How long did it take you to get ICU experience?

NMB IVP · Dec 10, 2007

Where I'm from, it's relatively easy to get a job in any ICU even for new grads. However, if you are looking for ICU experience that will get you into CRNA school, you may want to consider more than just one year. I don't see how someone can get sufficient experience in just one year. (just my opinion) My advice is for you to get some ICU experience and just apply somewhere just for the interview experience. Even if you don't get in the first time, the interview experience is priceless. Who knows, you may hit the nail on the head the first time. I just remember that I was not ready after just one year of experience.

Jen1.0 · Dec 10, 2007

I have worked in 2 ICU's, and both hired new grads (ADN or BSN). I definitely agree with biglum about not feeling adequately prepared with only one year of experience. I've been working in the ICU for 3 years, and am still amazed with how much I don't know. Good luck!

LonghornRN · Dec 10, 2007

Its very easy to secure ICU position here in Houston. I disagree with other posters who say 1 year isn't sufficient. The research that I have done on being a CRNA has shown me that while the knowlegde and skills that you obtain in the ICU will be built upon and are important. ICU nursing and Nurse anesthesia are two different animals.

Just My $0.02

Longhorn

krzysiu · Dec 14, 2007

Went into a CV Thoracic Surgical ICU right out of my BSN program. Thought it was a great experience. I am glad it worked out the way it did. Due to shortages in my geographic location, with a strong interview, many institutions including large teaching hospitals are willing to give you a shot.

chris

destined4CRNA · Dec 14, 2007

It took me about 2 years to get 5 years' experience.

See? All that mandatory overtime is good for something.

krzysiu · Dec 14, 2007

It took me about 2 years to get 5 years' experience.
See? All that mandatory overtime is good for something.

Think this is an EXCELLENT point. The director from my school is familiar with the hospitals from my past. I made the number of hours I worked clear because it gave me more experience when compared to calendar time. I know PLENTY of nurses that are from various areas. They proceed pick up shifts in a particular place, once in a blue moon, and say oh i have such and such experience.

chris

destined4CRNA · Dec 14, 2007

I was actually mostly joking, Krzysiu, as the thread's title made me laugh - "How long did it take you to get ICU experience?".

But you're right, there IS a difference....working in a facility that has one IABP machine (where the average nurse gets more exposure to it in their annual refresher class than in use in a patient) IS different IABP experience than that had in a facility where IABP use in commonplace.

Similarly is the amount of critical thinking involved in one's line of work. It is usually said that the best experience is had in a tertiary care, Level I Trauma- type facility. Whilst I agree that these hospitals invariably have more cutting-edge equipment and routinely see higher-acuity patients, it does not always foster an environment for nurses to think critically. I am aware that saying this will undoubtedly stir up controversy, but it's true -- (and I know it is, having worked critical care for 15 years, in hospitals ranging from 80 to 1200 beds).

In fact, I currently work in both a big level I trauma center, blah blah blah (my regular job) and in a small (about 100 beds) community hospital ICU. In the "big" hospital, sure, we're doing CRRT or putting in IABP's or LVAD's on our patients... and we have super-fancy beds, monitors, etc. Maybe the foley counts each drop of urine made and inputs that right into our computerized charting. Nice, no? Well, yes, without a doubt. But when we run into trouble, or, moreover, when our patients do, we call the resident or fellow over from the other side of the unit (or maybe the cafeteria), and they come hold our hand while we restabilize. They'll tell you what drips they want you to go up on. They'll make some vent changes. Maybe every thirty minutes. They may even mess with the IABP timing (even though you know it better than they do). You know what I'm talking about.

Now, on the other hand (and I'm NOT saying the community hospital approach is better for the patients), in the small hospital, I get to do more critical (autonomous) thinking. If my patient's going to hell, I'm lucky if the doctor returns my page. After a few phone calls and I've hung dopamine...and maybe phenylephrine....the doctor still has no more desire to come in than he had an hour ago. Or six hours ago. (OK, I'm painting a night-shift picture here). He's trusting me to be his eyes, ears, and part of his brain, to provide him with the whole picture....so decisions can be made. OK, it's a couple of hours later. Since the patient is likely in septic shock and we've already hit him with three broad-spectrum abx, ARDS is in full effect, and he's now in renal failure, I start norepinephrine. By the end of the shift, his heart rate is starting to slow, his sat won't stay above 88%, his pH is 6.9, and I'm spending 50% of my time consoling his 20-something daughter (since the patient's in his 50's, had minimal medical history, and has been in the hospital for less than 15 hours (ok, let's just say he waited till the LAST minute to be brought to the hospital)). Sure, the doctor came in at 0600, but there wasn't a thing that would have been done differently had he been there all night. Did I mention this was my day, yesterday? Heck, at least at the big hospital, he would have been 1:1.

I guess my point (and it really is along the lines of the thread) is that there IS a difference when it comes to experience.

