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

PANurseRN1 · 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.

Not really. Yes, I read your qualifiers as well, but they were soon forgotten as I read your description of how "clueless" ED nurses are. As a former ED nurse, I was offended.

kiddo911crnahopeful · Jul 2, 2006

At my first interview I had 3.5 years of ER experience and 8 months of picu. i was accepted. i started a job in trauma icu about the time i got accepted to get some more experience with adults in icu. it's possible. just apply to the programs that post on their website that they take ER experience. I really enjoy ICU and ER and feel that each experience taught me so much. good luck!

roosevelt127 · Jul 2, 2006

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

actually, I'm a WOman

dfk, RN, CRNA · Jul 3, 2006

hey mmac..

there must be a reason why most schools (all in do time, i'm sure) "require" ICU.. no matter where and how much ER experience u get, (for which i've had level I and II), and i thought i knew quite a bit re: drugs and the like.. boy was i wrong ! you will definitely learn and mold better in an ICU.. granted, the ICU's where u never see a swan will definitely hurt you.. i worked in an small community hospital ICU (8 beds.. considered a high[er] acuity med/surg) and realized this was not going to be beneficial in the end (end meaning acceptance).. i would recommend ANYONE to gain the most they can in a very intense(ive) care unit - would definitely make me feel better if i was the patient...

just my cents worth - -

MmacFN · Jul 3, 2006

Ooops!

:eek:

actually, I'm a WOman

MmacFN · Jul 3, 2006

Hmm

I went from CVICU to the ER and thought just the opposite. Ive been at this for 9 years and i found the ER a much more challenging place to work. Lets be honest, anyone who has worked in the ICU > 2 years knows full well that every patient is simply a standard Dx which means a standard set of complications occur. The is little or no mystery.

PAs and drips are similarily boring. After doing them for awhile there is little of interest. A least in the ER (and in flight where i work currently) things change and you never know what your going to get.

ICU experience is helpful for getting some access to PAs and drips you may not see in the ER. However, any suggestion that it is the only place critical care resides is based in ignorance. The ICU can be a protocol driven place filled with people who simply "call the Doctor" anytime something happens. The rare few (yes rare) who do critically think in nursing can be found in all aspects of the profession and eventually migrate to advanced practice roles or leadership roles.

I find the blanket ICU requirement offensive because it is unjustifiable. Learning a PA or a neo/vasopressin/whatever drip is monkey work. Anyone can be taught it. Its no different than all the new things ICU RNs have to learn when they come to the ER. Critically thinking and being an investigative driven provider who strives to know the "whys" as opposed to the technical protocols cannot be taught. You either are, or your not.

Geesus, i can see to get off this soapbox..

Nothing personal just a rant ;P

hey mmac..
there must be a reason why most schools (all in do time, i'm sure) "require" ICU.. no matter where and how much ER experience u get, (for which i've had level I and II), and i thought i knew quite a bit re: drugs and the like.. boy was i wrong ! you will definitely learn and mold better in an ICU.. granted, the ICU's where u never see a swan will definitely hurt you.. i worked in an small community hospital ICU (8 beds.. considered a high[er] acuity med/surg) and realized this was not going to be beneficial in the end (end meaning acceptance).. i would recommend ANYONE to gain the most they can in a very intense(ive) care unit - would definitely make me feel better if i was the patient...
just my cents worth - -

dfk, RN, CRNA · Jul 3, 2006

albeit as it may... er is limiting is many a sense. you get the initial.. but after that.. ER sends em to the OR and after that the ICU..whatever field.. i don't agree.. i think you definitely learn more in the ICU.. however, ER is definitely unknowing and quite invigorating.. and unexpected to say the least.. i have to say.. i always wanted to be an ER NP.. would be just great.. save for the H+P's..

