Daily grind of critical care nursing vs. CRNA

zrmorgan · Mar 29, 2008

This is a question for all CRNAs but particularly the newer ones. I was wondering how the daily routine in a very busy day of a CRNA compare to one of a critical care RN who has a busy but stable assignment. We all like unstable patients and thinking through the treatment with the physicians but we all also get those assignments that are full of tasks and ADL sort of things that fill your day and keep you running without the brain stimulation.

one of the things I appreciate now as opposed to when I was in the ICUs...is there seems to be less uneccessary busy work. For example- I never have to fill out restraint documentation (chemical or physical), or get a physician order for zofran, or worry about calling the right doc to get something done, or double checking my insulin etc etc...and a hundred other things that used to bug me about being a staff rn. I spend more time thinking about what is best for the patient, and less time what has to be done to follow the hospitals protocols. It was always the tasks that some middle manager thought up that used to tick me off the most...the ADLs were fine...but I don't miss the code browns :).

It still burns me though when I need one of my fellow RNs to focus on the patient, and they are banging away on some ridiculous form on the computer because someone who isnt at the bedside made some rule about documenting a braden assesment or something.

just my two cents

EmeraldNYL, BSN, RN · Apr 2, 2008

As a new CRNA, I still have scut work, but it mostly involves doing pre-op assessments and post-op rounds. My days are still crazy busy, but there is much less secretarial work, waitressing, and appeasing people (except for the surgeons!!). Some days can be quite long and boring, when I am stuck in a long case like a lap gastric bypass where the lights are off and I am getting sleepy and just dying to get up and walk around or talk to someone. Other days I am in the ENT room and I barely have time to finish my paperwork before we are on to the next case. On those days I run to drop my patient off in PACU, see the next patient and start the IV so the surgeon isn't kept waiting. Yes, there is still paperwork, and if it isn't right, some administrative person will come after me to fill in a surgical end time or procedure on the anesthesia record, but I am not filling out a million braden assessments or restraint documentations! If I feel the patient needs some metoprolol I give it-- no hunting down an intern for an order. I feel that being a CRNA is a lot less emotionally draining as well-- I no longer have to deal with family members who have a loved one dying on a vent and 3 pressors making the tough decision to withdrawl care. That being said, some surgeons can be very difficult to work with, and there are a lot of very different strong personalities in the OR, so it takes a certain assertiveness and skill to deal with this.

tioul · Apr 9, 2008

I have to agree with the 2 above. I was in the ICU for 17 years before making the move to CRNA. The autonomy is something that nurses who do not do advanced practice cannot even phathom.

I used to dislike the waiting game and being run around by some resident doctor just because he/she read the recipe in a book and I was supposed to help him/her learn by making mistakes from plan A to Z. Or that I knew what the patient needed and was always put aside as if I was invisible. I guess that after many years in the ICU, I did not know everything (and I still don't), but I knew a lot and I felt that there was little credit from other departments/disciplines as well as my own peers. It seems like nursing just kept rewarding the people who kept their thoughts and mouths to themselves and the movers and shakers were labeled as trouble makers.

I do not miss the bedside and the bickering between peers and other departments. I felt very undervalued as an ICU nurse even though I was a powerful informal resource person who was a "go to person" and well-respected in many ways. But still , for many, I was considered very assertive and outspoken which bought me a label of "trouble maker".

For the first time in my life as a nurse, I feel like I really do make a difference and that I am really part of the team as a CRNA.

I work hard and the cases can turn over very fast depending on what surgical service I work with that particular day. But I never have the interruptions of 10 family members needing to talk to me about the same patient, or PT/OT, pharmacists, xray. I am the one along with my attending anesthesiologt who comes up with a gameplan and calls the shots. Occasionally, we let the surgeon suggest something.

Anesthesia is the most rewarding work that I have ever done. Had it not been for the hardships as an ICU nurse, I probably would not appreciate where I am today. But how I struggled to be less assertive and less outspoken has taught me to be more diplomatic. I learned how to negotiate as an ICU nurse. I have taken those skills of working for many years with people that I thought were difficult and bring it to my present practice. So everything happened for a reason!!

