ICU experience

[studentrn1008]

Can anyone tell me if a Special Care Nursery would meet the ICU experience for a CRNA program? I am still in nursing school and have my plan laid out to continue school to become a CRNA but I would like to work with children both once I graduate as an RN and when I finish school as a CRNA. I really have no desire to do adult ICU unless I absolutely have to in order to get into the CRNA program. I had an opportunity to talk with a CRNA while doing my OR clinical rotation at the local children's hospital but did not get to ask her the question about the special care nursery. If anyone could help, I would appreciate it!

[Rage, RN]

UT medical center (level 1 trauma) and Blount memorial will start new grads here in Knoxville.

[smileyRn96]

How quickly can a newly licensed RN get work in an ICU?

(while we're on the subject! :))

It seems to vary in different areas of the country, but every place I have worked will accept new grad RNs in the ICU.

-Smiley

[GregRN]

Your absolutely right Greg, copied from their catalog it states :

New RN graduates (graduation in the past year) who are currently working in critical care positions, and who will have met the one year of experience (excluding orientation periods) prior to actual enrollment are welcome to apply. In the past, some of these new RN graduate candidates have been accepted on the first interview; however, many have not been.

But also in their catalog it states:

While not an area of highest priority, applicants will be considered who work in recovery rooms where patients routinely have invasive hemodynamic monitors. Emergency room experience will be considered only if the candidate can demonstrate he cares for patients with

invasive monitors in this setting.

The school in mention is: http://www.mtsa.edu/index.php for your followup convenience.

Some schools will consider E.D. experience as suitable for meeting the Critical Care requirement, most do not. Some E.D.'s in a Level I Trauma Center use plenty of Swans, a-lines, central lines, CVP's, etc. However, this is still rare and most of this experience is gained in the ICU setting (I'm fairly certain it doesn't take place in a specialized nursery setting). The key piece to critical care is the critical thinking aspect: being able to pull information from many different places to give you an accurate picture of what's going on with the patient. In the E.D. you typically treat the acute issue, then street 'em, or send them to the ICU for extremely sick cases. Pulling together information from labs, monitoring hemodynamic status, invasive lines, vents, titrating drips, etc. are usually not done in the E.D. And when things go south in a hurry, (things go from boring to intense pretty quickly in the ICU) you better be the RN who immediately orders x-rays, gives the fluid bolus, orders labs, starts the vaso-active drips, all the while telling your co-workers what you want done and when, while one of them calls the doc. These things are typically done WITHOUT any orders. That's the critical thinking piece. Critical thinkers don't need orders to act on a drain-circling patient.

There are exceptions to this ICU experience, however, and schools that recognize this exception spend a good deal of time quantifying just how much experience someone has doing this. If someone truly is interested in CRNA as a career, they would be best suited to find a position in the ICU to best prepare, as this type of experience is preferred and accepted by ALL schools.

[GregRN]

i've posted this before but thought i would share my thoughts and experience on working as a new grad in the icu:

there are many variables that need to come together in order to go straight into the icu out of school and be successful. some of them have to do with the person, some have to do with the hospital and/or unit you will work. first, is the icu where you really want to be? are you aggressive/assertive enough to move at that pace and not get pushed aside when things turn south? do you work better getting to know 1-2 patients very well and at a deep level, vs. 5-8 patients on the surface? do you like the detail involved in putting together the puzzle of an icu patient? when the fit hits the shan and your patient crashes, do you want to be at the forefront in getting them stable again or would you rather let someone take care of the crisis and then you take the patient from there? can you navigate the delicate waters of family members' anger and anxiety when their loved one becomes acutely ill and they have nowhere else to place that energy except on the nurse? are you prepared to handle/learn end of life issues, both from the patient's perspective and their family's? those are just a few things to think about. if you answered "yes" to those, then the second part becomes the most important.

secondly, does the hospital where you are considering going into the icu have a track record for successfully placing new grads in the icu? what is their training program like? how long? are you 1:1 with a preceptor? does that person have a successful track record as well? what resources are available to you as a new grad icu nurse, i.e., education and training departments in the hospital, cns's, access to doc's, resource books and material, computer applications and training, hand's on education, etc? how acute is the facility in which you will be working? how long is training before you will be expected to work independently? what is the culture like on the unit in which you will be working? are they receptive to new grads or would they rather beat them up for a bit to see if they can "make it"? when working independently, is the unit very helpful to new grads just off orientation or do they give the attitude of "sorry, you're on your own now"?

i've seen very smart, driven and capable people fail miserably going straight to the icu because the facility in which they were working was not adequately set up to take on new grads. the system failed them and no matter who was placed there, it's likely they would have failed as well. likewise, i've seen people who were not quite ready for the icu get through a very good training program, only to decide later that the icu wasn't quite right for them. where you fall in the middle of all this, and the facility in which you work, will likely predict your success in going directly to the icu from school.

[thyme39]

" I would like to work with children both once I graduate as an RN and when I finish school as a CRNA. "

Wayne State University in MI has pediatric CRNA training. I think it is a certificate you get after you finish CRNA school. If they have it maybe other schools where you are have it to. So, even if you you have to work in ICU with adults, after you are a CRNA you can go onto specialize in pediatric CRNA. You might want to check into this.