DesertSky

Why would you even consider CRNA school without ICU experience? Would you honestly feel confident and prepared to step into an OR as a SRNA and manage critical patients with only "book knowledge" versus real life experience? CRNA programs require ICU experience in order to show an applicant has become competent with patient assessment, managing and understanding multiple different kinds of monitoring devices and equipment, and understanding the complex management of patients who are actively trying to die on you your entire 12 hour shift. There is already a steep learning curve going from an experienced ICU nurse to a SRNA. Set yourself up for success and get some ICU experience before taking on such a demanding and intense goal.

No way. A charge nurse needs to be an expert and a resource on the unit. You are the go-to person to help in a crisis or take a patient assignment if the unit is slammed. Also, if an organization will hire you as a charge nurse in a critical care unit without critical experience, RUN!

Thanks for the information!

Do you think there would be anyway to negotiate days I work in a travel contract? If so, I could keep my foot in the door at my current job, but would be able to do a contract and help a hard hit area.

All of my AGACNP clinicals are cancelled for the rest of the semester and as of right now there is a possible my Summer semester clinicals may be on hold. All of my in-person NP classes have switched to online for the rest of the semester which is disappointing as I went to a brick and mortar program for a reason. Though these are bumps in the road, it's important to focus on the larger, more important picture that we need to be diligent in managing and preventing further spread of this pandemic. As a working critical care nurse, my area of the country is just starting to get our first COVID-19 patients as of a few days ago. Keeping my fingers crossed we will have enough PPE and ventilators....

Thank you for your thorough response. I should have been more clear in my initial question, but you addressed what I was asking - I was referring to a "no code" in the case that the patient has already been intubated. It was also interesting to hear thus far, COVID patients on mechanical ventilation have not been given paralytics in your practice. I was wondering about this as we often given our patients in severe ARDS (obviously not COVID patients) paralytics as a last ditch effort to help their respiratory status before considering ECMO. Your right about possibly running the risk of running out of paralytics as many of these patients are taking a long time to recover and come of the vent (if they do recover).

MunoRN - Thanks for sharing your findings thus far. I had read similar information coming out of Italy regarding patients having severe cardiac issues with low EF's resulting in cardiac arrest after some of the COVID-19 patients started to improve. In Italy, I know some hospitals are not performing codes on these patients d/t there being nothing more than can really be done. Has this been discussed in your institution?

Been fielding calls quoting $4,000-5,000/week for ICU RN with 48 hour a week requirement in NY and NJ. Tempting to take...

I work in a busy, urban level one trauma/surgical ICU - we see a wide range of injuries including lots of penetrating wounds like gunshot wounds and stabbings, MVC's and motorcycle accidents, and suicide attempts. We do lots of procedures ranging from chest tube insertions, percutaneous tracts and PEG tube placement at the bedside, IVC filter insertions, assist with central line, arterial line, and dialysis line insertions, intubations/reintubations, and run MTP's. There are lots of behavior issues working in trauma ICU because the patient population can be difficult to work with and often have lots of social issues. As others mentioned, this can be draining and difficult. You said you "have a good understanding of general critical care," but with all due respect as a student with one semester of critical care under your belt, you still have a ton to learn. Go into the rotation with an open mind, be willing to jump in and help your preceptor and other nurses on the unit, and ask questions and research topics or questions that arise during your clinical time.

Wow, it sounds like your organization has a great residency program! I would love to hear where if you don't mind sharing with me. It will be interesting to see the research regarding how NP's who completed a residency fare compared to those that do not. Perhaps that data will encourage more organization to offer NP residencies and validate that they are financially beneficial for the organization as well as beneficial for new NP's entry to practice in terms of boosting knowledge and confidence.

Thank you! PM sent.

How long is the critical care fellowship at your organizaton? Does the fellowship rotate students through multiple specialties or focus on a specific unit? Thanks in advance!

ArmaniX - that's good to hear as a current AG-ACNP student! I currently have 6 years of high acuity ICU and ER experience as well as my CCRN. By the time I graduate, I will have over 7 years. It's always interesting to hear about people's transition from RN to Acute Care NP as well as how much experience they had at the bedside. Did you have any difficulty finding an Acute Care NP position? Thanks for your time.

I am hoping my 7+ years of high acuity ICU and ER experience counts for something when I am looking for my first Acure Care NP job after graduation next year.... I am actually looking at trying to get into an Acute Care NP residency even though the first year salaries are lower than many jobs. I feel like that will bridge the gap to practice and also give me some great connects at many of the academic centers and teaching hospitals where they are offered. I'll take a lower first year salary for the extra support and experiences offered by Acute Care NP residency's offered at places like Emory University and UPenn.

