New grad in the ER, is CRNA school out of the question?

athomas91 · Mar 24, 2006

i did ER my entire nursing experience... the last year i did CVICU as well for my "requirement"... it didn't hinder me in the least.

MmacFN · Mar 24, 2006

hey there

I would expect you will need some ICU time. I know there are many programs that will take ER time but it has to be high acuity ER time. Most ERs wont see swans and IABPs (though some ive worked at do) so you would be missing out on alot of the hemodynamic monitoring which will be done in an OR.

Lucy54 · Mar 24, 2006

I had been an ER nurse for 3 1/2 years and had about 8 months of ICU under my belt when I applied. They actually did give me a pretty hard time. I had a good GPA and MAT but they didn't like the fact that I only had 8 months of ICU, despite almost 4 years in the ER. I ended up getting in as an alternate. There are some schools that say they will take ER, but if you're up against someone with the same GPA that has ICU experience, they will probably take that person over you. It also depends on your GRE scores, recommendations, and interview skills, but experience probably weighs the most. Get into an ICU asap. Good luck!

apaisRN, RN, CRNA · Mar 25, 2006

I don't think you'll have trouble getting into an ICU after some ER time. You will learn some basics of critical care in the ER and you will have proved you can work under pressure. I don't know any nurses who have gone ER-->ICU, but I think it's only because the ICU feels too boring and controlled to ER nurses.

Brian_SRNA · Jun 30, 2006

Most programs say they require ICU experience and take extra experience as an added bonus. More ICU experience will beef up your candidacy. Your best bet is to contact the program director and ask them what they want. If what you want is to be a crna than you need to find a ICU for he best bet.

Brian

berry · Jun 30, 2006

I was in the same boat went to the ER out of school and then thought about taking the crna route. I spent some time sulking about places not considering the ER critical care. You can get into several schools with only an ER background; some consider it critical care others look at it case by case. When I got serious about applying to schools, I realized I would be a better candidate with ICU experience. I am sure you could transfer to a unit in your hospital relatively easy. I got in with 3.5 years ER and about 1.5 SICU experience. Looking back it was a good move, when I compare my time in the ER and my time in SI to my time in the OR it is more similar to recovering hearts than stabilizing an emergency code/trauma/burn. I was familiar with most of the drips in SI from the ER but I learned so much about vent management in SI, which you need a solid understanding of in crna school. I did not have much exp with hemdynamic monitoring before going to SI (I think assisted floating one in the ER) were every heart come out with one..

SorenDrake · Jul 1, 2006

I also transferred to CCU after working in a trauma center. At the time I didn't understand how the experience could really be that different; boy was I wrong! I've learned so much in the past year. Oh, and about ER nurses not wanting to work in CCU, it was true for me. I was so worried I'd be bored and the nurses wouldn't like me. It was completely the opposite! I love where I work, and almost wish I didn't have to leave.

roosevelt127 · Jul 1, 2006

From my experience (2yrs combined SICU/CCU, moderate acuity with the occasional super-sicky, exposure to PA caths, all types of vasoactive gtts, vents, the works) I would say you might want to get into an ICU for your own good.

At my particular hospital, the general story is that ED nurses are either:

1. clueless about vents, vasoactive meds, PA caths (e.g. pt. with resp. failure/aspiration pneumonia in ED vented for hours waiting for bed is never suctioned b/c they don't know how; patients reaching my unit with BP 55/22 b/c all of their gtts are screwed up due to the fact that the [20 yrs experienced] nurse is completely clueless about how to use or titrate phenyl, levo, or dopamine and therefore took some MD orders very literally, rather than asking or admitting she didn't know how to titrate the drugs.) or

2. know how to use and do these things on a basic level but b/c of the nature of the unit don't have the time/opportunities to learn the finer points of drug titration, hemodynamic parameter interpretation (or shooting the swan #s for that matter), or do something as simple as have any sort of follow-through in any aspect of patient care, or doing a H&P.

These are (from my understanding) some of the most important things CRNA programs are interested in you knowing before you start training, so it might be a good idea to get yourself into a unit where you can get the maximum number of opportunities to do these things and to have people who truly understand and can give you the tools to help you understand them well.

That said, your education, clinicals, and job are what you make of them, nothing more. If you're the type who can use your ER experience to your learning advantage and seek out the types of cases you need to learn these things, by all means...it just might be hard in the ED b/c patients who are sick enough to need these kinds of interventions are usually rushed to the unit ASAP, which is where the lack of opportunity might catch you. Experiences and learning opportunities will bypass you to get the patient into the unit so drips can be started, intubations can be done, swans can be floated, etc., under much more controlled conditions and often with much more experienced physicians and nurses than is/are often the situation in potentially chaotic emergency rooms.

