CRNA vs ACNP

Trauma Columnist · Apr 8, 2008

Hi Mark - may I ask how much experience you have as an RN? Have you shadowed CRNAs? What other homework have you done? My suggestion would be to talk with and shadow both types of APNs and then perhaps with a little real-world time, you might be in a better position to make a decision. As it is now, I wouldn't make such a far-reaching decision until you are sure. Good luck. Hopefully some others will be around to help you out.

gasmaster · Apr 8, 2008

Well, you would have plenty of patient contact as a CRNA, plus you would be performing very advanced skills. I have friends who are NP's who are disappointed because they are often not allowed to use the advanced skills they learned in school out in clinical practice (chest tubes, central lines, etc). Are you currently a NP? For me I never had a desire to apply to an NP program. I think it's just individual preference.

mark2climb · Apr 9, 2008

I have seven years as a RN and all of it in critical care (ED, ICU, and PACU). I have shadowed a CRNA and spoken with ACNPs as well.

Here's what I see is the difference:

CRNAs have more rigorous academic programs and get to do more advance skills while in school. They intubate, titrate vasoactive gtts on a daily basis, and put in invasive lines frequently if not multiple times a day. They have great understanding of cardiac and pulmonary physiology and pharmacology as well as pathophysiology. They are great at handling emergent situations. Their focus is seeing the patient through the procedure in stable condition if possible.

ACNPs have more in depth knowledge of specific disease processes that may be affecting the patient. They think about the details covering the patient's health including issues such as skin, nutrition, and antibiotics. I've also seen that NPs and MDs involved in critical care tend to care more about intricate vent settings than your typical CRNA or anesthesiologist. They also have more prolonged interaction with patients and their families whether good or bad.

Would you agree that CRNAs tend to have shorter interactions with patients and families, whether that's good or bad? CRNAs also tend to not care or need to know all the minute details regarding the patient's condition, ie the pt's abx and latest CBC.

How do most CRNAs feel about the sometimes factory-like operation of some ORs? "Just crankin' them out!" Any CRNAs have negative experiences dealing with demanding surgeons who treat you like his personal servant? Etc.

Just thoughts....

CRNAGAL · Apr 9, 2008

I was never torn, either, CRNA all the way. I still have plenty of patient contact. Its very satisfying to meet and develop a rapport with my patient, deliver a nice anesthetic, and have them wake up happy and comfortable.

Trauma Columnist · Apr 9, 2008

And the flip side, is I'm an APN who works quite often in the ICU with very complex patients - I enjoy the "why's" of their pathophys as well as getting the families/pt to understand why this happened and what type of outcome they might have.

I did consider CRNA and in fact have recently been to the OR to do some intubations for my pre-hospital RN license. The CRNAs that I encountered (eight in a two day period at a level one trauma center with 28 ORs) all seemed very unhappy with their jobs. At this particular facility, the CRNAs had to have an MDA in the room during intubation/induction. So...I think that while CRNA is certainly a lucrative field, its not for everyone.

At any rate, to invest so much time, effort and $$$, I really think you are doing the right thing by investigating multiple options. Good luck with your decision.

mark2climb · Apr 9, 2008

What were some of the causes for the dissatisfaction of the CRNAs? Was it mainly lack of autonomy or other things?

gasmaster · Apr 9, 2008

Mark2climb, you are incorrect in the assumption that CRNA's don't know disease pathophys as well as an NP. That's incorrect. The pathophys course that is taken is more rigorous by far, and they do care about what abx the pt is on and their latest CBC because it can impact their anesthesia delivery. I've met few CRNA's who were dissatisfied with their job. Mainly it was due to the facility they worked in, not their actual career choice. Some MDAs micromanage but that's the exception rather than the rule. Many facilities have no MDA's or maybe just 1 or 2. The CRNA's are very independent. A lot of facilities utilize the CRNA in the ICU for line placement, intubations, etc. For instance, one of the large trauma centers in Fort Worth does this. Sure, pt contact isn't as long term as in the ICU, that's true. So it's a matter of what your comfort zone is.....

Trauma Columnist · Apr 10, 2008

Mark - the dissatisfaction of the CRNAs I met was because they didn't feel they were given enough autonomy. It was also very evident that they didn't feel they needed the MDA in the room for intubation/induction.

These CRNAs had little call (because the MDAs took most of it and they worked strictly 45 hours/week.

ktcblue · Apr 12, 2008

Mark, I was in the same position as you in July of 07. With experience as a ER nurse, I was attracted to the high acuity patient care. I thought for sure ACNP was the route for me. Until, my cousin's wife (CRNA) sat me down and educated me on her profession, I was still uncertain. I took it upon myself to speak with multiple ACNPs and work side by side with some of them in CVICU (since I switched units). After all the research I did on both professions and the schooling involved in both (including economically), I was still torn. I made a drive across the state to shadow my cousin's wife for a day. I fell in love, CRNA was the route for me... the autonomy, responsibility, and all the different patients and procedures. I knew this was the profession I wanted as a lifetime career. I worked hard on the applications to multiple CRNA schools and am proud to say that I am starting this fall at FIU. Long story short, it is your future, you need to make an educated decision on a career that fulfills your needs and you continue to love in the future!!! Good luck to you!

mark2climb · Apr 12, 2008

ktblue,

Did the ACNPs that you shadowed feel that they were utilized to the full extent of their training? Did they put in lines and intubate?

stanman1968 · Apr 12, 2008

There were several reasons for my choice, one being a huge pay differential. The second was I have no interest in seing someone forever for a hangnail. God love patients but there are times it hard for me to tolerate them for the assesment. I think just bite your tounge in 15 min asleep and silent.

I think job disatisfaction is related to autonomy,I have completer autonomy so I am pretty happy, I do not do well with authority, but that is my personality. Some are happy being tightly directed some need little direction so much depends on your temperment.

think hard and long and good luck.