RNJohnny23

Yeah, well I may submit an application to one just for S and G, but I'm not hopeful. All the other things I've read make it sound like you have to already know everything and that the school just confers the degree on you when you're done. I know that's not true, but it certainly seems that way. And now several schools want CCRN, as well, and this whole DNP business is enough to make a guy wonder what is going on. Thanks for the positive comments. Good luck to you in the rest of your program!

You haven't had a job as an RN, either ADN or BSN, yet. Is that correct? You're still a new grad either way. Unless you have obligations locking you into whatever geographical area you currently inhabit, I'd consider relocating when you're done with the BSN. I'd suggest finding a metropolitan area (NYC, LA, Chicago, Boston, Seattle, St. Louis, Atlanta) that fits your personality and start searching there. Heck, these days there are so many online applications that you could apply to several hospitals in several cities and see who gets back to you. Make sure you let them know that you want to relocate and become a part of their healthcare family. you just have to impress on the HR folks and any Nurse Managers you meet that you are a good investment. Good luck!

I just thought I'd follow-up. I did transfer to an ICU and am at the 8 month mark. It's a rural ICU (really a combination of ICU and PCU) and probably not the experience that Anesthesia schools want. Haven't had a Swan and don't think I will, a handful of art lines, but I have had some really awful DKA/Sepsis, Mixed pH disorders, several crash intubations, several pressors and other things. Several, unpreventable deaths. I'm now in-charge on days and several of the staff and management wanted me to take the Manager position when it came up a couple months ago, but that's not for me. I've definitely grown as a bedside RN (we're all RN's, can't we think of something to call me other than "bedside," LOL), but I knew that would happen. I've also been presented with a new career path that I had no concept of before: ACNP. I didn't know what they did, but I do now. Don't know if I'll be able to work that out either, but at least I have what I think is a very strong resume with ICU, Open Heart Surgery, and Cath Lab. So in short, I probably will never join the CRNA ranks, but I have a lot of company there. I did want to thank everyone who responded to this post for reading and responding. It's frustrating to know that you are capable of something, want to do it, but not be able to get things in line to make it happen. Sorry if I offended anyone. Thanks again.

I did IR for a couple of years and had these same issues arise. Even though we had a charge nurse, the director was a Rad Tech. Nothing wrong with that, except they don't understand nursing and try to just send one of the nurses--charge or otherwise--to meetings of the other nurse managers. Or Surgery is supposed to manage this specialty, but spends almost no time in the area. It seems that as far as IR goes, it is an ignored middle child. I'm out of IR and into ICU now. I prefer to be in an area that is more nursing focused. I miss procedures, but not enough to go back.

I've been an OR Nurse for 9 years and just started in a rural, 11 bed ICU (there are no specialty ICU's, just us). Even though I've been a RN for a long time, it's different and stressful! There are definitely situations that I haven't had to deal with or haven't had to deal with in quite the same way, everyday. But I want to go to CRNA school and I had to start somewhere. Everyone on the team and the manager is really supportive. This is the most important thing about any unit anyway and especially important when you're new and learning. Just study things you don't know (I really like ICUFAQS, too) and ask team members you trust for help. Be humble, gracious, and do what you can to help others when you can. That's all any of us can do. Good luck to us all!

I took a job, not a fellowship (not sure what the fellowship entails exactly) as my first job. If it's right for you, you'll know in a month or less, but give yourself a year or two to become competent. Others may not be so nice to you, or downright mean, but that's not the way everyone in surgery is and that's not the way all surgery departments are run. I have spent 9 years in the OR and enjoyed it very much; however, you should really examine your goals for after your first job. I don't see many NP's or CNS's in surgery. Some, but not many. Mostly PA's and CRNA's. CST's do most of the scrubbing and in some places there are Anesthesia Tech's. In that situation, you do very little (in my OR XP I served as the Anesthesia Tech/Circulator). If you have aspirations beyond being an RN and working in the OR and you aren't interested in being a manager or educator, then you might look elsewhere for your first experience. It's not as easy to change specialties as schools make it sound. It's possible, but hard. So examine your goals and find out where would be the best place to achieve them.

I've worked in a few different hospitals and OR's. In all of them the surgeon signs the OR record which I would argue validates all meds, positioning, etc. Anesthesia usually charts whatever they've asked me to give as though they gave it. Standing orders are good, but redundant if the same information is on a preference card. I've heard of OR's where the Circulator has to write a verbal order for everything and the surgeon signs it later. This also seems redundant and silly, especially if the surgeon signs the record too. The environment is very different from floor nursing and many of the familiar things are altered or not present. One simply has to get used to these differences. Or not.

I've worked with several APN's in my 10 years in the Perioperative setting. They were all good people and good at their jobs and I would never disparage any of them. I do wish that we could clarify the differences between the various APN roles, specifically CNS, NP, and CNL. No one questions what a CRNA does, do they? But tell me what does a Perioperative CNS or NP do? This clarity would also help those of us who are interested in becoming APN's identify the best way to achieve our goals and market ourselves. The one thing that does irritate me is when APN's behave and state that they aren't nurses. It's in your frickin' titles! As for this "doctor nurse," thing, there have been doctorally prepared nurses for a long time. Personally, I don't even call my GP physician, "doctor." I call him, Mike, because that's his name, we're all human, and anyone who handles my junk annually is automatically on a first name basis

My background: BSN with 10 years of experience in my specialty area. Function as a resource to administration and less-experienced staff. Am frequently, "in charge." Question: How does a CNL function differently from what I do? Not trying to be a troll or jerk, I just want to understand why we are adding increased role confusion in our profession.