Don't be afraid to go to a smaller hospital for good experience. You can go to a big place later (if you desire) to use all the "cutting-edge" equipment. But there are hospitals out there where the only doctor around is the ER doc asleep in the cottage across the parking lot, where there is no pharmacist at night, and where there may be no respiratory therapist at night. Sounds a bit scary, but it teaches you how to make GOOD decisions, how to make them quickly, how to perform GOOD assessments, and how not to depend on others all the time. Before you call the doc at 0300 to say there's no urine output, make sure you flushed the foley. And make sure it isn't disconnected. It may not be a big deal if you call the intern who's in the next room and they come discover the problem, but you surely don't want to call the attending who has to drive in from home (which may be an hour away) and have HIM notice that your foley is kinked. Details make all the difference. Be sure that you're not practicing medicine in the ICU, but be the best nurse you can be.

Don't forget, when you're a CRNA, you ARE the licensed professional. YOU will be deciding what medications to give. And when your patient goes bad, sure you can call for help, but it's still YOUR patient.

krzysiu · Dec 15, 2007

I was on the same page with you. However, I turned my stupidity for torturing myself all those extra hours into a selling point in the interviews :) :up: have a good weekend everyone! :icon_wink::icon_wink:

I was actually mostly joking, Krzysiu, as the thread's title made me laugh - "How long did it take you to get ICU experience?".
But you're right, there IS a difference....working in a facility that has one IABP machine (where the average nurse gets more exposure to it in their annual refresher class than in use in a patient) IS different IABP experience than that had in a facility where IABP use in commonplace.
Similarly is the amount of critical thinking involved in one's line of work. It is usually said that the best experience is had in a tertiary care, Level I Trauma- type facility. Whilst I agree that these hospitals invariably have more cutting-edge equipment and routinely see higher-acuity patients, it does not always foster an environment for nurses to think critically. I am aware that saying this will undoubtedly stir up controversy, but it's true -- (and I know it is, having worked critical care for 15 years, in hospitals ranging from 80 to 1200 beds).
In fact, I currently work in both a big level I trauma center, blah blah blah (my regular job) and in a small (about 100 beds) community hospital ICU. In the "big" hospital, sure, we're doing CRRT or putting in IABP's or LVAD's on our patients... and we have super-fancy beds, monitors, etc. Maybe the foley counts each drop of urine made and inputs that right into our computerized charting. Nice, no? Well, yes, without a doubt. But when we run into trouble, or, moreover, when our patients do, we call the resident or fellow over from the other side of the unit (or maybe the cafeteria), and they come hold our hand while we restabilize. They'll tell you what drips they want you to go up on. They'll make some vent changes. Maybe every thirty minutes. They may even mess with the IABP timing (even though you know it better than they do). You know what I'm talking about.
Now, on the other hand (and I'm NOT saying the community hospital approach is better for the patients), in the small hospital, I get to do more critical (autonomous) thinking. If my patient's going to hell, I'm lucky if the doctor returns my page. After a few phone calls and I've hung dopamine...and maybe phenylephrine....the doctor still has no more desire to come in than he had an hour ago. Or six hours ago. (OK, I'm painting a night-shift picture here). He's trusting me to be his eyes, ears, and part of his brain, to provide him with the whole picture....so decisions can be made. OK, it's a couple of hours later. Since the patient is likely in septic shock and we've already hit him with three broad-spectrum abx, ARDS is in full effect, and he's now in renal failure, I start norepinephrine. By the end of the shift, his heart rate is starting to slow, his sat won't stay above 88%, his pH is 6.9, and I'm spending 50% of my time consoling his 20-something daughter (since the patient's in his 50's, had minimal medical history, and has been in the hospital for less than 15 hours (ok, let's just say he waited till the LAST minute to be brought to the hospital)). Sure, the doctor came in at 0600, but there wasn't a thing that would have been done differently had he been there all night. Did I mention this was my day, yesterday? Heck, at least at the big hospital, he would have been 1:1.
I guess my point (and it really is along the lines of the thread) is that there IS a difference when it comes to experience.
Don't be afraid to go to a smaller hospital for good experience. You can go to a big place later (if you desire) to use all the "cutting-edge" equipment. But there are hospitals out there where the only doctor around is the ER doc asleep in the cottage across the parking lot, where there is no pharmacist at night, and where there may be no respiratory therapist at night. Sounds a bit scary, but it teaches you how to make GOOD decisions, how to make them quickly, how to perform GOOD assessments, and how not to depend on others all the time. Before you call the doc at 0300 to say there's no urine output, make sure you flushed the foley. And make sure it isn't disconnected. It may not be a big deal if you call the intern who's in the next room and they come discover the problem, but you surely don't want to call the attending who has to drive in from home (which may be an hour away) and have HIM notice that your foley is kinked. Details make all the difference. Be sure that you're not practicing medicine in the ICU, but be the best nurse you can be.
Don't forget, when you're a CRNA, you ARE the licensed professional. YOU will be deciding what medications to give. And when your patient goes bad, sure you can call for help, but it's still YOUR patient.