EtherFever

While I am an SRNA, I am not in the Raleigh program... I go to a neighboring school. But many of my friends/former co-workers are in the Raleigh program and they love it. However, they have told me it is a pretty steep learning curve in the beginning, due to it being a "truly integrated" program. They were in clinical within the first or second month of starting school, while my program wasn't in clinical until 2nd semester. We all talk about school with each other and from what I understand, the first few months were rough in the OR for them because some of the didactic hadn't been presented to them yet. On the flip side, I got some didactic that didn't quite make sense until I got into the OR. They get some good experience with interesting cases (neuro, cardiac etc.,) however was told that regional/neuraxial experience was difficult to come by. I do know that they have produced some great CRNA's, as I've been precepted by a few former Raleigh grads. Hope that info helps a bit!

1. Desire to learn & maximize potential 2. Adaptive & quick to learn & apply (mechanically inclined, tactile learner etc.) 3. Humble & willing to accept criticism (Thick skin) 4. Organized, type A, OCD 5. Ability to prioritize Currently in school. The ones who didn't make it out of first semester were missing one or more of those characteristics. GPA, GRE, work experience... those may help, but personality traits probably play the biggest role. Some of the people in my class who are doing well had lowish GPA, GRE, or limited work experience, but are doing great, and they have all of the above personality traits.

My program is somewhat in between. First semester is all didactic with 2 weeks of OR shadowing near the end. Then starting second semester its 2 days a week of clinical. From there on out the number of clinical days increases while classes decrease. I don't know about the experiences of people in other programs, but I'd imagine that being in a fully integrated program (Clinical from the start) would be difficult without at least a baseline knowledge, and a truly front loaded program might also be difficult as some people need to have hands on to really understand & apply the didactic. I'd say, think about how you did on orientation as a new RN. And be honest with yourself. If you feel like you picked up quick and learned things best by demonstration and practical application, and were quick to learn and apply, then front loaded might suit you well. If you need to learn all of the why's to understand, then didactic would probably be better. If you are one of the latter, being in the OR with CRNA's with high expectations is probably not a good idea.

It depends on the school. Just ask the program director. I do know, that my program weighed pretty heavily on the math portion of the GRE.

I'm a little surprised that ID doc said it like that. I'd understand letting a patient have a slight fever, but your patient's hemodynamics are priority. Fever & sepsis causes increased metabolic demand, and eventually cause other hemodynamic changes i.e. hyperdynamic state... low BP/SVR vasodilation, crazy high CO, high SVO2 r/t decrease oxygen extraction by tissues, shifts in your oxyhemoglobin diss. curve etc. Also, in a CCU, increased metabolic demand causing tachycardia is prob not the best thing for that person's cardiac function.... not sure about the specifics w/your patient. In the end it depends on whether that fever is high enough to start causing the patient to become unstable. If the pt is unstable, and the doc was still adamant about not tx the fever, I'd advocate, and if no result would then seek higher powers.

As an ICU preceptor, I do recommend starting out somewhere other than the ICU. The learning curve is super steep, and in addition to learning how to be a nurse, you are having to also cram in tons of other learning i.e. hemodynamics, vasoactive meds, multiple support devices etc. It's often difficult enough for experienced nurses who come from various units, let alone a brand new nurse. Not to say it can't be done, cause there are a few new grads here who have done exceptionally well. But on the same side, there are new grads who scraped by, and are still struggling off orientation. One happy medium, might be to start on a stepdown/tele unit instead of med/surg. Patient acuity is higher, you get some exp with vasoactive meds, intro to critical thinking, and overall confidence etc. It's a great way to get you prepped for ICU. Several of the new grads who did not do well in ICU orientation, ended up going to the stepdown, and after a year are now getting ready to come back to the ICU. Way back when, I started on the stepdown as a new grad, and I had a much easier time transitioning to ICU, compared to other people in my group who were new grads. If ICU is your ultimate goal, then talk to the ICU manager and see if they would consider hiring you after a year of stepdown experience. If so, it might be possible for them to secure a spot for you. I know it's not always possible, but that's what happened with me. I let them know that ICU was where I wanted to be, and they saved a spot for me, so that right at my 1 year mark, I started the transition process into ICU.