+1,000,000 The more research I do into this whole APN "thing." The less I want to do it. Especially, since my specialty is and would be Perioperative. That's a frickin' mess.

Thr problem with AORN's position statement re: the Perioperative APN is that it is too vague and inclusive. CRNA's and CNMW's have a very clearly defined role already. The Perioperative CNS or NP (or new CNL) have no SPECIFIC DEFINITION of roles WITHIN THE PERIOPERATIVE SETTING. This definition is especially important because these APN's will not function as physician extenders, due to the surgeon and anesthesiologist or anesthetist being present at all times. Already there is a Pre-op RN, Circulating RN, scrub nurse (CST or RN), possibly an RNFA or another scrub nurse, then there is a PACU RN. All these in addition to the surgeon, CRNA or anesthesiologist. There is also Nurse Manager or Director of the Department, who increasingly holds a MSN in Management or an MBA. The Clinical Educator role is often held by someone with a BSN or an MSN in Education. What does the Perioperative CNS, NP, or CNL bring to the team that is unique and valuable beyond the roles that are already clearly defined in the OR? How does such a person sell themselves? I'm asking because this is something that I'm interested in doing, but I'm put off by the very real possibility of having to explain the value of my role to a potential employer.

I didn't mean to offend you. Perhaps, I should have said expanded role? I am a bit offended that you think of assisting in the OR, as somehow less than what you do. At least that's what your comment implies. But let's not argue, we all perform a vital function in the care of our patients, regardless of how much education, certification, etc. we have.

I'm writing this partly to get it off my chest and partly to maybe help others who feel the same.... I don't have a Master's degree, just a plain ole' BSN. Still I consider myself an advanced practice nurse in spirit if not in fact. Here's why: I've been an OR nurse for the better part of 10 years. I've done almost everything a Circulator can do, in every kind of case or situation. I've scrubbed and assisted on rare occasions; never enough to become, or maintain, an RNFA. I have no desire to be a manager. I Relief Charge occasionally, but have no designs on that job and I definitely don't want to be a Director. Similarly, I like teaching new employees and students, but don't want to solely be the Educator. I've worked in Pre-Op and in PACU and am competent, if not exemplary, in those areas as well. I have taken a patient all the way through their Perioperative experience on more than one occasion. I am respected by most all those who I work with be they Surgeons, Anesthesia Providers, RN's or Techs. The facts are that the RNFA role is dying, CNOR is costly to gain and maintain with rare compensation. The NP's and CNS's have to do rounding and office or data analysis, that I don't have to do. I've traded the APN's specialization for diversification. And 95% of the time it makes me happy.

No, I've never worked in an ICU and you're correct that knowing the tools isn't the same as knowing how to use them. But there are ICU's that hardly ever see Swans, like those in rural areas, but according to the letter of most NA schools' prereqs. they would be considered over someone like me. What I'm getting at is that it would be impossible for anyone's experience, regardless of how intense, whether in ICU, CVICU or what have you, to be perfect and complete. Regardless, I'm just frustrated and a bit irritated that even thought I've been assisting Anesthetists for 10 years, in some really hairy situations, as stated above, that I'm not considered qualified. Also, it's annoying that the RNFA, the traditional Perioperative APN, is dying and there is nothing that I've seen to replace it. Anyway, thanks for the response.

I know that this has been asked before in different ways, but bear with me, please. And I apologize in advance for the frustration that will probably come across. Nothing personal :) I would like to know why it is that Perioperative experience is not accepted for Nurse Anesthesia schools? I am well aware that Surgery experience is considered unacceptable by all schools. I'm just trying to understand and alleviate my frustrations. As a Perioperative Nurse (Pre-op, OR, and PACU) in a rural-suburban area, I've worked with Anesthetists and Anesthesiologists for the last 10 years. There are no Anesthesia Techs where I work--there's just me. I set up their central line kits and Swans (as well as programing the monitor), I've trouble-shot the gas machine, vents, and monitors. I've set up and managed all the drips and lines in CVOR. I have handled all the tools of their trade. I know the difference between a MAC and Miller blade. I've extubated patients in PACU, under supervision, of course. I've managed airways while administering Moderate/Conscious Sedation. I've assisted in codes. All that sure sounds like what AANA calls "acute care," to me. So please tell me what exposure ICU would give me that the OR, PACU and CVOR haven't? I mean the way the folks on hear make it sound, there is no "instruction" in the CRNA programs...you just have to know everything before you get there. I'd really like to hear from someone who worked in the OR before becoming a CRNA or, even better OR to CRNA to CRNA Instructor. Again sorry for the tone, but I'm frustrated by my--possibly erroneous--belief that I am just as capable of being successful without ICU as a nurse who has ICU experience, at least in the part of the country I'm from. I know there are things I don't know, but isn't that what school is for?