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!

Wow, very impressive.

Hey--no fair. This is an on-line forum. I wasn't writing a paper/essay. You JUST SOUND MEAN. To be more to the point--as if the first sentence of my last posting didn't say it all---This is a thread about the fact that CRNA's may, in the near-future be required to have a doctorate. NOT about entry levels of education for RN licensure. The rest of my post was me reacting to you--so I won't bother to explain it to you as it wasn't important. I know you aren't a CNS--I wasn't writing about you!:angryfire

I thought the conversation was about CRNAs requiring doctorate degrees!!! On your assertion that O-chem isn't that useful in the practice of anesthesia--FINE, I don't even practice yet, I'm still jumping thru all the hoops to get into a program; a lot of programs want o-chem, bio-chem, physics--sound familiar,'''''''' yes it does--pre med. I should add that many medical schools are wising up and actually accepting applicants with more of a liberal arts background!! Like I said, I just want to provide anesthesia, I didn't make these things true and if I could change them I would. BTW I am a less than BSN--RN(will be for another 2 semesters), and you can bet your '''''' when the'''''' hits it, my colleagues would rather have me around than the CNS or any other ''''''''poser running around our hospital!!!!!!!!!!!!!!!!! I agree that a BSN should be entry level--BUT NOT FOR THE REASONS YOU DO!!!! OH YES, JUST STIRRING THE POT.

Hey, I was just reading up the thread and realized that I repeated things already said--so do forgive--but glad to drive these points home. Also, I wonder why it illicits such anger when an RN brings up comparisons to MDs? Of course we all know we have a different profession. I think we are all sticking our heads in the sand if we don't understand that the further you go in nursing--CRNA, NP, RESEARCH---whatever, the lines DO get a little blurred--not that as an RN I want to practice medicine--but hey, I just had some more clinical shadowing pre-CRNA program--looked in on cases with MDAs and CRNA's and guess what--same job--the overseeing by the MDAs was minimal if not non-existant and dare I say for the record ONLY. I really don't care who out there is kidding themselves. I just want to provide anesthesia as my specialty, I'm willing to put in the work to get there--so what if we do the same job minus a twist. I JUST became aware of the existance of Anesthesia Assistants and looked at the programs for this specialty too hhhmmmmmmmmmmm---I don't care what the CRNAs say about that either--looks like the same preparation to me--I haven't interviewed any of those folks yet though. Just saying, if CRNA programs DO the work of a DOCTORAL program-- AND THEY DO-- but are only awarded an MS--why not go be an anesthesia assistant who doesn't require all the clinical time PRIOR that you don't get any credit for? FOOD FOR THOUGHT PS I am bringing this up to discuss--it does look like employment for AA's is more limited in some states--and I'm sure I'll find out other unfavorables, but it brings up an interesting perspective--going back to my initial question--why does it illicit so much anger to compare professions and the actual work? Does it have something to do with the paying of DUES we are all so CRAZY about? What about CRNA programs that consider one year of E.D. experience adequate and others that require 2-3 of high acuity CVICU. Many of us have different backgrounds and quantifying those experiences is difficult. What about people who are just plain talented with very little ICU but have it all over those with YEARS? If you are not giving credit for it--do it all the way!!!!

I agree with the thoughts on this thread that it would be a positive step to make the educational standard for advanced practice nursing a doctorate. I DO HOWEVER think the amount of coursework/clinical hours spent in each specialty should be re-examined. I've been trying to bring this up in other threads too. Let me illustrate: by the time an RN, BSN gets into a CRNA program with the requisite critical care hours, certifications and prerequisites (many outside a normal BSN program--like (PHYSICS, advanced MATH and O-CHEM), goes thru the 50 something credit hours++all the clinical time, you have a person who has delivered well OVER the requirement for JUST ABOUT ANY DOCTORAL PROGRAM I CAN THINK OF. This SIMPLY isn't fair. It's a huge expense, not to mention the time and effort to put into something that others spend much less time EARNING--and IT'S OVERKILL TO BOOT. Mind you, I'm not saying the time isn't necessary--I'm merely pointing out that the proper ACADEMIC credit is not awarded for everything. My point is--give a person REAL CREDIT for getting thru this program--the MS just doesn't cut it. Backtracking a little--look at the prerequisite work to get into a diploma or AA RN program; likewise these nurses could do a LITTLE more work (if everything were reasonably recognized) and come out with a BSN---so you see----this is way from the beginning. I think unless we re-examine EVERYTHING we are building a house of cards. How will we attract the right people into these professions when they know they can start out in med school (with the same course work, time dedication and money) and go straight thru to an anesthesia residency!--using the CRNA analogy. Now I know I'll get flamed on this--comparing to the docs--but I don't care---IT'S THE TRUTH. PS the odds of getting into med school are starting to look a lot better than the odds of getting into a CRNA program too! PSS many people are attracted to nursing in the beginning because it looks like a stable career with a good salary and it is--it's when you are moving up the ladder that things scew--are you getting me---when we start thinking of nursing as a profession---getting me more------because people in general don't consider an RN a professional designation----GOT IT! THIS IS WHAT I BELIEVE THESE ORGANIZATIONS ARE TRYING TO GET TO THE BOTTOM OF---WE WILL HAVE TO DECONSTRUCT TO DO IT RIGHT. OH I COULD GO ON FOREVER--I'LL GIVE YOU ALL A BREAK.

