One of the reasons I like MICU nursing is the same reason I used to like it in the restaurant business when the hostess fills up your section on a busy Saturday night:

It can’t get any worse than this.

Let me explain. Working in the MICU, You will most likely get assigned two very sick patients, often both on the ventilator, sometimes with multiple drips and multiple disease conditions, and with high acuity. You know at the beginning of your shift what you will be dealing with.

When the hostess completely fills up your section on a busy Saturday night, the underlying thought is this: I may be in the weeds right now, but it can’t get any worse than this, because she can’t seat me anymore.

This is not true at all with floor nursing, or in my case, recovery room nursing. You get four patients that you have to recover from a procedure and each one of them is a ticking time bomb. Anything could go wrong at any moment. And when things do go wrong you don’t have the same resources that the ICU has, so you just wing it. You can call the medicine intern and hope they will come up and assess your patient who is A&Ox1 with increasing 02 requirements. You can page the radiology fellow to tell them that your patient has 9/10 pain, and pray that the fellow hasn’t already begun his next procedure (in which case the patient in pain is SOL.) You can page the radiology attending (because none of the fellows are answering their pages) to tell him that your patient has spiked a fever, their BP has shot up to 260/110, with HR in the 120’s, only to be yelled at for paging the attending instead of the fellow.

I miss the MICU, and I miss working with pulmonologists. No doctor in the MICU has ever yelled at me for alerting him or her to a change in my patient’s condition.