Just starting out

WntrMute2 · Sep 28, 2001

Well, I think any good sophisticated ICU will do. The reason I say this is that exposure to physiology, drugs and critical thinking is more important than whether you've taken care of a pt with a particular type of pathology. RNs from the ER or OR are accepted. At first I wondered how someone with little PA cath or vasoactive drugs could function but in just a couple of weeks I've seen that these people are not really at a disadvantage. I do think it might be easier to get into a program w/ ICU experience but anesthesia is NOTHING like ICU care, NOTHING, and its quite a shock. They expect that you'll know all about the repercussions of a particular pathology or the details of pharmacology so your experiences in the ICU should include all this. There are a number of people in our program that don't have a good grasp of why you give neo for instance while the've been administering it for years. This is the kind of stuff you need to have easily retrievable in your brain before you start. A couple of certifications should also help you. GRE scores around 1500 or better should be ok and a GPA > 3.5.

Notanurse · Nov 4, 2001

How is school going? I am not far, down here in Augusta, GA and have the Medical College of GA close by. I thought about applying, when I get further along in my undergrad degree, to the schools you mentioned along with MCG.

Is it what you thought it was going to be like?

KC CHICK · Nov 4, 2001

WntrMute2, that's great info. Do you know if MOST schools are now accepting RN's from the OR?? I've thought about becoming a CRNA myself but thought I was at a disadvantage in the OR. I would go to ICU if I had to. I have talked w/CRNA's at work and they all say that their job is nothing like working in ICU.

I need my BSN...starting next summer or fall.....so my journey to CRNA won't be starting for awhile if that's what I decide to do. However, it's good to know that I may not have to leave the OR to do it.

nilepoc · Nov 5, 2001

In my recent interview for CRNA school, the interviewers specifically asked if any of my experience was in the OR. They stated that that OR time was not enough experience for entry in to their program. This is aparrently the general feeling of the programs out there. To confirm this, surf some schools web sites, they are usually very frnak about their entrance requirements.

Like wintermute says, you need to know clinically why you are doing certain things, like starting dobutamine instead of dopamine. The only clinical question I remember is "What vaso active drugs are you familiar with?" What would your answer be?

If you can't rattle of at least ten drugs that aren't all PO, you need more experience.

good luck in your quest.

KC CHICK · Nov 6, 2001

If that's the case, then maybe I'll be transferring out of the OR in a few years. Depends on how I still feel about going on w/the training after I'm done w/BSN.

WntrMute2 · Nov 7, 2001

All of the schools i interviewed at require ER or ICU experience. That said, FIU in Miami accepted at least 1 student with basically only OR experience. I don't know if that's a trend or an aberation. Now I'm sure I'll take some heat for this but - OR nurses do not have the same responsibilities, or pt care exposure you'll need. OR nurses check that the right pt is getting the right procedue, they help position pts, they move pts to and from the OR table and do a lot of charting/documentation and run for supplies, and insure the right equipment is in the room. They don't exhibit and I mean exhibit the same advocacy traits nor the management skills that one developes being in the ICU. I really don't mean to denegrate them, they have different skills, highly prized BTW. The skills just aren't what one needs to move into CRNA school. I don't think this is a flaw it just means that different folks have different skills. For instance I could never work on the floors. ICU nurses frequently think they are more highly skilled than floor nurses; I disagree, we just have a different skill. I can manage 2 extremly sick patients but heaven help them if i had to take care of 8 patients in different rooms with the Drs writting orders without me talking to them. Some of these pts even get out of bed on their own!! Anyway, long story short (too late for that) I believe while there are surely exceptions, one needs hands on patient care to succede, constant vigilance is a highly desired attribute, things change minute to min, there is no one else to rely on. This is what ICU care develops (ER too I suppose). Just one student's opinion. Fire retardent suit in place - flame away.

KC CHICK · Nov 8, 2001

Wntrmute, I totally agree w/you that we OR nurses have a knowlege and skill base that is worlds apart from the ICU nurse. There is no disputing that.....why else would they be called "specialties"??? I, however, do think that there is some merit in being w/the CRNA's on a daily basis (5 days/week) and observing what they are doing....even talking w/them about different things i.e.: what they are doing and why they are doing it. Many CRNA's are VERY good educators. I feel that I've learned a lot from my RN preceptors..and from the CRNA's I work with everyday.

What is your opinion on the PACU....how would that prepare one for CRNA training hypothetically????

Anne :)

PS:

We do assist anesthesia during intubations on occasion....cricoid pressure, etc. If their hands are too full, an IV start is not uncommon. As circulating RNs, it is part of our duty to be there for the CRNAs just in case something goes bad.

