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

Brian_SRNA · Jul 6, 2006

I think we are getting off point here a little. The first post asked a simple question, and the answer starting a bashing war. In every fields of nursing, IUC, ER, PACU you are going to have good nurses and nurses that don't really think for themselves. No need to start bashing groups. The most important thing you can do in order to give yourself the best oppurtunity at getting accepted is to call the various schools and see what they require.

For instance:

(1) My school requires a BSN, now at first glance you might say , OH all schools require a beachelous degree. But some schools accept a bachelor of biology, and a bridge to get an RN license. My school did not, it was either a BSN or MSN, emphasis on the nursing, or you dont get your application looked at. Fair, maybe not, but it was there rule.

(2) My school requires a statistics class, grad level, before you matriculate, not necessarily before you get accepted. I got accepted on the condition that I would pass my class. Which I am now taking.

(3) My program requires PALS both before you apply and it must be good through your furst year.

The bottom line, call the program. They are usually more than willing to talk to you, even sit down and meet you months or years before you are ready to apply.

Also, please remember that if it is your ultimate goal to become a CRNA, as was mine, than you might need to do the crappy, not always so glorified job of an ICU nurse instead of the fast paced, flight nursing or ER. But in the end, as it was for me, when you get that acceptance letter, it will ALL BE WORTH IT.

Good luck and god bless,

Brian

athomas91 · Jul 6, 2006

i agree with brian - the topic tracked off a bit... let's face it - ER and ICU are different beasts..i have done both - and I happen to agree with Mike - ER is more challenging.

that is my personal opinion - just as those who debate ICU is more challenging happens to be their personal opinion.

the AANA requires 1 yr of acute care setting - this requirement is decifered by each individual school and some do accept ER/trauma as an acute care setting. I for one am happy that i had experience in both areas- as both of them added to my skills and knowledge as a nurse...

Brian_SRNA · Jul 8, 2006

Remember, put your best foot forward and go for it.

GOod luck

Brian

SigmaSRNA · Jul 8, 2006

i agree with brian - the topic tracked off a bit... let's face it - ER and ICU are different beasts..i have done both - and I happen to agree with Mike - ER is more challenging.
that is my personal opinion - just as those who debate ICU is more challenging happens to be their personal opinion.
the AANA requires 1 yr of acute care setting - this requirement is decifered by each individual school and some do accept ER/trauma as an acute care setting. I for one am happy that i had experience in both areas- as both of them added to my skills and knowledge as a nurse...

Not to add flame to the debate (but I know I probably am) but I would agree that ER is more challenging if it wasn't for the fact that most ERs in america are more primary care clinics and not on the level of a Charity, Grady, or Parkland. If every ER in the US was a level 1 you all would have a point. Having worked both (mostly military settings), I give the nod to ICU.

For the poster: Some schools will take you with ER experience and with ICU experience (and the grades and test scores) you can be a very strong, well-rounded candidate.

SigmaSRNA · Jul 8, 2006

Another point I thought I should mention:

When it comes to the ABCs, nothing gets you ready better than a HIGH ACUITY Level 1 ER/Trauma Unit. NOTHING!!!

As far as the pharm/physio aspect of it all, its all about ICU.

Maybe schools should require a year of both. (can feel the hate from that last statement). :madface:

Brian_SRNA · Jul 9, 2006

Sigma,

I must disagree. I have worked and currently worjk in a level one trauma ICU. I also work in a Level one Trauma ER and mult ICU's. In the ER setting the nurses are always overcrowded by the ER physician barking orders, yelling out the ABC's to follow, then you have a trauma surgeon, residents and fellows at the door when they roll in. In the ICU's that I have worked, The decisions to do ro not do something, or let the doc's knwo about somethign is in the hands of the Nurse. To be able to differentiate and criticaly think about what is going on with the pt is what the ICU has taught me. Not only only the ABC's, but being able to think clearly, on your own, how to apply them(Much more like the role of a CRNA). The best canidates are the ones that get accepted, regardless of grades, Experience or test scores. Best of luck

