AGRN152

My response is similar to what others have already said: 1. If you're asking about a patient's condition or intake/output or any other data, are you asking because you truly want to know? Or is it because you need to fill out your flowsheet and report to your superior. As an ICU nurse, I can tell you that we couldn't care less about what means you employ to fill out your morning sheet, in the morning, after we worked all night long with no sleep or food or bathroom break sometimes, the last thing we want is to spend the last 20 minutes of our shift giving information to a student/ first year resident when we are doing last minute care, med passes, charting, and cleaning up the shift. At this point in your career/education, you are not ordering anything, you are not directing the patient's care, and you have no decision making power over that patient. We ICU nurses know this, and will not waste time feeding you information that you will do nothing with aside than relay it to your superior with whom we have likely already spoken. 2. Do not interrupt change of shift report 3. One day you will be the experienced resident with the authority, and we will love you. We will call you, trust you, and seek your input. We will include you in our circle and celebrate your victories. This is a rite of passage. If we seem indifferent now, it is because we are. We are here to care for our patient's. 4. Get your numbers at 5am, long before the morning bustle. Sacrifice your sleep and we will sacrifice our time.

I would inspect your work life balance, as a preceptor, nursing instructor, and practicing nurse myself, I find that most of my peers who experience burnout is not because of the job itself but because they have "at home" issues and also "at work" issues and so they are in a constant state of stress every waking hour. They may not have control of the life issues but the work issues can be resolved by quitting, big mistake. There was something that brought you to ICU, perhaps the acuity, the need to have the experience for graduate school, the continuous learning, the bragging right, the training to do travel nursing...something. My advice is always to do two things: 1. Resolve the at home issues and decrease your out of work responsibilities or 2. Work less hours if financially feasible. Do some introspection and analyze your stress tolerance and whether critical care is what you want, if so why do you want it?

As both a current critical care nurse and dialysis nurses I may have some insight. I have done hemodialysis in the inpatient setting for years and I have worked as an ICU nurse for years as well. I have never in either role had to have tube feeds turned off during HD. Nutrition is a major issue in the ICU and 9-12 hours a week of no nutrition has been shown to correlate with increased hospital stays and prolonged healing times. Additionally, in the setting of CRRT/CVVH the treatments would be running for days making it impossible to starve patients this long. The blood flow rate on a CVVH machine and on a dialysis machine is nearly the same and the hemodynamic shift would not be much different. In the US many patients in the outpatient setting are advised not to eat but in a hospital setting they eat whenever they want and truthfully I have seen not consistent trend that I would even say remotely links hypotension to eating.

Per the ACCN, you can sit for the CCRN exam after you have worked 1,750 hours in a critical care setting post-orientation. When you apply to any college they are going to ask for transcripts from all your schools and they will review it with a fine-tooth comb. At that point you have to explain why you were deficient in those areas but even more so, what did you do to improve. I too had a degree before nursing and had courses I far from excellent in, I was asked to elaborate why. The main point being that you show an upward trend in grades and GPA.

I would also add that when you applied to nursing school you had no idea what to expect. You lacked the clinical knowledge and training to function as an RN and look at you know, you have a BSN, you worked critical care and successfully gained admission into one of the most competitive fields in the country. You must be doing something right. Trust your instincts, manage your time, and enjoy the last few months of freedom you have before you enter the whirlwind of CRNA school. I start school in August of this year and yes I feel the crunch primarily because of everything I have read about the "nightmare" that it is but not so much by virtue of direct experience. I find that fear by proxy is worse than what you fear itself. We made it to the next phase, we'll be fine!

