CRNAs in Critical Care Medicine

Specializes in RN-BC, CCRN, TCRN, CEN.

I'm looking into CRNA programs as I get more critical care experience. I've noticed most intensivists are Pulmonologists that do fellowships in Critical Care medicine but I've seen a handful of MDAs who also cover critical care, which makes perfect sense- they're proficient in airways, central lines and invasive monitoring. Just wondering if it's a possibility for a CRNA to potentially branch out into this field. One of my hesitations with the field is spending my whole life in an OR (I posted a thread about ED nurse to CRNA highlighting my drawbacks to the career). I understand there are other options such as pain management and endoscopy centers, but I enjoy critical care.

18 Answers

Specializes in Anesthesia.

In general CRNAs don't work that way since NA school does not usually cover long term care of critically/acutely ill patients. MDAs spend a significant portion of their training in ICU.

There is also will be the complication with credentialing and prescriptive authority depending on the state you want to practice in. Most CRNAs that work in critical care/ER etc and in anesthesia are dual certified as an NP and CRNA.

Not sure if anyone has followed up with this thread, but this is an excellent point. Personally I did the ACNP program first (graduated in 2013), and then went back for CRNA (Graduated 2021). Working in critical care would be an amazing blend of specialties, but as someone said the CRNA program is not designed to include true critical care medicine. Currently I work in critical care and I love it. I enjoy not bein restricted to the OR, but instead being allowed to practice to the extent of both certifications. If someone is interested I am open to discuss it. Before anyone make the assumptions that there is a higher pay in CRNA, my salary exceeds 200k. The old culture of NP's being paid far less is a thing of the past. 

Don't know what shadowing experiences you've had, but there are many, many anesthesia jobs that are for all practical purposes, critical care. CC patients come to the OR every day and are managed there every bit as well or better than in the ICU. Some places have a greater number of those patients coming to the OR than others, but, by and large, anesthesia is managing CC patients to one degree or another.

if you want to do CCM that acute care NP degree thing would probably be what you want.

In twenty plus years in Critical Care I rarely see MDAs/CRNA except for transport of patients.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

I work as an ICU NP in a setting where a large portion of our intensivists are "MDA's" (for lack of a better term because we have one DO). These physicians trained as anesthesiologists primarily but also did a year of critical care fellowship with some who also finished additional fellowships in cardiac anesthesia or liver transplant. In general, anesthesiology and critical care medicine trained intensivists are seen in academic centers on the the opposite coasts (I've not seen many in the midwest). My point is, these providers are not just trained anesthesiologists but are also trained in critical care by a fellowship. In the same vein, I think CRNA's who want to work in the ICU alongside intensivists should also have ACNP training.

Specializes in Critical care.

CRNA's can practice in some really small, isolated facilities, and thus can expect to be utilized in some atypical way, (the 'many hats' finding that's common to such situations) but it's not something to base a career decision on.

As already posted, an ACNP is better prepared to do the ICU work you are describing.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
An anesthesia component to ACNP training would go a long way too...

...which I agree is lacking. Some ACNP's in critical care settings do intubate and provide procedural sedation, these are skills that take some on the job training (based on my experience) because many of our programs don't provide the exposure.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
A lot of universities offer an FNP or ACNP certificate for nurses with MSNs already. Would something like this be an option? It doesn't specify you already have to be an NP already.

Theoretically, you could get a post-master's ACNP after CRNA (or the other way around). It's not going to be as simple as picking up a post-master's ACNP from another NP specialty such as FNP or ANP. NP programs share many common pre-clinical courses that are transferable across various programs. CRNA programs tend to be specialized from the get go and many approach the pre-clinical courses differently than NP programs. You may have to actually spend almost the same amount of schooling as someone without a prior APRN degree.

Specializes in Anesthesia.
Theoretically, you could get a post-master's ACNP after CRNA (or the other way around). It's not going to be as simple as picking up a post-master's ACNP from another NP specialty such as FNP or ANP. NP programs share many common pre-clinical courses that are transferable across various programs. CRNA programs tend to be specialized from the get go and many approach the pre-clinical courses differently than NP programs. You may have to actually spend almost the same amount of schooling as someone without a prior APRN degree.

That is changing with the consensus guidelines at least where NA schools are taught through schools of nursing. It will never be as easy as getting another NP certification if you are already an NP, but I think more and more NA schools are or will be sharing the basic classes (pharm, path, phys etc) with NPs.

The NP school I attend does this currently. All APRNs (FNP, ACNP, CRNA, PMHNP, etc) take the same core classes and then we branch off and specialize. So we all have the option of doing a post-master's certificate in any area should we choose to do so. So maybe someday I'll be a CRNA too. Haha. My wife would kill me if I said I wanted to go back to school again...

Specializes in AGACNP.

I'm currently an Acute Care NP working as a Hospitalist, and I'm looking to go back to CRNA school. Did you go back to the bedside for CRNA application? I have over 6 years ICU experience as a nurse, so I'm really hoping I don't have to.

Devaughn ACNP CRNA said:

Not sure if anyone has followed up with this thread, but this is an excellent point. Personally I did the ACNP program first (graduated in 2013), and then went back for CRNA (Graduated 2021). Working in critical care would be an amazing blend of specialties, but as someone said the CRNA program is not designed to include true critical care medicine. Currently I work in critical care and I love it. I enjoy not bein restricted to the OR, but instead being allowed to practice to the extent of both certifications. If someone is interested I am open to discuss it. Before anyone make the assumptions that there is a higher pay in CRNA, my salary exceeds 200k. The old culture of NP's being paid far less is a thing of the past. 

I'm currently an Acute Care NP working as a Hospitalist, and I'm looking to go back to CRNA school. Did you go back to the bedside for CRNA application? I have over 6 years ICU experience as a nurse, so I'm really hoping I don't have to.

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