New Grad In CVICU

[xagx]

Hey everyone, I just started my first job as a new grad RN in a trauma CVICU. I'm really loving it so far and I'm getting exposure to a ton of cool things. CRNA school is my long-term goal (will likely be applying in 3-4 years once I get the hours + prereqs), and I want to make the most of my time here.

For anyone who has been in my shoes and is available to answer:

- What skills/knowledge should I focus on developing early?

- Any advice for standing out as a strong CRNA applicant when the time comes?

- Anything you wish you'd done differently as a new grad RN?

Thanks to anyone who sees this and responds!

[LightMac10]

Great place to start! Wish I had the chance to get trauma cticu as a new grad. Currently interviewing for CRNA with 5 years ICU (mostly MICU). 

Advanced hemodynamics: waveforms, ranges, nuances
Vasoactive medications: frequently used, MOA, receptor sites, provider rationale for choosing one or the other, new large data on picking one or the other.
Ventilator management: do not brush off the vent to the RTs, know your way in/out of modes, mechanics, parameters, pathophysiology
Leadership: get on UBC, do projects, get charge
Postop fresh hearts <3

[offlabel]

I'd just say don't take coagulopathy for granted. Really understand TEG and what it indicates for treatment of bleeding in terms of which products, protamine etc. Not talking about the coag cascade, just the practical, day to day management. What derangements in PT/PTT/INR call for etc.

[CRNA School Prep Academy]

Agree with what others have said about advanced hemodynamics, vents, vasoactives, and not sleeping on coagulopathy and TEG. Trauma CTICU is a gold mine for CRNA prep if you are intentional about what you learn.

If I were starting there with CRNA in mind, I would focus on:

1. Big picture resuscitation and shock

Get very comfortable deciding if the patient needs volume, pressor, inotrope, or afterload reduction.

Know how sepsis, hemorrhage, cardiogenic shock, and obstructive shock actually look at the bedside, not just in a textbook.

2. Vasoactive and cardiac meds

Norepi, epi, vaso, phenylephrine, dobutamine, milrinone, nicardipine, nitro, amio, lidocaine.

For each one: receptor profile, primary effect on HR, contractility, preload and afterload, and when anesthesia or CT surgery prefers one over another.

3. Ventilator management

Modes you actually use, what each control changes, and how to respond to rising CO2, low sats, high peak pressures, bronchospasm, auto PEEP, etc.

Watch what RT and anesthesia do for severe hypoxia, ARDS, and post-op cardiac patients who are hard to wean.

4. Trauma and massive transfusion

MTP steps, product ratios, when to push for uncrossmatched blood, and how calcium fits into the picture.

Really understand the practical side of TEG or ROTEM like another poster mentioned, and how derangements in PT, PTT, INR, fibrinogen, and platelets actually change what you hang.

5. Post-op cardiac specifics

How to interpret PA cath numbers and arterial lines together.

Recognize tamponade, graft issues, RV failure, low cardiac output states, and when someone might be headed to the OR again.

Temporary pacing, chest tubes, and post-pump vasoplegia.

6. Neuro and airway vigilance

Frequent neuro checks after big cases or trauma, early recognition of stroke or increased ICP.

Intubation, extubation criteria, difficult airway clues, and what to have at the bedside when things do not go as planned.

7. Leadership and communication

Volunteer for charge, precepting, and unit projects once you have your feet under you.

Strong handoffs, calling providers early with a clear SBAR, and learning how surgeons, anesthesia, and ICU teams think will all help you a lot when you hit a CRNA interview.

8. Make your learning "sticky"

Keep a small notebook or digital file where you jot down interesting cases, meds, vent changes, and what finally worked.

When you have a quiet moment, look up why the team chose that approach. Those are the stories and rationales that impress interview panels later.

If you lean into all of that, you will not only be a strong trauma CTICU nurse, you will also have a solid bank of knowledge and real cases to pull from when it is time to apply and interview for CRNA school.


This free 8 Steps to CRNA Road Map has some additional details about being a competitive applicant: https://community.crnaschoolprepacademy.com/8-steps-roadmap

Feel free to reach out if we can help! Cheering you on, future CRNA-- you GOT this! 

[PropSuxTube, BSN, DNP, RN, CRNA]

I agree with the other posters 

Expectations are high for CRNA applicants. There is a lot to learn in the ICU and you can get overwhelmed. Just know your time horizon of 3-4 years will naturally allow you to learn many of the things outlines by the above posters. 

At a very basic level, you should be know pharmacology of meds, when/why to give them, different disease states and treatments, and device management are most important. Don't forget your CCRN and committee/leadership aspects. But don't get too stressed. You have time.