Yes, the surgeons can be difficult. It is just a fact to be accepted. But for the most part, the rushing is to keep everything on time so that when the traumas start to come in, the electives are hopefully mostly done for the day (or we can squeeze them in between a ruptured diaphragm or spleen and a femoral fracture).

I am guessing that you are planning on moving onward to advanced nursing practice. Good luck in whatever you decide to undertake.

Carla

com4table · Apr 10, 2008

Do you work in a large hospital or a rural hospital? Is there much difference between what is expected of a CRNA in a larger hospital versus a smaller one?

stanman1968 · Apr 11, 2008

work in a rural hospital 25 bed and perform about 25-30 cases a week ortho totak knees hips scopes etc, and genral surgery lap choles, colon resections, and the occasional trauma. I am independent and do all of it myself. Would not trade the total freedom I have for anything. I decide the anesthesia and have the final say on going to the OR or not. For anyone who has an independent frame of mind anesthesia is the way to go, particularly rural.

tioul · Apr 11, 2008

I work in a rural setting but in a very busy hospital with an adjoining surgical center that is also hopping. We get a lot of traumas and have a large number of elective surgeries daily.

When I was at the county hospital for my CRNA residency, I felt the same as I do now. The setting did not matter in that respect.

The part of the country perhaps does matter. I did part of my residency in Texas which was the worst experience of my anesthesia career so far to date. I hope to never again practice there. There was something so hostile about the majority of the CRNA's and MDA's. The worst part was that the OR nurses were the meanest people I think I had ever met in my life.

I was in Ohio for another part of residency. It was a large teaching hospital. That was a decent experience too, like in my primary residency site.

So, I have only really worked at 4 places (1 as a professional out of school). But I did see the way CRNA's can be treated in several environments.

Generally, if you are working in a practice with MDA's, they will be "supervising" you. Some will hover over your every move. Others will allow you to practice anesthesia. Sometimes, until they get to know what you are capable of, they will stay close by. And they have every right to be there. It really all depends on the people involved and the experience level with anesthesia and as a supervisory role.

I work in a practice that I have a lot of autonomy. My MDA's work with the CRNA's like a true team. There is mutual respect and a lot of teaching between both disciplines. Perhaps since I am in a small practice, it forces us to be more informal and respectful than if we were in a large practice and never spoke to each other but once a month.

There are no guarantees. People will be people. People react differently to other people. But you will find the right place for yourself when you are ready to find your first job out of school.

The most important bit of advice that I can give is to stay humble. You may know a lot, but there is always more to learn and there is always someone else who knows tons more than you. Listen to what your teachers have to say. It may be something you already know and have done a million times over. Just say "thank you". Being humble will get you through the rough times with any surgeon or any MDA/OR nurse/CRNA that is trying to provoke you. It lets you step away thanking them for the insight, so that it does not cloud your learning with anger (plus you do not want to be like them when you get out of school). It is sometimes hard to bite your tongue, but it was an invaluable lesson one of my friends who was a year ahead of me in school told me and I still use it. It was great advice for me since I am direct and assertive. I did not want to come across as overly confident. I am sure I still did to some while I was a student. But anyone who has worked with me long enough and knows me, knows that I am the first to step forward with my weaknesses.

Anyway, I am just rambling on. I hope this info helps you. Good luck!

:wink2:

EmeraldNYL, BSN, RN · Apr 14, 2008

Do you work in a large hospital or a rural hospital? Is there much difference between what is expected of a CRNA in a larger hospital versus a smaller one?

I work in a 400 bed level II trauma center in the suburbs of Philly. We practice in the care team model but for the most part the environment between the docs and CRNAs is pretty congenial. No, I do not practice completely independently, but I do get to do big cases, like hearts, cranis, and trauma. It is very busy so if I finish my room early I am expected to do pre-ops and post-ops or make sure my coworkers have had breaks as well.