WntrMute2 · Nov 8, 2001

Well you make some good points but let me put a different spin on it. Assisting and observing are not the same thing as living or dying by your decisions. In many ICUs the lives of your patients hang by the decisions you make. How much fluid am I going to give? Am I right in refusing to give that medication you are convinced is the wrong choice? Did I miss some subtle sign that tells me a trip to CAT scan is a one way trip? Am I reccomending the right treatment to a resident who doesn't know to pick dopamine on his ACLS test when they give him the first 2 letters? Can you stand up to the trauma attending and say he needs to take this patient with an ICP of 70 or compartment pressures of 40 to the OR now and stop jerking around? Am I not calling a Docs attention to some lab value because it is not important or am I just too lazy to run in more potassium, his EKG looks OK. I don't think these decision making skills are learned by observing and assisting. The first time you put your hands into someone's chest to stop a bleeder while "Wheel of Fortune " is on the TV - nursing takes on a new light. Wheel the young girl to angio while she is on a HFJV with 14 chest tubes, get caught in an elevator with a fresh trauma and the trauma surgeon between floors. Carl Mauldin said it best "What will you do, what will you do?" these are situations to be experienced firsthand because patient's lives are going to depend on you and your ability to keep working while their and your world falls down around you.

I don't believe PACU will do it for you either. These patients stay with you for a short interval only. One, IMHO, needs to MANAGE what is happening to you and your patients for 12 hrs, you need to learn to live by those decisions you made @0800 this morning or even a week ago, not to ship that one out 3 hrs later. Learning to bail yourself out of trouble is a valuable tool in your pocket. I don't know that you can't succede with the experiences you want, but I THINK I'd want someone who is not only smart, well trained but also has been forced into critical thinking by many of the scenerios I wrote about earlier. Tested under fire so to speak. Feel free to disagree!

KC CHICK · Nov 8, 2001

Well, I certainly don't think I deserved the "in your face, so there!" response that you gave me.....seeing as how I agreed that there were differences between our specialties in the first place. I will, however, put that behind me and continue to be civil. I think you're expecting some sort of major disagreement...I have none to offer.

I will do what it takes if I decide to continue down this road w/my training. ....even if it means changing my specialty of nursing for a few years. They do recommend a MINIMUM of only one year of critical care nursing for entry into the program. How much of what you have told me do newbies into ICU actually get out of their first year?? Just interested to know in case I do decide to go for it.

Anne

nilepoc · Nov 8, 2001

KC, Lets say you were just hired onto my unit. A busy Trauma, Burn, Surgical, catch all ICU with 18 beds.

First you would have to attend a 6 week ICU care class, that meets twice a week while attending this class you would start working on the unit two days a week. Attend classes in disrythmia, Ekg reading, and specialty topic classes and case studies. This in conjunction with the minimum 6weeks orientation, but more often than not runs closer to 12 weeks for someone with your experience background. During this twelve weeks, you would start out learning vents, and how to juggle "stable" pairs. ( keep in mind no patient in an ICU can truly be considered stable, two weeks ago three of our stable patients went south at the same time, with three of my new hires carring for them, I was stressed, We cardioverted one, Swanned another and addressed an acute abdominal compartment syndrom in the other while admitting a new patient.) Once you are comfortable with two patients, you start moving into harder stuff like patients with vaso active drips, fresh admits, opening bellies in the room, fresh burns with air way involvement, swans, ............ neuro patients........ to donors.

Then after you finally get comfortable with those, you are on your own, starting at the stable pair again, and not taking admits for at least a month. So now we are on month five, and you are just starting to get interesting patients. So do we start your year of experience here? I would think so. But too many people think that they are already half done with the required ICU time to become a CRNA. I think you can see some of the folly in that thought pattern.

Anyway, my point is one year of experience is really more like 1.5 years actual time. So, I would advise you to switch to ICU as soon as you finish your BSN and feel comfortable starting the learning process over.

Good luck.

Craig

KC CHICK · Nov 8, 2001

Thank you Craig. That's really valuable information that I'll keep in mind when I'm considering my options in the future.

And....thank you for being considerate in not labeling my present "specialty" as only 'assisting' and 'observing'. That last post by Wntrmute really ate away at me today as I was working my butt off with my preceptor. We don't have a NINE MONTH training period for nothing!! Believe it or not, we actually RUN THE ROOM that we are assigned to. When it comes to patient advocacy...we have to be the ULTIMATE patient advocate because our patients are either completely unconcious, or 'under the influence'. We also develop management skills that allow us to 'survive', and I mean S.U.R.V.I.V.E. in the OR. You can drown, get trampled on, or eaten alive real fast if you don't plan ahead and manage your time or activities well.

As for going to the ICU....the only reason that I would go there would be for the experience to qualify for CRNA school. (Don't think I wouldn't give it 100% either..I would work as hard there as I do in the OR) I know that I would end up back in the OR eventually....where I really want to be. Even though it's freezing cold most of the time, and we don't get out much..... it's my home.

Have a great day Craig. (thanks for reading my venting...I appreciate it)

Anne

PS.

I asked one of our CRNAs today if her job was anything like the 1.5 years she worked in the ICU. She said it was nothing like it....she didn't even work w/the same drugs now that she did then. I don't know.....I'm sure you are supposed to be comfortable in handling life-saving situations. However, when our CRNAs get in a bind...they have us call the Anesthesiologist for assistance. They aren't on their own when it gets really bad.

**my observation**