How much weight does the type of hospital hold (ie, level 1, 2, etc) for applicants?

[Vanillanut, DNP, RN, APRN]

I am an emergency RN who recently moved to the states. I have all of my experience in emergency, although I am very comfortable with ICU patients as often I have taken care of ICU patients for days (in Canada, the system is more backed up then it is in the US). In any case, I would like to eventually apply to CRNA school in the future.

I have received 2 job offers:

Job A: Small outreach hospital, working in Emergency. Almost outpost nursing but with a few more resources thrown in. No support staff, no birthing unit to send people to. I (and another nurse or two on shift with me) are essentially "IT". Also I would be oriented and floating up to ICU at times- although the bulk of my work would be Emergency.

Job B: Larger hospital, has cath lab, higher acuity (level 3). Emergency, with no floating up to ICU.

Other factors like pay and distance from home are the same.

I already have acute care experience at a level 3 hospital which is much busier & more acute then Job B.... so essentially, Job B looks very much the same on paper as my previous experience.

I decided to go with Job A, to diversify my experience and also potentially spend more time in the ICU, despite being an outreach hospital. Is this a wise choice for me, or did I just make a big mistake here (bearing in mind CRNA school is the future goal).

[tswim]

From my research... Most CRNA schools require ICU experience, and many specifically state that they prefer 2 years of current (full-time) ICU work. Those few that accept ER experience prefer that it be at a Level 1 trauma center where there is regular overflow of ICU patient's.

The job you took (job A) does not sound like one that would provide you the critical care experience that CRNA programs are looking for. If the ER is so small that it only requires 2 nurses at any given time, then even the ICU in that hospital probably would not do a very good job of preparing you for CRNA school.

Job B didn't sound a whole lot better in terms of getting you into CRNA school, since you would not likely get a ton of ICU exposure. Even if you worked in that ER with some ICU overflow, here in the states, overflow usually means hours, not days.

If you really want CRNA, you should look into getting a job in a high-acuity ICU, i.e. one that frequently uses titrable drips, ventilators, and invasive hemodynamic monitoring. Level 3 hospitals can provide this, but of course a Level 1 or 2 would be best if possible.