ED nurse to CRNA

[FlyMurse, BSN, RN]

Hi all,

For the past few months I've been reading forum after forum looking for answers, trying not to start another "Should I be a CRNA" topic, but alas, I've given up.

I've been a nurse for just over 3 years and am currently loving my position in the ED. A little bit of background- I was diagnosed with ADHD in 7th grade and struggled through undergrad to get my BSN (which explains why my post will kind of jump around). My grades were decent, but I had to work very hard for B's and a few A's. I've been considering CRNA school ever since I learned about the career in high school. I need more critical care experience but I don't want to leave the ED. I enjoy the constant turnover, seeing someone at their worst and discharging them feeling better hours later. I worked tele as a new grad and had difficulty staying on task with 0800 assessments, 0900 meds, etc. Which is why I feel like I am at my best in the ED. Maybe it was just me being a new grad, I don't know.

That being said, I know ICU is very intricate and resembles floor nursing in terms of the daily "timeline" and time management. I'm just wondering if CRNA school is actually plausible for me. Again, I don't like sitting still- I like to always be moving, so an 8 hour OR case doesn't appeal to me right off the bat. The few job shadows I've done, I tended to jump between different cases just for a change in pace. My mind is always working and, not to put myself on a high horse, but I'm often a resource for nurses' questions in my unit. I like to stay on top of current research and EBP, and never stop learning. I love pharmacology and jump at the opportunity to quiz our pharmacists. I jump at the opportunity to control the airway of a crashing patient before RT gets there. And I enjoy having "sick" patients.

One final concern is that I still take meds for ADHD (non-stimulants only. I refuse to take stimulants) as well as insomnia. My mind never stops and I can't sleep because of it, even if I'm physically exhausted. I know the late nights and taking call are part of the job and would have to find another solution besides Ambien for things to work out. I have recently found that I'm not needing as much sleep and seem to function well any time of day, compared to seemingly always being tired in nursing school and struggling to wake up early. As for the ADHD, it's controlled to where I can function, but can definitely be a little scattered at times (i have about 6 tabs open on my browser right now). I could see myself getting focused on one thing, like the pt's vitals, and one of my drips running out without me knowing, for example.

I could go on and on, but the bottom line is that, despite the obstacles and drawbacks, I really think this is the career I want. They say you can do anything you set your mind to, right?

What are your opinions as SRNAs, CRNAs, or RNs applying to schools? Thanks for your insight!

[FlyMurse, BSN, RN]

Anyone? I'd appreciate even a partial insight on anything above.

[CCRN_CSC_0710]

You sound like a really fantastic ED nurse. I crosstrained in the ED and you definitely sound like the coworker I'd want. I'm a SRNA and I can say we do sit there for 8 hours with one patient and there's no bouncing around. I don't understand why you think CRNA is right for you. Could you elaborate on what draws you to the profession?

[FlyMurse, BSN, RN]

Thanks for taking time to reply CCRN!

I want to be a provider and be in complete control of the patient. I am getting tired of knowing what a pt needs, but having to ask a doctor for an order. At first I thought NP would be a good choice, but over the past few years I'm starting to realize what they really do- work at urgent care or doctor's offices, or in the fast track in ED with minor cases. I feel like I wouldn't use my full potential and scope of practice. As far as ACNP goes, I don't know what the job market would be like. I've never seen an NP throw a central line in, and I maybe saw one intubate once. The few who work for internal medicine or trauma are usually heavily supervised in my experience.

Basically I like the hands-on and control. During my shadow last week, I tried to stick with one CRNA at a time so I could truly see what it's like to be in their shoes and follow a whole case through. It wasn't as bad as I thought. We were able to go around and check out the surgery here and there. He summed it up well- "I like being in complete control of the patient. I can raise or lower their HR, BP and RR. I can tweak every little thing about them".

[anotheroneofmany]

You are in control of the patient in the OR, but nearly all of the time, it's of stable pts, which sounds like it might be boring to you. No one wants instability or crashing pts in the OR. You sound like you love that aspect of the ED.

I think you would like ACNP, actually, if you found the right hospital. My level 1 trauma center is an academic medical center, and in the trauma ICU, the NPs run the show. They outrank all the residents a far as getting to choose what to do with the pts if there's a disagreement between them. I can't tell you how many lines and intubations I've seen them do (it's all the time). They are a resource for the nurses on staff and the residents. During rounds, they have their own pts assigned to them, just like the residents do. Everyone reports to the attending during rounds, but that's just for collaboration purposes.

So I think maybe this aspect you'd love, getting to be a provider in a fast-paced setting. Not a CRNA that sits on their rear end for 8 hours of a low-key case. Even trauma surgery isn't crazy in the OR all the time. And you have to stay there after the procedure is over, while they close, etc.

So maybe take another look at NP at other facilities? You can also shadow NPs. You'd hate to spend all that time and effort on CRNA just to hate it. And if you still want to pursue CRNA, I'd most definitely recommend shadowing a lot of hours, and stick with one single CRNA in their entire set of scheduled cases, not bouncing around. You need to watch what one actually does, from the start of their day to the end of it, in real life day-to-day. If you can't stand days like that, you can't make it your career.

Anyway, just my two cents.

[m1lkofamnesia]

anotheroneofmany is right. When I worked in the ICU one of our critical care teams was made up of multiple PA's and NP's, under two attending MDs. The PA's and NP's threw in all types of lines (arterial, central, Swan), intubated, bronched, and even performed bedside trachs. They were our favorite team to have for our patients!

[CCRN_CSC_0710]

Before applying to CRNA school, I shadowed about 10 CRNAs and 10+ NPs because I wasn't sure. For some people this is overkill but I think you should try to shadow as many of each as possible. Just like you've seen NPs who only work fast track, I shadowed a CRNA who worked under an anesthesiologist in an endoscopy suite where there was really no autonomy and another who worked in an outpatient surgery center that didn't push his own induction agents. On the other side I shadowed one at a level 1 trauma where there was an attending nearby but I never saw him until a GSW came in and the CRNA needed extra hands. What I'm getting at--one shadow experience in one setting won't always be enough to really know what your future holds. Keep working hard. You sound like an excellent nurse and you will be an excellent APRN regardless of what you decide.