PACU or ED for CRNA

allnurses Guide · Jul 13, 2013

The requirement for admission into nurse anesthesia has recently changed. A minimum of 1 year of critical care experience is required for entrance into nurse anesthesia school.

Each school still has the ability to define what critical care is, but I think you are going to find fewer and fewer schools accepting PACU or ER experience.

Editorial Team / Admin · Jul 13, 2013

Depending on the facility, nurses in PACU may not have the opportunity to work with invasive monitors and drips. Many facility policies state these patients are to bypass the PACU and go straight to ICU. If you think you want the kind of PACU experience you're talking about, make sure any facility you look into actually will be able to give it.

DoeRN · Jul 13, 2013

Make sure you check out your school's requirement before venturing down this PACU road. I have several friends who are CRNA's and they all had to have ICU experience. A couple who worked in the ED had to transfer to the ICU in order to qualify for admission to the program.

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calivianya, BSN, RN · Jul 14, 2013

I don't know offhand of any schools that would accept ED or PACU experience. I have done a little bit of research on my favorite schools since I plan to attend CRNA school.

This is from my first choice (Wake Forest Baptist): "A minimum of one year (2,080 hours) of full-time experience within the 2 years prior to application in an intensive care or coronary care unit."

From the Kaiser Permanente School of Anesthesia: "Minimum of 1 year of current full time nursing experience in adult critical care ICU (Emergency Room, Post Anesthesia Care Unit, Step Down Unit, Cath Lab are not considered adult critical care)."

Rush University: "A minimum of 1 year of recent fulltime experience as an RN in an adult ICU at the time of the application deadline (Two years of recent full-time ICU experience as an RN at the application deadline is strongly preferred. To be more competitive it is advisable to be currently working in the ICU at the time of application. [...] The nurse anesthesia program at Rush defines ICU experience as that obtained in an intensive care unit or cardiac care unit. We do not have a preference of one type of intensive care unit over another (medical vs. surgical vs. neuro vs. burn/trauma vs. CV). The program does NOT consider the recovery room, emergency department, telemetry units, step-down units, invasive radiology units, the operating room or the cath lab to be intensive care units. In recent years the applicant pool has been extremely competitive. Most, but not all, successful applicants in the last several years have had between 3 and 4 years of ICU experience on the application deadline.)"

You get the idea. Obviously, these places don't take ED or PACU, and I don't think very many (if any) places do. And even if they did, it seems like most institutions believe ICU is the gold standard for admission, so even if it was acceptable you would probably weaken yourself as an applicant with only ED or PACU experience. With so many people competing for so few spots, you want to be the best applicant you can instead of one that just meets the minimum criteria, right?

Maybe you could take an ICU job and work per diem in a PACU or ED. That way, at least you'd get the fun experience of ED or PACU while still meeting requirements for CRNA school.

PMFB-RN, RN · Jul 15, 2013

So I'm interested in being a CRNA, but I don't really like the ICU. I feel I could get the same experience with hemodynamics and vasoactive drips in PACU, as well as critical thinking, etc in the ED.

*** Well you are mistaken but it really doesn't matter what you "feel".

Would a mix of these two works for CRNA school?

*** Almost certainly not. If you do find a school who would accept that experience instead of critical care experience you would limited to applying to that one school.

but the certification bodies specify one year of "critical care" which ED and PACU both count as.

*** What? Since when? I have worked as a staff RN in 2 countries, 4 US states, and done travel contracts in two other states and in none of those hospitals was ER or PACU critical care.

Anyone have experience with getting in with many years ED and/or PACU?

*** I have known dozens of nurses who went to CRNA school. 100% of them came from ICU. I have never heard of anyone getting accepted to CRNA school without critical care experience.

Do you think PACU and ED are good pre-CRNA experience?

*** Absolutly not.

I feel PACU is especially relevant as you learn the effects of anesthesia, reversal agents, and in most cases ICU is technically a step down from PACU

*** In most hospitals (every one I have experienced) PACU just handels the standard cases and anyone sick or unstable bypasses PACU an goes directly to ICU.

manusko · Jul 15, 2013

I know not all EDs and PACUs are the same but in my experience: ED stabilizes and then transfers to ICU. The PACU recieves post-OP PTs but if they require active drips and what not, then they go straight to ICU. The ICU nurse takes care of those PTs 12 hrs a day and sometimes for multiple days in a row. Actively titrating drips and monitoring the PTs hemodynamics.

SlyFoxRN, BSN, RN · Jul 15, 2013

*** Well you are mistaken but it really doesn't matter what you "feel".
*** Almost certainly not. If you do find a school who would accept that experience instead of critical care experience you would limited to applying to that one school.
*** What? Since when? I have worked as a staff RN in 2 countries, 4 US states, and done travel contracts in two other states and in none of those hospitals was ER or PACU critical care.
*** I have known dozens of nurses who went to CRNA school. 100% of them came from ICU. I have never heard of anyone getting accepted to CRNA school without critical care experience.
*** Absolutly not.
*** In most hospitals (every one I have experienced) PACU just handels the standard cases and anyone sick or unstable bypasses PACU an goes directly to ICU.

