Aug 31, 2015
34
5
Status
Pre-Health (Field Undecided)
Like in Med, Surg, Cardio Thoracic, CCU, etc.

I'm thinking about becoming a PA since my pharmacy career plan may be a bust. Since my mom is a nurse on the CTU she's seen PA's change/insert tubes in the chest and neck and groin that lead to major arteries and stuff. I really can't imagine myself doing this, I'm way too queasy. But I can handle stuff like skin disorders or like diagnosing, perscribing. What do PAs do on the medical or surgical ICUs, specifically or on NICU and PICU?
 

BreathDeep

5+ Year Member
Apr 20, 2012
64
38
Status
Non-Student
I have no idea what goes on with the childrens, but here's what our PA/NP's do in the MICU/CVICU and Neuro ICU:

*First, I must mention that my hospital (UCSF, no sense hiding it I suppose) has an "open ICU". It's an odd set up and I (plus almost everyone else) hates it, but essentially it means that any following team can write orders for a patient in the ICU. So typically the primary team continues to follow up to ICU, along with any consulting teams, while the actual "ICU team" (which is run by Anesthesia but the residents are typically a mix of Anesthesia/Medicine/Emergency Medicine) is responsible for Airway, Blood Pressure, CRRT, sedation, tube/line insertion, other random things, and "ICU medications" that don't fall strictly under Cardiothoracic or Neurosurgery.) Confused? So are we. Anyway, moving forward...

On our Med-Surg unit the NP/PA is interchangeable with the ICU Resident. Airway wise they write the ventilator orders, they can intubate if needed, order to extubate, and order different respiratory therapies and medications. They manage all the vasoactive drips. If Renal lets them they can also manage the CRRT. They can run a code blue. They insert central venous/trialysis catheters and arterial lines. In essence, they make sure the patient is still breathing and hemodynamically stable through the night (or day). Since they also follow every ICU patient, I've noticed they tend to do a lot of "shepherding" of the other teams as well, making sure every team is on the same page and all the proper teams/ancillary teams are consulted. On the cardiac ICU, there is a specific PA that is solely responsible for the ECMO's.

On occasion a patient will be "Primary ICU" - in which case ICU manages everything - which means the PA/NP is literally managing everything, but those patients are exceedingly rare and I've only ever seen it happen a couple times. Both were homeless direct from the ED to ICU admits with a Ddx of "He's sick everywhere, and uh, we don't know why?" (I'm 99% convinced it's just because no other team wanted them...)

But I have to ask, if you like skin disorders why not just go into derm? Or if you're queasy, why not something like primary care?
 
OP
S
Aug 31, 2015
34
5
Status
Pre-Health (Field Undecided)
Job security- I mean how many dermatology PAs are needed? Primary care is in the doctor's office right? I don't know if I want to go into that... I'm so confused about life! Whatever job I consider, it feels like it'll be a huge risk- not something I can wholeheartedly set my mind on.
 
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Mad Jack

Critically Caring
5+ Year Member
Jul 27, 2013
35,621
65,307
4th Dimension
In our med ICUs, they did everything the residents did, but generally the residents would take any interesting procedures if they weren't busy. The big difference between the PA and the resident though- the resident gets finished in three years, then their salary doubles (or triples if they go on to do a fellowship), while the PA is stuck making 80-90k a year, inflation adjusted, for life.

In the surgical ICUs, the PAs were basically just there for housekeeping while the physicians and residents were in the ORs. They had to call in any major decisions or changes.
 

styphon

Senior Member
10+ Year Member
15+ Year Member
Jun 25, 2001
713
275
New york
Status
Attending Physician
My experience at a Tertiary care hospital

medical ICU: "closed unit" Dobhoff placements, central line placements, rarely A-line placements, Ventilator management - intubation was done only by anaethesia. staffed by a dedicated ICU team, the primary hospitalist teams stop following the patient when they entered the ICU. An NP/PA on this team acted as a resident - rounds with the team, presents the patient to the ICU attending. They worked 3 12s a week.

"step down/long term ICU" - "open unit" patients on long term vents, often w/ trachs. There was a PA/NP staffing this unit, the patient was also being followed by the primary hospitalist team. The midlevel interacted with the ICU attending, who was in consult with the primary team. Often a NP/PA from the ICU would staff this for a change of scenery

cardiac surgery ICU: "closed unit" For post surgical patients the NP/PA's would do most of the post op care as their attendings were in the OR.

surgical ICU: "open unit w/ consult" Dobhoff placements, central line placements, rarely A-line placements. At first was staffed by PAs who were employed by the surgeons, but they were all let go and replaced with 2 dedicated surgical ICU attendings.
 

MEN2C

5+ Year Member
Jun 27, 2013
284
248
Status
Fellow [Any Field]
I've been to two large well respected university PICUs and the NP/PA effectively acts as a fellow. In one place they share call with the fellow so there's always either a fellow or NP around. They follow all patients and lead night rounds if the attending isn't there. During the day, generally the fellow leads the rounds.

Both places I've been have had attending coverage 24/7 though but usually you don't see them much at night unless something really bad is happening.
 
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