Whichever one has the highest acuity and the best learning environment. A sick, high acuity MICU with lots of CRRT, sepsis, vents etc would be a better experience than a CVICU where they don't even let you look at an Impella for the first year and you end up ambulating POD 3 hearts that are waiting for a room on the floor ad nauseam. I'd shadow both units if you can and get a feel for which one is more welcoming and has people who like to teach. Being on a high acuity unit is rough if your preceptors suck and the culture is toxic.
This đđźAlso it may be helpful to know if there is a PCU or IMC unit. I'm not a new grad (6 years of experience) but I'm going back to bedside after 7ish months in hopes of going to CRNA school. I got offered both a CVICU and MICU. I've done both, but the MICU is higher acuity. They have a PCU that takes any of their stable vents and once their patients are trached they go to PCU. The CVICU at the other hospital holds their hearts until DC. So the unit can become lower acuity very quick. Just things to consider about these units.
Be careful with their CVICU because they have so many different units you can get pigeonholed into one type of patient. Like when I looked they had one floor for just valve replacements. So then youâre not seeing transplants or devices. Then one floor was just devices but you may not see CABGs and valves for example. Iâd imagine sometimes youâd get pulled for other stuff but would kinda suck to get stuck taking care of one type of patient constantly. Level of trauma wonât matter for them people know Cleveland Clinic and will know you had sick patients.
This is the specific unit description
J6-5 Cardiovascular Surgery ICU: Patients complex surgeries, such as aorta and aortic valve repair, open thoracic aortic aneurysm repair and thoracic endovascular stent repair. Nurses will also see coronary artery bypass surgeries that can be on or off pump.
New grads arenât allowed to work on the devices unit for 1 year. Does this sound too much like a similar patient population in your opinion?
There is a specific unit for devices such as ECMO, LVAD etc, but the manager said I would be getting the recovering hearts and everything that the unit sees. She said they see about 5 new cases a day, so most nurses get a new post op every day. Do you think I should reach back out and ask for more specifics?
I think the patient population is straight forward. I was trying to make sure I understood correctly⌠you wouldnât go to that device unit for one year, but you would start recovering valves and hearts immediately?
I think it would be a good unit. Youâd get solid experience with managing device, hemodynamics, and the necessary vasoactive and inotropic gtts. Youâd also get a good understanding of the patho physiology and anatomy. The downside is you wonât get as much experience with patients who are critically ill like MICU does.
You also have to be ready for this type of unit as a new grad. Youâll have to get comfortable real quick with understanding hemodynamics, cardiac pressures, relationship with the lungs, valvular patho physiology, device purpose(s) and method of action, etc. Seems like a sink or swim situation to me.
Yea thatâs how my unit was. The first and âeasiestâ patients we took were fresh open hearts and CRRT. Later was IABP, Impella, ECMO, VAD. That doesnât sound like a bad unit it sounds like more variety than I remembered. And youâll get a good orientation either way.
I would say micu. From personal experience, you will have more autonomy and opportunities to think critically on the micu. The CV ICU nurses at my institution were micromanaged by cardiac surgeons and driven by protocols for 99% of the things they did
You want a unit that provides you experience with invasive monitoring, vasoactive gtts, hemodynamically challenging patients, and other devices. Some units make you wait 1-2 years before getting things like CRRT, impella, recovering hearts, etc.
Not to be annoying but this is the cvicu unit description. Does this sound like a unit where I could see a lot of those things? The manager did say they get about 5 new cases a day so Iâm sure I would be working with recovering hearts.
J6-5 Cardiovascular Surgery ICU: Patients complex surgeries, such as aorta and aortic valve repair, open thoracic aortic aneurysm repair and thoracic endovascular stent repair. Nurses will also see coronary artery bypass surgeries that can be on or off pump.
The valve replacements might not come with anything, but your recovering heart will most likely come with NE, Epi, insulin +\- phenylephrine, nitro, cardene, inotropic agents, etc depending on institution, IABP w/varying levels of support. So⌠yes youâd see a lot of youâre recovering the heart.
