PiperLambie

I applied AGACNP with three years ED/CVICU experience, and was not offered admission. Congratulations to those who will start the next phase of their education this fall.

Nashville local here also waiting for some news. Could be a little later than today- we had rapid Winter weather come through overnight and jam up the roads, so unless the sender of decision emails is working remotely it's tough to know if they were able to make it into work or not today.

I'm guessing that "immediately call ED to floor report and let transport take them" is not what we're going for in this thread??

ED nurse here. Easiest report I've ever given was just the other day: Had a patient with TONS of stuff to be done after hospitalist finally got to my patient after about five hours of waiting. As I watched the admission orders roll in at 18:20- MRI with, additional serial blood work, 5000 home meds to be reconciled, VTE prophylaxis, needs a full brief change, etc. I strongly consider treating my computer like its the copier from Office Space, while muttering like I'm Joe Pesci's double in Home Alone. About 18:30 dialysis sudenly rolls in and takes him away "It's cool, we'll change him during dialysis". Welp. Glad I didn't take out my computer terminal... 18:35 bed drops. Damn, this nurse isn't gonna answer the phone for me, but she does. I report to her like it's the 90's and I've gotta call home collect for a ride because I don't have a quarter: "I know you're prepping for shift change, but this guy just went to dialysis and all charting is up to speed, He's stable, just needs an MRI form as dialysis is changing into a gown and pharmacy interns will get the med rec, I'll make notes for your relief to see about 21:30 when he gets to your unit, have a good night!"

I started in an ED with no prior intern/externships or medical experience, straight out of nursing school. The division of the company I work for has fully transitioned to the nurse residency model for new grads. I know there are some mixed reviews in general amongst my peers regarding residency, but I cannot recommend it enough. In my case, orientation was 13 weeks (as opposed to the 5-6 for an "experienced" nurse- even one with only six months before transferring to the ED). During this period there were days spent on the unit with my preceptor, as well as in-person and online didactics to supplement things. It was also a great time for the unit to get my ACLS and PALS taken care of with all the additional education time available. As far as type of facility, if trauma is your thing then apply to the trauma center, but throw some eggs into other baskets as well, just to maximize your opportunities. Again, all places are different, but as has already been mentioned above, commute, ability to pay expenses, work environment, and personal goals are some of the many variables that only you can know for yourself when figuring where to start. Emergency nursing has been wonderful to me, and has helped me to know the next steps I want to take professionally due to the nature of being exposed to so many different sicknesses in so many different presentations. Best of luck in your endeavors to enter the ED after graduation!

...to the people that do med/surg nursing. Seriously. We were boarding the other day and my assignment included three admit holds and one room that was going to be "LA" (yeah, like it ever stays LA). All I can say is that I will always hold med/surg nurses in high esteem, as I never want that as a full-time gig. By the time I finished passing 0900 meds around 1230 (there were about 90 between three people), I felt defeated, and it was only three patients. Eventually they went upstairs and I was able to get back into my ED frame of mind, but man, that just sucked! Reason #237 I'm glad to be an ED nurse!

Most nursing programs, following pre-reqs, will require you to take some terminology, where you will learn that there is no pseudo to his terminology. I think it was in the didactic part of my skills course that we had a separate terminology exam each week for the first month (in a class that was only seven weeks long) in which we had to write down the meanings of roots and combine terms, etc. I totally understand your point about not using medical jargon, or what I like to call 'nursey words', when talking to patients, but depending where you work (I'm in the ED), it's almost necessary just to read and understand the radiology/imaging reports that we follow up on- radiologists ONLY write reports in medical jargon. Not to mention, when you have to give report, and hopefully you review the patient's record to include physician progress notes, you'll have to be able to decipher that cholecystectomy is the same thing as gall bladder removal, or that hyperkalemia is the same thing as high blood serum potassium, in order to be properly informed. You seem to be taking it in stride, but never be afraid to ask questions- most physicians I have met that are around education at all do it because they enjoy teaching students, no matter how gruff they might seem on the exterior.

