Considering changing to CSICU....any comments?

  1. I am currently working in a 14 bed CCU in a large teaching hospital. We are primarily medical .....the only time we get surgical patients is when they are overflow (we have a Surgical trauma and a CSICU). While I have gotten some great experiences with vasoactive gtts, swans, vents, managing septic patients, etc..... I have very little surgical experience.... when we do have a patient go to the OR....(say they are overflow, etc) they have to be recovered in the PACU unless it is something like a trach or PEG tube. (Trachs we usually will do at BS)

    I am starting to think that not having any surgical background is going to hurt me when I apply to CRNA school. What are your thoughts on this? It seems as though recovering pts directly from the MDA/CRNA would be the optimum experience that schools are looking for. Also, I think that the surgical experience would be quite valuable.

    Now, that being said.... if I were to start considering transfering to a CSICU....how long do you think is an appropriate time frame? I started in my unit last June....so I don't want to leave too soon...although it would be at the same hospital (or at least I plan on it being). The other thing is that after about 14 months or so I will be trained to take CVVHD and IABP pts and will be able to carry the code beeper. (our CCU nurses are the only nurses who respond to nonICU codes in the hospital)....so I am undecided about when and if I should change.

    Any thoughts/comments/suggestions?
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  2. 5 Comments

  3. by   TexasCRNA
    Stay where you are, you are getting the drips, swans and you will soon get to be on the code team. Sounds like thats the place to be. Hey, if you want pacu experience go moonlight somewhere on your days off from the ccu.

    Having too much experience is not a bad thing but I would stay somewhere long enough to get a good handle on what I was doing before switching. Also remember there are many different names to critical care units but what the school is interested in is what types of pts did you manage and of course drips, swans, etc...

    I know you are anxious about learning everything you can but just know it takes time and whatever you don't learn as a nurse you will learn by the multitude of cases you do as a srna.

    Just my opinion, Lee.
  4. by   New CCU RN
    Thanks for the post Lee. I do understand what you mean about staying until I have a good handle on the unit. I do most of the time feel as though it is all coming together (by no means an expert...just usually feel as though I can anticipate the next step....generally understand rationales..etc)

    I am also at the point where I can't wait to get the IABP and CVVH pts. I already volunteer to take the hardest pt (heh...I am known for it...the other nurses on the unit always comment And the code team is something I have really been looking forward to.... it was what made me decide my unit over the MICU actually when I was interviewing (just love the excitement)

    I do feel lacking though in the whole surgical area and think that may be viewed as a weakness when it comes time for interview/application time. My plan is to work as an RN for probably three years and then apply. (so just over two more years til the big app/interview time) So with that time I thought maybe half in the medical side half in the surgical side would be beneficial.

    Also, I just was looking at alot of the "essays" that schools ask on their admission stuff and it seems as though alot of them ask you what direct contact you have had with a CRNA in their day to day routine type deal...and well... I have very little....except for when they come to intubate my patient...and then obviously it is not like I am asking them what they think of their jobs, etc.

    While I have researched alot on what a CRNA does.... what do people generally do to really see first hand and be able to actually see them in action (other than their emergency calls for intubation) I don't know if this sounds like a dumb question.

    Thanks again for your post.
  5. by   VaMedic
    New CCU RN
    I am a Paramedic and working on my RN. I can only speak from my Paramedic experience though, but I have done quite a few hours in the OR with a CRNA. I would intubate her patients and then usually sit there and talk with her about everything or in the downtime between cases. I also will be doing another 40+hour stent in there with another CRNA for refresher hours soon. I know the local hospital here is very great with their employes broading their scale of experience. Maybe they will allow you some observer time on a day off with a CRNA in the OR. It can't hurt for asking and they may be impressed with your willingness again to gain more knowledge. Just a thought.

    Rob
  6. by   yodakelly
    New CCU RN,

    The experience you are getting is certainly adequate as far as acuity goes. I think your ideas about wanting some surgical experience are on target though. Learning about and dealing with the immediate post op cardiac surgery patient, the hemodynamic changes, seeing the effects of anesthesia after the OR, etc, are all very valuable. In my interview process for anesthesia school, the statement was made to me on two separate occasions that the personal opinion of the individual interviewing me was that cardiac surgery icu experience is the best gateway to anesthesia school. That being said, the fact is that nurses with all sorts of ICU/ critical care experience get into anesthesia school and succeed, so i would't take that opinion as the end all be all. If you have the opportunity and the time, it never hurts to be a little more well rounded and better versed in a larger variety of situations.
    I think that giving your unit 9-12 months before leaving is probably reasonable. Is your unit director supportive? I left my first position after about 9 months because my unit director knew my plans included anesthesia school and helped me get into cardiac surgery icu-- of course, that's probably not the norm.
    Anyhow, I think we have a few nurses leaving soon in CSICU, so you should think about coming across the hall and joining us.
  7. by   Brenna's Dad
    I would also recommend staying where you are until you feel you are proficient at it. I'm not talking 20 years either. When you find you are getting bored at work or can handle ANYTHING that comes through the door, make the switch.

    If you plans are to fast track into anesthesia after the minimum 1 year experience, I think working full-time in one unit would look better than switching to a second after a short-period. Like Gowkout said, you are already getting the requisite expereince and you can always pick up in a different unit on your days off. And my recommendation there, would be to try and make it something totally different from what you are doing now. Trauma or Neuro for instance.

    CSICU is interesting, but can become rather routine in a short period of time. Don't get me wrong, I like it quite a bit. But for the most part you will recover the same patient most of the time. There's nothing like a well rounded experience base in my opinion.

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