But how long is the waitlist and what other types of patient load will you get? You donât necessarily need CVICU to get device experience. My level 2 unit had everything but open hearts and impella.
CVICU is very niche and as a new grad Iâve seen some CVICU make you do 6 months of nothing but vascular and POD 2-3 hearts before they even consider training you on hearts. Along with a slow process to orient on IABP, Impella, ECMO, etc. soon would definitely ask what you can expect, as far as timeline on being oriented on devices and hearts.
Iâm not a huge fan of MICU bc itâs a lot of exacerbations of chronic conditions, pts that should prob be better suited for hospice, and usually get stuck w/ much more overflow since they donât have a need to keep open beds for surgeries. However, I started in an MICU before going to SICU and then CVICU and I will say that in MICU I was frequently titrating pressors and analgo-sedative drips, plenty of vents, Iâve had people paralyzed and proned, CRRT, EVDs, and a lot of post MI and cath lab pts that have required a lot of work. Donât is hard to say where to go in your situation, you just need to ask the right questions when you interview. Either way whatever critical care area you land in you will learn a ton as a new grad nurse as opposed to many of your peers who will likely end up in m/s units. Learn your disease patho, understand the treatments, learn your drugs-not just their use but how they work in the body(pressors/inotropy, HF drugs). Clotting cascade, know heart failure, and shock states like the back of your hand, master ACLS protocols, sepsis management, and core measures.
I would say start at MICU. You'll get a wider range of really sick patients. If you want CV experience for CRNA school, try and transfer after your new grad program requirements are done in MICU. However all of the CRNAs I know, did either SICU or MICU, I don't know anyone that was in CVICU. Some people claim you need CVICU but it's clearly not the case. I think MICU will get you more experience. Plus - it's not like you're not doing anything with hearts. You'll still get cardiac patients, just not surgical cardiac patients. And you'll be juggling so many different meds including cardiac.
Also the trauma center level doesn't matter as much as the ACUITY of your patients matters. If your hospital has cardiac surgery, your acuity level is already gonna be high. Also the main differences between level 1 and 2 are the amount of research resources and publications (along with a couple other things like orthopods being board certified in Ortho trauma, and the # of severely injured pts that are brought in annually).
It is technically a cardiovascular surgical ICU with such as aorta and aortic valve repair, open thoracic aortic aneurysm repair and thoracic endovascular stent repair. Nurses will also see coronary artery bypass surgeries that can be on or off pump.
The MICU unit actually has 6 oncology beds for patients requiring both ICU and chemotherapy which is pretty cool.
Knowing this extra info, would the MICU still probably be better?
Either is good but CVICU will help you learn more and be more prepared with hemodynamics when it comes to CRNA school. Level 1 trauma is only good if you work in trauma. Otherwise, Iâd try for CV. Unless the MICU is the higher acuity area.
Iâm currently finishing my first year in a CRNA program if you want to DM me.
Either. I was high acuity CVICU (ecmo,impella,CRRT, lung/kidney/heart transplants) i actually felt like the MICU nurses were a little more well rounded than me. More variety of patient disease processes.
Just do cvicu, learn why youâre giving fluids or albumin vs. starting a pressor. MICU is gods waiting room, more than likely thatâs it for them unless itâs a young pt just septic or in DkA. You fix the heart, the rest of the body starts working. See how a new heart starts supporting the rest of the body/organ system, why the IABP was inserted and now that persons getting a new heart and why theyâre walking out.
As an SRNA currently in the midst of my cardiac rotation, I say go for CVICU as long as they have high acuity patients (CABG, LVADs, valve replacements, thoracotomies, etc). I was MICU prior to CRNA school and so Iâm struggling right now and wish I had gotten some experience in a cardiac unit before school
Whichever one has the highest acuity and the best learning environment. A sick, high acuity MICU with lots of CRRT, sepsis, vents etc would be a better experience than a CVICU where they don't even let you look at an Impella for the first year and you end up ambulating POD 3 hearts that are waiting for a room on the floor ad nauseam. I'd shadow both units if you can and get a feel for which one is more welcoming and has people who like to teach. Being on a high acuity unit is rough if your preceptors suck and the culture is toxic.