I'll be starting CRNA school in 3 weeks, and the road to get there is not easy. It can be fairly difficult for new grads to get into an ICU right out of school, most ICU's prefer RN's with experience. As a preceptor who has precepted many nurses in the ICU, including many new grads, I can tell you that the ICU is a difficult place for brand new nurses. On top of learning how to actually be a nurse (i.e. time management, organization, basic skills), you are expected to learn about complex hemodynamic interpretation, learn about all sorts of gizmos and gadgets etc. I started on a stepdown right out of school, and had to move out of state to find a job. Then transferred to the ICU and got some good experience. Total nursing just shy of 5 years before starting CRNA school. Remember too, not all ICU's are equal. CRNA schools are highly competitive and they will only take the best of the best. There were 200+ people that applied to my program, only 50 got interviews, and only 25 actually got in. Keep in mind, that many ICU's are now having new graduates sign work contracts to try and prevent the high turnover of nurses going back to school. Yes, most CRNA schools only require 1 year of ICU exp, but IMHO 1 year is not enough. That first year, you spend 3-6months on orientation, then the rest of the year just trying to survive. CRNA's are highly autonomous and depend on prompt decision making and keen critical thinking skills. This level of autonomy and skill is not usually obtained within that first year of being a "novice" nurse. Some of the nurses on my unit who just reached their year mark are talking about submitting applications to CRNA school, yet are taking care of the least sick patients on our unit, and haven't developed that autonomy/critical thinking. Naturally, they are having difficulty getting good recomendations for CRNA school. If you are going into nursing, make sure you go in for the right reasons. You will earn every single penny. It is not a glorious job, but if you get into it because you like helping people, then you will enjoy it. Many new nurses where I work, who are "second career" nurses, got into it because it was considered a stable job with decent money. They aren't bad nurses, but they aren't spectacular either... I think some of it has to do with motivation/reasons behind getting into nursing. It's true it's a job, but it's alot more than that too. Same with CRNA. There is a reason behind why CRNA's make the salary that they do, long hours, call, and an extremely rigorous program. Many CRNA's that I've spoken to say that if you go into the program soley for the money, you either don't do well in the program, or don't find true enjoyment in their role. IMHO, if you feel like you are drawn to nursing because you enjoy caring for people, or if you are drawn to CRNA school for reasons other than monetary, go for it. However, if your main reasons are for money, stability, or "just something new", you may want to stick with what you've got, and expand on that. Nursing & CRNA, are huge investments of time & money, and there are tons of trade offs... you just have to determine if it's worth it.

Awesome thanks for that info, we weren't sure if the balloon actually counted the augmented pressure in it's mean calculation. As far as this particular pt, you're right, no need for the balloon with ecmo, but it was placed before they crashed this pt on ecmo, and we kept it in assuming he'd need it if we were going to attempt weaning off the ecmo in a few days. Plus, after talking with some of the perfusionists there is some benefit with coronary perfusion r/t counterpulsation since w/direct aortic cannulation the cannula sits above the root, and w/axillary comes in at the arch. Not sure if this is evidenced based or just case by case based.

I'm not looking down at floor nurses, nor am I calling them glorified waiters. I'm simply making a comparision that some days as a floor nurse, I felt like one ex. having a busy day r/t to the multitude of small and insignificant things that patients ask for. And I'm not saying its always like that. I do respect floor nurses, as they have to catch small details that hint at a patient about to go downhill, with less concrete numbers available compared to the ICU. Floor nursing is difficult, but in ways that differ than in the ICU. ICU nurses where I work are usually very aggressive in advocating for patients, are aggressive in getting things done in fast but in a safe and correct way. We do this to stay 2 steps ahead in case something unexpected happens. Sometimes this personality can come across when giving or getting report from floor nurses, hence the idea that ICU nurses look down on floor nurses. Some strongly opinionated ICU nurses that I know don't care what other nurses think of them, so this can come off as standoffish. I personally do not look down on floor nurses, nor do I think I am better than floor nurses. I'm just offerring some perspective as to the reasons why some of us are the way we are. Since I do have floor nursing exp, I try to apply that to my practice i.e. changing dsg in the am so they don't have to do them, getting an extra walk in with my pt so it's one less they have to do on the floor, etc. I am more patient when giving or receiving report, because I do remember how it was on the floor. And I try to help other nurses on my unit, specifically the newer orientees, in understanding floor nursing, and in trying to dispel this attitude that ICU nurses are superior to floor nurses. So I hope this clarifies my previous post, in that I do not support the idea of ICU v. Floor nurse, I'm merely stating the reasons why it exists. ICU & floor nursing...It's all apples to oranges, and unless you've done both, it is difficult to understand.