Best of luck!!

MmacFN · Jul 1, 2006

With respect roose. thats a little slanted view. Here is where i see it differently.

- The ICU experience hasent been deemed important enough to be mandated by the AANA. This is only a requirement of individual schools, which varies greatly. The AANA actually includes ER as eligible. After calling them (AANA) about this discrepency, they told me the reason they use "acute care" is to encourage schools to evaluate every student individually based on their expeirence as opposed to making blanket requirements which (ICU only) which are not predictive of success (see next point).

- ERs vary in their acuity, much like ICUs. You could work in an ICU for 20 + years, never see a PA cath, never use anything outside dop and levo and, therefore, be no more prepared than the ER nurse you depict.

- People vary in their aptitude or attitude as well. I have worked with both CVICU and ER nurses that do little more than follow the protocols and call the docs. These are not people you want in a CRNA program. Working in the ICU does not guarentee anything, we have all seen that.

- ERs are not what they used to be. I have taken IABPs in the ER with 3 other patients due to no CVICU beds. Now it was easy for me with the backgound in IABPs, however, this trend isnt changing its continuing. Conversley, Ive had DNRs in the ICU for 2-3 shifts where my job was to be a personal care tech more than a critical thinker.

- The problems you mentions about drips and vents as well as BPs etc are NOT the norm. First off, you dont take care of the vent either, thats the pervue of RTs in 90% of facilities. Second, it is neither acceptable or usual that ERs RNs lack knowledge of vaso active drips and titration.

I know your trying to be helpful here but you are blanketing an enitre professional group on Nurses based on your 2 years of experience, none of which has been in the ER (something I did as well until i worked there). I have been doing this for quite some time, CV and ER have been my primary areas. I almost washed out of the ER as a CVICU RN, which BTW, is typical of ICU RNs who come to the ER.

You may have had some bad experiences but remember, they exist on every side of the fence. :)

Having said all of that, I agree that an applicant will be more competitive with PA experience and, tyically, the CVICU, SICU, TICU are the only places where someone can get it.

roosevelt127 · Jul 1, 2006

Mac,

Just a couple of quick clarifications...If you read my post carefully, you'll notice that in hopes of avoiding attemps to belittle my opinion, I prefaced what I said by saying that it was based on #1. my limited (people will obviously get this from the 2 years part and, like you, may believe my opinions aren't worth considering because I haven't worked at many different hospitals or in many different types of units) experience, and #2 my particular hospital. Before posting, I also edited out the sentence in my post that said I realize this is not the care everywhere or with every nurse - an oversight on my part which may cause some issues.

Also lend focus to the part where I mentioned that education, clinical, and jobs are what you make of them, which you've emphasized by reminding everyone that people vary in attitude and aptitude regardless of where they work or what types of things they're exposed to.

For everyone's comfort please realize I'm obviously very much aware of this, and realize that I'm indeed not blanketing any group of nurses except the ones with whom I directly work (the 'my hospital' comment was meant to clarify this) - simply an opinion (based on truths from a real unit) mixed with some venting about some (many, in fact) not so hot experiences with nurses on "my" side of the fence.

Mac, I hope this makes you feel more comfortable with my post and helps others realize I didn't mean any harm.

MmacFN · Jul 1, 2006

Hey Hey

n/p man. Its something that comes up all the time here. :)

Mac,
Just a couple of quick clarifications...If you read my post carefully, you'll notice that in hopes of avoiding attemps to belittle my opinion, I prefaced what I said by saying that it was based on #1. my limited (people will obviously get this from the 2 years part and, like you, may believe my opinions aren't worth considering because I haven't worked at many different hospitals or in many different types of units) experience, and #2 my particular hospital. Before posting, I also edited out the sentence in my post that said I realize this is not the care everywhere or with every nurse - an oversight on my part which may cause some issues.
Also lend focus to the part where I mentioned that education, clinical, and jobs are what you make of them, which you've emphasized by reminding everyone that people vary in attitude and aptitude regardless of where they work or what types of things they're exposed to.
For everyone's comfort please realize I'm obviously very much aware of this, and realize that I'm indeed not blanketing any group of nurses except the ones with whom I directly work (the 'my hospital' comment was meant to clarify this) - simply an opinion (based on truths from a real unit) mixed with some venting about some (many, in fact) not so hot experiences with nurses on "my" side of the fence.
Mac, I hope this makes you feel more comfortable with my post and helps others realize I didn't mean any harm.