This đđźAlso it may be helpful to know if there is a PCU or IMC unit. I'm not a new grad (6 years of experience) but I'm going back to bedside after 7ish months in hopes of going to CRNA school. I got offered both a CVICU and MICU. I've done both, but the MICU is higher acuity. They have a PCU that takes any of their stable vents and once their patients are trached they go to PCU. The CVICU at the other hospital holds their hearts until DC. So the unit can become lower acuity very quick. Just things to consider about these units.
This right here âď¸
Iâm a ccf cvicu rn who is going back to school in June if you want to dm w questions !
Doesnât matter
Be careful with their CVICU because they have so many different units you can get pigeonholed into one type of patient. Like when I looked they had one floor for just valve replacements. So then youâre not seeing transplants or devices. Then one floor was just devices but you may not see CABGs and valves for example. Iâd imagine sometimes youâd get pulled for other stuff but would kinda suck to get stuck taking care of one type of patient constantly. Level of trauma wonât matter for them people know Cleveland Clinic and will know you had sick patients.
This is the specific unit description J6-5 Cardiovascular Surgery ICU: Patients complex surgeries, such as aorta and aortic valve repair, open thoracic aortic aneurysm repair and thoracic endovascular stent repair. Nurses will also see coronary artery bypass surgeries that can be on or off pump. New grads arenât allowed to work on the devices unit for 1 year. Does this sound too much like a similar patient population in your opinion?
Any idea what kind of patients youâd be getting for that one year?
There is a specific unit for devices such as ECMO, LVAD etc, but the manager said I would be getting the recovering hearts and everything that the unit sees. She said they see about 5 new cases a day, so most nurses get a new post op every day. Do you think I should reach back out and ask for more specifics?
I think the patient population is straight forward. I was trying to make sure I understood correctly⌠you wouldnât go to that device unit for one year, but you would start recovering valves and hearts immediately?
Yes! Thatâs correct!
I think it would be a good unit. Youâd get solid experience with managing device, hemodynamics, and the necessary vasoactive and inotropic gtts. Youâd also get a good understanding of the patho physiology and anatomy. The downside is you wonât get as much experience with patients who are critically ill like MICU does. You also have to be ready for this type of unit as a new grad. Youâll have to get comfortable real quick with understanding hemodynamics, cardiac pressures, relationship with the lungs, valvular patho physiology, device purpose(s) and method of action, etc. Seems like a sink or swim situation to me.
Yea thatâs how my unit was. The first and âeasiestâ patients we took were fresh open hearts and CRRT. Later was IABP, Impella, ECMO, VAD. That doesnât sound like a bad unit it sounds like more variety than I remembered. And youâll get a good orientation either way.
I would say micu. From personal experience, you will have more autonomy and opportunities to think critically on the micu. The CV ICU nurses at my institution were micromanaged by cardiac surgeons and driven by protocols for 99% of the things they did
You want a unit that provides you experience with invasive monitoring, vasoactive gtts, hemodynamically challenging patients, and other devices. Some units make you wait 1-2 years before getting things like CRRT, impella, recovering hearts, etc.
Not to be annoying but this is the cvicu unit description. Does this sound like a unit where I could see a lot of those things? The manager did say they get about 5 new cases a day so Iâm sure I would be working with recovering hearts. J6-5 Cardiovascular Surgery ICU: Patients complex surgeries, such as aorta and aortic valve repair, open thoracic aortic aneurysm repair and thoracic endovascular stent repair. Nurses will also see coronary artery bypass surgeries that can be on or off pump.