So I had to take Patho online (I was on a satellite campus that had not yet hired an on-site instructor), and the instructor had her doctorate in clinical pathobiology- she also asked the tough questions. For gross anatomy, I had a retired veterinarian, who also was the head of our cadaver program for the school. While he was pretty easy going, that didn't stop him from asking the tough questions, since a kidney is a kidney with mammals. Consider this: a veterinarian is an GP, surgeon, intensivist, orthopedic, and palliative expert all in one. He was absolutely the highlight of my accelerated nursing program. As for your surgeon being tough or mean, just be glad you are a nursing student taking patho- there are plenty of stories of med students and residents getting kicked out of whatever situation they are involved in for not being able to answer questions. My wife tells the story of when she was in med school and the OB, during a c-section, asked her to vocalize the pathway of blood in the maternal-fetal circulation. When she froze the OB asked the resident, who froze, was given some not nice words, and kicked out of the room to go crack a book and come back with the appropriate theory so that they knew the reason behind what to do/where to clamp/how to react if their patient started to hemorrhage in a similar situation. My point is that physicians (especially surgeons) hold themselves and their peers to impossibly high standards, starting as med students, as they work to improve safety, outcome, and quality rates. Nursing is heading that direction, but the one thing about nursing school (whether accelerated or traditional) is that it's like trying to drink from a fire hose- you get a lot more to the face than you actually get to drink, so stay as thirsty as you can.

I completely see the frustration and distrust this has fostered in you based on the post. That said, as someone that has managed large groups of employees at various levels, I want to second the idea that you schedule to meet with your NM and/or director and raise your concerns, rather than jumping the chain of command. I can almost assure you that nothing good comes from escalating something beyond your leadership that isn't a direct problem with that individual above you. There are always reasons why leadership makes a decision about a certain employee/issue, whether policy, legal, or otherwise, and without having the director's rationale available (or a transcript of their conversations with HR/legal/CNO), it is tough to fully understand how that determination was made- whether the result is agreeable or not. It's just a spotlight you don't want on yourself for overstepping boundaries. In the mean time, keep that NAP on a short leash when it comes to your patients. After all, when you don't have a license you cannot lose a license. If that person gives you the business for holding them accountable then follow the procedures to help your charge/NM/director to be able to initiate progressive improvement plans, and (potentially) disciplinary action, against that employee.

It is a great question to seek out by visiting osteopathic.org, where many of those types of questions are answered. At the most basic, is is a difference in osteopathic vs allopathic (though this term is often seen as derogatory by some MDs) school of thought. Osteopaths are trained from the outset in a model much more similar to the nursing model, which involves treatment of the whole person in addressing a health issue, rather than treatment of the specific ailment. In my ED there are two osteopaths, a majority of allopaths, but also a PA that went through a program at an osteopathic medical school. It is interesting that she has some of the same tendencies as the DOs on account of the culture of the school. As previously mentioned, there are good and bad DOs, just as there are MDs. I have always had good professional and personal experiences with the DOs I know, and I know many on account of my spouse being a DO.

psu, that is terrible in and of itself- if she keeps the BSN with the MSN that's even worse! Not to mention that anyone worth their salt looking to hire someone is going to absolutely judge her when they look on the header of the resume and see that it's out of sorts. I've not been a nurse manager, but in my time working for corporate management in my previous life, those were the kind of menial, small things that separated a serious candidate from someone that was perceived to not be willing to take the time to do things appropriately.

Well if it does turn out to in fact be her nursing degree, a noble-minded coworker might be kind and help her to correct the certainly unintentional dyslexia of credentials so that her degree comes first, followed by the license certification. Maybe it's my years of having to properly wear a military uniform, but as fixated as our profession is around post-nominal letters, coupled with the emphasis that is placed on attention to detail, the very least folks can do is ensure that they list them appropriately. Every time I walk past a colleague with an embroidered pullover I check to see if the "RN" is before or after the degree- and then mentally wince when it is before.

Nothing so exciting as an RN, but in my previous life I was a manager for one of the big two delivery companies (lots of purple and orange), and was running a wee bit behind one morning, decked out in my glorious work uniform. Cop pulls me over, looks at my attire, and says "what do you do for xxxx". "I am an operations manager." "Well go ahead and get on to operating, I don't want any trouble with my Amazon packages making it to my house." No complaints from me.

I have been off of orientation since the start of May (nurse residency has ~13 week orientation period), and every day is a toss-up. One thing that we do on my unit (ED) is run the shifts 06:45-19:15 for days and 18:45-07:15 for nights, with a couple of mid-shifters thrown in through the day. The first 15 minutes are for the oncoming shift to huddle and get report, and the final 15 minutes are for the offgoing shift to try and finish up any charting. 18:00-19:00 is well known as "Power Hour", and there has been more than one time where an ambulance rolls in emergency traffic at about 18:25 with a possible stroke or cardiac arrest- bingo, staying late! I guess my point is to continue honing your time management skills, but accept that there will always be something to hold you back. An hour is a bit much though IMO, as nobody wants to be a slug, but sometimes you have to pass on a little thing here or there to the oncoming to get out on time. Just remember when you pass on that the time will come where they need to do the same, so be ready. Patients are important, but equally important is your downtime so that you can relax, recharge, and be ready for the next day.

