Advice from acute/critical care NP's - page 2

Well I'm not exactly looking for advice as much as looking to hear about your job. I am still up in the air as far as whether I'd like to become a CRNA or critical care NP. I have looked into both... Read More

  1. by   gizmo12
    I really appreciate the information. I have never understood the secrecy.
  2. by   Atl_John
    So out of curiosity, no NP's do any First Assisting at all where your at? You just do pre and post op care in the ICU? Are you able to do things like Chest tubes, and if no, are the PA's. Can the the PA's do anything that you can't?
  3. by   juan de la cruz
    Quote from Atl_John
    So out of curiosity, no NP's do any First Assisting at all where your at? You just do pre and post op care in the ICU? Are you able to do things like Chest tubes, and if no, are the PA's. Can the the PA's do anything that you can't?
    Just to clarify, our NP service is directly under trauma and critical care services although we exclusively work in the cardiothoracic surgery ICU and sometimes follow patients on the floors at night when there is nobody from the cardiothoracic surgery service physically present at the hospital. The PA's who first assist with the cardiothoracic surgeons have been doing their jobs for an average of 15-20 years. Needless to say, they are excellent at it. Us NP's are credentialled to place chest tubes in and out of the unit, place triple lumen catheters or introducers, float Swan-Ganz catheters, place A-line, and perform BAL's.

    Other hospitals are different, however. Two of the NP's on our team have experience first assisting in cardiothoracic surgery when they worked in other hospitals. Interestingly, they were doing the role when they were not advanced practice nurses yet. Both received in-hospital training in their respective hospitals to assist while at an RN capacity. All of us prefer the ICU and that is the reason why there is no push for us to assist in the future.
  4. by   chellrn
    From another slant: I am a CRNA and am going back to school for ACNP. I was not happy in the CRNA role and no amount of money was going to change that. It is glamorous....but only from the outside looking in!! I practiced anesthesia for 7 years....

    Hope this helps.
  5. by   gizmo12
    Quote from chellrn
    From another slant: I am a CRNA and am going back to school for ACNP. I was not happy in the CRNA role and no amount of money was going to change that. It is glamorous....but only from the outside looking in!! I practiced anesthesia for 7 years....

    Hope this helps.
    You are the second person I have heard of that has done this. What were the main reasons you were unhappy as a CRNA?
  6. by   CAPRN77
    Quote from chellrn
    From another slant: I am a CRNA and am going back to school for ACNP. I was not happy in the CRNA role and no amount of money was going to change that. It is glamorous....but only from the outside looking in!! I practiced anesthesia for 7 years....

    Hope this helps.
    I would also like to know why you were unhappy in the CRNA role, especially since I start a CRNA program this fall. Thanks
  7. by   chellrn
    Main reasons:
    1. My main job was not critical care anymore, it was anesthesia. Totally different. It was mostly routine/boring. I missed the patients (as they are asleep) and the families (yes, believe it or not). This job was mostly talking to surgeons and other OR staff all day (without windows I might add......). Not to mention you are STUCK in the OR until someone gets you out to eat/go pee/anything if you are in a long case (which was common).
    2. Call. The kind where you do anesthesia all day and sleep in a call room (if you are not working) until 7am the next day. Very stressful over time.
    3. MAIN REASON: I did not realize how far anesthesia really was from critical care nursing until it was too late. I tried to make a go of it, but in the end, I quit and went back to the "critical care track", so to speak.

    chell
  8. by   Atl_John
    Well its official......I've decided to go get my ACNP instead of going to PA school. Surgery is great but can be pretttty boring....Trauma.....now THATS some fun.........ICU.....ohhhh yeah....I'm hooked now.
  9. by   juan de la cruz
    John, I don't know where in AL you live but doesn't UAB offer a combined ACNP/RNFA option for NP training?
  10. by   core0
    Quote from pinoyNP
    John, I don't know where in AL you live but doesn't UAB offer a combined ACNP/RNFA option for NP training?
    http://main.uab.edu/sites/nursing/98239/

    Not sure about the ACNP/RNFA program but their surgical PA program is very well regarded.
    I thought there was a PNP/ACNP program on the east coast but I can't find it now.

    David Carpenter, PA-c
  11. by   Atl_John
    Yes there is they do have one, only catch is you have to work OR for minimum of 2 years before hand, PA schools you don't. I originally went to Nursing school so I could go to PA school since I wanted to do surgery, to say that its complete gone would well be an over exaggeration, but I like the autonomy that NP's seem to have, and I don't have to take anything extra to be a NP.

    Its a real shame that NP programs do not have a surgical component like PA programs do I'm not talking about RNFA you can have that without being a NP. I'm talking real rotations in surgery etc just like PA's have to do. If I were to try to do UAB's PA program which is a surgical program I would actually have to take MORE pre req classes honestly I'm not interested in taking more pre-reqs for anything. I've thought about Emory''s I actually have all their Pre-Reqs. I'm just really curious as to why NP programs don't incorporate surgery. I would love nothing more than to work for a Ortho. Surgeon as his midlevel being a FA and seeing patients in the hospital/ER/OR. Love to do things like long bone reductions.
  12. by   juan de la cruz
    Actually, surgery rotations can be incorporated in an ACNP program. It all depends on each school and the availability of NP preceptors who are able to provide the sort of clinical rotation you are looking for. In my area of the country, there are NP's who assist in surgery and I am quite familiar with one who works in neurosurgery assisting with stents and endovascular procedures in addition to the usual craniotomies. She is known to precept students who are intersted in her specialty. In addition, some ACNP programs can actually individualize the rotations based on the student's career goals. There are NP students who have a guaranteed position after graduation because they have established a relationship with a particular physician group. A few of the students in my class fall in this category and have decided to focus their rotations in the particular specialty they will be working with after they graduate and get certified. One such student did a strictly cardiology rotation throughout school and did get hired by the cardiology group. Also remember that in spite of this, ACNP didactic sessions are still the same for every student and we all still need to go over all the body systems in terms of diagnosing and treating patients. But the danger I see in setting your eyes on a particluar specialty is that you may end up realizing that the existing job market is not favorable for that particular specialty you set your eyes on. Then you're out of luck for a job and not marketable enough for the other specialties that have job openings.
  13. by   Atl_John
    Hi Pino,
    I actually wrote to UAB the school I was looking at for NP about taking extra classes in surgical procedures/disease, etc. I always wanted to do surgery and while I wanted to do things like long bone fixations, I wanted to be well rounded so that if I needed a change i could go to urological surgery or Cardiology, etc. For me it is not so much about specializing, but it is what will give me the best education so I can specialize later on, and two what will give me the best education so I can provide the best absolute care for my patient. My patients outcomes and my ability to help them is the most important in whatever I do. I just know I want to be involved with procedures not just office/hospital visits.

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