Hey all, A question for people who are familiar with IABP. The other day, we had a patient on ECMO with a balloon, and the MAP on the balloon was reading higher than the systolic pressure on the balloon. Something like 67/47, mean was 74, Aug 100. We were talking with perfusion as most of us had never seen that before... and trying to figure out how that could happen. Does the balloon use the augmentation i.e. peak assisted systole for calculation of MAP? That was one of our possible explanations for this, however even after we had switched it to 1:2, unassisted MAP was still higher than unassisted systole. Naturally, we re-zeroed, changed out console etc, with same results. So I started thinking a little deeper. I wish I could post a pic of the waveform, but this is an explanation of what it looked like. Systole, dicrotic notch, augmentation, then insted of normal drop to diastole, a small increase then decrease, sort of like a chair... was told it was a bicuspid waveform during diastole. So I understand this can be r/t inappropriate sizing or positioning as normally with the iabp, a significant amount of blood has been displaced which is why there is normally a steep decline after augmentation.... however if the balloon is inappropriately sized or position, more blood is left in the aorta during diastole resulting in that bicuspid waveform. So normally, the monitor & balloon calculate arterial MAP based on it's on hemodynamic curve and everything underneath as opposed to the (SBP+2*DBP)/3, which is why your cuff BP does not equal your art BP even if the MAP is the same. Could that increased diastolic pressure (r/t bicuspid waveform) cause the balloon to calculate out the mean to be higher than the systolic? Another possible explanation to that waveform other than inappropriate balloon sizing or incorrect position, the patient was on ECMO w/direct aortic art cannulation, so possibly high flows could alter the art waveform on the balloon? If anyone has any expert opinions or explanations, it would be much appreciated. Trying to expand my knowledge here :) Thanks!

Craymond +1. As an icu nurse, and a former stepdown nurse, I will say that floor nursing is not easy. But it's on a whole different level of hard when compared to "hard" in the icu. In the ICU, the bar is set high as far as nursing expectations, critical thinking, & pathophysiology, and any momentary lapse has grave consequences. I felt like a hard day on stepdown was related more to difficulty with multiple tasks and completing them... honestly some days I felt like a glorified waiter. Nowadays, I feel like a hard day in the ICU is both physically and mentally draining, as there is no time for a "mental break," and you are constantly problem solving and trying to stay 2 steps ahead. I know that many of the floor nurses where I work do look at ICU nurses as snobby, standoffish, elitist, & aggressive. However, just know, most of the time it's nothing personal. I think part of the aggressive attitude has to do with the type of personality needed in the ICU. Additionally, 99% of the time, ICU nurses are under crazy time constraints, especially when it comes to transferring patients out to admit crashing or fresh post-op patients. That's why we always seem in a rush & why we are ancy to get to the nitty gritty.. again nothing personal, but just a little insight from someone who's been on both sides.

^spot on above. Work on getting good quality ICU exp, i.e. sickest of the sick type patients. Additionally, you could consider taking graduate level classes to show schools you are able to handle a grad level course. A couple of my classmates did this because their undergrad gpa & science grades were not stellar, and they are fine. Remember, it's more than just one thing like gpa, schools will look at the whole package.

Yup, if you still have 2 years until you start you will be fine. It comes with time and exp. I had similar reactions when I was getting ready to apply, by the time I got my app in I was feeling comfortable, and that last year after I got accepted made a huge difference in the way I felt. That uneasiness and panic was gone, you feel like a competent level headed nurse during those situations, and feel prepared for school. One way to improve on this, is to get involved, even if it's not your patient. If there's a patient who is looking like they might go downhill, get involved to find out what has been going on and starting working on figuring out potential causes i.e. diff diagnoses. Start working on that and getting familiar with that process now, so that when the s hits the fan, it will be more like 2nd nature to you. Hope that helps!

Hey SIguy, It's great to see potential applicants who do heed alot of advice on the board about really gaining the experience and having great reasons to want to be a CRNA. All too often, I hear newer co-workers and posters on here, about "the bare minimum" required to get into school. I even asked one of these people, "Why CRNA?", and got a deer in headlights look with a "I just like it" response.... sounds like you've done your hw and shadowed and are truly interested. I will be starting my program in a few weeks. I did want to tell you, that I initially had planned on applying for the previous year. I had taken my GRE, gotten my CCRN, had 2.5 years of exp in the CT-ICU, 3.5 years nursing overall. But, I decided to wait another year to truly become an "expert" in my field. And I will tell you, waiting that extra year has made a HUGE difference in my knowledge, confidence, autonomy etc. So again, I commend you on wanting to do it the right way. Sounds like you have a good game plan. My advice is to start working on your CCRN & GRE. On your unit, try to take any advanced unit classes to get trained on devices i.e. IABP, ECMO, or whatever is available where you are at. You want to be able to handle the sickest of the sick on your unit. You should be comfortable identifying issues and presenting solutions, as well as being assertive with your decision making. Get involved in precepting. See it, do it, teach it. You will learn more about yourself and gain a whole new wealth of knowledge by precepting. Get involved with your unit committees and become a leader on the floor. Other things you can do to help you stand out: Take graduate level classes i.e. adv A/P, pharm, chem, physics. This will not only boost your gpa but will also show schools that you can handle the graduate level workload. Also, most hospitals will cover some school tuition/expenses. Make sure you are financially ready. Remember, most schools will ask you for a $500-1000 deposit at the drop of a hat. Some schools may require you to front the cost of tuition for the first semester, depending on how the fed assistance gets reimbursed. And some schools expect you to live off a crazy meager budget while in school. My advice, pay off everything you can now. If it means not buying a new car, then don't. Live frugally now, and save your pennies. You will know when you are ready to apply. I knew, when I started wondering why people always came up to me for advice, and opinion, or help. When people casually refer to you as a unit resource, when providers are comfortable with bouncing ideas off you or accepting suggestions and advice, and when you are financially and emotionally prepared, you'll be ready :) Hope that helps and good luck!

