I am faced with a dilemma! I posted about 8 or so months ago regarding ICU experience. I currently work in a 34 bed Medical ICU in my region's largest hospital, and I've been building up some decent experience. I'm comfortable with basically all the vasopressor drips (Levo, Epi, Phenyl, Vaso), and fairly comfortable/proficient in other cardiac drips (dopamine, dobutamine, NTG, esmolol, etc). Our unit also uses a fair amount of sedation, as we often get severe respiratory failure or crazy, out of control detox patients requiring intubation and sedation. We used a ton of Fentanyl, Versed, Propofol, Dexmedetomide, Ketamine drips, and even a decent amount of Roc/Vec (both bolus and drips). But what my ICU does not do, which drives me crazy, is monitor lines. We have a fair number of Arterial Lines, but I've only seen a Swan twice (and it wasn't even in my unit; I had 2 orientation shifts in our CVICU) and very few CVP monitors hooked up. One of our outspoken big-wig (kinda douchey) MICU attendings hates CVP monitors, insist they do nothing, and are a waste of a perfectly good port on a triple lumen, even though on more than one occasion, our overnight midlevels will order bolus after bolus for a sick patient and we end up fluid overloading them because we don't measure their fluid status. Often I will hook unstable, new admit patients overnight up to CVP, only to come back the following night and having it be discontinued. I know the numbers and waveforms for CVPs from my own studying, but not more from experience. And Swans, I again know the normal numbers and waveforms, but not much else.

I'm trying to become the most well-rounded I can for CRNA school, so I guess I'm wondering what would be more beneficial: sedation drips or monitoring. Ideally, both, but it seems like I have to choose just one at my hospital. My hospital's CVICU uses a lot of cardiac drips and pretty much all the patients have Swans, CVP, and Arts but very little sedation, and patients are often extubated quickly and it's nearly impossible to get a job due to our unionized facility. In my MICU, we get ARDS patients on multiple sedation/paralytic drips and long term ventilation on PEEPs of 20, which I feel like is also very beneficial for anesthesia. Even our SICU doesn't use a lot of CVPs, but lots of Art lines.

I'm just conflicted on where to go. I'm considering my region's Trauma ICU as well because I assume they would have a decent combination, but I like the hospital I work at. Any advice on if my experience would be sufficient? Or should I pack up and move on?