Picking Your
First ICU

One of the most common things you will hear as a nurse who wants to become a CRNA is that you need to be in a CVICU. It gets repeated so often that it starts to feel like fact.

I do not believe that is true.

Choosing your first ICU is one of the most personal decisions you will make in your early career. This is not the time to pick a unit because someone on a forum said it looks best on a CRNA application. This is the time to slow down and ask yourself the questions that actually matter. What kind of patients do you feel genuinely connected to? What kind of pathophysiology excites you? What environment brings out the best in you as a clinician? Where do you feel like you would grow the most?

Those answers are worth more than any checklist.

Why I started in the MICU.

I started my ICU career in the Medical ICU and I am so grateful for that decision. The MICU is one of the most underrated starting points for a future CRNA and I want to tell you why.

When you go into a specialty ICU early, it is hard to know what else is out there without spending years figuring it out. The MICU does not let that happen. As a MICU nurse you see everything. Neuro patients. Heart failure. Sepsis. Multiorgan dysfunction. Respiratory failure. The MICU forces you to develop a foundation that is wide and deep at the same time because your patients do not come in with just one problem. They come in with all of them.

It was actually my time in the MICU that helped me discover what I was most passionate about. I noticed over time how much I was drawn to cardiac pathophysiology, the complexity of it, the way everything connects. That realization is what led me to eventually transition to the CVICU. And I am glad I did it in that order.

What transitioning to the CVICU taught me.

Moving from MICU to CVICU was eye opening in a way I did not expect. I noticed that in my new unit, rounds were almost entirely focused on the heart. Which makes complete sense. These patients had just undergone major cardiac surgery. But my MICU training had wired me to think in systems, to do a thorough head to toe, to consider every organ and how they were talking to each other. There were moments where I felt that broader foundation gave me something extra to offer. Not better, just different. And I appreciated my MICU experience even more because of it.

So if you are not sure which ICU you want to start in, consider the MICU. It may be exactly the foundation you need before you find your specialty.

A note on NICU and CRNA school.

Before you commit to any ICU, do your research on the CRNA programs you are interested in. There are many types of ICUs that qualify including MICU, CVICU, Neuro ICU, Pediatric ICU, Coronary Care Units, and more. One important note on NICU: neonatal intensive care is a wonderful and meaningful specialty but many CRNA programs do not accept NICU experience as qualifying critical care. If you know CRNA school is your goal and NICU is calling to you, research your target programs carefully before committing.