lonestargas · Jul 3, 2006

To the OP, it really depends on what kind of ER you work in whether or not the experience will be beneficial. Most hospitals will readily take ER nurses in the ICU's, so for your benefit I would transfer as soon as you can. Most CRNA programs prefer ICU experience. After working in several hospitals, I can say that ER's take care of "emergent" issues and than transfer pts. to the units, OR, cath lab, etc. for stabilization of the pt i.e starting gtts, IABP, etc. I don't know if this is a trend of late, but it's been many years since I've seen otherwise. ER nurses just don't have time (they put out the big fires). I agree with some of the above posters, the CCU has taught me more than I could have imagined. We take everything kind of "shocky" pt there is (cardiogenic, septic, hypovolemic...) with every gtt imaginable, and as unstable as they get. I'm sure I will appreciate that when my pt gets unstable in the OR. You cannot learn how to handle those situations in a textbook. That is why schools prefer to know that you have been in the trenches; at least for one year's worth!

KannRN · Jul 5, 2006

Hmm
I went from CVICU to the ER and thought just the opposite. Ive been at this for 9 years and i found the ER a much more challenging place to work. Lets be honest, anyone who has worked in the ICU > 2 years knows full well that every patient is simply a standard Dx which means a standard set of complications occur. The is little or no mystery.
Hmmmm.....every patient is simply a standard dx with a standard set of complications?? Perhaps there isnt mystery involved, but if this is your overview based on your ICU experience, please share with me why you believe that every patient is standard.
PAs and drips are similarily boring. After doing them for awhile there is little of interest. A least in the ER (and in flight where i work currently) things change and you never know what your going to get.
Yes, the ER and flight are areas of uncertainty, but at least in the ICU where I am, uncertainty is also frequent and requires the astute thinking of the bedside nurse--and often, we never really know what we are "going to get" from the ER and at times, direct from the helicopter.
ICU experience is helpful for getting some access to PAs and drips you may not see in the ER. However, any suggestion that it is the only place critical care resides is based in ignorance. The ICU can be a protocol driven place filled with people who simply "call the Doctor" anytime something happens. The rare few (yes rare) who do critically think in nursing can be found in all aspects of the profession and eventually migrate to advanced practice roles or leadership roles.
Beg to differ here. If it wasnt for the critical thinking and collaboration that occurs all the time, many patients would be in the toilet waiting for the big flush! Yes, there are protocols and unit standards--but these exist in many practice areas. Calling the doctor anytime something happens is not necessarily a source of comfort or even a resource depending on where you practice. I can see this more in a small community hospital, but definetely not in an academic center...
I find the blanket ICU requirement offensive because it is unjustifiable. Learning a PA or a neo/vasopressin/whatever drip is monkey work. Anyone can be taught it. Its no different than all the new things ICU RNs have to learn when they come to the ER. Critically thinking and being an investigative driven provider who strives to know the "whys" as opposed to the technical protocols cannot be taught. You either are, or your not.
Yeah, monkey work. I could teach my son to write numbers down but you are contridicting yourself here somewhat. Knowing what those numbers mean, and why, and where they are coming from, and what you are going to do about it, are interlaced with the technicalities and for many people, this type of environment is not suited for them. Your right, the knowing part cannot be taught, it comes with time, time and more time as well as a desire to want to know. Its far from monkeying around when you are doing something with the information and intervening on behalf of your patient.
Geesus, i can see to get off this soapbox..
Nothing personal just a rant ;P

nothing personal back, just a few different thoughts for you.... :idea:

dfk, RN, CRNA · Jul 6, 2006

well replied Kann... i think you have pointed out what many have thought in similar.. besides, most of the time in the ER, the nurses are working their tails off to get the pt upstairs and away from them.. agree, the volume in a day's work is most of the time great, but the intricacies of an ICU are usually not found elsewhere and the knowledge gained is most definitely invaluable... there must be a reason why 90% +/- of the schools require ATLEAST one yr of ICU, no?

KannRN · Jul 6, 2006

well replied Kann... i think you have pointed out what many have thought in similar.. besides, most of the time in the ER, the nurses are working their tails off to get the pt upstairs and away from them.. agree, the volume in a day's work is most of the time great, but the intricacies of an ICU are usually not found elsewhere and the knowledge gained is most definitely invaluable... there must be a reason why 90% +/- of the schools require ATLEAST one yr of ICU, no?

