CRNA acceptance after rocky orientation

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Hi all, I've been lurking in the shadows and this is my first post after much observation and effort at getting establishment in the profession. Thanks to all those who are more experienced that have shed light and helped others here with things that only experienced CRNAs/SRNAs could...

Anyway, I'm a new grad from a BSN program nearing the end of my 6 month orientation on a 12 bed CVIVU. My goal since prior to entering RN school has been to become a CRNA. I've done the shadowing, I've thought long and hard about what I want out of life and what I could see myself doing for 40+ yrs, and I've tried to gain as much knowledge about the CRNA profession as possible. I will be a CRNA, and I'm willing to let very few things derail my future.

Up until a month ago I've felt as if everything had been progressing as it should(especially in regards to my orientation), despite being challenged to a greater degree than I had anticipated. I have had my setbacks and sticking points with things(charting, order verificaiton, admit/discharge) here and there, but nothing r/t safety or capability to do "ICU" work. Well aparently some on my unit(manager, unit APN in charge of orientation/education, and 2 unnamed preceptors) felt I'm in no shape to be off orientation and practicing safely on my own. "The brains and heart are there, no doubt, but you're not able to focus yourself suffeciently for safe, autonomous ICU work." Issues were lack of focus/distractability, a lack of developed Crit. Thinking skills, and a general uneasiness with my degree of safety in managing 2 "ICU" level pt's. This was brought to my attention with only 2.5 weeks left for the scheduled orientation!! Needless to stay my holidays were quite overshadowed with a sick/helpless feeling.:icon_mad:

Today I had a 2.5 week follow up appointment with good progress noted, but not at the level it needs to be. I have till the 31st of Jan. to reign it in. I've never had problems/discipline like this in any of my schooling/externship, so I've taken this as quite a blow.

Providing I DO stay on:

1) How do you imagine something like this so early in my CRNA prep. will effect me getting accepted? In terms of LOR, peer review...

2) What to do if I don't stay hired on? I'd still be a hospital employee qualified for RN work, just not the ICU. Try a different unit for a bit then reapply, apply ICU at another hospital?

3) It was hinted and all but suggested during these meetings that I follow thru with chemical management (ADD meds). This of course was only after I openly suggested that subject in response to the distractibility issue. "Providing you do stay, these issues and unit stimulii aren't going to just disappear you know..."

Any help/advice on this subject would be appreciated. Trying to stay positive here but I can't help but have an awful apprehension for the outcome. Despite all my strengths and zeal I can't seem to show them what they need, even though the rest of orientation has gone well.

And as it is, nearly the entire unit disapproves of newbies trying to go to CRNA school. Including the NM who is vehemently opposed.

I'm not looking for pity/understanding, I'd just like some solid insight as the best route to go from here. Sorry for the length!!

:banghead:

-QuestForWa

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Specializes in Psychiatric & Critical Care.

Quest,

I also have aspirations to become a CRNA someday. Currently, I am in my last year of a BSN program. I can understand that you are anxious to achieve your ultimate goal of being a CRNA as soon as possible (I feel the same way) but maybe you are focusing too much on your future long term goals and not on the short term goal of becoming proficient in the area that your currently in. If I were in your situation, I would be more worried about not being able to handle the duties that I would have as an ICU nurse and hold off on pursuing a more advanced role. Maybe it'll take a while longer for you to achieve your goal if you take another route (i.e. Med-Surg then ICU) but it would probably be to your benefit to be able to perform basic nursing duties before taking on all the extra stress of an ICU. Like I said, I know how you feel because I can't wait until I'm able to apply for CRNA school, but I would not feel comfortable trying something as challenging as being a CRNA without having all of the skills needed to be a good nurse that is comfortable with handling the responsibility of patient care. So I don't know how long it'll take but I don't plan on applying to CRNA school until I am really good at being a registered nurse first. Whatever you decide, I wish you the best in achieving your goals.

MJ

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Specializes in NICU, CVICU.

I agree with msjoseph, the immediate focus needs to be on your nursing training, and becoming a competent, proficient, experienced CVICU nurse. One question...have you mentioned to others on your unit that your intent is to go to CRNA school? (that might certainly be having a negative effect on their appraisals of you)

It does take some time to develop good critical thinking skills - it comes with experience, too...

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Specializes in Junior Year of BSN.

I think you should stay focused on the skills in the ICU that you may need to improve. Also, you probably have told them your goal of being a CRNA and you have already stated they do not like newbies thinking that way. Not to say that there jealous or anything but they probably don't like the fact that they are orienting someone who will be on the unit for less than probably 2 years. I think you should think step by step. First finish your ICU orientating and better your skills. Then after achieving that think about the CRNA school. If you show improvement and then show that you can be a great ICU nurse I think thats what matters. First impressions count but lasting impressions count too.

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Thanks for the replies and ideas.

For an attempt at brevity I omitted some details in the 1st post...

I have NOT mentioned to these people my intentions, and I'm fairly certain that they are not focusing on that as a means to get rid of me. At this time our unit is getting slim with staff, so I don't think they'll be canning people willy nilly. There is another new grad in my orientation and he mentioned outright at his interview that he will most likely be going back after 3yrs to CRNA, so seems like they just don't want those who will "use" the unit for that one yr. req.

