OR RN position for FNP or CRNA

[alalani3]

Hey all,

Just got scheduled for an OR Residency Interview and wanted to make sure I was making the right decision for my future. The residency requires a 2 year contract. I am a new grad and hoped to get a job in a critical care setting so that I could apply for my FNP or CRNA soon. (I hope to shadow both before deciding, but have researched both and keep bouncing back between the two!)

In order to apply for those programs, most schools require 1 to 2 years of critical care experience. As a new grad, I have been searching for almost 4 months and have found it hard and competitive to land a job like that.

I did not mind working my way up to an ICU from Med-Surg, but all of the hospitals around my area are requiring a 2 year contract on the same floor/area for new grads. Since I hope to apply to a masters program in a year, that would not allow me enough time to wait to move to another floor.

Let me just say, I love surgery. I have done some shadowing with surgeries and found it really exciting. I want this job and I know it is a lot of work. I have heard; but although this is where I want to be as a nurse, I am not sure if this will be the best decision for me, but I am also running out of options since most jobs have already been taken by the new nurses that had graduated with me in this competitive city!

As far as a Master's program, I am not sure if I should re-apply again for a MedSurg position, or if OR may be enough if I prove that I do assess patients constantly.

What would you do?

[Rose_Queen, BSN, MSN, RN]

I have worked with some OR nurses who went on to NP school with no other nursing specialty experience. Was it easy? Not really, but they worked hard and made it happen. I also think you are overestimating the amount of assessment that happens in the OR- I do a quick little interview in preop, look at the chart, look at skin during positioning, and then look at skin after positioning. It's not an in-depth head to toe assessment- that's more a role filled by the preop nurse.

If you want to go to CRNA school in a year, then the OR is not the place for you. It is not considered critical care, and as an RN, you will not be the one titrating drips- that's a role filled by the anesthesia provider.

The other thing I recommend to keep in mind is that life is what happens when you're making plans. It may take longer to get the experience you need to go into a masters program just depending on what jobs you are offered. You may decide that your goals are changing.

I also want to point out that it takes at least a year to feel confident and competent in the OR. It's not an easy specialty to learn and comes with a steep learning curve. That's why the orientation lasts so long- very few nursing students get an in-depth exposure to OR nursing as they frequently only get observation days and are focused on watching the surgery, not the role of the nurse.

[Gottago]

Yep, Rose Queen is correct. Lots of good points.

[Hello123456]

Great questions and I hope I can give you some insight on the topic.

My first job was as a new grad nurse was in the OR (also with a 2 year contract in an academic hospital in SoCal). I am now an FNP with certification as NP surgical first assistant. I work in orthopedic surgery (clinic and operating room) and also work for an NFL team.

I have only worked as an OR nurse (never med surg/ICU - I have always hated the idea of working on the floors, just a personal preference). While working in med surg/ICU is the traditional path towards becoming an FNP and CRNA, it is not for everybody and it is certainly not necessary. There are FNP and CRNA programs that do not require med surg/ICU experience (actually pretty prestigious ones).

Because there is such a shortage of OR nurses (especially ones that can scrub in specialties ortho/neuro/cardiac), I was able to re-negotiate the 2 year contract. This was because I became independent in scrubbing ortho/neuro/spine procedures 6-months into the new grad program and my supervisor wanted to retain me because of this skill. You also have to understand that the "2 year contract" is sometimes used by hospital administrators as a benchmark in new grad education. It is assumed that the more "successful" a new grad education program is, the more new grads will be retained after 2 years. Sometimes supervisors' bonuses are tied to 2 year retention of new grads.

So with that said, after the 6-months I asked my supervisor if I could switch to night shift/weekends per-diem because I really wanted the trauma experience (but really just used this excuse to go back to school during the day). After 2 years of going to school during the day for the FNP program and working as a night shift OR nurse, I finished the FNP. Because the per-diem status is still viewed as "2 year" retention, it was a win-win for my supervisors' interests and mine. Also the per-diem status gave me the opportunity to take 3-5 days off whenever I had to study for mid-terms, final exams, and fulfill clinical hour requirements. This was a key strategy in achieving my goal.

1. differentiate your skills from other employees - become good at scrubbing specialty cases with "difficult" surgeons

2. leverage your specialized skill to get what you want from your manager

3. take your managers' perspective/goals/incentives into consideration

I have never regretted choosing OR nursing (although the culture is very challenging and tough to get used to with the constant bullying, verbal abuse, etc. etc.). You need to focus on your goals and not let the culture get to you. Additionally, there is a high demand for OR nurses (who can scrub/first assist) and you will always have job opportunities with at least 1 year experience. Lastly, the compensation for OR nursing can be quite high (+200k in my 2nd year as a nurse - mostly from taking all the on-call holidays/weekends/nights).

I hope this helps! Good luck :)

[Rose_Queen, BSN, MSN, RN]

I would really like to know what CRNA programs don't require critical care experience- those are the programs whose graduates I'll be avoiding.

[Gottago]

CRNA programs not requiring ICU/Critical Care...??? List them.

[Hello123456]

I was referring to ICU experience specifically, not critical care. "Critical care" experience is always necessary. However, some schools define "critical care" broadly (some will consider ER, OR, PACU as critical care).

DUKE CRNA

Admissions Requirements | Duke School of Nursing

[Hello123456]

I was referring to the original author's concern regarding exit opportunities in OR versus ICU, not "critical care".

In any case, all schools require "critical care" experience. However, some schools define "critical care" broadly to include ER/OR/PACU etc. You can google this information and there are websites that list these programs.

One program that comes to mind is Duke CRNA (not an ivy like Penn/Columbia/Yale nursing, but it is still considered a tier 1 university among most people).

I hope this helps!

[Rose_Queen, BSN, MSN, RN]

Duke says they will consider those areas, but prefer critical care. They also state this:

• The applicant must have a minimum of one year (two years preferred) current, continuous full-time acute care experience as a registered nurse in a critical care setting which offers the applicant an opportunity to develop as an independent decision-maker capable of using and interpreting advanced monitoring techniques based on their knowledge of physiological and pharmacological principles. Adult acute care experience offering on interpretation and use of advanced monitoring, care of ventilated patients, pharmacologic hemodynamic management, and independent decision making is preferred. CCRN certification is strongly encouraged.
  

Quite honestly, not sure how some specialties- and as an OR nurse, I'm including myself- count as the critical care setting experience they want.