Soooo..I'm in a bit of a dilemma. I am strongly considering applying to CRNA school in the future and have a few paths that could lead me there. I have been a nurse for 4 years in a few different specialties but am now ready to get a few years of valuable critical care experience so I can pursue these dreams.
I currently working in a large Level 1 Trauma Center and have interviewed in a Medicine ICU here. I would be caring for some really sick patients while getting experience with vents, drips, various lines, CCRT, etc. After my interview, the manager told me there would be a job offer so I was really excited! I interviewed a few weeks ago in a nearby hospital (not a trauma center) in a Neuro ICU. They take some overflow of Medical/Surgical ICU patients but are mostly neuro only. They have drips, vents, etc. But obviously the acuity is not comparable to the larger hospital. Well long story short.. I got a job offer today for the Neuro job...and it's good money..quite a bit better than I am making now. There are other incentives to taking this job as well, not just money, but the money will help me pay off some debt/save money for CRNA school.
I have been told ICU experience is valuable in almost any form. What are your thoughts?
Would I be wise to turn down a Neuro offer for a job in Medicine ICU regardless of pay at either hospital?
Honestly, I don't think it really matters what type of ICU you work in it mostly matters that the applicant is knowledgeable/proficient in the broad spectrum of critical care...i.e. pressors, sedation, vents, lines, etc and you will see all of this and more in Neuro. I currently work in a CICU in a state of the art new heart and vascular tower and I don't have near as many patients with the variety of gtts here as I did when I worked in neuro. IMO neuro is the hardest specialty and requires tremendous critical thinking ability....
Umm.... Could you explain what your point of emphasis is with the citations you provided? The first one that you provided (tcu) doesn't mention neuro preferred or otherwise (which you pointed out)? So what's your point? Simply because they omitted a specialty doesn't mean anything. Your second post is even more curious... I think you're inferring more than you should about neuro being less preferred simply because of where it's located on the list. Perhaps it might behoove you to read through the entire paragraph, it says nothing about that list of specialties being listed in order of preference, simply that it is among those that are preferred. In fact right above that list, all it states is that adult is preferred above NICU/PICU. If there is a "preferred" specialty it would most certainly be CVICU and according to your logic that would be third?.... Probably not.
Like you said, it does obviously vary greatly the preferences that each program may have. There is however no hard and fast rule that on a general basis of neuro being valued any less than any other specialty. You seem to be taking your own anecdotal experience and coming to some incorrect conclusions.
I doubt that you're offending anyone, I just want to ensure that incorrect info doesn't get disseminated as fact.
You are entitled to your opinion. I would suggest the OP ask the schools he is interested in apply with to know what they prefer. However, I have found another source link to support the order of preference of surgical ICU and CVICU being the top choice specialty areas.
The American Association of Nurse Anesthetists (AANA) and Council on Accreditation (COA) requires applicants who matriculate into nurse anesthesia programs to have completed at least one year (365 days) of critical care experience as an RN. This ICU experience must be obtained in a critical care area within the United States, its territories, or a U.S. military hospital outside of the United States. During this experience, the registered professional nurse has developed critical decision-making and psychomotor skills, competency in patient assessment, and the ability to use and interpret advanced monitoring techniques. The COA defines critical care areas as one where, on a routine basis, the RN manages one or more of the following: invasive hemodynamic monitors (such as pulmonary artery catheter, CVP, arterial); cardiac assist devices; mechanical ventilation; and vasoactive infusions. Examples of critical care units may include but are not limited to: Surgical ICU, Cardiothoracic ICU, CCU, MICU, Neuro Intensive Care Unit, Burn-Trauma ICU, and Pediatric Intensive Care.
Richwade, the order the lists are consistent among different schools. They list them that way for a reason. That is the order of preference. They are not listed in any other way (ie. alphabetical). Trauma center experience is also preferred.
Anastasiak, you should familiarize yourself with something called the burden of proof, don't worry I'll tell you since you obviously don't know, "he that asserts must prove". I wasn't the one who asserted that neuro is lower on the list, you and your friend however are, therefore it is your responsibility to prove. So while you seem insistent on throwing your two cents in, please show me ANY and I mean ANY proof that "they list them that way for a reason". It's called the list are being done arbitrarily.. Profound concept I know... I didn't see anywhere in your great source where it says, "ICU and CVICU are the top choice area of specialty". All your "source" showed was another arbitrary list. Thanks for your insight. :)
I see you are still insisting on your bias. Here you go from CRNA School Guide publication written by School Search Inc. Todd Hammon, MSN, CRNA, CCRN, CEN.
