PACU or ED for CRNA

[SlyFoxRN]

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. Would a mix of these two works for CRNA school? I know a lot of people say ICU only, but the certification bodies specify one year of "critical care" which ED and PACU both count as.

Anyone have experience with getting in with many years ED and/or PACU? I worked in both during school and enjoy them. My time in ICU was a little less interesting (though I still think it's a wonderful specialty and kudos to anyone working there! I just prefer higher turnover, I get bored with the same patient all day).

Do you think PACU and ED are good pre-CRNA experience? 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 (except CTICU)

[missnurse01, MSN, RN]

aw, you're so welcome! I try to shine a light on things b/c nothing is ever black and white. The cream of the ICU crop tends to be CVICU, as you will get lots of drips and hemodynamics, and plenty of nights with some adrenaline. You also rarely have the long term pt that has been there for months. The hearts usually go out in a day or two and the next ones come in. Not as fast a turn over as pacu or ed, but you could have a different pt every night. You get more training and get to do 1:1 with balloon pumps, VADs, or 2:1 with ecmo. Trust me there is a world out there to learn, you won't be board. If you are, go read the aacn procedure book (I read a good bit of it as a new ICU nurse), and study for your ccrn, csc, etc. Actually, look at a ccrn review book and see if the topics in it are something you think that you would feel comfortable with getting experience in a pacu or er. Might help guide you.

I still moonlight in the ER, as it is my first love. My critical care experience shows things in different lights then when I worked there without it.

Very good luck to you and keep in touch!

[PMFB-RN, RN]

Well you're wrong that its not critical care,

*** The question was about applying to CRNA school. In that context PACU and ED are 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

*** Is that what it says on their website or did you call them to get the most up to date information relitive to the COA changes?

[SlyFoxRN, BSN, RN]

*** Is that what it says on their website or did you call them to get the most up to date information relitive to the COA changes?.

The most recent COA papers say that one year critical care experience is required. They state to see the glossary for critical care definition, which states:

Critical care experience – Critical care experience must be obtained in a critical care area within the United States, its territories, or a US military hospital outside of the United States. During this experience, the registered professional nurse is to have developed critical decision- making and psychomotor skills, competency in patient assessment, and the ability to use and interpret advanced monitoring techniques. A critical care area is defined as one where, on a routine basis, the registered professional nurse manages one or more of the following: invasive hemodynamic monitors (such as pulmonary artery catheter, CVP, arterial); cardiac assist devices; mechanical ventilation; and vasoactive drips. The critical care areas include intensive care units. Those who have experience in other areas may be considered provided they can demonstrate competence with invasive monitoring, ventilators, and critical care pharmacology. (+)

[PMFB-RN, RN]

So no answer to my question. I guess that is understandable.

The most recent COA papers say

*** Ya, I know.

The point is those who want to go to CRNA school should go to work in a critical care unit, not PACU or ER. Are there some schools that MIGHT consider non critical care areas like ER or PACU? Well it would seem so, or was so until recently. Why aim for the smallest percentage? Why place obsticals in the path to NA school? Why decrease the number of schools who would consider you?

[kateee]

I know there are a few schools that accept pacu or Ed experience without any icu needed! I'm the same way! Crna interests me and i intern in the pacu now and love it! So I am looking into those schools! Some in Connecticut and Rhode Island I know of

[crnahopeful2]

Good luck in an interview when they ask you how you handled a crashing patient, or about vent settings, or about a time when you made a crutial catch, or anything of that nature. They might consider you initially, but when everyone else they're interviewing has substantial experience with these types of things, you're going to be overshadowed in a heartbeat.

[manusko]

Question I was asked by each panel. What are your typical patients?

I have heard that there are high acuity PACUs out there but they cannot compare to a high acuity ICU. PACU is generally getting stable patients and the ones that need more attention will generally go straight to ICU. Pacu may hold until a room opens. You may be happy that a couple of programs will take you but why limit your pool of schools?