CRNAs in critical care medicine

  1. Hi all,

    I'm looking into CRNA programs as I get more critical care experience. I've noticed most intensivists are Pulmonologists that do fellowships in Critical Care medicine but I've seen a handful of MDAs who also cover critical care, which makes perfect sense- they're proficient in airways, central lines and invasive monitoring. Just wondering if it's a possibility for a CRNA to potentially branch out into this field. One of my hesitations with the field is spending my whole life in an OR (I posted a thread about ED nurse to CRNA highlighting my drawbacks to the career). I understand there are other options such as pain management and endoscopy centers, but I enjoy critical care.
    •  
  2. 13 Comments

  3. by   offlabel
    Don't know what shadowing experiences you've had, but there are many, many anesthesia jobs that are for all practical purposes, critical care. CC patients come to the OR every day and are managed there every bit as well or better than in the ICU. Some places have a greater number of those patients coming to the OR than others, but, by and large, anesthesia is managing CC patients to one degree or another.
  4. by   JMurse89
    Yes, I understand that. I am just wondering if an intensivist or hospitalist group would employ a CRNA, especially since MDAs are able to do the same. While most intensivists are pulmonology/critical care medicine, I have seen some on the medical board listed as anesthesiology/critical care medicine.

    I'm not sure I want to invest in this career if I have to work in the same setting (OR) for the rest of my life. I went into nursing for the variety and ability to switch specialties. Just looking at all the options for CRNAs.
  5. by   wtbcrna
    In general CRNAs don't work that way since NA school does not usually cover long term care of critically/acutely ill patients. MDAs spend a significant portion of their training in ICU.
    There is also will be the complication with credentialing and prescriptive authority depending on the state you want to practice in. Most CRNAs that work in critical care/ER etc and in anesthesia are dual certified as an NP and CRNA.
    Last edit by wtbcrna on Dec 22, '16
  6. by   Aromatic
    if you want to do CCM that acute care NP degree thing would probably be what you want.
  7. by   OllieW
    In twenty plus years in Critical Care I rarely see MDAs/CRNA except for transport of patients.
  8. by   juan de la cruz
    I work as an ICU NP in a setting where a large portion of our intensivists are "MDA's" (for lack of a better term because we have one DO). These physicians trained as anesthesiologists primarily but also did a year of critical care fellowship with some who also finished additional fellowships in cardiac anesthesia or liver transplant. In general, anesthesiology and critical care medicine trained intensivists are seen in academic centers on the the opposite coasts (I've not seen many in the midwest). My point is, these providers are not just trained anesthesiologists but are also trained in critical care by a fellowship. In the same vein, I think CRNA's who want to work in the ICU alongside intensivists should also have ACNP training.
  9. by   Wile E Coyote
    CRNA's can practice in some really small, isolated facilities, and thus can expect to be utilized in some atypical way, (the 'many hats' finding that's common to such situations) but it's not something to base a career decision on.
    As already posted, an ACNP is better prepared to do the ICU work you are describing.
  10. by   offlabel
    Quote from juan de la cruz
    In the same vein, I think CRNA's who want to work in the ICU alongside intensivists should also have ACNP training.
    An anesthesia component to ACNP training would go a long way too...
  11. by   JMurse89
    A lot of universities offer an FNP or ACNP certificate for nurses with MSNs already. Would something like this be an option? It doesn't specify you already have to be an NP already.

    Again, I absolutely love everything I've experienced during my shadows, and I really want to make this my career. I just don't want to get stuck in a rut I can't (or want to) get out of. However, I think I'm experiencing that right now in the ED. I still absolutely love the fast pace and variety, but I was just thinking about how it really is the same thing day in and day out. Chest pain, abdominal pain, shortness of breath, sepsis, altered LOC, sore throat, back pain, blah blah. Even though there's a variety of complaints, the workups are all the same. Emergency medicine is, IMO, ~80% Algorhythms, 10% consultation, and 10% or less of bedside procedures. "If this, do that"... "If chest pain, ASA, Trop Q6h x3, CK, EKG and place in obs". "If abdominal pain, CBC, CMP, Lipase, CT/US, consult GI/Uro/Gen surgery". Docs spend 5 minutes getting an H&P, walk out and order some tests. Wait for results then consult consult consult! Occasionally they're at the bedside intubating, throwing in central lines (rare except one doc we have who will look for any excuse to do one), or doing a FAST exam. Other than that, it's all computer work.

    Sorry for the tangent, I guess all I'm saying is I don't want to get stuck in something I may or may not love in 5, 10, 20 years. The investment in CRNA school is too great (assuming I can even get in), which is why I'm so carefully considering every side of things.
  12. by   juan de la cruz
    Quote from offlabel
    An anesthesia component to ACNP training would go a long way too...
    ...which I agree is lacking. Some ACNP's in critical care settings do intubate and provide procedural sedation, these are skills that take some on the job training (based on my experience) because many of our programs don't provide the exposure.
  13. by   juan de la cruz
    Quote from JMurse89
    A lot of universities offer an FNP or ACNP certificate for nurses with MSNs already. Would something like this be an option? It doesn't specify you already have to be an NP already.
    Theoretically, you could get a post-master's ACNP after CRNA (or the other way around). It's not going to be as simple as picking up a post-master's ACNP from another NP specialty such as FNP or ANP. NP programs share many common pre-clinical courses that are transferable across various programs. CRNA programs tend to be specialized from the get go and many approach the pre-clinical courses differently than NP programs. You may have to actually spend almost the same amount of schooling as someone without a prior APRN degree.
  14. by   wtbcrna
    Quote from juan de la cruz
    Theoretically, you could get a post-master's ACNP after CRNA (or the other way around). It's not going to be as simple as picking up a post-master's ACNP from another NP specialty such as FNP or ANP. NP programs share many common pre-clinical courses that are transferable across various programs. CRNA programs tend to be specialized from the get go and many approach the pre-clinical courses differently than NP programs. You may have to actually spend almost the same amount of schooling as someone without a prior APRN degree.
    That is changing with the consensus guidelines at least where NA schools are taught through schools of nursing. It will never be as easy as getting another NP certification if you are already an NP, but I think more and more NA schools are or will be sharing the basic classes (pharm, path, phys etc) with NPs.

close