Get the RIGHT Critical Care Experience
All nurse anesthetist schools require at least one year of recent RN experience in an adult critical care unit. However, most applicants you're competing with will have 2-7 years of experience in a critical care unit and 4-10 years as an RN.
Some CRNA schools have certain ICU units that they prefer (usually surgical and cardiovascular). Other schools aren't as concerned with the unit you worked in as much as they are the type of experience you had, and the level of comprehension you have walked away with.
What is the best type of ICU experience to prepare you for CRNA school?
Tip from a CRNA:
It is important the type of ICU experience one has when applying to CRNA school. CVICU/CCU is very common. The main goal is having the knowledge and experience of not only handling critically ill patients, but hanging, titrating and sometimes mixing drugs such as Neosynepherine, Nitroglycerin, Dopamine, Dobutamine and others. Also, an RN is most likely to gain firsthand experience in learning to read wave forms of PA lines, Art lines, Wedge Pressures etc. My advice to the RN's who are working in these settings with a goal of going to CRNA school is to assist the physician in placing these lines. The more experience you have helping with placement, learning wave forms, watching how difficult placements are overcome, the more comfortable you are in learning how to place them in CRNA school.â€
– Todd Hammon, MSN, CRNA, CCRN, CEN
Each practice area brings its own advantages in terms of nurse preparation. And consider that each CRNA school may have its own preference for the type of ICU experience they consider the best for your preparation of CRNA school.
This section is mostly taken from the WFUBMC website, with some portions taken from other CRNA school FAQ pages:
As a CRNA student, you will care for patients who are neonatal to 100 years old, and you will have to be equally comfortable with many aspects: drug dosing, age-related factors, etc. for each age level. A neonatal ICU nurse will find great comfort adapting to pediatric anesthesia, while the former coronary care unit nurse will have a breeze in evaluating ECG and stress test results prior to cardiac surgery.
Having said this, the majority of your patients will be adults, so even though experience in the NICU or PICU will always help, it should be balanced by at least one year of adult ICU. Fortunately, nurse anesthetist schools will do their best to help you bridge the gaps between your past experience and the broader set of responsibilities you will face as a CRNA.
No one area is perfect in terms of previous experience, although a surgical ICU will give you familiarity with many aspects of anesthesia care, anesthetic medications, postoperative complications, etc.
If you are considering a job change to better prepare for nurse anesthetist school, you might consider changing areas as well to give yourself a broader experience base. For example, if you are in a small surgical ICU and you are going to move to a larger ICU to get more diverse experience, consider going to a medical ICU to increase both your breadth and depth of experience.
It is always best to gain your experience in a large ICU. In fact, 1-2 years in a large ICU is probably better than 10 years of experience in a in a small ICU. The reason is that large intensive care units offer more experience in the following areas (and these things are critical to your success in nurse anesthesia school):
ï‚· Dynamic and independent decision making
ï‚· Continuous ECG monitoring
ï‚· Invasive lines (such as pulmonary artery, central venous, and arterial catheters)
ï‚· Vasoactive infusions
ï‚· Ventilator support
ï‚· Life threatening pathophysiology
If, by the time you apply, you will only have experience in one area, the following types of experience will give you the best starting point as an SRNA:
ï‚· MICU (Medical Intensive Care Unit)
ï‚· CICU (Cardiac ICU)
ï‚· SICU (Surgical ICU)
ï‚· Cardiothoracic surgery ICU
ï‚· Neuro ICU
ï‚· CCU (Coronary Care Unit)
Look, I am not saying Neuro ICU can't prepare you for CRNA school. But, it is NOT the first choice of many CRNA schools. As competitive as CRNA school is, you do not want to have anything against your candidate profile. If it comes down to all things being equal on paper (GPA, years of experience, GRE score etc.), some schools will prefer Surgical ICU experience in a level 1 trauma center over Neuro ICU.
