Choosing a route - CNS vs CRNA (chem bachelors, ADN)

[cjb19]

Background: I graduated with a bachelors degree in Chemistry from SUNY Geneseo with 3.04. Just finishing up my 1st year of ADN with a 3.71. I currently work as a HUC on a neuroscience floor that also receives a lot of regular medicine patients. I know the value of working on a med-surg type of floor as a graduate nurse, and I can see how much I would learn, but I also see the poor staffing (sometimes to the point of it being unsafe), and high amount of stress and turn over that goes on on our floor as well as any other med-surg floor in the hospital. After my first semester of nursing school, I was pretty set on wanting to go on and get my masters as a CNS. I love the role they play, but have also been told how they are the first to get laid off and pay is not that much better. I've been encouraged by lots of seasoned nurses and instructors that going the CRNA route would be best for me and my background. I'm a 23 year old female, unmarried/single and I don't want to have kids until my late 20s. I've enjoyed caring for my patients on the med-surg floors I've had clinical on, but I don't like the idea of having 4-6, sometimes 7 if staffing is bad. We don't get to do a critical care rotation but I'm trying to see if they will do a special elective as they have in the past.

Anyways my question is do you think it's ok for a graduate nurse to go straight into an ICU to get that experience before applying to CRNA school? The hospital I work at takes new grads. Part of me just feels like I should get a year of med-surg, but some people have said it doesn't matter and I should just go for it. Also, my GPA is weak from undergrad, I realize. I got a C+ in biochem, B's in orgo, B's in physical chemistry, a C is analytical chem....my program was brutal, and my school is known for chem and physics majors having the lowest GPA's (oh C's in physics as well...I HATED PHYSICS). I still feel very comfortable with math, and its one of my strengths (minus like differential equations). Also, I know I wouldn't like the NP role...I don't like the idea of charting all day long or working in a family practice.

[littlepeopleRNICU]

As far as NP goes, you will do more than chart, and you will also have more than family practice to choose from. There are so many roles an NP can go into now, and you will have charting as a CRNA as well. I can only imagine the amount of charting that is necessary as a CRNA...something as serious as providing anesthesia has to have detailed documentation along with it, I would think.

To answer your question, I don't think it's a bad idea to go into ICU as a new grad.

[Rocknurse, MSN, APRN, NP]

You wouldn't be able to apply for CRNA school without at least a year of ICU experience, and a CCRN certification is also a plus. The competition is tough and the places few, so having something that stands out is beneficial. Also, a 3.04 in chem might not look so impressive. There's no rush and a CRNA role is one full of responsibility. You would benefit so much from a year or two in the ICU, preferably a cardiac ICU so you understand how to use vasopressors and what it's like to manage a crashing patient. There are many already practicing ICU nurses who struggle to get a place at CRNA school and in my opinion the best thing you can do is try to get an internship. However, your main stumbling block is your ADN as many hospitals now will not consider an ADN nurse for ICU and they generally (in my experience) only hire BSN graduates. My own ICU would occasionally hire new grads as interns but only the best of the BSN students were taken. Perhaps go back and do your BSN and concentrate on your GPA, and then get an ICU position during which you'll get your CCRN certification. Make yourself as marketable as you can. Right now, you are still inexperienced and the schools will see that. There's no reason you CAN'T be a CRNA, but you have to plan the long and arduous road ahead of time. It's not easy.

[PG2018]

The charting anesthesia providers give usually isn't that detailed or lengthy. It seems like the higher you go on the totem pole the less charting you do.

OP, I respect your ambition and believe you to be quite capable in any pursuit. I believe that CNS might be a bit limiting for you, however. Perhaps roles are different in your area, but here the acute care nurse practitioner might be a better route over CNS.

Your conception of NP is incorrect. As I stated, the higher up, clinically, it seems the less paperwork. There is also dictation, i.e. you speak (and record) as quickly as you can and someone else types it later. There are also computer programs now that do this. Also, NPs, I assure you, are not limited to family practice.

There's a poster here, Diego maybe, that frequently discusses his role as a nurse practitioner in the critical care environment.

[mommy.19, MSN, RN, APRN]

How exactly do you mean the CNS role would be limiting?

[PG2018]

As I know the CNS role, it is largely an unfunded certification filled by people who want to be the A kid on the unit...just without any significant reimbursement or enhanced scope.

[mommy.19, MSN, RN, APRN]

It would seem you are terribly uneducated about advanced practice RNs, and don't care to change that.

[PG2018]

It would seem you are terribly uneducated about advanced practice RNs, and don't care to change that.

Hardly.

[Red Kryptonite]

It would seem you are terribly uneducated about advanced practice RNs, and don't care to change that.

You know, PsychGuy was nothing but polite to you and offered feedback based on having seen the role at work. And then you chose to toss this his way.

Who peed in your Cheerios this morning?!

[mommy.19, MSN, RN, APRN]

No one 'peed in my cheerios'. I happen to care enough to correct outright incorrect information. I personally think he is the one being overtly rude making broad generalizations about an entire profession. If he thinks these generalizations are true, he is definitely uneducated about APRNs.

[mommy.19, MSN, RN, APRN]

OP: My best suggestions is to shadow a few individuals in the progressional roles you are considering, to obtain the most objective view.

[PG2018]

No one 'peed in my cheerios'. I happen to care enough to correct outright incorrect information. I personally think he is the one being overtly rude making broad generalizations about an entire profession. If he thinks these generalizations are true, he is definitely uneducated about APRNs.

How is it so incorrect? As I have been told and have read, the CNS (at least for my state and presumably for others) is an APRN who has trained and been certified to provide increased knowledge for nurses. They are a clinical specialist, i.e. acute, adult, peds, etc. They don't order anything, diagnose anything, or bill for anything but rather serve a consultant or educator role - generally. My state no longer trains CNS folks. However, I worked with an ED nurse who was a CNS (with DEA#) in a border state, and with an additional 200 hours of clinical experience she was able to apply for my state's board of nursing and gain prescriptive authority. She got the wound cert and now travels doing wound things. Nonetheless, I've never encountered a CNS, in clinical practice, that actually worked in the capacity the CNS was intended here.