Well, the school that I am preparing to apply to states its requirements (minimally) as "1 year of recent acute care experience". As an insider within the facility, I know that what they mean is "1 year of ICU experience". "Acute" care could read as a surgical floor too, for the unknowing venturing into this. But this is not what they want! Infact, we have people who come to our unit for the sole purpose of "time" to meet the rigid requirments.

The ER where I work is usually slammed with traumas; those people come in, are worked up and out to the OR/floors and units depending on their acuity. Its rare that a vented as well as a patient on "jet fuel" would remain in an ER bay for long, at least where I am. They do not have the space, place and staff to manage this. I'm not saying that the nurses dont practice in a critical area, its just different and doesnt allow for plans, interventions, evals, and using broad knowledge and experience in the same WAY that an ICU does.

I have never received a lined pt. from our ER...most always is done on the unit---also in the OR typically for the livers and others where it is overwhelmingly urgent. And, while I have absolutely NO authority to speak coming from the inside of a helicopter, it is therefore just my impression that those pt's are retrieved and deposited to their new location. I'm not saying that FN'ing is for the "monkeys", but how long is the typical flight? Beyond keeping the pt. stable (which is terrific, mind you!) and experience and knowledge, insight, etc., is necessary, the patient still goes away and the practioner seems to have limited contact--much more limited than an ICU.

berry · Jul 6, 2006

My background I worked in the ER about 3.5 years then SI for about 1.5 years after I moved to SI… I continued to pick up 1-3 shifts every 2 weeks in the ER until I started CRNA School. I think the nurses that work in each are just different breeds. I think I learned valuable lessons and skills in both. Here are my thoughts on the issue.

Most ER nurses are bulldoggish (is that a word) ready to push people aside and take care of any problem including new docs who hesitate for a second or less experienced nurses. Most feel that they can handle any problem that rolls through the door and the good ones can. You have to improvise-read and react to very chaotic situations then in one a moments notice change directions. The ER is set up for a different mission than the ICU the GOAL is to stabilize/diagnoses then move to the appropriate level of care (in some hospitals that is transferring to a different facility, in most it just means moving to OR, cath lab, ICU, or floor admit). The ICU is set up to provide critical interventions to maintain and improve patient health until they can move to a lesser level of care.

In the ER, I learned things are never like the book and most of the time if it looks like a duck and quacks like a duck it is probably a zebra. I learned to prioritize numerous problems in seconds medicine orders and assessments are not done on schedules everything is written for now. In the ER, you draw your ABGS and stick them on ice to await RT you give breathing treatments, you push your patients to ct/mri, you set up vents, you fight crack heads some time going toe to toe, you become proficient at skills like IVs, ng/og tubes, you do things like cardiovert a patient in the hallway because there are no rooms, people give birth in the ambulance bay, you never have the luxury of asking people to call report in 30 minutes(I tried it the damn paramedics never listen). I have worked shifts and had a acute MI I was trying to get to the cath lab then got a 2 year old having allergic reaction ready to code.

In SI, I recovered mainly post op hearts, learned to fine-tune my assessment skills (something if you would have told me before hand that by leaving the er would improve I would have never believed you). I could come in and pick my patients from the day before up and listen to them and know what the chest x-ray would look like before I pulled it up as compared to the day before, the learning opportunities you receive by taking care of the same patient for a couple of days is irreproducible in the er. I learned to truly run a vent, when you wean and extubate a patient nearly everyday according to your judgment (within set protocols) and take care of ARDS patients, hell I never used PC vent settings until I moved to SI. You learn more and become more comfortable with hemodynamics monitoring and gtts during the first 2 hours with each heart than all the trauma/burn/arrest patients in the ER.

In the ER I have had seven patients- one sp arrest and another waiting for ICU beds 3 that would be tele admits and a couple that would be d/c and the other hand I worked harder taking care of a fresh heart with more iv pumps that the er has total being paced and on a

IABP as a 1:1 patient.

My $.02 SI prepares you better for school in the OR it is more similar to recovering a heart than working in the ER. That being said I think a person would do fine with only