ER and ICU NPs, what is your day like?

[kbl7td]

Long story short, I will be applying to CRNA schools in May 15'....with that being said, I have taken interest to the FNP field as well. Can anyone who's in the ER or ICU, tell me about a typical day? I am currently in the ICU as an RN, CCRN-CMC, TNCC etc, but I know I will do advanced practice of some sort, I just can't stay at the bedside. In my hospital the only fnps I actually see are in the ED. I believe there is just one, maybe two. From looking at our patient tracker, many of the patients are children, skin issues, cough and congestion, etc.

I often find myself in the ICU reading/completing orders and thinking, *** are they doing that for? I would have chose this, that, etc. This is with a select few docs, and partly drives my interest in this field.

[Corey Narry, MSN, RN, NP]

I am part of a group of ACNP's working within our Adult Critical Care Medicine division. We have recently expanded and will be up to 20+ ACNP's after all the hiring is completed. We will be covering various adult ICU's in two different campuses of an academic medical center. At the current time, we cover a Med/Surg ICU, a combined CCU/CTS and Vascular Surgery ICU, and 2 Neuro/Neurosurgery ICU's. We work with attending intensivists who have various specialty backgrounds as physicians. We work 12-hour shifts 3 days a week. We perform invasive procedures including all kinds of central lines, arterial lines, intubations, and procedural sedation.

[Annaiya, NP]

Before you apply/start an NP program, be sure it's what you want to do. It's good you're asking questions here, because it sucks to start and then realize you want to do something else. I mention this, because you are talking about FNPs that work in ICUs. I know there are a few places still around that have FNPs in the ICU, but everywhere I've worked require acute care certification, not FNP. Some EDs use FNPs, because they see the "fast track" patients that are more similar to sick visits in an office than a true ED patient. I work with a number of PICU NPs who wish they went to CRNA school, because their hours and pay are better. However, I think it depends on what you like to do. I love my job and couldn't imagine doing anything else.

A typical day on dayshift: Get to work, get updates on the overnight events of your patients (we get sign out the night before from whichever NP had the patients that day), look at labs, notes, etc. in the computer. See the patients, make sure you know your plan for the day. Round, eat lunch, call consults, manage patients/orders/admissions/transfers. Then sign-out to night shift, finish any documentation that's left and go home.

A typical night shift: Get brief sign-out from day shift. See patients, manage patient issues, admissions/transfers, update paperwork like transfer/discharge summaries.

The thing that drove me to be an NP was I wanted to understand the disease processes and medical management of my patients better and I wanted to be able to impact their care by having a say in their treatment plan. I feel like we have a unique perspective with our nursing background, and we add a lot to the medical team. It is very different from being a bedside nurse in the ICU. Good luck with your decision.

[ghillbert, MSN, NP]

Agree- if you want to talk ICU, you need to do Acute Care NP, not FNP. FNP is trained in primary care of children to adults. ACNPs are trained in acutely and critically ill adults. If you have ICU experience and interest in ICU role as a provider, choose ACNP (or CRNA if you like that side of things).

PS: Often what seems like a clear decision when you're a nurse is not that clear when you're the one writing the orders... you often have many considerations that the nurses are not aware of as to why you ordered (or didn't order) things a certain way.