While I have seen a surplus of FNP's in my area of the country, Acute Care NP's are still in demand. Most of the job postings I see for Acute Care NP's specify 3-5 years of progressive RN experience as a requirement. I feel this will weed out those without significant RN experience who quickly jumped from their BSN to grad school. If you want to work in an inpatient NP position, only Acute Care NP's are being hired as well. As a current Acute Care NP student, reading forums discussing the possible NP oversupply make me nervous and a bit anxious about the long-term job outlook in the profession. However I do feel I attend a rigorous program and I am happy that my school provides all preceptors. By the time I graduate, I will have over 7 years of ICU and ER experience as well as my CCRN, so I am hopeful that will count for something!

Thanks for sharing. I will gladly trade the physical stress for mental stress. I totally understand the consequence and weight of the decisions I will be making as a provider versus a bedside RN. That is why I have worked at the most challenging hospitals in the most challenging units to prepare the best I can clinically as a nurse before pursuing the NP role. It's great to hear you love what you do and thank you for the advice on what to look for in a NP job.

Thank you for sharing your thoughts and experience. You bring up some good points on the stressors being different in the RN vs. NP role. I do feel like much of my burnout is feeling overwhelmed with bedside care duties and not having enough time in the day. Nothing like having one crashing trauma patient and then getting a new unstable post-op patient from the OR. You give some great advice to find a unit that will work for me.

Congratulations on approaching your first year as a NP! It sounds like you really prioritize self-care and ensuring you are not over extending yourself. This is great advice as I'm sure it help to create a work/life balance. You also bring up a good point that there are many other areas outside the ICU that AGACNP's can work. I've always thought it would be interesting to work on a hospitalist team or in a speciality if I wasn't a NP in the ICU setting.

Thanks for your input. I'm wondering if my current job setting is what is contributing to my questions. Both the RN's and NP's on my current unit have to deal with some pretty intense situations and I feel there is a lack of support. I hope to find a AGACNP position that allows a work/life balance, but as a new grad this may be tough.

I'm curious to hear if anyone has any regrets regarding becoming a NP? If so, what do you wish you would have pursued instead? I have a few concerns that give me pause such as over saturation of NP's and provider burnout. What if I go through NP school to not be able to find a job? What if I get burned out as a NP? I have been a critical care nurse for over 5 years and I'm not sure if my feelings stem from stress from balancing work and school, or if it's second thoughts creeping in. I'm halfway through a MSN AGACNP program at well-respected, brick and mortar school where my preceptors are provided. I work in a level 1 trauma center ICU and see how hard our AGACNP's work and that a number of them seem to be rather burned out from the sheer amount of work and responsibility they constantly have on their plates. I would love to hear thoughts from anyone who would be willing to share.

I'm curious to see how the demand for AG-ACNP's compares to FNP's? As previously mentioned, about 75% of new NP grads are completing their FNP. As a critical care nurse with years of clinical experience attending a reputable in-person brick and mortar program that finds my preceptors for me at level 1 trauma facilities, should I be concerned about being able to find a job after graduation? It seems like there are way fewer nurses going the AG-ACNP route, so I'm hoping that makes a difference....

I have a question I'm hoping someone can assist me with. I am currently looking for a PT job, but only see FT jobs posted. Would it be okay to apply to a FT position and then speak to the HR recruiter/nurse manager more about the position once we speak? There are a number of FT positions open in the department I am looking to work and I would assume a PT employee is better than no employee...? I'd appreciate any insight or experiences you can offer. Thank you!

I just saw your reply about not being able to relocate out of Florida due to elderly obligations. Would it be possible for them to move with you? I know that's not a always feasible, but worth a try? You can always reevaluate if your current situation changes. Good luck

BabyBoss19- Congratulations first of all on finishing your PNP! Whatever you decide, your years of wonderful experience will serve your patients well in either role! I have one year left in my NP program. I understand some of the thoughts and feelings you are having although I don't have as many years of bedside as you do. I work in critical care and one of my coworkers is a very experienced nurse/turned NP now back at the bedside after working as a NP for about 5 years for various reasons that are similar to yours. One thing to think about and consider is how long you will physically be able to work as a bedside nurse. Nursing is a physically demanding job. One injury can be life changing. Working as a NP will allow you to work for many more years in my opinion than if you stay at the bedside. Just so something to consider. I also feel you will be able to find an employer willing to pay you more based on your experience and will provide the ability to move up as you prove yourself in your new NP role. You will have to be flexible and may have to move to find this opportunity, but it's out there! Good luck 🤗

I was wondering if some ACNP's who work in the hospital setting could share what positions they hold. Most of the ACNP positions I have seen or ACNP's I work with are working in ICU. I have a background as a critical care RN, but I was wondering if there were also other inpatient areas where ACNP's are used. Thank you in advance! Michelle Camden