I am sooo sorry to hear that. I am studying for my first exam--community health nursing. I bought the books and downloaded the study guide. I think I will like this venue. I know it seems expensive but it actually is comparable to the state colleges in CA---the books are even cheaper. I paid 130$ for my (paperback) math book at the local CC--my 2 books for comm health were cheaper than that--and hard back! CA is such a rip-off when it comes to education, and texts are the BIGGEST SCAM EVER!!! There is NO WAY they should cost what they do.

LINDARN--I've got to say, I think you are fabulous but I think you've been a little harsh on this one. I agree that LVNs should not be in the ICU but for different reasons--more political/business reasons. I started out my career as an ICU-LVN (military trained). Like the previous poster I was very proud of my abilities/expertise and QUICKLY found myself out-nursing MOST of the RNs around me. Having said that, I think there is a large variance in training; theory as well as clinical. The talents of people getting thru LVN and RN programs also varies markedly. Here is the point: we have to have a GENERAL MARKER for making sure that the people hired to perform in critical care are up to the challenge; I agree that should mean an RN license with the appropriate certifications, ACLS etc.. I truly value the work of some talented LVNs and I think there can be a place for them in clinics etc.. I think that because an RN is responsible for the overall care that otherwise licensed people are providing, it doesn't make sense to have them provide it. So, while I really feel for the talented LVNs out there who are outraged--channel your outrage into an RN license and get paid double for the work you are already doing! Get your training any way you can and see if the hospital will pay for it. I SAY THAT WITH GREAT LOVE AND RESPECT. ALSO BECAUSE I AM THE SAME PERSON I WAS WITH THE SAME BRAIN, AND WITH VERY LITTLE ADDED EDUCATION WAS EARNING OVER TWICE WHAT I MADE AS AN LVN DOING THE SAME JOB. DON'T GET MAD---GET PAID!!!!!!!!!!!!!!!!!!

kriso, Couldn't you guys just refuse to wear the ribbons and slogans. Don't you find that a little demoralizing? Do they have the MDs in your organization wear those ribbons too? Gag me!! My--RN--designation is the only slogan I feel like wearing to work--I too take great pride in the job I do and I do it VERY WELL--I would resent being given the --Wal Mart--slogan ribbons.

I just read the earlier portions of this thread because I was sent the latest. This particular posting REALLY hit home. It occurs to me, that this would be my observation of NURSING in general; your finding of the staff members you'd left behind looking haggard and unhappy. I am sorry to say that this is my finding IN GENERAL. I personally believe that most hospitals are operating in such a way that the nurses are working themselves into the ground. 40 hrs a week working at the pace and intensity that we do is just not healthy. Enter an efficiency group whose job it is to cut costs, and are so uncreative that they go to the largest dollar outlay which is nursing (because we do the actual pt care duuuuuuuuuuuuhhhhh) and cut costs there. These groups do this with very little observation, or with manipulation of data; don't tend to to leave room for the human factor. I have been floated to a med/surg before where all my pts spoke a different language (San Francisco) and NO I AM NOT EXAGERATING, and three of my elderly pts were confused and combative. I had a total of 5 pts which for them was a good ratio (I am an ICU/ER nurse--OUCH!!) I was asked to do some data collection at the beginning of this shift an the computer--I forgot what they called it; but this was standard procedure for them--the data was supposed to assess the acuity of your load--BASICALLY CYA for the hospital I think; anyway the questions were worded in such a way that it DID NOT IN ANY WAY capture the acuity of my pt load. That's what I mean by manipulating data. That was a nightmare shift--after one other such FLOAT to the floor--I transferred to the ER. I WILL NEVER WORK ANOTHER SHIFT OUTSIDE OF THE UNIT OR THE ER AGAIN. I tip my hat off to all y'all working your back sides off; I do too, I just think I am allowed a much safer work environment.