As far as CRNA admissions goes, I would say the amount of hours you work seems to be a big emerging topic. Many schools are asking you how many hours a week you work, an ICU nurse who is working 24-36 hours will require longer training than one who is working 48-60 hours a week. Of course, that's not to say that the ICU nurse who works 60 hours a week is more prepared, but their tolerance threshold for long days and many hours is definitely higher and their endurance is also higher when juggling life, school, and clinical as a SRNA. Cross training to a variety of critical care settings is also very appealing to schools, especially in high autonomy units like Open Heart Recovery units where you will monitor invasive hemodynamic values and wean/extubate your own patients using your own judgment. Be careful if going into ICUs that are too niche or specialized because you risk missing out on key critical care experiences. Understanding vents, therapeutic hypothermia, vasoactive drugs and sedative agents, CRRT on pressers, even basic surgical patients are a MUST. This is MY OPINION, again nurses who work in these units and became CRNAs will disagree but overall, I would avoid ED-Trauma 1,NICU, Burn ICU and Neuro ICU. I would highly recommend MICU, SICU, CTICU/OHRU/CCU. The reason I say I would personally avoid those is because the type of critical care you give in those aforementioned units is so specialized that it doesn't apply to the majority of critical care patients which ultimately is what you will manage in the OR as a CRNA. Realistically, I don't see how anyone with less than a minimum of 2 years experience and four weekly 12 hour shifts would feel comfortable managing an ICU patient by themselves in the OR. As an ICU nurse, nursing instructor, and preceptor I know that the first 6 months of your ICU career is spent on orientation and the last six months of your first year is spent requiring frequent cues and direction from senior nurses that guide you in caring for your patient. During this time, you are not independently thinking and are usually relying on the experience of your peers to safeguard any mistake you will make. Thats OK, this is normal, we were all new ICU nurses at one point. The pitfall is that CRNA school builds on your experience, they are not going to re-orient you to ICU so if you haven't developed the "gut" and anticipatory thinking, you will have a very hard time developing that while being in anesthesia school. Getting your CCRN is a must for two reasons: For one, it validates your critical care knowledge and demonstrates to the admissions committee that you possess the minimum amount of knowledge required to start CRNA training. Secondly, it will make you aware of all the things you didn't know, because my favorite saying is that you don't know what you don't know. Train to be in charge of your unit. Developing leaderships skills is very important as a new ICU nurse that aspires to become a CRNA. In the OR, you are the go to resource for anesthesia in absence of the anesthesiologist. As a result, you need to have a commanding presence and understand the important of task delegation, trouble shooting, time management, and conflict resolution. This is something that comes with time and experience, start early. As far as the GRE, if you had a good enough GPA (higher than 3.5) I would explore as many schools as possible who would offer a waiver to high-GPA students only because studying for this test is time-consuming and costly and ultimately does not add knowledge or understanding to either nursing, critical care, or anesthesia. You mention that you want a DNP program, if you get into MSN as of this point thats fine. You can always do completion programs down the road and if you are done before 2025 you will be grandfathered in as an MSN CRNA. General advice is don't walk into your first day of ICU announcing that you want to become a CRNA. ICU nurses are very good at sensing and dissecting the applicants that only want to put in their 1 year and hit the road. They will not invest the time and patience into training you if they know you plan on leaving 6 months to a year after orientation. Additionally, and I know this will rub some people the wrong way, but ICUs across the land are full of green-eyed monsters. There are many who want to become CRNAs but due to life circumstances cannot/ could not. Be wary of these individuals, they can be hard to navigate if you are not a strong Type A personality. Last but not least, don't give up. Tenacity is key to perseverance. If you apply and get rejected, apply again and again. Eventually, you will be the most experienced and most comfortable interviewing and will get the spot. I was rejected and wait-listed before I was finally accepted and it was the best thing that would have happened. This was a very long-winded response and I apologize to the other members who had to endure this post. I am very passionate about helping the nursing tadpoles navigate the pond!

It will be interesting to see what experience the Cedar Crest College students have since the former director of U of Scranton CRNA program is the current assistant director of the new Cedar Crest College Nurse Anesthesia program in Allentown, PA.

I would highly disagree that $125,000 is the cheapest program out there especially if you're talking about Pennsylvania. These are some of the total costs for some of the CRNA programs in PA: University of Scranton ($72k), Bloomsburg University ($43k), Drexel University ($95k), Villanova (97k), York ($104k), and that's just to name a few. The Cedar Crest program is a brand new program so no way to know if they will provide a curriculum that will be conducive to passing boards and the first set of these numbers won't be out for 3 years when the first class graduates. The program has its students learn through the Frank J. Tornetta Anesthesia program via teleconference for a portion of the program which begs the question whether you'd be better off applying to LaSalle's program which costs about the same but has a proven track record. Aside from the two directors, there are no other onsite CRNA faculty that can serve as a resources which any CRNA or current SRNA can vouch is crucial to survival. The program is front loaded which gives you the opportunity to work during the first year but clinical seems to cover a broad geographical span from Delaware to New Jersey to Pennsylvania. Three states is a lot of traveling and commuting at a time when you will barely be able to afford ramen noodles not to mention the brutal northeast winters. In the end there are two kinds of applicants: those that will apply anywhere just to get in and duke it out and those who carefully consider the pros and cons before applying. This program is ideal for younger applicants who are childless and single, those still living at home or with the capability of moving back in with parents, or those who are married and can afford to be unemployed for three years while the at-home support system mans the fort. This program is not designed for mandatory dual-income households or single parents with no support system, most CRNA programs are not. The program will likely be great, many hospitals in the area. However, growing pains is not unexpected.