In my "previous life" I was a manager for one of the two large delivery companies here in the 'States. Part of my job involved teaching new drivers how to drive the trucks. If I had a dollar for every time I had an employee tell me how nervous they were to get behind the wheel of the truck I would always point out that: 1. this truck is a lot smaller than the big rigs, and 2. have you actually seen some of the folks that drive those big rigs? If they can do it so can you! Needless to say, as an adult learner studying for my BSN I experienced this in nursing school- "if that person can have an MSN/DNP and be a professor..." as well as in work- "if this person made it this many years as a nurse..." then I think I'm going to be okay. That said, no amount of preparation can prevent the slight bewilderment when encountering someone else that fits the criteria.

I started in the ED via a nurse residency program (with no prior medical experience) after graduation in December, which is not quite the same as a student externship but no so different from my early on days either (aside from the whole "it's my license" thing). I received about 13 weeks of preceptor assigned orientation (residency requirement), where by the end it was expected that I could pretty much handle the four room assignment on my own, with minimal need for the preceptor to intervene. I'd like to share a couple tidbits with you. First, one of my nurse manager's first statements to me about the ED: "Expect it to take 6 months to a year to start to truly feel comfortable. It takes a while to develop your routine, and to see enough different things that you have some exposure to a wide variety of diseases and treatments. If you leave here after a few years and go to another ED, expect it to take up to six months to feel comfortable in the new environment- even with the experience you already have." You may feel good after the eight weeks, or your head may still be spinning. Either way, if it convinces you that the ED really isn't the dark side, then maybe this is a good fit for you. Second, while in nursing school, I started one, yes one (1), IV on a human being, and placed a single foley catheter. Within about 30 minutes of my first shift in the ED I had already stuck several people to place IVs (some successfully and others not), and by the end of the day I had done a couple of straight caths- and this is as a full RN. The fact that you have the chance to hone these skills as a student is an amazing opportunity, so take full advantage of it! Third, whether you want to work in the ED or not, this is a job interview. Even in a town with as much healthcare as mine (Nashville- healthcare capital of the United States), it's amazing how small the nursing community is. These people are the folks you want to be able to ask for letters of recommendation, and that will be asked about you (or maybe even interviewing you if there is a peer interview process) should you apply to this facility. In fact, one of the competing hospitals in my area only hires nurse residents into their ED if they were previously externs in their ED. Lastly, as has already been advised, soak it all in- a lot will drain right back out, but you'll start to see the routines and rhythms of how things are handled with a STEMI, or a stroke, or a sepsis. Ask questions to clarify things. You might have to jot them down and ask later, but still ask them. If you're curious as to why something a provider is thinking is different from what your textbook might have said, same thing- find a good time and ask. Even as an RN I probably go up to each of the docs I'm sharing patients with at least once a shift and say "well doc, what's your thinking on this one?" if something a little different comes in. They will tell you, because ED providers absolutely 100% rely on their nurses for tons of things. It's something our medical director talks about regularly. Don't be afraid to go after something if someone asks if you want to do it. If you aren't comfortable, make sure that's known- sometimes things can be slowed down enough for it to be a teaching moment, and others you might have to just observe and talk about it after, but next time it should be all you. ED staff are not quite like anyone else in the hospital. We are (usually) strong, if not Alpha, personalities. With a few exceptions, most ED nurses are not nearly as wordy as I am- especially on this board (what can I say- personality flaw? Yeah maybe it is for them, but we all have at least one). They're not trying to be mean, just efficient. Things are happening, whether it's an ESI level 1 CPR in progress coming off the ambulance, or its an ESI 5 that we are moving out the door as quickly as possible to clean and fill that room. It is close knit- not just the nurses, but the providers as well. The providers are always there, and I have learned just as much from some of the docs as I have from the nurses, but it's not stuffy. We laugh, we joke, we eat a lot of snacks. No, seriously, someone is always bringing us donuts, or candy, or chicken biscuits- it feels excessive some days, not that I don't grab a donut, mind you. Okay, I know I said 'lastly' two statements ago, but here is the final word: Have Fun! This is a great opportunity that will only help you as you finish school and start your practice. How many of your classmates in August will be able to say that they've watched a full STEMI workup, or stood in CT as a stroke patient's scan comes back with this wild midline shift? Best of luck to you (and don't be too hard on yourself)!

