PACU or ED for CRNA - page 2

by SlyFoxRN, MSN, DNP, CRNA | 2,535 Views | 15 Comments

So I'm interested in being a CRNA, but I don't really like the ICU. I feel I could get the same experience with hemodynamics and vasoactive drips in PACU, as well as critical thinking, etc in the ED. Would a mix of these two... Read More


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    Make sure you contact the school the school(s) that you are interested to verify they are still taking ED and/or PACU experience. The school may have just not updated their websites since the COA changes took effect.
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    Quote from missnurse01
    SlyFox, I know it sounds like people are being harsh but you asked an opinion and they are giving it as they have experienced it. Each program decides how they are going to define 'critical care' and you never know when their definition is going to change. Each ED and PACU is different. I have been a nurse a while and have worked all over the country, and the majority of the hospitals do not have PACU take the critical pt's. They come straight to ICU. I know that some PACUs take these pt's, but many are unable to monitor invasive lines, etc. If they do take them, then it is for a short time until an ICU bed is available. As a new nurse, it will be difficult to learn as much as you can without having the pt for 12 hours. You will constantly be trying to get the pt's out as the next post op is rolling in. In the ICU you will have time to watch the trends, follow the protocols, see what happens. You can learn all about the different diagnoses, talk with fellow nurses and docs about what is going on about the pt. You are exposed to a lot more. The ED can have crashing pt's, however in most ED's it's get them stablized and move them upstairs. I worked ED in many hosp over the years and it was always amazing they would ever only use dopamine for low blood pressure. I didn't know how much that I would learn when I move to critical care. I didn't want to go either, but have learned a ton.


    You could also see if one of the schools that you found that accepts pacu/ed has a current student or alumni that you could speak with about different types of experience and how it impacted their schooling and their crna career. You could also shadow a crna and ask them the same types of things. CRNA school is meant to take the most experienced nurses at following trends and hemodynamics, and train them to do even more. You need to decide what path will make you both successful in school and as a crna. You could be in a hosp where you are the only practicing anesthetist, and you will want to have exposure to a wide range of diagnoses, meds, etc to be able to have that knowledge. etc etc etc


    If you want it badly enough, you will do all that you can to get into a great school, and be the best practioner that you can be.


    good luck to you!
    Thank you so much for this post. It's so typical on allnurses for people to just flame and attack, with harsh posts because people don't do things their way. You validated my point of view, but then explained why another route might be better and the exact reason why it might be better. Instead of shutting down and ignoring the rest of your post, I was open and receptive to it, and actually see your point of view. I get the ICU requirement a little better now, and hopefully I'll be able to find an ICU where I'm happy. If not, I'll pursue a different graduate nurse career.

    Thank you!
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    aw, you're so welcome! I try to shine a light on things b/c nothing is ever black and white. The cream of the ICU crop tends to be CVICU, as you will get lots of drips and hemodynamics, and plenty of nights with some adrenaline. You also rarely have the long term pt that has been there for months. The hearts usually go out in a day or two and the next ones come in. Not as fast a turn over as pacu or ed, but you could have a different pt every night. You get more training and get to do 1:1 with balloon pumps, VADs, or 2:1 with ecmo. Trust me there is a world out there to learn, you won't be board. If you are, go read the aacn procedure book (I read a good bit of it as a new ICU nurse), and study for your ccrn, csc, etc. Actually, look at a ccrn review book and see if the topics in it are something you think that you would feel comfortable with getting experience in a pacu or er. Might help guide you.

    I still moonlight in the ER, as it is my first love. My critical care experience shows things in different lights then when I worked there without it.

    Very good luck to you and keep in touch!
    Scooby-Dooby-Doo likes this.
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    Well you're wrong that its not critical care,
    *** The question was about applying to CRNA school. In that context PACU and ED are not critical care.

    and you're wrong that ICU is required. In my research since my post I have found numerous programs that say they accept PACU and ED. The Cleveland clinic states ED and PACU are fine. U Michigan says ED is fine, etc. I just hoped to find more
    *** Is that what it says on their website or did you call them to get the most up to date information relitive to the COA changes?
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    *** Is that what it says on their website or did you call them to get the most up to date information relitive to the COA changes?[/QUOTE].

    The most recent COA papers say that one year critical care experience is required. They state to see the glossary for critical care definition, which states:

    Critical care experience – Critical care experience must be obtained in a critical care area within the United States, its territories, or a US military hospital outside of the United States. During this experience, the registered professional nurse is to have developed critical decision- making and psychomotor skills, competency in patient assessment, and the ability to use and interpret advanced monitoring techniques. A critical care area is defined as one where, on a routine basis, the registered professional nurse manages one or more of the following: invasive hemodynamic monitors (such as pulmonary artery catheter, CVP, arterial); cardiac assist devices; mechanical ventilation; and vasoactive drips. The critical care areas include intensive care units. Those who have experience in other areas may be considered provided they can demonstrate competence with invasive monitoring, ventilators, and critical care pharmacology. (+)
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    So no answer to my question. I guess that is understandable.

    The most recent COA papers say
    *** Ya, I know.

    The point is those who want to go to CRNA school should go to work in a critical care unit, not PACU or ER. Are there some schools that MIGHT consider non critical care areas like ER or PACU? Well it would seem so, or was so until recently. Why aim for the smallest percentage? Why place obsticals in the path to NA school? Why decrease the number of schools who would consider you?
    phillycpnp-pc likes this.


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