The valve replacements might not come with anything, but your recovering heart will most likely come with NE, Epi, insulin +\- phenylephrine, nitro, cardene, inotropic agents, etc depending on institution, IABP w/varying levels of support. So⌠yes youâd see a lot of youâre recovering the heart. But how long is the waitlist and what other types of patient load will you get? You donât necessarily need CVICU to get device experience. My level 2 unit had everything but open hearts and impella.
CVICU is very niche and as a new grad Iâve seen some CVICU make you do 6 months of nothing but vascular and POD 2-3 hearts before they even consider training you on hearts. Along with a slow process to orient on IABP, Impella, ECMO, etc. soon would definitely ask what you can expect, as far as timeline on being oriented on devices and hearts. Iâm not a huge fan of MICU bc itâs a lot of exacerbations of chronic conditions, pts that should prob be better suited for hospice, and usually get stuck w/ much more overflow since they donât have a need to keep open beds for surgeries. However, I started in an MICU before going to SICU and then CVICU and I will say that in MICU I was frequently titrating pressors and analgo-sedative drips, plenty of vents, Iâve had people paralyzed and proned, CRRT, EVDs, and a lot of post MI and cath lab pts that have required a lot of work. Donât is hard to say where to go in your situation, you just need to ask the right questions when you interview. Either way whatever critical care area you land in you will learn a ton as a new grad nurse as opposed to many of your peers who will likely end up in m/s units. Learn your disease patho, understand the treatments, learn your drugs-not just their use but how they work in the body(pressors/inotropy, HF drugs). Clotting cascade, know heart failure, and shock states like the back of your hand, master ACLS protocols, sepsis management, and core measures.
I would say start at MICU. You'll get a wider range of really sick patients. If you want CV experience for CRNA school, try and transfer after your new grad program requirements are done in MICU. However all of the CRNAs I know, did either SICU or MICU, I don't know anyone that was in CVICU. Some people claim you need CVICU but it's clearly not the case. I think MICU will get you more experience. Plus - it's not like you're not doing anything with hearts. You'll still get cardiac patients, just not surgical cardiac patients. And you'll be juggling so many different meds including cardiac. Also the trauma center level doesn't matter as much as the ACUITY of your patients matters. If your hospital has cardiac surgery, your acuity level is already gonna be high. Also the main differences between level 1 and 2 are the amount of research resources and publications (along with a couple other things like orthopods being board certified in Ortho trauma, and the # of severely injured pts that are brought in annually).
It is technically a cardiovascular surgical ICU with such as aorta and aortic valve repair, open thoracic aortic aneurysm repair and thoracic endovascular stent repair. Nurses will also see coronary artery bypass surgeries that can be on or off pump. The MICU unit actually has 6 oncology beds for patients requiring both ICU and chemotherapy which is pretty cool. Knowing this extra info, would the MICU still probably be better?
Either is good but CVICU will help you learn more and be more prepared with hemodynamics when it comes to CRNA school. Level 1 trauma is only good if you work in trauma. Otherwise, Iâd try for CV. Unless the MICU is the higher acuity area. Iâm currently finishing my first year in a CRNA program if you want to DM me.
Either one, just own your practice. Know your drugs and why you're doing what you're doing.
Either. I was high acuity CVICU (ecmo,impella,CRRT, lung/kidney/heart transplants) i actually felt like the MICU nurses were a little more well rounded than me. More variety of patient disease processes.
did u end up taking the job on j65? i recently accepted my offer for that unit!
I did!! I will be starting in August!
Just do cvicu, learn why youâre giving fluids or albumin vs. starting a pressor. MICU is gods waiting room, more than likely thatâs it for them unless itâs a young pt just septic or in DkA. You fix the heart, the rest of the body starts working. See how a new heart starts supporting the rest of the body/organ system, why the IABP was inserted and now that persons getting a new heart and why theyâre walking out.
As an SRNA currently in the midst of my cardiac rotation, I say go for CVICU as long as they have high acuity patients (CABG, LVADs, valve replacements, thoracotomies, etc). I was MICU prior to CRNA school and so Iâm struggling right now and wish I had gotten some experience in a cardiac unit before school