ICU exp. (I am sure you've seen before)

UCDSICURN · Mar 2, 2006

It looks like you have wide variety of experience and will soon include medical and surgical hearts. I personally think that would be enough. Schools only require 1 - 2 years of experience, although the average tends to be higher. What they are looking for are basics such as drip titration, hemodynamic monitoring, ventilator management, and the ability to critically think and apply and understand the principles of treatment for various pathophysilogies. I honestly think you'll be at an advantage due to the variability of your patients than someone who is in a special care unit. You will have done hearts, neuro, general medical ICU players and probably more. What do you feel you are or will be lacking in your exposure?

The "Level" only refers to the trauma designation, and in that only refers to what services they have available 24 hours a day. Do a goole search if you want the specifics on the trauma designation requirements. A straight forward valve repair, multi-vessel cabbage would be very similar at a hospital not designated as a trauma center as it would at the big level 1 trauma/regional referral center. I'd say stay where you are, build your reputation so you can have a strong letter of recommendation and continue to get the varied experience it sounds like you're getting.

If you feel that you are truly lacking in some area or the overall acuity of your patients is low, then by all means move to the bigger facility.

Hope this helps a bit....

91CRN · Mar 2, 2006

Believe me before I posted I did a search on ICU exp. but did not find exactly what I was looking for, and I keep revisiting this question so please bear w/me :)
I currently work in a 337 bed urban hospital with a level III 12 bed adult ICU. I have been an RN for about 8 months in which I have been at this ICU. We do get somewhat of a variety w/medical, neuro, and some post-op pts. I work with a lot of vents, vasoactive gtt titration, some paralytics, a few ventrics, a-lines, CVP's, an rare swan etc. I am also going to begin next week spending half of my schedule in our CCU (also critical care) where they have even more hemodynamics, balloon pumps, swans, open heart, etc. What I am wondering is if I need to try to work at the level I trauma center in my area to gain even higher level experience. I will begin applying to CRNA school this summer/fall and I am wondering how necessary/improve my chances it would be if I was at a level I such as their CVICU or SICU.
I know it is really important how you utilize your time in the ICU just as what level unit you are in. I am always trying to further my learning, be involved, taking continuing ed. classes, just took CVVH class, and will be planning for CCRN in near future. I am just wondering if it would be worth it to uproot my self at this point, retrain for a new job, and possibly have to start over again w/clinical references close to the time I will be applying to schools. Also when looking at critical care openings at the level I, I noticed there were openings for new grad. RN's and RN's w/2 yrs. ICU experience--where does this leave me w/ 8 months exp.? I know there are not black & white answers, I would really appreciate some opinions!

NO YOU DON'T NEED TO DO THAT!!!

I am in the opposite position:)! I work in an emergency dept. we used to be rated for trauma, now only an EDAT, but I have all the training--TNCC etc. We now have a fast track into our cath lab too which I think will up our acuity a little--or at least the experiences. I worked for years in a very busy SICU when I was in the ARMY. For me that CLASSIC Critical experience is about 15 years ago--with short stints in ICU's working for registries. I haven't found any experiences to be up to the standard of a SICU/CVICU with regard to the use of vasoactive drips, use of ventilators, swans, a-lines, etc. My time in MICU's I'm sorry to report was like working in a SNF(skilled nursing facility) except that everyone was on a vent.--with rare exception. I'm sure if I can figure out this difference in experiential quality and variety; then the program coordinators for CRNA programs can too. Having said all that, what I am finding is that I need to find a program that is the best match for me with the experience and qualifications that I have or am getting now--because I am not all the willing to go back into the ICU. I'm sure you can find a program that will think your experience is just fine too. If you are intent on a particular program NEAR you or based on some other priority--you can run your CV past them. I have found a few programs that are even willing to mentor you with a 2-3 year plan. It may not be worthwhile to go to a LEVEL ONE TRAUMA CENTER. They might not have the number of cases that you can be a part of to make a difference. Like the previous poster stated--that is a designation for what they can do--are set up to do--in many cases it just means that they have an in-house neuro-surgeon. See what I mean. There are just so many variations. DO IT YOUR WAY. YOU WILL GET IN.

Dreamweaver2be · Mar 4, 2006

Thanks for your replies, it helps to hear others opinions. I understand a bit more about the trauma designation, meaning what services offered 24 hrs. a day--the google search helped :)

I will just keep applying myself were I am at now, I guess I was not sure what I was missing as this is the only critical care I have worked in. Also I am a bit concerned b/c in our CCU they do not train newer nurses to take open hearts-or at least not until 4-8hrs. out for a while, maybe quite a while, and it seems the same w/becoming IABP certified. Do you think at a larger hospital they would train newer nurses off the bat for open hearts and IABP's, or is this normal?

