PACU for critical care experience

CRNA, DNSc · Nov 2, 2004

Today I was talking to a recovery room nurse and she said that PACU experience is critical care. She also said that it would be the best unit to work in if you are interested in anesthesia school. Now, this makes sense to me, considering that in PACU you are dealing with the effects and after effects of anesthesia.
So my question -
Is PACU experience accepted for CRNA school? and if so, is it better or worse than ICU experience?

Many programs will not accept PACU as critical care experience and in those that do it may not be rated as highly as ICU. While there are positive experiences to be gained in the PACU the frequency in which advanced monitoring and other experiences gained from the ICU occur in the PACU may vary widely.

heartICU · Nov 2, 2004

Today I was talking to a recovery room nurse and she said that PACU experience is critical care. She also said that it would be the best unit to work in if you are interested in anesthesia school. Now, this makes sense to me, considering that in PACU you are dealing with the effects and after effects of anesthesia.
So my question -
Is PACU experience accepted for CRNA school? and if so, is it better or worse than ICU experience?

Some programs will accept PACU experience - it depends on the school. At the particular hospital I worked at, PACU and ICU were very different units. Both were fast-paced and very hectic, but the patients in the ICU were definitely more critically ill. In all of the students accepted in my class, every single one had ICU experience. Some had PACU in addition, but all had ICU.

In all honesty, if you are truly interested in going to anesthesia school, get into an actual intensive care unit. There are several benefits to this: ICU experience is accepted at all anesthesia programs, you will get more experience with invasive lines and vasoactive drips than in a PACU, and you will get more experience with vents/airway issues airway issues than in a PACU, all of which are vital skills/experiences for a nurse anesthetist. IMHO, ICU experience will make you a more competitive candidate.

As for one being better or worse than another - it really depends a lot on the hospital, and how you define better or worse. (I assume you mean which one will give you the experience you need for anesthesia school). One hospital's PACU patients may be another hospital's ICU patients. Acuity is all relative. You can probably get the experience you need for some programs in a PACU. But to provide yourself with experience that all progams will accept, go to an ICU. Some will say cardiothoracic or general surgical ICU is preferable to any other, but I know many people currently enrolled in CRNA programs that worked in other areas (PICU, NICU, MICU, etc), and who are doing well in their programs. Good luck!

rhon91 · Nov 2, 2004

I have worked both PACU and cardiac ICUs. I can see where the ICU is more valuable as it pertains more to what you do as a CRNA. Being with the same pt for 8-12 hours and esp when they are on the vent, vasoactive gtts and hemodynamic monitoring lends more to knowing about the physiology one needs to know. I just dont think one gets this experience in the PACU.

UCDSICURN · Nov 2, 2004

I work in a level 1 trauma center. Our PACU is also ICU overflow. However, if we, the surgical trauma ICU, gets a sick admit, we bump our lowest acuity patient to PACU to make room for the sick patient in our unit. We also recover our own patients, meaning we recover some of the sickest patients coming through the doors. The only other unit that does that is the cardiothoracic/transplant icu.

Do what you want to do, but keep in mind the requirements for the school you're looking at (some specifically state PACU is unacceptable). Also consider that if you do get into a large hospital the surgical ICU's usually recover their own patients in their unit, in essence you'll be recovering the sickest surgical patients.

This is at my hospital and yours could be different.

Hope this helps a bit.

D.C.

subee, MSN, CRNA · Nov 2, 2004

I was suprised to find out that a CRNA school is accepting OR experience as "critical care". In our OR, the RN's barely touch the patient - only to help move. This man has no patient care experience except for OR and I don't think schools should be accepting OR as critical care experience since I don't think its even nursing.

rhon91 · Nov 2, 2004

I was suprised to find out that a CRNA school is accepting OR experience as "critical care". In our OR, the RN's barely touch the patient - only to help move. This man has no patient care experience except for OR and I don't think schools should be accepting OR as critical care experience since I don't think its even nursing.

