MICU vs SICU

Medical ICU is by far the better learning experience. Its the most "generalist" ICU.

i'm biased, our MICU is all Pneumonia/RF and ARDS. SICU is where all the action is! If you want crazy sick patients w/ drains out of every orifice, tubed/ titrating meds (pt on 8-15 drips at a time), the SICU is your choice.

Which population do you have more of an interest in working with? I am in the critical care float pool where I work, and our SICU is a combined surgical, neuro, and trauma ICU. It is a great unit, and initially where I wanted to work, but I actually like the MICU more (something I would not have guessed before working there). Medical patients can be very complex, and very sick. A patient in septic shock will typically develop multi system organ failure, and the crashing pre-transplant patient will be in the MICU before transplant, and in the SICU after (unless it's cardiac).

However many people don't like the MICU for some reasons I understand. Surgical patients have a somewhat expected course of care and recovery (which can be fast sometimes), and with medical patients you will see a lot of unusual things, and a lot of unknowns. In a large tertiary hospital you will learn a ton, and will deal with plenty of drips and intubated patients in either unit. I guess it depends on if you prefer medical or surgical patients.

SICU is where the fun is!! Your patients actually get better and move on (for the most part). MICU is where all the chronic paintings hang around forever!! I personally enjoy coming into work and seeing a different patient each day and not the same ones for months and months! Another evil of MICU are all the CIWA patients - oh they drive me crazy!! SICU - acute in and out vs MICU - chronic and never leave

What Yammar said is all basically true. Some other things to consider is what you want to be doing at work. In the SICU you will get more invasive monitoring experience (art lines, CVP, possibly ICP, etc., though you will also get some of this in the in MICU), and in the MICU you will get more dialysis (HD and CRRT), and procedural experience (bronchoscopy, GI Scopes, Colonoscopy, etc.). You will also have to deal with quite a bit more death in the MICU, and possibly more codes. If you have future plans for moving into flight or CRNA school the SICU is probably a better choice because it relates more, otherwise just go with what appeals more to you. Also after a year in one unit, it should be fairly easy to apply you experience and transfer into a different ICU role pretty smoothly if you want to.

I think it depends in the facility yo work on. In my MICU we move pts pretty fast in and out to our stepdown units. We do get pts with chronic complex pathologies and its very interesting and fascinating to learn multisystem involvement.

We have seperate ICUs, this is our breakdown

CCU= Where your MIs, cardiac arrest pt with hypothermia protocol, cath lab gone wrong, and general dying of a bad heart pts go.

RICU= ARDS/Full resp failure, severe sepsis, stroke and general dying of unable to breathe.

MICU= General ICU that does not fall in the categories

SICU= Open hearts, post op caridac and unstable post surgical pts.

In my facility pts are funneled into the ICU that they most belong in. If we run out of beds in RICU for a respiratory patient, they can be sent to another ICU. Open hearts only go to SICU.

3/4 of the ICUs deal with sick patients that come into the ER/Front door door due to them trying to die at home or on the floor. In SICU they are here because they just had an open heart or brain surgery or some kind of procedure.

Each hospital is different.

As a side note, my hospital cross trains all ICU nurses. In a 8 week span, ICU RNs end up floating 3 days to diffeent ICUs

I agree with the folks who say it depends on what you'd rather be doing, but consider this as well: would you rather be working with surgeons (common in SICU) or not (MICU). I've had some real sick patients in MICU, CCU, SICU and CSICU, but in SICU and CSICU I've mostly worked with surgeons and any medical specialties are merely consultants. In MICU and CCU it was the other way around.

I agree with the folks who say it depends on what you'd rather be doing, but consider this as well: would you rather be working with surgeons (common in SICU) or not (MICU). I've had some real sick patients in MICU, CCU, SICU and CSICU, but in SICU and CSICU I've mostly worked with surgeons and any medical specialties are merely consultants. In MICU and CCU it was the other way around.

I was working in ICU when we split into MICU and SICU back in the late 1970s. I made the choice to go to the MICU simply because I didn't care for the attitude of many surgeons.

I just had to pop in on the MICU side. I love our MICU. Yes, plenty of chronic geriatrics, but also plenty of younger acute issues. Things can go really wrong, PEs, septic emboli, suicide attempt with acetaminophen OD. Some of my sickest patients have been younger MICU patients. Our SICU and CVICU also have their share of chronic patients, admittedly MICU has more.

What are you looking for in your patient population and what are your long term goals?

SICU if its a level 1 trauma. Nothing is quite as fun as getting a bad trauma! Trauma patients can be incredibly sick and often have multi-system injury. Also, SICU definitely has more in the way of invasive lines. But I'm also incredibly bias considering I've been working with surgical patients since I graduated. Either way, ICU is a great learning experience!

I really don't know if one is "better" over the other, to be honest, because they are both so different! I have only floated to our SICU, but my home unit is a MICU, so I can tell you a bit about that... In MICU, we deal with a lot of chronic illness, and everyone is right who says that our patients typically stay a long time - that is, unless they die or are simply having an acute health problem but are healthy at baseline. We have an extremely diverse pt population with a lot of complex problems. We have a lot of really, really, really sick patients. A lot of... gross things... a lot of infection and enhanced precautions. A lot of gtts (pressors, paralytics, sedation, etc).

I didn't see anyone else mention this, so idk if it is common - but our MICU (2x the # of beds of the other units) is the overflow for all of the other units (CICU, NSICU, TICU, SICU, and BICU). We get a lot of the mid-level ICU pts of all types and our nurses are more highly trained because of that (we do extra cardiac, neuro, and trauma training in addition to our own yearly stuff). We also get transfer patients from other ICUs that develop acute medical problems (so sepsis following a surgical procedure, and most s/p code patients). If there is an RRT or a code on the floor, the patient nearly always comes to the MICU (unless it is an obvious cardiac issue or something like that). We also staff the PFT lab when they're short, work as additional resource nurses (starting IVs, transferring pts, etc), and help staff the ED when those areas have short-term needs! If your facility is similar, it may be something that could sway your decision. I am all about the extra training and experience!

I have floated to all of the ICUs, though, and I really love them all for how different they are! My dream job would be to be a permanent ICU float. :)