91CRN

Hi, I really don't think anyone is going to be able to help you decide whether or not to go Army. It sounds like you have excellent credentials/experience, and are a viable CRNA candidate. I am also older, 46 now and have considered the Army; I have about 8-10 years depending on delayed entry etc.. I do know that all your time will count--I don't know if reserve time is somehow prorated. The only REAL information you can get is from a NURSE recruiter; a good one; someone with obivious knowledge about all this. ONLY count on what you get in writing--no promises. The rest is simply a personal choice; if you are like me and you just have to try things--simply hearing about it won't do---then you are in somewhat of a bad position military wise--you don't get to quit until your ETS date. Military training is the BEST, I don't think this can be argued with; but other programs are VERY good. You will work MANY more hours in the Army than as a civillian and you are salaried (bonuses don't even begin to cover your OT; you will almost certainly be deployed (if that is not what you want don't apply). I have personally ruled the Army out. Having said all that; I found my time in the Army to be some of the best years of my life (pre Desert Storm) I was NEVER in a field situation except for training purposes. I wish I could help, I understand the impulse to reach out.....this is such an investment.....all the best 91CRN

Yes, CVICU is cardio-vascular ICU; in my experience primarily post op major vascular cases and hearts.

I have done SICU, MICU, CVICU, CCU and am currently in the E.D. where I've been for the last 7 years--done lots of other things too. I agree with just about everything being said to a certain degree. The biggest thing I agree with is that it's just DIFFERENT. Obviously I prefer the E.D. because that's where I've stayed. All areas in NURSING not just critical care require critical thinking skills. In my personal opinion, the easiest area that I;ve worked was SICU, why?; because it was the best fit for me and my personality--I don't happen to live near a hospital that has a SICU without an MICU component--yuckola!--why don't I like medicine cases?; personal preference of course, they tend to be chronic in nature. No one--no where in my many years of experience EVER worked strickly(or even primarily) off protocol, and in the E.D. it's been my experience that we practice less off protocol than in the ICU--does it mean I'd dis any of my colleagues and the work they do--no--the protocols are there so that when we CRITICALLY recognize something needs to get done--we can do it without getting a Drs order. We don't tend to need them so much in the E.D. because as previously mentioned--we work side by side with the docs most or much of the time (at least in my E.D.). I just have to talk about the equipment. I don't think that machines/equipment should scare anybody; I say that because a lot of new nurses are intimidated and they shouldn't be--they're just tools--in many cases they make your job that much easier--you just have to learn to use them and that's generally pretty easy. I am being required to go back to the ICU; where I've spent years--years ago; to qualify for the graduate program I wish to attend. Does that seem right to you? Oh, I guess now that I'm a student again I should learn to answer the question being asked: I think it's better to get experience in the ICU first before going to the E.D. (and I think clinically the reasons for that are obvious), but I don't think it should be a requirement. One of our best new nurses is a new graduate--she's smart, pays attention, has common sense and cares. It's harder to go from ICU(somewhat controlled) to the E.D. because of the pace, but it can be done--I did it. E.D. to ICU I think would be easier--but go to a different hospital because all the ICU nurses typically think the E.D. folks are incompetent-- Just my 20 dollars worth

I have been doing some reading lately on adult learning styles and learners. I do believe there is evidence to support that the older we get the more we move away from being (traditional classroom/auditorium/lecture) style learners. The up-side to this is that CRNA education in large part is interactive with a physical component mixed in with the mental experiential components; and the classroom stuff is so tied into the practice I really look forward to it. For myself in particular, I've had to go back to school and get more resent science and math courses done. That has been difficult for me. I find it's hard to be SITTING in class then SITTING in lab all day. I am not doing as well as I anticipated and I think in large part it's because I don't really enjoy the classes. I want to become a CRNA so I will stick EVERYTHING out and do my best--apply everywhere and see what happens. It's just very scary to be putting in all the work to get to the fun part of CRNA school/practice and hear that I may be discriminated against because of my age. I really do feel that I bring something more to my practice than chemistry and physics (I do absolutely realize the importance of these), but the human element is still very important; as well as the critical thinking ability you get from years of varied nursing practice. I would really like to hear from CRNAs who started school over 40 and their experiences. Also, I wanted to share that I have had some clinical shadowing experiences lately with CRNAs that have gone thru programs recently, and as far back as 18 years ago--it seems that things have changed quite a bit--it is MUCH harder now to get INTO school and the programs themselves are much more demanding.

