Medical ICU not enough?

[CS911]

Aspiring CRNA here, looking for guidance.

So, here's the deal. I'm steadily approaching my 1st year out of school as a nurse in a 32-bed Medical ICU, Level I/teaching hospital. Fairly diverse patient population, including neurosurgical patients with EVD placement/ICP bolts.... plenty of vents and pressors, CVLs with CVP, ALines, maybe some Nitric Oxide on vents, but *rarely* PA caths.... maybe 1 per year?

I feel like I am very comfortable with the Medical ICU variety patient. I've started precepting both nursing students and new hires. Respiratory failure, DKA, Cirrhosis, GI bleeds, Sepsis/Septic Shock, CHF Exacerbation, etc, but I feel I need more cardiac experience. I really want to learn open heart recovery, deeper interpretation of ECGs, balloon pumps, (more) chest tubes, in order to really successful as a future SRNA.

So, should I stay in the Medical ICU and get CRRT certified -> charge nurse, etc... -- or -- would it be more helpful (in the context of being a well-rounded and comfortable ICU nurse / SRNA candidate) to transfer to either a CVICU or SICU? My hospital has both, and I did rotations during my critical care residency in both, but only for 2 weeks.

Do SRNAs really need a good cardiac/open heart foundation? Or does the Medical ICU I described suffice?

Thanks in advance,

-CS

[Ifeoma Pamela]

My opinion, if there is opportunity, go to SICU. I left neuro icu in January to SICU. I don't know if that had part i my acceptance to a program. But regardless, best decision ever. Exposed to soo much more. Fresh hearts, LVADS, ECMO, etc. In SICU, I see more things I would deal with as a CRNA....and I have gotten really close with the medical director over the ICU and secured a job for myself when I graduate my program.

[ProgressiveThinking, MSN, CRNA]

MICU is really a catch all unit. If your MICU is mixed (as mine was) and allows you to take care of surgical patients as well, then I would stay put and focus on getting letters of recommendation. On your resume, just REALLY emphasize that you take care of medical, neurosurgical, and surgical patients. I think medical and neurosurgical patients would probably be okay as well

If your patients are mostly medical in nature, I would email the program directors of each program you are interested in and ask them for their input. I emailed A LOT of PDs just to get a general idea of what they were looking for and to find out if I was a competitive applicant or not. While one PD told me their program DID prefer SICU, most stated that MICU was fine, and the most important thing was that I was comfortable with vents and gtts since anesthesia will be learned in anesthesia school and not in ICU. Some also stated they prefer any ICU at a large academic medical center.

I come from a MICU at a very busy academic medical center that's mixed with lots of sepsis, GSWs, traumas, and neurosurgeries (SAH, SDH, GSW to the head, etc.). MICU was really just a label for my unit, but in reality, patients went wherever there was an open ICU bed.

With my mixed MICU experience (I really emphasized the MIXED part on my resume), and very mediocre GPA, I applied and ended up completing applications for 3 programs, and was invited to interview at all 3. I was accepted to 2/3 schools, and declined to interview at the third because I was already accepted. However, I do quite a bit of code/rapid response, had CCRN-CMC, and did well on the GRE, which I think helped make me more marketable. Personally, I think that how you interview is the most important factor.

CRNA programs used to accept ER nurses who obviously had zero experience with LVAD, ECMO, CRRT, fresh hearts, etc. They all did just fine and are practicing as CRNAs.

The following breaks down SRNAs by ICU specialty and age, and MICU is listed and has a high pass rate, so obviously MICU is sufficient.

https://www.nbcrna.com/certification/Documents/NCE/NCE_SEE_Annual_Rpt_FY2015.pdf