CRNA and ICU Nurses Please Help!!!!

VICEDRN, BSN, RN · Sep 10, 2011

I am not an ICU nurse. (I am however married to one. lol.) Take the smaller hospital's offer. Based on the experiences each of us and our friends have had over the last two years, I would guess that the other job will likely involve you spending your entire career on step down. I also bet that the smaller hospital gives you a wider variety of experiences as SICU is just that...SICU. No DKA on insulin drips for you!

Munch · Sep 10, 2011

I am with VICEDRN. I am not a CRNA or an ICU nurse but one of my good friends is a CRNA(at another hospital I worked at, not at the hospital where I am now) and he said to go with the smaller hospital. You would get much more experience with the smaller hospitals ICU. You would take care of all kinds of patients(surgical patients included). Before my friend became a CRNA he worked as a nurse in a general ICU(it was a smaller hospital, they didn't have SICU's or NSICU's, they just had an ICU) he said the unit had about 10-14 beds. He worked in the ICU for about a year and a half and then he became a CRNA. So I would go with the smaller hospital. If you take the job with the bigger hospital you might end up spending a lot of time in the step down unit...you just don't know.

krisjazzer13 · Sep 10, 2011

I would personally call the schools you are interested in and ask! The reason I say this is because I worked in a general ICU in a small hospital right out of school (13 beds) and my school would not accept ICU experience that was not at a level one trauma center, so I ended up changing hospitals within the system to the surgical ICU that was recommended by the program director...then at least I knew that the transition needed to be made and I could start the schooling process sooner! Best of luck to you!

Eiano · Sep 10, 2011

Hmm.. I disagree.

I would personally take the level 1. Chances are you would spend sometime in the SICU even though you'd also be taking care of Step-Down pts. I'd ask the manager how often you are required to go to step down.

The smaller community hospital can only help a *sick* pt. so much before they transfer them to a level one. In the end though, if the community uses gtts, CVVHD, does complex procedures and it's patients are brought back from the OR sedated and intubated, you're golden there.

meandragonbrett · Sep 10, 2011

I also bet that the smaller hospital gives you a wider variety of experiences as SICU is just that...SICU. No DKA on insulin drips for you!

Not necessarily. The name on the door generally doesn't mean anything when it comes to needing a bed for patient placement. Surgical patients have post-op issues that relate to CAD, MI, Diabetes, COPD, CHF, etc. In the 8 bed SICU that I used to run we frequently had every drip you could imagine. We had IABPs, CVVH/CRRT, etc. as well as insulin gtts, DKA, COPD, CHF, Resp failure, etc. We medically managed disease processes in the surgical population.

If it were me, I would go to the larger facility and just bide my time working both the SICU and the step-down until you could get a permanent SICU position. You will still learn things and be exposed to things in the step-down unit. The smaller community hospitals sometimes are not able to offer the level of care that a patient needs and fly them out....it just depends on the hospital and the services offered.

I would call the director and clarify how time is split between working SICU and step-down. What is the patient acuity on step-down? Clarify with the other hospital if they do neurosurgery or cardiac surgery. Do they do IABP in their hospital? CRRT/CVVH? Swan Ganz? proning of ARDS patients? etc. Then sit down and make your decision.

I have worked in both large academic facilities as well as smaller community and you never know what you will get. Some community ICUs are garbage when it comes to getting good experience with sick unstables and others are fantastic. Same goes for academic facilities.

Esme12, ASN, BSN, RN · Sep 10, 2011

Hi Guys, I just graduated from an accelerated BSN program in August. I plan to apply to CRNA school after a couple years of ICU experience. I have been interviewing for ICU jobs and have received 2 job offers.:yelclap: The first position is at a level 1 trauma center in Surgical ICU 7pm-7am. The problem: when I applied for the position, it was posted as a Surgical ICU position. Once I went to the interview, the manager explained to me that I would cross train for Intermediate(Step Down, 20 bed unit combined). I am only interested in the Surgical ICU. I do not want to work in Intermediate or Step Down. They offer 16 weeks of training along with a residency program that last for 12 months. I am afraid that if I take this position, I may end up working a great deal of time in Intermediate which would not help me in getting the ICU experience that I need to prepare for CRNA school.
The second job offer is at a smaller hospital, 299 beds to be exact. They have an ICU that consists of 12 beds. If I take the position, I would be an ICU nurse. The manager told me that they are a general ICU and take all types of ICU patients. She says that I would see and experience a great deal. This facility also does not have residents. The training is 12 weeks and if needed I could ask for more training time. The position is also during the day 7am-7pm.
I am not sure which position I should take that will help me the most in the long run. I am afraid that if I take the Surgical ICU/cross train Intermediate position that I may not get the experience that I need to go on to CRNA school. If I take the ICU position at the smaller facility, would I still get accepted into a CRNA program? Those of you that are CNAs, in CRNA school, or ICU nurse's...please provide me with the best advice possible.
Thanks.

For the residency alone....I would go for the larger Level 1......then after a year and getting to know everyone you can either apply to another ICU within the facility or, you have made friends with enough of the anesthesia staff that they want to keep you there in the SICU.

Working in the small community ICU doesn't mean you won't get pulled to another floor....unfortunately floating isn't uncommon in this day and age...:twocents:

allnurses Guide · Sep 10, 2011

Just one thought: What is the time commitment to the ICU with residency program, and what is the penalty for not completing the time commitment?

Ahhphoey · Sep 10, 2011

As others have mentioned, I would find out approximately how often you be on the step down unit as well as looking into what the CRNA programs your interested in require. Don't discount the smaller hospital though because I worked in an ICU in an even smaller hospital than what you mentioned and we did CVVHD, multiple drips, continuous cardiac output monitoring, intra-abdominal pressures, etc. We did have to ship some patients out as we did not do IABP or ICP monitoring, but more often than not we took care of these patients. This hospital was a part of a larger hospital system that has a level 1 trauma center though and shared the intensivist physician group, so that may have been the difference.

msn10 · Sep 10, 2011

I teach at a university that has a CRNA program. They will not accept ICU experience unless it is level 1. Residency programs are wonderful, however, and that is a huge added bonus to you as a new grad. Statistically you will have greater confidence, few errors, and you are building capacity within yourself and your profession. Usually there is no commitment to stay on after the program is complete because the ROI for the hospital is huge, but even if there is, it is usually only 2 years from date of hire such as in UHC/AACN programs. Find out first but step down units in some level one trauma centers is the equivalent to ICU's in smaller hospitals.

And at least they are taking the time to cross-train you and provide you with a residency which means they value education. Some hospitals would just precept you in your assigned area and make you float with little training or orientation in the other area. Sounds like the ICU/step down is a great job for a new grad.

tulogna · Sep 11, 2011

It depends on the program, level 1 Trauma centers are great, but do u really need CVVHD? or PA caths? mayb u need a CardioVascular ICU if u want to learn all of that. But my recommendation is to find out which programs u intend to apply and see their criteria for experience and even talke to some one in the program (i.e. PD or assistant PD) just to get an idea, goodluck.

vanasd · Sep 11, 2011

There is no time committment or penalty. I just don't want to spend the majority of my time on step down.