First, some definitions:

SICU = Surgical Intensive Care Unit. This is where post-surgical patients go.

MICU = Medical Intensive Care Unit. This is where everyone else goes. This is also where I work.

Staff nurse = One who is employed by the hospital.

Traveling nurse = One who is employed by an agency.

So I was at a party the other night, a party with a lot of nurses in attendance, a lot of traveling nurses, that is.

I discovered some interesting beliefs among them:

Many seem to think that the MICU is (in their word) a hell-hole.

And all staff nurses are crazy for not joining agencies and doubling their salaries.

So here’s the conundrum: If you are a traveler, and the only assignment you can get is the MICU (which you believe is a hell-hole) then isn’t the joke on you?

I met another traveler who had recently ended his stint at the MICU. I asked him where he was going next, thinking that he would be leaving the hallowed halls of GHOAT for greener pastures.

Nope, he was moving down the hall to the SICU. He seemed to think that this experience will be worlds better. He also was of the notion that if you work in the SICU, you can work anywhere. If you work in the MICU, you can?t even transition to a SICU.

I’m assuming that this means you need to have more skills in the SICU, skills that could not possibly be learned in the MICU.

I’m wondering what these skills are. Bow hunting perhaps? Or programming in C++? Translating obscure Russian poetry? Because I’ve had a few post-surgical patients. (spillover from the SICU) They have some drains and some surgical wounds. They can be extubated quicker. You have to get them up out of bed and make sure their pain is controlled in order to allow them to do this.

Am I missing something?

Call me naive but my feeling on transitioning to another unit is this: If I spend a couple years in the MICU at GHOAT, I could pretty much work anywhere I wanted as a staff nurse. Two factors are at play here. Number one it’s GHOAT (Greatest Hospital Of All Time). Number two there’s a nursing shortage.

The other complaint about the MICU is that people never get better. It is true there are some who don’t. There are even some that end up in chronic vent facilities (a fate perhaps worse than death). I’ve learned to appreciate small victories. For instance, when a critically ill patient comes in with a very bad prognosis, it’s easy to be pessimistic right off the bat and think that this patient will never make it home. On the other hand, you could start thinking that if this patient makes it home just for a few days/weeks/months it will be a gift. The family can have time to say goodbye to their loved one.

I love a good extubation. It really makes my day.

I’ve gotten report from traveling nurses who sprinkle their report with comments like, “This patient is so sick and probably going to die. The resident/intern is just chasing her tail. I don’t know what these doctors are trying to do.”

Ummm… It’s called curing/healing. It happens sometimes. It’s a beautiful thing.

It is true that many people I work with accepted jobs in the MICU because there were no openings in the CCU. Not me. I got sent to the MICU as a student, not even knowing that there were SICUs and MICUs and CCUs and CSICUs. I got roped in. You see, my nursing school was associated with a hospital that has the distinction of being the “father of modern trauma” so in nursing school, everyone studying critical care was pretty much a trauma jockey. “Give me some trauma! I love blood and guts!” was their cry. Not me. I hate blood. That’s why it took me over ten years to even entertain the idea of becoming a nurse.

The other cool thing about the MICU: If you loved your pathophysiology class, you can see it come to life right in front of you. There is no better way to learn it and really know it. You see how the kidneys, lungs, liver, and circulatory system all interact. You learn that fixing one system is a matter of balancing it with the other systems. You get too aggressive in your treatment of one system and the other systems start to complain; grumbling at first and then turning into a full-fledged roar: “Get these vasopressors out of my bloodstream NOW or I swear to you I will turn all of my fingers black and make them fall off!!!”

So now I’m not sure if this rant is about MICU vs. SICU or agency nurses vs. staff nurses. I guess it’s more about why I love the MICU. Perhaps if I spend a long enough time with these super-sickly MICU patients I will become jaded and wonder what the point to all of this is. But for now I very much enjoy being their champion.

Imagine this: There’s a liver failure patient who’s been bounced up to your MICU at least 4 times now. After the second visit to the MICU you know his chances for survival significantly plummet. You’ve gotten to know him and his family a little and you are rooting for them. One time you even chased the docs around all day because you knew he was ready to be extubated but they were wrapped up in more urgent matters. His family comes in that night pleased as punch because they can actually talk to their father tonight because there’s no tube shoved down his throat. This is a small victory, though. You think he’s probably not going to make it because liver failure really sucks. Then you come to work a few nights later to see three dozen Krispy Kreme donuts in the nurse station, compliments of Mr. Liver Failure’s family. What happened, you ask? Apparently Mr Liver Failure got worked up for a transplant, a liver was made available, and voila, now he is recovering in the SICU.

So the SICU gets all the happiness and all the glory.

All the MICU got was the Krispy Kremes.

I guess I’m fine with that.