UCDSICURN · Mar 5, 2006

Do you think at a larger hospital they would train newer nurses off the bat for open hearts and IABP's, or is this normal?

It's probably unit specific. They may train you and orient you, but like everyone else you'll probably start off taking the easier patients until you prove yourself.

piper_for_hire · Mar 8, 2006

It's a bit of a catch-22. You need to get clinical time along with your IABP cert, so you need to be ready to take care of hearts. So - they usually won't train you until you think you're going to start taking hearts right away. In my CTICU/MICU, you have to do MICU only for a year. Not a bad idea - by then you know everyone and where everything is so you can concentrate on learning the new stuff.

-S

It's probably unit specific. They may train you and orient you, but like everyone else you'll probably start off taking the easier patients until you prove yourself.

91CRN · Mar 8, 2006

It's a bit of a catch-22. You need to get clinical time along with your IABP cert, so you need to be ready to take care of hearts. So - they usually won't train you until you think you're going to start taking hearts right away. In my CTICU/MICU, you have to do MICU only for a year. Not a bad idea - by then you know everyone and where everything is so you can concentrate on learning the new stuff.
-S

This was my point exactly about changing units and getting the IABP training. First you have the move from MICU or ER to SICU--then you have the IABP training--then you have to factor in how many cases YOUR SICU will even get that will be using a IABP--then you have to factor in preceptorship/experience. Geez that could take up to two years for experience that really isn't even a part of anesthesia training. Most of the programs I have been checking out want ICU experience--when you call the coordinators they will state that SICU or CVICU is probably the most applicable training--BECAUSE OF THE INVASIVE MONITERING--VASOACTION--VENTS etc. NO ONE has mentioned even once to me about LVADS OR IABP certification. I have contacted: Albany Medical, Charleston West Virginia, ALL the programs in North Carolina except Raleigh, All the programs in California, and the Army--Oh ya University of Iowa too. So even though this is good training and probably would make a candidate look better on paper. The energy to profit ratio TO ME doesn't warrant it. I have personally decided that I will go back into a local ICU from the ER even though I didn't want to just because my SICU experience is about 15 years old--but let me tell you---I had all that training before--it's NOT all that mysterious---a lot of the learning curve is working with your team--being familiar with your unit/equipment--the other stuff is a reservoir of critical thinking/skills. WHEN YOU GO TO ANESTHESIA SCHOOL you will be with another team--in other units. You will draw on that reservoir. Those are just my thoughts on the topic---but hey like I said--I wasn't going to go back into the ICU either but here goes nothin--just to look better on paper. Believe me--the ER teaches one QUITE NICELY how to think on your feet--react---manage mult. critical priorities. But if someone wants me to use that latest model of vent.--take care of a pt for more than the stabilizing period--OK--I'll do whatever it takes to get in. I know you probably will too. I just don't want it to take forever--when I'm done with my BSN--I want to apply--heck--I plan on applying to some schools even before I graduate (there are some that allow this)--(there are some like WAKE FOREST that allow you to apply before you have all your ICU hours in too, as long as they are in progress. GOOD LUCK TO US!

Btorres-LPNsoon2beRN · Mar 8, 2006

I have a quick question for anyone who might know. I plan to continue on after school to obtain my nurse anethetist (quess i better learn how to spell it first ) any way, does any one have any pointers on good schools to apply to, or the process involved after you've worked in ICU for 2 years?

91CRN · Mar 8, 2006

I have a quick question for anyone who might know. I plan to continue on after school to obtain my nurse anethetist (quess i better learn how to spell it first ) any way, does any one have any pointers on good schools to apply to, or the process involved after you've worked in ICU for 2 years?

Yes, read the posting on this board for pre CRNAs. Read the site for American Association of Nurse Anesthetists. THEN it will become clear to you that it is a VERY individual choice based on more factors than I can count; none the least of which are geography, cost, length, type of degree, requirements. You will gather probably MANY choices and start weeding down from there--visit the locations etc.--then get a list going of 3-4 schools that you'd actually like to apply to. ALSO, SHADOW A CRNA FOR A COUPLE OF DAYS. It is a big commitment for something maybe you don't even want to do!!!!!--You've probably already done that. Most of my friends in the ER and ICU say they'd never even consider CRNA --- why you ask--to critically trained nurses CRNA can be considered BORING--that is the statement I get from most of my colleagues especially in the ER. Make sure you don't agree. Frankly, I could use a bit more sit down time