I am currently a critical care nurse working in a large Neuro/Trauma ICU. I'm a huge nerd that loves to know WHY about EVERYTHING, and loves to be involved in the decision-making about my patient. I'm a nurse through-and-through--I love educating the families and helping them to understand what is going on with their loved one and make sense of this hell that they are experiencing. But I'm also very controlling of my patient--my rooms must be setup in he same way each day so I can find my stuff in a crisis, and I like my patients clean and well-positioned in their beds. I'm very protective of my patient in that the procedures and orders carried out on him/her must be appropriate in type and in timing--if there is any question about it, it will be cancelled or rescheduled. So, I'm a bit bull-headed, too, with a low tolerance for bureaucracy--if I need something for my patient, no is not an answer I will accept. I'm starting to feel like I'm outgrowing the ICU--I'm losing some skills, desiring more knowledge and influence over plan of care and delivery of care for my patients, and reaching my limit for tolerating blame for scheduling or communications issues that are out of my control--so I'm looking into advancing my career. I am applying to CRNA school, but I have a few fears that my personality and desire for knowledge and control might not be a good fit.
I like the role of the CRNA in that you perform a lot of advanced procedures--intubations, line insertions, and blocks. You're in charge of the hemodynamic and pulmonary issues that arise, which can be a little touchy at times, requiring you to change your plans often and think head 20 steps in case the case goes from lap to open or the surgeon knicks an artery. You're involved in surgery--something that is often done to help improve the patient's quality of life rather than harm them (as I often feel like I am tending the vegetable garden in the ICU.) But I'm concerned that I'm going to miss out on the critical thinking about all of the medical issues that the patient is undergoing and how they all affect one another and the patient's quality of life and how to get them back to a good quality of life (and the creative ideas and solutions that go along with that)...but I sure won't miss the readmissions because they didn't listen to our advice. I fear that life in the OR might be more monotonous in an assembly-line kind of way, and I'm so much of an adrenaline-junkie that I fear I might eventually get bored. I'm concerned, too, that it will be a constant struggle of being belittled by the MDA, with their constant oversight and opinions about my practice (not to mention the fact that they're able to bill for 4 separate procedures at once since they're overseeing 4 separate CRNAs that are doing a majority of the work). I don't want to feel limited in my practice in not being allowed to do certain cases such as open hearts due to my lack of knowledge in comparison to an MDA.
So, my question for those practicing CRNAs out there is, do you identify with any of these concerns/fears? Do you miss the ICU for those reasons I'm afraid I might miss it? Would you do it all over again?
