Former ICU nurses - I need your help

  1. Let's start off by saying I love what I do.

    (long winded rant?/explanation of my life incoming)

    I've been in critical care nursing for 7 years now and I still find my self on off days reading/learning about drugs and advanced patho/pharm because I'm one of the people that love to try and know as much as I can. I love to teach; being a preceptor/mentor to new hires gives me even more reason to read/learn so I can be the best preceptor possible. I love to help people find comfort when they have a loved one that's on the brink of demise. I love to help other nurses out when they need it. I never say no to a turn. When appropriate, I always try and make the day light by singing my best Creed karaoke underneath my breath at the Pyxis. When is someone is having a bad day, I make sure I help them out, even if it's just grabbing them a coffee or passing their other patient's morning meds, if I can. I guess I get my sense of service/helping others out from my CNA days and from my mother (most generous person I've ever met;Happy Mothers day mom!).

    BUT....I am having a problem.

    I guess you could say, I am missing something; a higher "need".

    As a nurse, I've always worked hard at becoming the best nurse I could be. From training to be a charge nurse as soon as possible, taking the CCRN when I was immediately eligible, being on committees, preceptor, and other extracurricular teams;I tried to be the model nurse.

    Right now, I am at a "Top 10" hospital and see the highest level acuity patients. Although I feel like I am getting stimulated from the complexity of these cases, I just still feel like I am missing something. My mentality of trying to be the best nurse I can be feels like it is being capped out right now, hence this long rant.

    At my hospital, it's like a revolving door for CRNA hopefuls. Not even CRNA hopefuls, but grad school students in general. The saying at this hospital is if you want to do CRNA school, being in my unit is the best place you should be.

    Not to dog my once fellow co-workers, but they just come through, get their 1.5 year/2 year experience and go to school. I mean, good for them, but I don't know, maybe I'm just jealous because they have a goal/purpose and are working towards it and I'm just stuck here at Starbucks drinking my coffee and reading about Stewart's strong ion difference.

    People at work tell me that I should go back to school, and I usually have just scoffed and said I am happy doing what I am doing now,but that has increasingly been becoming more and more false over the last year.

    So, I reached out to my CRNA educator and got in touch with someone and set up a shadow last week. Going in, I had my thoughts and ideas about what a CRNA does, which turns out, was a little different. I think it had to do with the CRNA that I shadowed. He was very impressive. He blew me away with his pharmacology knowledge and his demeanor. From his bedside manner/approach to fearful patients, to his skill set in the OR, he had me admiring him by the end of the day. Turns out, he is the Chief CRNA and even teaches at a few of the local universities. We left with a few pleasantries and he told me to come back for another day to get more of an experience (which I am hopeful will be this week).

    The whole idea of being at the head of the bed and in charge of someones hemodynamics and being like "hey, you see that bp/heart rate? yeah, I did that" gives me a sense of worth/power (not that I don't have that now, since in our unit you have A LOT of control over hemodynamics (gtts/ECMO/etc.), just a different type). On my way home I was like, "Yeah, I could DEFINITELY see myself doing that." But after that shadow "high", I was like, man....I might miss the whole bedside interaction and all of the "pow-wows" we have with the fellows/residents on we should do that and we should do this. I truly do love the ICU rounds, listening in/learning, and chiming in here and there when appropriate to help out. Over time, I've gained that trust with the attendings/fellows/residents; it's fun to talk about complex cases.

    It got me thinking; yeah I think I would miss the "whole" picture critical care portion of my career. Managing a really sick patient and all of their systems is something that I would love to do. With that being said, why don't I just become an APN and get a job as a critical care NP and round with the ICU team and help them out? Yeah, I think that would be really fun, but I still feel like I would be missing out on the whole " I am in charge of their airway/hemodynamics" because the residents/fellows would steal that spotlight in the ICU.

    I have heard of people eventually getting DUAL NP degrees (eventually) so that they could do both OR stuff, in addition to an ICU roll (which sounds AWESOME, yet terrifyingly so much school).

    SO. Here I am. On allnurses. Looking for anything. Any type of guidance/experience/pearls of wisdom you can give me.

    Obviously, any and ALL feedback/thoughts are appreciated but specifically, I am looking for that RN that LOVED the ICU and everything about it, but decided to go back to CRNA school. How are you feeling about the change?

    Thank you all for coming this far and reading this entire post. Thank you so much!
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  2. 11 Comments

  3. by   MurseJJ
    Maybe you could also do a search here for the role of ACNPs (a number participate on this forum). I think you'll find that, depending on the facility, NPs are indeed in charge of hemodynamics and airway for their patients in the ICU. In my hospital, for example, we have two MICUs and CCUs, and one of each is run by NPs, who manage all aspects of their patients (our medical ECMO program is also housed in the NP MICU). Many facilities that have residents and APPs have rules like if its your patients its your procedure (so a resident couldn't steal an intubation from an NP on the NP's patient, for example).