I know deep down that I have what it takes to become a profecient ICU nurse, and I know that that must come first. I am not just focused on the end CRNA goal here; I truly do enjoy ICU work and desire to know as much as I can so I can provide the best/safest care. I have also heard much positive reinforcement from other preceptors and have had days where I've felt really good about my progress. So let me paint over the picture of me as a cocky/whiny new grad with grad-school tunnel vision.

Sidenote: Has anyone found the use of ADD medication to be NOTICEABLY useful in focusing at work? I am not entirely opposed to trying that if it actually helps.

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I wanted to address your sidenote first: WHY is this a sidenote? Do you feel you have ADD? Have you been diagnosed as having ADD? If so, then yes, medication can be effective. If you are basing this information purely on another's interpretation of your attention and focusing skills, then no, medication will not be effective. Yes, it is true. Distractions and extraneous stimuli are a given in the ICU... they are a given anywhere in nursing. Welcome aboard!

You have mentioned two preceptors who have given unsatisfactory performance appraisals. Do you have a primary preceptor who is best suited to evaluate your performance as it has (or has not) progressed, and what does he or she think? Having said that, how many preceptors have you had? Inconsistency in your precepting experience may be attributing to your "poor" performance. Are you evaluated daily, whether formally or informally, as to how you performed for the shift? If not, isn't it a reasonable expectation that your preceptor provides such feedback? Have you been provided specific instances when you were performing sub-par? There are many gaps in your original post, but not gaps I want you to fill in front of the AllNurses.com world. These are questions I want you to ask yourself and your preceptor. I wouldn't be surprised if your performance may be the afterbirth of poor direction, management, and precepting.

Though you should work towards your future in nurse anesthesia, you should address the "here and now" issues you currently are experiencing in the CVICU. Overcoming your hurdles and showing improvement will make you stronger professionally and personally, and give you a one-up on your future aspirations. Good luck and don't give up.

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Welp, things didn't work out so well. I took other posters' advice and really tried to fix the things they cited. In the end the concensus was that I was unable to get up to speed and safely/independently manage 2 ill/unstable CVICU patients on my unit. Nothing I could say or do to change their opinion, so I thanked them and respectfully bowed out rather than whinning or making a scene. Good news is that I'm not fired from the hospital, I just need to find another unit, one with a better "fit" as they put it. And they are going to help me get placed there. And I still haven't revealed my CRNA aspirations to them yet.

So the question now is, what is the best route or the best unit to go to now? Should I try the OR, interventional radiology/cath lab, one day surgery/special procedures? What/where is going to give me the most room to grow and improve my critical thinking and time management skills? That way in a year or so I can reapply to the same or diffent ICU. Keep in mind they recommended that I not try to go to a floor unit and take the 4-6 patient loads commonly found there, and I myself would rather stay away from that.

Btw, my focus and organization had markedly improved so I think it was a matter of doing some self-talk and prioritizing and I no longer think there is an ADD issue as I'd previously wondered.

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Specializes in Anesthesia.

Just curious: do most institutions place brand new grads in CVICU?

deepz

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Specializes in ICU, currently in Anesthesia School.

Deepz- If the area is experiencing a shortage of RN's you will find new grads in just about any type of ICU. For example- when I worked in western north carolina, you had to have at least a year IN critical care to be considered for a position. But in the metro DC area, you need a pulse and a license and they are throwing jobs at you:)

So although I cannot answer for "most" institutions, in my travels I have noticed regional differences in the acceptance of new grads.

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Specializes in Trauma/Surgical ICU, L&D.

QwestforWa,

I am sorry you've had such a negative experience. I'm sure you've heard of many ICU RNs with the reputation of "eating their young." It's a sad truth in some units. The fact is, managing 2 ICU patients "well" is tough. It CAN be difficult to focus, when there are so many needs pulling you in different directions, while you are trying diligently to stay on task, on top of your charting, and meds. If they are not admitting this to you, they are LYING or aren't very good nurses. Hang in there. It takes a long time to establish a routine to keep focused (especially for a new grad) A few suggestions, look at other ICU nurses that you respect and admire. Ask them what helps to keep them organized (BIG KEY) and focused. Look for mentors who are positive and enjoy teaching. (we're out there) Not pompus, self-righteous nurses (they're out there). If I can offer any other suggestions or help at all, send me a PM. Good luck, keep motivated and strong. If all else fails, trade your purfume for pepper sauce (keeps the nurse-eaters away). Heads-Held-High......Rockstar..

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So the question now is, what is the best route or the best unit to go to now? Should I try the OR, interventional radiology/cath lab, one day surgery/special procedures? What/where is going to give me the most room to grow and improve my critical thinking and time management skills? That way in a year or so I can reapply to the same or diffent ICU. Keep in mind they recommended that I not try to go to a floor unit and take the 4-6 patient loads commonly found there, and I myself would rather stay away from that.

.

I would suggest a step-down unit of some sort. Still sick patients but not at the acuity of an ICU. Then, if you improve in your above deficiencies, you could re-apply to an ICU. I'd avoid day surgery. Interventional radiology and cath lab are or can be very high acuity and you're critical thinking skills would be challenged.

Good luck

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