BSN GPA 3.86, Science GPA 3.9, NO GRE, 3.5 years of MICU/OHRU experience, CCRN-CMC certified

Allegations of neglect against the elderly is a serious accusation and dialysis is primarily an elderly-serving specialty, you will not be hired if this is found in your record. I've worked in dialysis for many years, we have let people go for less than this.

We have fired nurse for less than that at one of my employers. It demonstrates a lack of understanding about appropriate work to personal life boundaries and I would personally say I would never post anything about my job on social media unless it was a work function or a group picture of me with other nurses in my unit but never involving anything to do with patients.

I will agree with most of the posts here and say that comfort comes from experience but you will always have a Day 1. Orientation, regardless of how big the unit or how expansive the amount of time spent orienting, will never cover every single type of patient multiple times in order to afford comfort in caring for the patient. I always ask the nurse giving me report what to look out for or what my areas of concern would be if I am uncertain as to what we are looking out for. If the preceding shift is also unsure, there is always a senior nurse on the floor and if everyone is a 1-2 year nurse (sometimes a common finding on night shift), then there is always a resident or a physician who can explain what they want done and what their areas of concern are. Nursing is a profession built on experience, asking questions, and humility. An epidural is a great experience to seek out and can help you build on your experience especially if you end up caring for patients with nerve blocks or other forms of regional analgesia.

I never understood why seasoned ICU nurses are salty that newer ICU nurses put in their 1-3 years and leave. This is a NATIONAL REQUIREMENT, if it wasn't a requirement, I can guarantee few CRNA-hopefuls would choose ICU as their starting point if they knew how demanding the unit could be. I started in critical care with no intention of anesthesia school, but after several encounters with CRNAs as well as shadowing and learning more from coworkers who were in anesthesia school I decided to pursue the career. I loved ICU and always will, but I have definitely seen the green-eyed monster show its face when nurses decide to pursue anesthesia but yet when someone pursues an MSN in education, CRNP, CNS, or MHA, no one thinks anything of it and yet all those degrees are the furthest away from critical care with most graduates from those programs never seeing the inside of an ICU or touching a drip ever again. I will agree with most people here, although it was not my experience since I had a very supportive ICU team and the reason I got in was thanks to their help and commitment to my training, I WOULD NEVER reveal my intentions to become a CRNA unless I was at the point where I needed LORs from leadership. Nurses like Ruby Vee exist in EVERY ICU and many will do exactly what they do. Give you patients with no drips, chronic trach and ostomies, they will sit you on psych 1:1 or float you to step down or med surg units, essentially limiting the experience you are getting and making it impossible for you to evolve and grow within your practice just because they have a Guardian of the ICU complex and feel they have been endowed with the duty of selecting who they feel deserve a "proper" orientation. If this is ever happening to you, don't hesitate to leave that unit and work some place else, you don't need that energy in your life.

I was once waitlisted as well, I will give you my personal opinion. Unless taking these courses offers you some sort of guarantee during the next cycle I would so move on to other schools. The worst feeling on earth would be to take these courses and end up getting a rejection next year. You would have wasted time, resources, and money not to mention the emotional investment in an institution that may not end up taking you. I had a very similar situation happen to me and I would not consider taking classes at that school because admission was not guaranteed. Instead, I focused my efforts on applying to other programs and got accepted there. I don't know your GPA, stats, experience, or background so again grain of sand, but overall I would never give money to a school who isn't guaranteeing me the position I want. This is the same as the general studies game many undergraduate schools try to pull.

I don't know what schools you'll be applying to so take my advice with a grain of salt, but biochemistry is a tough science course and it is not an expectation for probably 90% of CRNA programs. It would probably be equally beneficial to retake your basic chemistry course and demonstrate strength in that way. I had a C in chemistry retook it, got an A and moved on. I was offered multiple spots after interviewing, and only one school asked about my grades in passing. As applicants we tend to dissect our applications but truth be told, type/years of experience, overall GPA and certifications are the driving force for most students with GRE included for some schools.