Looking for advice

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For the sake of brevity and transparency, I'm going to attempt to be quick and blunt. I have been a NICU RN for the past 4.5 years. I have my BSN, my only cert is RNC-NICU. My cumulative GPA is 3.25 due to me acting a fool in the beginning of college. My nursing school GPA is 3.47 and my science GPA is 3.54. (Included just to demonstrate I can put in the work once I put my mind to it).

I have found schools that accept NICU experience so that part isn't an issue other than it severely limiting the amount of schools I can apply to (vs me having something like SICU experience).

I understand based on my stats alone, I'm not necessarily a competitive applicant. I'm looking for advice on what I can do to improve myself in order to start applying in the next year or two. I'm looking into taking some graduate level patho, pharm, or maybe o-chem. Is there anything else I can do? I'm also willing to change jobs and/or apply anywhere and move if I have to, although there are a couple schools near family that it would be ideal to get into simply because then I wouldn't have to take out much in COL loans.

Be blunt, be brutal. I'm open to any and all advice and suggestions. Thanks for reading.

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Specializes in SRNA.

Since schools can be picky regarding NICU experience, I would contact the schools that accept NICU experience directly and ask them what classes to take. I say this because although all schools you end up with a degree, they are different. Some place more emphasis on chemistry and/or physics vs others that would like to see a graduate patho class. I remember during my interview they asked what I would do to improve if I didn't get in and I said take a graduate chemistry course. Her response was: that would probably be a waste of time... the chemistry isn't that difficult. Haha oops ?

They are going to be hard on your GPA so taking a hard class and getting a 4.0 in it would help to show you are serious at this point in your life and you could say that during interviews.

Can you get your CCRN as a NICU nurse? If you can I would. It got emphasized several times during my interviews.

Don't stress about loans and let them stop you from advancing your career. Think about how much money you are loosing each year by putting it off. I am having to take out a ton (probably have 250k in loans when done). Even while paying off this debt I will be better paid vs a floor nurse and after 7-10 years of paying the loans I will be very well paid. The benefits are tons better too. You are treated like a physician in regards to benefits if you get into a group practice. I'm taking medicaid... pay nothing and not even starting on 401k benefits. Some will just put 20k a year in a 401k without any employee contribution?

Worse comes to worse go to any ICU for a year and then apply to as many programs as you can.

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Contact the schools for feedback. I would say get ICU experience and expand your options for school as well as your ability to care for critically ill adults (a large portion of your future patients as a SRNA and CRNA). Take a graduate level science course to show you can handle the work. If needed prep and give a great performance on the GRE. Good luck

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Full disclosure, I'm not a CRNA or an SRNA. However, I do have a handful of friends who have done CRNA with just NICU and/or NICU/PICU experience, and I spend an inordinate amount of time on the SRNA/CRNA forums for not actually being one.

On 8/25/2019 at 3:01 PM, livmoore89 said:

I understand based on my stats alone, I'm not necessarily a competitive applicant. I'm looking for advice on what I can do to improve myself in order to start applying in the next year or two... I'm also willing to change jobs and/or apply anywhere and move if I have to.

IMHO, I'd imagine the best thing you could do to improve your chances of acceptance is to get an adult ICU job, preferably a CVICU (cardiac surgical) or perhaps a SICU job.

Unfortunately, the general consensus seems to be (both on AN and in my anecdotal experience) that SRNA students who only have a NICU background have an incredibly difficult time; there is so little overlap between NICU and adult ICU. Maybe this is an oversimplification (SRNAs please correct me if I'm wrong), but I think of the domains of CRNA as management of the airway, hemodynamics, sedation/pain control, and intervascular access. None of these things are managed the same way in NICU as they are in the adult ICU. Airway: the vent settings we use in NICU (i.e PRVC) are basically never used in adults. Hemodynamics: NICUs use dopa and dobuta gtts; adult ICUs also use levophed, epi, vaso, nicard, nipride, lidocaine, and probably others that we literally never use in NICU. In addition, adult ICUs use CV technologies that don't exist in NICU like balloon pumps and VADs. Sedation: NICU is pretty much exclusively fentanyl; adult ICUs also use propofol, benzos, ketamine, precedex, etc. IV access: even the drug admin routes that CRNAs establish are rarely or never used in NICU (peripheral a-lines, IJs, epidurals). Resuscitation and emergency/code management are also vastly different; ALCS is filled with code drugs and algorithms that many NICU nurses have never used (vs. NRP's simplistic 'establish and airway and push epi' approach). As you probably realize, the pathophysiology that you're most familiar with (prematurity, PPHN, RDS, NEC, PDAs) has almost no relevance to adult phathophys, and we literally never manage the conditions that are most common in the adult world (COPD, Type II diabetes, CHF, etc.)