I would certainly agree that SICU is the best experience. I have experience in almost every kind of unit. Every one has it's ins and outs. SICU is hands down the most relavent for CRNA training. A previous poster was comparing MICU to SICU and that was very telling. How often will you see sepsis or ards in an OR suite? MICU pts are generally NOT surgical candidates and most CRNAs don't respond to emergencies around the hospital, (at least not in my neck of the woods). Major vascular cases is where it's at. Believe me, I am not happy that the last 7 years I've spent in the ER is (in most programs) not even considered. I've learned a TON in the ER--gotten all kinds of certifications--TNCC-MICN etc., but reluctantly I agree--most of the pts I start on vasoaction I transfer to the ICU ASAP---same with vents. We stabilize and transfer--get ready for the next train wreck. Critical thinking, you betchya, critical care--not so much--long term that is. On the way by. I am pretty old--45 and am hoping to apply to CRNA programs next spring/summer. I'd like to hear more about this dirty rumor that the over 40's statistically have a higher failure rate. Can anyone with news on that front post or PM me please? I think I read that in one of the CRNA threads here. I've been heavily researching programs/statistics and have not run across such a thing:( Hope it's not true!

Drifternurse, Thank you for your sensitive reply. I really do understand the issues regarding time and getting all the patients treatments done while trying to honor their needs and preferences. It is precisely my point that something like dialysis that requires fragile/at risk persons with multiple morbidities to be 3-4 hours in a recliner should be set up in a different way. As I previously stated, this is a way of life. From the patients point of view I just don't think that trying to keep such rigid schedules etc. is the way to best serve. Having said that, I don't have any viable ideas on changing the way things are done at the present time. A personal dialysis machine for everyone who needs it and a home health nurse who specializes in the treatment--and or training for family members and patients who are able to manage this on there own and are candidates would be my first choice:) I know there are wonderful nurses and technicians out there who do their best with the broken system we are all serving in.

I've never been a dialysis nurse but my brother was unfortunate enough to be a dialysis patient. I've read thru some, not all of this thread--maybe I missed a few things. My overall impression of the 4 dialysis centers I have observed is that they are basically like factories. My brother was terrified of being even a few minutes late for treatment because he said the nurses would treat him poorly--I witnessed this first hand. He had intractible nausea/vomiting and it was sometimes very hard for him to get there on time--he did the best he could. I am almost positive that the policies regarding incontinent patients probably vary widely. The units that I observed would not have cleaned the patient--ANY variation of the planned dialysis was simply not in the equation--their days were absolutely packed. A good friend of mine from the ICU took a short stint in a dialysis unit (basically doing the director who was a friend a favor), she quickly resigned; she made it sound horrible; like a conveyor belt--anything out of the ordinary and that was IT your day was shot. My brother's life was a living hell primarily because of his disease--made worse by being chained to a dialysis machine 3 days a week. I wish there was some way to uninstitutionalize the whole process. This is a way of life for these poor patients, especially those people who cannot afford home dialysis, or who live in rural locations and must travel great distances for treatment. Healthcare should be a basic human right. Dialysis centers should not be set up so rigidly as to not account for the individuals needs.

Does anyone know if there were any accessory charges made in this case? If her psych professional was charged with anything, if her pastor/priest was charged with anything? The case for child endangerment here is so strong; I'm very surprised to see that her husband was not charged/convicted of that at the very least. Do psych professionals have the same failure to rescue issues as the rest of the medical field does? I'm pretty sure that clergy members have mandatory reporting mandates as well. Any thoughts?

Yoga, I will miss your postings. I find you objective and insightful. I know where I'm going to go now for CRNA school. You take care---BREATH and STRETCH. You will be missed AND you made a difference for ME! I'm going to sign off too. I agree too much with the, (why are nurses so catty?) thread, and it creates too much negative energy to reply kindly in any meaningful way. Besides, I HAVE TO STUDY:) Regards, 9lCRN