Brian

SigmaSRNA · Jul 9, 2006

Sigma,
I must disagree. I have worked and currently worjk in a level one trauma ICU. I also work in a Level one Trauma ER and mult ICU's. In the ER setting the nurses are always overcrowded by the ER physician barking orders, yelling out the ABC's to follow, then you have a trauma surgeon, residents and fellows at the door when they roll in. In the ICU's that I have worked, The decisions to do ro not do something, or let the doc's knwo about somethign is in the hands of the Nurse. To be able to differentiate and criticaly think about what is going on with the pt is what the ICU has taught me. Not only only the ABC's, but being able to think clearly, on your own, how to apply them(Much more like the role of a CRNA). The best canidates are the ones that get accepted, regardless of grades, Experience or test scores. Best of luck
Brian

Okay, I'll say this. How many times have you had to worry about Airway, Breathing, and Circulation (PRIMARY SURVEY) in a level one ER vs. the busiest trauma ICU. In the ER, as you well know, the primary survey takes place. So why would the ICU be better for this than the ER? I've seen more tubes go in patients in the ER than the ICU (where MOST, not all, of the time the tubes are already in place). As far as the use of airway adjuncts, the manipulation of an airway (the alcoholic patient or the child with croup) or conscious sedation gone wild, you see all this in the ER, so why would the ICU be better as far as the ABCs? That was my argument. As far as decision making, I agree ICU might be better but that's another topic.

darienblythe79 · Jul 11, 2006

Okay, I'll say this. How many times have you had to worry about Airway, Breathing, and Circulation (PRIMARY SURVEY) in a level one ER vs. the busiest trauma ICU. In the ER, as you well know, the primary survey takes place. So why would the ICU be better for this than the ER? I've seen more tubes go in patients in the ER than the ICU (where MOST, not all, of the time the tubes are already in place). As far as the use of airway adjuncts, the manipulation of an airway (the alcoholic patient or the child with croup) or conscious sedation gone wild, you see all this in the ER, so why would the ICU be better as far as the ABCs? That was my argument. As far as decision making, I agree ICU might be better but that's another topic.

I am not disagreeing with you, but I will add that the particular hospital I work in(no trauma here) rarely does the intubating. More often than not patients are shipped to the unit to be intubated. So, some ER's may not be that much better in ABC's. I will admit, if I need emergency care, I will not go to the facility that I work for. However, we are known for excellent critical care.

Just wanted to add, best of luck as you begin you clinical adventure!

SigmaSRNA · Jul 11, 2006

I am not disagreeing with you, but I will add that the particular hospital I work in(no trauma here) rarely does the intubating. More often than not patients are shipped to the unit to be intubated. So, some ER's may not be that much better in ABC's. I will admit, if I need emergency care, I will not go to the facility that I work for. However, we are known for excellent critical care.
Just wanted to add, best of luck as you begin you clinical adventure!

That is fair. Very True

japaho41 · Jul 11, 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!!

This post right here pretty much sums why ER nurses should never be even considered to be admitted to a program without significant ICU experience. Why? Read the above post and that is why. To add to this they lack the volume of exposure to critical patients and when they get them situations like the above happen. Also most lack the indepth critical thinking tool which is essential to becoming a CRNA. If something happens there is always a doctor available to get to figure it out for you. You may say well I work at a huge trauma center, well any major trauma has multiple doctors,residents, PA's and NP's making decisions and most are going to go to the OR if it is anything significant. I recall my first anethesia interview, during the introduction a girl had stated that she worked in a 8 bed ER. thought to myself I would say that because that will definetily not get you in this program.

Brian_SRNA · Jul 11, 2006

Sigma,

I see some good points that you have made. Many times a critical patient goes to the ER and does buy a tube. But who is making the decision, the nurse, or the doctor at the bedside. In the ICU it is gonna be the nurse who is going to have to do the primary survey to call for anesthesia or someone to intubate. it will be the ICU nurse who will make tha first decision and not a doctor. That is where I feel the ICU may have a leg up on ABC primary survaey. In addition, the most vulneraable(?) time for any airway are in the first two hours post extubation, stridor, anxiety, obstruction, pain and sedation for a newly extubated patient. Not too many ER's, unless they are holding for days and days, are going to be extubating and needing to contiunally survey the adeqaucy of the airway.

BTW, sigma, are you in a program. Just curious, thanks for the great dialogue.

Brian

japaho41 · Jul 11, 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?

I would agree with this totally. ER nurses are among the hardest worked group of nurses in a hosiptal. It is work that I have never desired to do. I have found in my limited time in the ER that it is mush like sifting. You are sifting through individuals, the chronic abusers of the ER, those whom have a reasonable complaint that can be fixed and send them home, ICU, trauma, arresst, DOA, observation, and to the floor. Simply sifting through patients.