FYI, I interviewed and accepted a few months ago. Out of 15 in my interview group, 14 had their CCRN. About 10 came with 2-5 years of ICU exp from larger level 1/academic hospitals. I think there are 4 or 5 of us in our class from my interview group. Trust me, you want to stand out, and not in a negative way like the only person who didn't have their CCRN. I think with CRNA school being so competitive, you almost have to have your ccrn just to be on par with other candidates. Also, that person didn't get in. It may have been b/c of other reasons, but who knows if the CCRN would've give him that edge.

Also look into shadowing CRNA's as early as you can so you will understand exactly what they do. Shadow multiple times and ask questions. I've met a ton of nurses who want to go to CRNA school but have no clue as to what they do. :) and SAVE SAVE SAVE.

I agree too, that you should apply to a few programs. There's a healthy balance between applying to too many schools "just to get into CRNA school" i.e. getting into a "crna farm school", and having options available. Research the other schools you might consider... who knows, you may find it's a better fit for you. Just because a school is #1 doesn't necessarily mean it will be the best program for you. Some things to research: 1. Find out class size, usually smaller means less students per instructor 2. Same with clinicals, I know of a few friends who are in large programs, and have 2 students per OR for clinicals... not ideal when you are trying to learn how to be an independent practitioner. 3. Clinical locations: do they offer a variety of experiences i.e. rural vs non rural vs academic center etc. What about peripheral blocks, epidurals, central lines, etc. Some schools only offer exp w/peripheral & spinal blocks in sim labs only. 4. Cost 5. Faculty- check out the schools in person, make an appointment to meet the director, see if you can speak to staff. Checking out the schools in person will give you a good feel about how a program fits for you. 6. Front loaded vs integrated program- there's isn't a clear benefit with one or the other, it's more about how you learn best and what suits your learning needs. If VCU is the closest school to you, I can think of a few good programs in the vicinity. You might have to relocate a few hours, but if you find the program that best fits you, wouldn't you want to be at the program? I applied and got accepted to a few programs, in the end I feel like I picked the school that works best for me! Good luck and hope the info helps!

Maybe a typo for PEA arrest i.e. pulseless electrical activity... electrical conduction of the heart without mechanical capture/pulse. The only other medical abbreviation I can think of for PA would be pulmonary artery but that wouldn't fit with arrest. Other abbreviations... maybe post-admission arrest... PEA makes the most sense though.

It's not so much the drug calculations, but the experience of co-morbidities you run into with adults and older adults that affect your anesthesia delivery plan. Yes peds & adults are two totally different worlds, but you simply don't run into comorbidities in kids like you do with adults, & the proportion of adult cases is much higher than peds. Some schools will take NICU experience, I think there are 2 NICU nurses and 1 PICU nurse in the class before me, and they are doing fine. But there was another post on here or over at *allnurses.com CRNA forum* about a peds RN SRNA who kinda froze when having an issue with an adult patient with multiple co-morbidities. She ended up doing fine, but there was def a lot more she had to learn, simply because she had never been exposed to it. I'm not saying NICU exp isn't good or valuable, just giving you an idea of why some schools may not consider it as pre-admission exp. Hope that helps and good luck!

Are you applying to a CT-ICU as an internal transfer or applying to other hospitals? I'd say, try to find out who the nurse manager is and contact them directly. HR can be super slow in getting your info to the nurse manager and a job posting online may be gone by the time you apply. Get in contact with the NM directly, talk about your strengths and reasons for wanting to get into CVICU... ask about shadowing, and make a good impression on staff. AND, follow up constantly... it may feel like you're being a pester, but it's all about keeping your name at the forefront of their memory.

If you're even remotely considering graduate school, be warned, every grade does matter. If you're thinking CRNA school, be prepared to answer when they ask about your general chem & bio from freshman year... Getting good grades now will save you a ton of hassle later if you decide to go for grad school. All of the people I work with that had "acceptable" GPA's