I think of it kind of like the two-year NICU requirement for NNP school--Could an adult ICU nurse theoretically successfully complete NNP school (in an imaginary world where they could be granted admission with NICU experience)? Maybe. Would they have an exceedingly hard time? Almost certainly.

So here's where all of that plays into admissions: The admissions committee is likely aware that SRNAs with only NICU experience tend to struggle compared to their adult ICU peers. Therefore, it seems unlikely that they'd admit a NICU nurse with a less-than-stellar GPA. Presumably, the student with the NICU background would have to work even harder than their adult ICU peers to keep up, and a lower GPA implies that you may not be able to do that.

As I said, I've known a couple of people who were admitted to CRNA school with just NICU or NICU and a smidge of PICU experience. Their applications were exceptional; as you realize, yours probably isn't. Just because certain schools will accept exclusive NICU experience doesn't mean that you'll be able to get accepted into them (and honestly, by CRNA standards, even the 3.5 nursing and science GPAs may not be that impressive).

Once you have adult ICU experience, you could sell your NICU background as an asset because it brings a diversity that a lot of applicants don't have; however, with just NICU, it seems like a pretty big liability. Even if you could be accepted to the program without adult experience, do you really want to begin the program at a disadvantage? CRNA school seems hard enough without starting behind the curve.

That said, even if you do get adult experience, it may help to get your neonatal CCRN (ideally in addition to your adult CCRN). From my understanding, your RNC will be pretty useless as a CRNA applicant. I have both my neonatal CCRN and my RNC; in my experience, both tests were equally difficult from a knowledge standpoint, although the CCRN exam was more poorly written (and therefore, some of the questions were harder to answer). I'm happy to answer questions about the neonatal CCRN if you have any. As an FYI, you can take your adult CCRN with only a year of experience.

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On 8/26/2019 at 4:22 PM, PropofolForAll said:

Since schools can be picky regarding NICU experience, I would contact the schools that accept NICU experience directly and ask them what classes to take. I say this because although all schools you end up with a degree, they are different. Some place more emphasis on chemistry and/or physics vs others that would like to see a graduate patho class. I remember during my interview they asked what I would do to improve if I didn't get in and I said take a graduate chemistry course. Her response was: that would probably be a waste of time... the chemistry isn't that difficult. Haha oops ?

They are going to be hard on your GPA so taking a hard class and getting a 4.0 in it would help to show you are serious at this point in your life and you could say that during interviews.

Can you get your CCRN as a NICU nurse? If you can I would. It got emphasized several times during my interviews.

Don't stress about loans and let them stop you from advancing your career. Think about how much money you are loosing each year by putting it off. I am having to take out a ton (probably have 250k in loans when done). Even while paying off this debt I will be better paid vs a floor nurse and after 7-10 years of paying the loans I will be very well paid. The benefits are tons better too. You are treated like a physician in regards to benefits if you get into a group practice. I'm taking medicaid... pay nothing and not even starting on 401k benefits. Some will just put 20k a year in a 401k without any employee contribution?

Worse comes to worse go to any ICU for a year and then apply to as many programs as you can.

Thanks so much for responding! I'm definitely looking into some grad level classes I can take. Any suggestions for best ones to look at? I'm also looking into CCRN so I appreciate the heads up on the interest for that!

On 8/28/2019 at 5:03 PM, CRNA, DNSc said:

Contact the schools for feedback. I would say get ICU experience and expand your options for school as well as your ability to care for critically ill adults (a large portion of your future patients as a SRNA and CRNA). Take a graduate level science course to show you can handle the work. If needed prep and give a great performance on the GRE. Good luck

It's looking more and more like I'll need to switch to an adult ICU...it just makes me so nervous to completely jump fields right before applying to a whole new program. Do you know of any graduate level sciences that would show better than others? I'm looking at patho currently. Definitely need to study up for the GRE too. Thanks so much for responding!

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Specializes in SRNA.

Grad level classes are tricky. If you can find one in an area you struggle in or have no experience in that would be good. BUT only if you can get an A. Otherwise it will be a waste and could hurt your chances. Use ratemyprofessor to get an idea of what your getting yourself into before committing to any class. If still unsure of what class to take I'd call and ask a few of your top choice schools and ask what they want.

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