care of that population for the good of the patient and my license. They needed a real NICU nurse, not a PICU nurse who is adventerous. I also had some ethical issues in the NICU. We had great technology to save these babies, but there were oftentimes quality of life issues that were challenging for me...and the real NICU nurses as well. It was a nice change of pace, and I loved the staff that I worked with, but I would not have wanted to spend my entire career in the NICU.
We had plenty of new grads who did well in the PICU fresh out of school, so don't be afraid of it. The ones who did the best were naturally bright and talented, were passionate about critical care, and knew that they had a lot to learn and were not afraid to ask questions.
You could always test the waters of the PICU by working as an NA or a unit clerk or tech if you have a local childrens hosital. Some of our best nurses in the unit started out in these positions and were hired immediately after they graduated. Human connections are so important in the work word, but thats a speech for another time.
Best to you,
Mrs H.

I've been thinking about your advice, and I am now adding PICU to my list of ICUs that I am considering working in. I had always avoided PICU because I assumed that I wouldn't be able to do it, or that it just wouldn't suit me, but after what you've said, I think it could work for me. I would be terrified to start out in PICU as a new grad, but I would love to have such an awesome opportunity. I may look into getting a job as an NA in a PICU close by as that seems like great advice. Thank you again for your advice, it has been wonderful.