Yes, I think that is risky. I would not even want to go to a school who accepted OR as critical care. How can anyone in their right mind go to CRNA school without ICU experience? Dont you WANT to know the things you should know and the experience it brings? I would want to be prepared. To be ill-prepared is my worst fear.

schmatah · Nov 2, 2004

In my opinion, a good 5 years experience is needed for PACU staff. For CRNA, you should consider CSU for experience to get used to Swan Ganz catheters. The issue with PACU is that you have to be very familiar with all aspects of critical care because problems do arise and you have to fix them quickly. You cant sit around wondering whats wrong. Nurses I've met who work PACU with ER or outpatient experience really are lacking in acute situations.

apaisRN, RN, CRNA · Nov 2, 2004

I was suprised to find out that a CRNA school is accepting OR experience as "critical care". In our OR, the RN's barely touch the patient - only to help move. This man has no patient care experience except for OR and I don't think schools should be accepting OR as critical care experience since I don't think its even nursing.

I think it's nursing - the RN has serious responsibilities like maintaining sterility, making sure the surgeons don't try procedures the patient has consented for, keeping the place running smoothly. But it's not bedside nursing and aside from familiarity with the OR, gives a nurse almost no knowledge useful for CRNA school.

An analogous situation came up for me a few years ago. I was in a 20-week critical care orientation with three other nurses. One came from an ortho floor, one from my general surg floor. The third had worked ortho briefly some years back, but had been in the OR ever since. She worked really hard and the educators did their best to help her, but since she couldn't manage basics of bedside care - like figuring out the flow sheet - she eventually went to the floor to reorient. She was supposed to come back to ICU in a while but I haven't seen her. She was kind a spacey person and I'm not sure she would have made a good ICU nurse anyway, but she must have had some level of competence in the OR to have stayed so many years. She just had no idea how to take care of patients.

subee, MSN, CRNA · Nov 3, 2004

Yes, of course the OR RN's have important responsibilities but do you need to be an RN to assume these responsib ilities? I think not. Why not have techs who complete as associate degree and come our with tech experience and training in circulating? They could graduate on Friday and take call on Monday instead of these long orientation programs for people who get pregnant or leave to other OR's who weren't willing to train them in the first place?

mwbeah · Nov 4, 2004

Hey there,

Just wanted to give you some input from a CRNA who never worked in an ICU (I was a L&D nurse in NYC for four years prior to school). I went to the US Army Graduate Program in Anesthesia Nursing and did quite well, I maxed my certification boards and went on to deploy to Operation Iraqi Freedom and provided trauma anesthesia for roughly 150 soldiers and EPWs (some of the worst trauma you could ever imagine).

My advice, don't let anyone tell you that you cannot do what you want to do. I can only shake my head at the ignorance that people have when thinking that "ICU" nursing is the only real nursing....I also know of several great (and I mean great) nurses who would be offended by that statement.

My take on it is this, you are either talented and have the aptitude or you are not. If you have worked in a setting long enough then you know what I am speaking of. There are people you work with that probably could do whatever they put their mind to...on the same token there are probably some people you look at and just shake your head (no matter what type of unit you work on). I have several colleagues that are great nurses...in the ICU....on MED/SURG.....in L&D.......in the ER.....etc. My point is you are either a talented nurse or you are not. Your training in school will teach you to be a good CRNA (I knew of 2 ICU nurses that thought they "knew it all" and quickly proceeded to bring in their past to the school and were abruptly asked to leave when there test scores were not up to standards). Bottom line you either want it or you don't, there is no in between.

Hope this helps,

Mike

athomas91 · Nov 4, 2004

mwbeah - although i completely agree with your statements - (as a former ER nurse) - i also feel that any extra experience you allow yourself to have only enhances what you know and what you bring to the table. because ER isn't considered "critical care" by my school i actually did a short per diem time in the CVICU - and i (who hated every minute of it) must say that it only benefited me. sure i knew enough - sure i was smart enough - and i am sure i would have been fine without that extra CVICU time - BUT - it lessened the amount of things i needed to learn and orient myself to - so in the long run it just saved me a little extra heartache while in school.

So i guess what i am saying is that noone here is telling anyone "you can't do it" - what they ARE saying is - it may benefit you to broaden your horizons - and to tell someone that increasing their level of expertise isn't neccesary is just a disservice to them.