Sweetether you are painfully misinformed. Neuro ICU experience is in no way "last on the list". I don't know where you're getting your information from but please educate yourself before stating things as fact. I am a current SRNA and sit in on the admissions committee for incoming students (in a very, very well respected program) and neuro ICU experience is valued just as highly (if not more so) than any specialty ICU. And the fact that you think it ranks in the same category as PICUS/NICUS betrays your ignorance, most schools require adult ICU experience, therefore making PICU/NICU ineligible as prerequisite experience to gain admission to CRNA school and thus they are not even remotely in the same category.
It may depend on the school. In the Tristate area we have some schools that don't accept neuro icu experience and others that actually state it is last on the list.
This is entertaining. I personally could not imagine working full-time in a strictly neuro ICU. I can see how it would be good experience, but then again, I can see how other areas may offer better experience. I think adcoms look at the WHOLE picture, not just your experience. If your GPA and GRE are good, then neuro ICU will be fine. If your GPA is subpar like mine, then you need great experience.
I work in a mixed ICU with the second highest census and turnover rate in my state. lots of traumas, lots of medical patients, and lots of surgeries. Lots of patients in general actually. We see a lot. I don't have CVICU experience (although I may transfer soon), but I would rank patient acuity like this: Medical, surgical, trauma, neuro (notice I didn't include cardiac).
Medical patients are SICK. They stay sick for a really long time, which can burn you out. I have learned the most patho from medical patients. Trauma patients are cookbook, and really aren't very difficult aside from massive transfusion protocols with a level one prior to going to OR. If they make it out of the field, out of the trauma bay, and then out of the OR, 90% of the time they're usually going to okay (hemodynamically eat least). YEAH, you do have your trauma patients who herniate and/or have a a bunch of drains or fractures, but they're all the same. You can also get some really sick surgical patients, and there's usually a faster turn around rate with them. Your fluid resuscitation judgement has to be on point, and you are exposed to surgical staff and procedures, which is why I think it is the preferred experience.
My experience with neuro in a busy trauma center has been this: Q1hr neurochecks/ICP/EVD output/Licox monitoring, bleeds with cardene gtts to keep SBP 160, pressors in herniating patients who are going to herniate no matter what, subjective GCS assessments, funky smells, pushing 23.4% saline to bring down ICP in patients who are stuck in the ICU for months.
I still think that a crashing medical patient who is septic patient with heart failure/MODS, and DIC who is throwing a PE and on multiple gtts along with coding multiple times throughout your shift is the most fun. Sure, it's not as "sexy" to a CRNA admissions committee, but you sure do learn a lot. Debatable of course, I know...
I'll let you know how I rank cardiac after I get the CT ICU job :)
I would strongly advice you against taking the Neuro ICU job. Schools do rank candidates according to their area of specialty. Generally, Surgical ICU and Cardiothoracic ICU are the most preferred, then Medical ICU, and Neuro and PICU/NICU are last on the list. Also, the trauma experience will gain favor for you as well. I would stay at the current level 1 trauma facility and work in the Medical ICU there.
You are painfully misinformed and giving bad advice. Neuro ICU is fine. Just fine. The OP will be fine either route they choose.
You are painfully misinformed and giving bad advice. Neuro ICU is fine. Just fine. The OP will be fine either route they choose.
How can you say this when there are schools that don't accept neuro or say it is last on their list? I work neuro now and am switching because of this. It is very school dependent and yes, to some schools the unit does matter.
How can you say this when there are schools that don't accept neuro or say it is last on their list? I work neuro now and am switching because of this. It is very school dependent and yes, to some schools the unit does matter.
Because I am actually one of the people sitting on those committees. For two different programs. Thousands of miles apart. Neuro is not frowned on any more than CVICU is preferred. This is a crazy myth the permeates this board, and it is pure dogma. I attend conferences with faculty from all over the country, and I know what they like and things about which they care not at all. Almost every post presented here as evidence actually makes the opposite point. Those lists are not in any particular order. Level I does not matter either. Far better to be in a large, busy, community ICU not crawling with residents and where critical
thinking and assessment are necessary. So many, many myths on this site.
ccuccrnap16
67 Posts
Honestly, I don't think it really matters what type of ICU you work in it mostly matters that the applicant is knowledgeable/proficient in the broad spectrum of critical care...i.e. pressors, sedation, vents, lines, etc and you will see all of this and more in Neuro. I currently work in a CICU in a state of the art new heart and vascular tower and I don't have near as many patients with the variety of gtts here as I did when I worked in neuro. IMO neuro is the hardest specialty and requires tremendous critical thinking ability....