How "good" of an ICU nurse does one need to be?

[PrimeRib]

Sorry for the extremely long-winded post on an already tired topic, ie "what does it take?". I felt my particular question was perhaps different enough in nature to warrant a new thread.

My question, in short, is how "good" an ICU nurse should one be in order to even consider taking the CRNA route?

The background on the question, and myself: I've been a BSN prepared nurse for a little better than 6 years and have taken the low and slow track into the ICU and moving towards (thinking about) applying for CRNA school, something I had never even really considered until recently. I spent a year in med/surg, a few on a stepdown unit, and have been working in our hospital's CVICU now for a little better than a year and a half after realizing, "Hey, I'd like to see what goes on in the ICU!".

As far as what I feel I have going for me - I work at a large academic medical center and we do care for some of the more complex and critically ill patients in the state. I'm happy for all I've learned in my short time in CVICU and have grown to be fairly proficient and confident with most of my drips, working with swans and other invasive HD monitoring, caring for patients with VADs, ECMO, IABP, CRRT, etc. and all the other CVICU nursing basics. Our unit is both medical and surgical so regularly sees fresh heart and lung transplant patients as well as the myriad of other CVT surgical possibilities, in addition to those patients with advanced heart failure. I work on a great unit with a supportive, helpful co-workers, whose company I enjoy both at work and in the outside world.

That being said, while I do generally like my job now, I realize it's not something that I will want to do forever and have always felt that grad school was on the distant horizon. When I first became a nurse I always imagined myself becoming some sort of NP and/or perhaps a nursing professor. It wasn't until realizing, "Hey, I don't totally suck at working in the ICU, maybe becoming a CRNA wouldn't be unfeasible...", that I have begun to consider the CRNA route as a possibility. For that reason, I have an organic chemistry class in progress as we speak with plans to take my CCRN and probably the GRE in the spring.

As far as what I feel I have going against me - while I have grown proficient in most of the day-to-day ins and outs of working in the CVICU and always do my best to be very thorough in caring for my patients, I am not, and have never been "Mr. Code". I'm not "that nurse"(you know the type) who is always the first to arrive and intervene/offer their two cents when someone else's patient is crumping. I'm not the one who acts fast and goes ahead and oh-so confidently draws epi off the bag when a patient's blood pressure is suddenly tanking (I'm more likely to crank up the drips and yell for help, ha). Heck, I'm not even particularly skilled with putting in an IV, as our hospital's IV team does 99.9% of them. To be perfectly honest, emergency situations still scare the hell out of me and I do find that I still rely a lot on the advice/assistance of my co-workers when such situations arise with my own patients. This isn't to say that I'm not a competent nurse and completely lose my cool when something bad happens. I am trying to be more of a go-getter in terms of "getting in on the action" so that I'll learn more and develop these skills for when I need it with my own patients. But to be totally honest with myself I'm still really not the quickest on the draw when it comes to emergencies and often find myself taking a backseat to the more skilled nurses when it comes to these situations, which I attribute largely to still being unsure and afraid of making a mistake.

I know some of these skills take time and experience to develop, as well as a good foundation of knowledge, but also perhaps a certain personality that I do not have. What I'm wondering is whether it's completely unrealistic to consider applying to CRNA school in the near future with my present skillset, considering myself to be a competent, progressing ICU nurse, but still a far cry from being one of the strongest nurses on the unit, ie "Mr. Code", and it's going to take another 5 years of ICU experience and soul-searching before I might finally have what it takes to become a CRNA. Or if maybe it's worth a shot to just give it a go?

Thanks much, any thoughts, positive and negative, will be happily welcomed.

[gazpaz]

What attracts you to being a CRNA? Most people want autonomy, then the more flexible schedule, more reimbursement.

Critical thinking and and acting fast on your feet is a huge part of the job. You can learn and grow in school, but you have to comfortable being that person - the person the in room initiating the code, starting the massive transfusion protocol, telling the surgeon it's time to stop and flip the prone patient to manage the airway. You have to know what to do for a stat c-section when the baby comes out blue and mom starts freaking out while hemorrhaging. You have to be comfortable making the call and initiating action. There are great surgeons and OR nurses out there, but you need to know what to do in the case that they can't help you and you are on your own until more help comes.

Most of the time things in anesthesia go well, but when the don't it's really bad and things go south really fast. You need to feel comfortable as an independent provider, regardless of where you practice.

There isn't a magic formula for making a "good ICU nurse" and having that translate to a good CRNA. You have to comfortable and confident in your skills, otherwise you are just putting yourself and patients at risk.

Shadow a few CRNAs (try to find one in independent practice). Go go into every code and run a few, learn to become charge nurse, do as many IVs as you can (anesthesia is the IV team in many places). Do whatever you need to be "that nurse." And in the end, if it doesn't work out there are plenty of other nurse practitioner roles to explore.

[PrimeRib]

Thanks for the feedback. I suppose my motivation for wanting to become a CRNA is a combination of what you mentioned, and in particular a desire to work in a profession requiring higher-level thinking, which is not to say that high-level thinking isn't required of a nurse in the ICU, but having more autonomy to solve problems this way is attractive to me. Also, to be flippant but completely honest, the possibility of working in a related field but not necessarily always having poop, pee, and getting somebody up to a chair affecting the workflow of every day is also a big motivator. I don't mind it now but I don't think the bedside is where I will want to be when I'm 50 years old. Lastly, I do find the nature of the work genuinely interesting. I have done some shadowing, but not really recently enough to convince an interviewer that I have a totally solid understanding of what CRNAs do, so that is a goal I will need to meet, as well.

I agree that I need to gain more confidence in my skills in order to decide whether this is a route I dare attempt to take.

[loveanesthesia]

Imagine that taking a back seat and letting someone else take the lead in a code was not an option. You had to take the lead and there was no one to ask for help. How would that make you feel? If that is a position that makes you anxious then a career as a CRNA could be very wearing on you.

[guest769224]

you have to comfortable being that person - the person the in room initiating the code, starting the massive transfusion protocol, telling the surgeon it's time to stop and flip the prone patient to manage the airway. You have to know what to do for a stat c-section when the baby comes out blue and mom starts freaking out while hemorrhaging. You have to be comfortable making the call and initiating action. There are great surgeons and OR nurses out there, but you need to know what to do in the case that they can't help you and you are on your own until more help comes.

I had no idea CRNA's were responsible for all these situations, what a huge responsibility to have each day while working. Fortunately ICU codes as an RN can provide immersion and familiarity in some of these instances.