    Good luck in your decision!
  4. by   johosa12
    Interesting. I'll definitely look into that! Thanks for the insight!
  5. by   PresG33
    For me, the big thing that pushed me to CRNA as opposed to ACNP was that I wanted equal parts thinking and doing. NPs do lines and intubate, but in my unit a main portion of their day was "managing" patients, which means telling nurses what to do and hoping they follow your orders. As a CRNA, you do a ton of procedural skills, make the decisions on managing the patient, then do the actual intervention. If my patient needs a med, I decide which, I draw it up, and I give it. I think it is the most autonomous specialty there is because a CRNA does such a wide variety of things. This way I still can have the days where I'm changing drip rates every few minutes to keep someone's hemodynamics stable, where as I think I would miss out on this type of hands on stuff as a NP (if an NP tried to mess with my pumps when I was a unit RN I woulda given them the boot out of my room!!). That being said, I think I would have been happy as a ACNP, I'll just be happier as a CRNA.
  6. by   johosa12
    I like the way you put that; "equal parts thinking and doing". I really do think that I would miss that. I also think that I'd be happy with either one, just want to do what I think would fulfill me most.

    Thanks for the response!
  7. by   Bluebolt
    Quote from johosa12
    I like the way you put that; "equal parts thinking and doing". I really do think that I would miss that. I also think that I'd be happy with either one, just want to do what I think would fulfill me most.

    Thanks for the response!
    As a student in CRNA program my only advice is to only go to CRNA school if it's the only thing you could ever see yourself doing. The program is brutal and you will wonder many times what you got yourself into and if you could have been happy doing something else. If you can see yourself doing a career that is much easier to attain and much cheaper (like NP) you should heavily consider that route.

    Our cohort just had two of our students fail out because they made a 79 in one of the courses, which is immediate dismissal, no second chances or mercy. They are about $60K in debt and have to start paying that back right away. They're considering going to NP school now and wishing that over a year ago they had just pursued that route.
  8. by   pale
    Thank you very much for that piece of gold. As I grow closer to my applications and waiting to hear from different schools, I get really nervous. I have been wanting to do this for ten years now, and when I shadowed, I was blown away by the skill, knowledge and above all the autonomy of the crna . I definitely want to do this. It is either it or nothing.
    Thank you again
  9. by   calivianya
    Just saying - you don't have to work somewhere that residents and fellows are. Nobody has to steal your spotlight.

    My favorite intensivist used to not only teach at a major top medical school, he also was the medical director for a number of their units and was pretty much in charge of just about everything related to critical care. He moved to my "less fancy" non-teaching hospital (that's actually LARGER than the teaching hospital, a fact lots of people who work at the fancy teaching hospital conveniently like to forget), and he says that on most days, the acuity in my MICU blows the fancy teaching hospital out of the water.

    So, there are places you can work as an ACNP where you're not fighting the residents and fellows for the fun stuff. Not all critical patients live in teaching hospitals. There are non-teaching hospitals with higher average acuity than teaching hospitals.
  10. by   BigPappaCRNA
    Just be aware, that the vast majority of what anesthesia does, is mundane, and pretty routine, and often times quite boring. There is the occasional adrenaline rush for sure, but if you are doing your job correctly, there are not too many. The 25 year old having their ACL repaired, or the 35 year old having their gall bladder out, or the 45 year old having their hysterectomy, or the 55 year old having their knee replaced, are just a few example of cases that one would routinely be doing every single day in practice, and they are pretty straight forward and boring.
  11. by   BigPappaCRNA
    If it is "action" you seek, my bet would be as an NP of some kind in a busy, large, ICU, not affiliated with a University. A big community hospital. Probably more action seen there on a daily basis than you might see in a month doing anesthesia.
  12. by   offlabel
    Quote from BigPappaCRNA
    If it is "action" you seek, my bet would be as an NP of some kind in a busy, large, ICU, not affiliated with a University. A big community hospital. Probably more action seen there on a daily basis than you might see in a month doing anesthesia.
    Depends on the job, I'd say. A patient without an A line that I don't start an inopressor for is the great minority of my cases.
  13. by   offlabel
    Quote from BigPappaCRNA
    If it is "action" you seek, my bet would be as an NP of some kind in a busy, large, ICU, not affiliated with a University. A big community hospital. Probably more action seen there on a daily basis than you might see in a month doing anesthesia.
    Depends on the job, I'd say. A patient without an A line that I don't start an inopressor for is the great minority of my cases.

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