Yoga, I read your posts with great interest. Thanks for your contributions. Have you come across anyone in your practice from the following programs and could you give your opinions on these programs if any: OHSU--Portland, OR--new Samuel Merritt,Oakland, CA Kaisier Permanente,Pasadena, CA Duke, Chapel Hill, NC UNC Charlotte,Greensboro, NC CAMC, WV Albany Med, NY Have you heard a lot of favorable stuff about a particular program in general? Thanks for any and all, 91CRN

why would you use lido in the back of a rig---? my thoughts on this are basically my thoughts on most things. rn's need only assess the situation. if lido would be appreciated/warranted USE IT. if not, don't. i for one customize my practice to the situation. lido is easy and fast but in my experience it's the fear of the needle that people object to--and in the case of lido you are giving them two needles to object to and that's if you are in on the first try. hey in the ER we are all experts; but all of us can miss on that dehydrated 100 year old or 300 lb diabetic; in the case of infants and children--it's widely understood that their issue is fear and being held down--get to it and make them better asap. if i was prepping for surgery or some otherwise scheduled case, i'd do what i always do--collaborate with my patient--if they are unable to do so i make my best judgement--but i certainly consider it.

ICU, You sound like you have it all together. I wish you all the luck in the world. Where do you plan to apply? I will finish my BSN (hopfully) by July of 2007. I will apply to Samuel Merritt in Oakland and Kaiser Permanente's school in Pasadena, I'm not sure about others. I have years of old ICU, SICU experience but am in the E.D. now. I completely agree with your finding that even the most experienced nurses come across things they are unsure of. The ability the think on your feet, stay calm, use resources well and prioritize, is what it's all about; that along with a good knowledge base I hope to see you posting as a CRNA along with me in a few years. Take care, 91CRN

Dreamer, My history is very similar to yours. You were hired because you were talented and your talent was known based on your colleagues exposure to you. Most RN's are hired strictly by virtue of our licensure. This is quite a dilemma for a lot of units/admin. It seems we work in a volume BUSINESS, everything has to be streamlined and that includes hiring practices; therefore protocols are put into place to reduce liability all the way around. This is good and bad. We wind up hiring a lot of people that look good on paper; but you can miss out on the actual talent. Having said that, I have come around to be one of those that doesn't believe an LVN should be in the unit. In CA the scope of the LVN is limited--making it difficult for an RN to "oversee" the LVNs work; I believe that this makes the LVN obsolete in the ICU here. Furthermore, I have become a proponent of the idea that RNs should be BSN trained. I am not yet a BSN; but I am becoming active in the politics, basically to try and help turn around our embattled profession. Because professions are valued (in part) based on the level of education that is needed to qualify for licensure. I believe it is essential for our professional image; which in turn would help us gain the professional foothold we so richly deserve. I want to stress the point that in my experience I haven't found that BSNs are any better than diploma RNs. I have seen a wide variety of good and bad in both cases and would agree that BSN programs need to become for clinically focused so that graduates can actual perform the job and not just write a paper about it;) Nursing today is facing some big challenges none the least of which is POLITICAL. If we want to go forward and help the public to fully actualize the value of our profession. I believe the BSN is a necessary step.

The point I have been trying to make in this thread is that if you really look at the course-work and clinical/case hours required to become a CRNA (in total) you pretty much have a doctorate. I never meant to imply that CRNAs are over-trained/educated or anything of the sort. I agree it's an important job with a lot of autonomy and the patient deserves the utmost. I do think that if even more education were to be imposed that the logical person would start to weigh in medical school--especially since (as I posted earlier) the odds of getting into med-school are starting to look better than CRNA school and the prerequisites are similar--and in many cases easier (as I also pointed out earlier in the thread--many med-programs are weighing liberal arts backgrounds much more heavily than they used to). Also, look at the first year of medical school, sure you need chemistry, math, but it is expected that you will learn in medical school what you should know to become a MD. For CRNA school prospective students need to be able to hit the ground running with these courses FRESH under their belts, recent extensive ICU experience 3.75-4.0's, killer GREs, the ability to absolutely DAZZLE in an interview--(yes yes--I know many programs don't list these as minimum requirements, but when the competition is so great--you'd better to have any hope of getting in). Anyway, I digress. I just wanted to drive home how absolutely educated and prepared one has to be in the first place to get into a CRNA program--add that to the 50++credits and all the clinical time--that's a doctorate already!!!!! Look at the requirements for a PhD in any other field and see if you'd disagree with me. Nurses are cheated because we aren't given credit for clinical time. If you are going into a clinical field like anesthesia--that just seems crazy to me.

Amen to that!