Well you're wrong that its not critical care, and you're wrong that ICU is required. In my research since my post I have found numerous programs that say they accept PACU and ED. The Cleveland clinic states ED and PACU are fine. U Michigan says ED is fine, etc. I just hoped to find more.

missnurse01, MSN, RN · Jul 15, 2013

SlyFox, I know it sounds like people are being harsh but you asked an opinion and they are giving it as they have experienced it. Each program decides how they are going to define 'critical care' and you never know when their definition is going to change. Each ED and PACU is different. I have been a nurse a while and have worked all over the country, and the majority of the hospitals do not have PACU take the critical pt's. They come straight to ICU. I know that some PACUs take these pt's, but many are unable to monitor invasive lines, etc. If they do take them, then it is for a short time until an ICU bed is available. As a new nurse, it will be difficult to learn as much as you can without having the pt for 12 hours. You will constantly be trying to get the pt's out as the next post op is rolling in. In the ICU you will have time to watch the trends, follow the protocols, see what happens. You can learn all about the different diagnoses, talk with fellow nurses and docs about what is going on about the pt. You are exposed to a lot more. The ED can have crashing pt's, however in most ED's it's get them stablized and move them upstairs. I worked ED in many hosp over the years and it was always amazing they would ever only use dopamine for low blood pressure. I didn't know how much that I would learn when I move to critical care. I didn't want to go either, but have learned a ton.

You could also see if one of the schools that you found that accepts pacu/ed has a current student or alumni that you could speak with about different types of experience and how it impacted their schooling and their crna career. You could also shadow a crna and ask them the same types of things. CRNA school is meant to take the most experienced nurses at following trends and hemodynamics, and train them to do even more. You need to decide what path will make you both successful in school and as a crna. You could be in a hosp where you are the only practicing anesthetist, and you will want to have exposure to a wide range of diagnoses, meds, etc to be able to have that knowledge. etc etc etc

If you want it badly enough, you will do all that you can to get into a great school, and be the best practioner that you can be.

good luck to you!

gwapo · Jul 15, 2013

Well you're wrong that its not critical care, and you're wrong that ICU is required. In my research since my post I have found numerous programs that say they accept PACU and ED. The Cleveland clinic states ED and PACU are fine. U Michigan says ED is fine, etc. I just hoped to find more.

Some schools do accept ER. Not sure about PACU."critical care" experience is required. Personally, i think pts in PACU are not critical. If pts were seriously critical, they would not have done the surgery or if they absolutely had to and did the surgery, they go straight from the OR table to ICU paralyzed, on the vent, with 10 drips going, chest tubes, drainage tubes, and all lines /cables tangled. Now an ICU NURSE will have to take cAre of that pt for 12 hrs. In some places where there are no doctors or residents available and it happened at night, the nurse will have to make tough decisions .. To me, that is what a critical pt is. A critical care nurse should be able to manage that kind of pt for an extended period of time at any time of the day.. It is this kind of experience i think that will train you to be a good crna or any aprn for that matter.

ive worked at 3 hospitals in 7 yrs, no offense to the ER nurses here, but in my experience they are always in a hurry to send the pt to ICU. Sometimes we had to go down to ER not necessarily to help take care of pts but to ... Guess what??.... To set up a CVP, arterial line or hook up a newly placed Ventriculostomy to the monitor :)

Do whatever pleases you coz if you are not happy with what you are doing, it will not be worth it. Good luck..

allnurses Guide · Jul 15, 2013

Make sure you contact the school the school(s) that you are interested to verify they are still taking ED and/or PACU experience. The school may have just not updated their websites since the COA changes took effect.

SlyFoxRN, BSN, RN · Jul 15, 2013

SlyFox, I know it sounds like people are being harsh but you asked an opinion and they are giving it as they have experienced it. Each program decides how they are going to define 'critical care' and you never know when their definition is going to change. Each ED and PACU is different. I have been a nurse a while and have worked all over the country, and the majority of the hospitals do not have PACU take the critical pt's. They come straight to ICU. I know that some PACUs take these pt's, but many are unable to monitor invasive lines, etc. If they do take them, then it is for a short time until an ICU bed is available. As a new nurse, it will be difficult to learn as much as you can without having the pt for 12 hours. You will constantly be trying to get the pt's out as the next post op is rolling in. In the ICU you will have time to watch the trends, follow the protocols, see what happens. You can learn all about the different diagnoses, talk with fellow nurses and docs about what is going on about the pt. You are exposed to a lot more. The ED can have crashing pt's, however in most ED's it's get them stablized and move them upstairs. I worked ED in many hosp over the years and it was always amazing they would ever only use dopamine for low blood pressure. I didn't know how much that I would learn when I move to critical care. I didn't want to go either, but have learned a ton.
You could also see if one of the schools that you found that accepts pacu/ed has a current student or alumni that you could speak with about different types of experience and how it impacted their schooling and their crna career. You could also shadow a crna and ask them the same types of things. CRNA school is meant to take the most experienced nurses at following trends and hemodynamics, and train them to do even more. You need to decide what path will make you both successful in school and as a crna. You could be in a hosp where you are the only practicing anesthetist, and you will want to have exposure to a wide range of diagnoses, meds, etc to be able to have that knowledge. etc etc etc
If you want it badly enough, you will do all that you can to get into a great school, and be the best practioner that you can be.
good luck to you!

Thank you so much for this post. It's so typical on allnurses for people to just flame and attack, with harsh posts because people don't do things their way. You validated my point of view, but then explained why another route might be better and the exact reason why it might be better. Instead of shutting down and ignoring the rest of your post, I was open and receptive to it, and actually see your point of view. I get the ICU requirement a little better now, and hopefully I'll be able to find an ICU where I'm happy. If not, I'll pursue a different graduate nurse career.

Thank you!