Yes, Charge200J! I'm a new grad ED nurse (~6months), and never liked the idea of having my stethoscope around my neck (where an acute patient can easily grab it- and me- at the worst moment. I'm also a guy that grew up with a grandpa that advocated gentlemen wear a belt with pants, to keep them up, and once I found scrubs with belt loops I snagged a BatClip and have never looked back! I know you don't need a belt, but that clip has a pretty beefy edge on it. The worst part about spending the money on this product is that every one of my coworkers (providers and nurses alike) knows the one person on my unit that reliably has ears at all times, and I become rather sought after from time to time.

While I am not an LPN, nor did I have any experience prior to nursing school, I am five months into a nurse residency program (NRP), and thought I'd chime in, though I am afraid that I may be a bit long-winded. I did not start nursing school until I was 32, and I entered an accelerated BSN program that had me done pretty much a year and change later. That said, I have a ton of life experience from my prior career of 13+ years. Also, the residency programs in my area (Nashville) are highly competitive. Since healthcare is the Nashville region's primary industry, it's tough to spit without hitting a nurse, nursing student, or aspiring nursing student. The big three companies vying for nurse residents in my area are TriStar (HCA-largest private hospital corporation in the world, headquartered in Nashville), Vanderbilt, and St. Thomas (Ascension-largest Catholic hospital corporation in the United States). I only mention all of this so that you can know where I am coming from with my experience in the process, which ultimately led to me being successful in securing a position in my preferred specialty area. It is important to determine a couple of things: First, what is your absolute, number one choice? Mine was ED. It seems that you are set on L&D, and that's awesome! I know that L&D is one of the most sought after specialty areas in the big three nurse residency programs in my area; further, this is probably true in most programs across the nation. I hope you get it, and it makes you as happy as my choice made me. Second, and much more important than your first choice, since many NRPs require your top three, what other two areas would you be okay with working in for at least two years (the minimum time contract commitment to an NRP) to gain experience before working toward your preferred area? In my case, the other two areas I really liked from nursing school were psych and perioperative. HOWEVER, the two areas that I put down were perioperative and ICU. You might be asking why I didn't put down psych as one of my two, and if you aren't then you should be now, because this is an important strategy. There is a large need for psych RNs all over. If I would have put down psych as one of my top three, when the application reviewers got together I would have immediately been sorted to that specialty just because there are so few applicants. I know this because one of the HR recruiters thought they heard me say I liked psych, and they were still calling me after I had accepted a job in the ED at my current facility. Yes, this happens- the directors sit and divvy up people before and after interviews, and they do it by their need, not by your heart-set desire. Choose two areas that would be acceptable to you; two areas that you could live with waking up and working the 36 hours a week required of you for as long as two years before you could transfer. If you don't want Med/Surg and you put it down, guess what there is a good chance you're going to get? Exactly. If you can research the needs of the facilities in your area to which you are applying, you can play this part of the game. Now we can get to the next part of things, which I believe is your original question, the cover letter/essay. I used to be a manager that did a lot of hiring and firing in my previous life, and I've read my fair share of cover letters from prospective employees. All of those things they taught you about structure, grammar, and word choice are all true, and the cover letter can influence the hiring team's opinion of your commitment to the application process without ever meeting you. Introduce yourself, and absolutely talk yourself up- but don't misrepresent your experience and credentials. Everyone knows there is a little stretching going on, so make sure you toe the line there. Talk about your experience, both in healthcare and outside, and why that helps you to be ready as a new RN in their specific NRP. More importantly than why you'd be a good RN, since nursing school and the NCLEX are fairly standardized across nursing education, make sure the reasons why you would be a good member of their team are clear. The NRPs and department directors want good team members that are going to collaborate, get along, and work together. The letter should be customized to each individual NRP/facility, and discuss why you think that their specific program would be a good fit for you. In other words, do your homework and don't just pump out a generic cover letter. The interview process is typically pretty structured across programs, and should include a peer interview as well as a management interview. My particular peer interview at the facility I received an offer in-specialty to was not with ED nurses, however my manager interview was with the ED manager (the other was a med/surg manager)- that is how I knew they were serious about my application, because the ED will only take residents if one of the managers from the department interviews. This is why it's important to know what your other two areas are, and be okay with getting a spot in one of them. The bottom line is that this is a tough decision, but you have to measure your desire of specialty area over your desire to start gaining some experience in the NRP regardless of specialty area. I went into things knowing that it was more important to me to work at the facility I am at than in the area, and it was just icing- yes, tons of tasty sweet icing- when I also got offered the specialty, but nothing was certain. The cover letter was absolutely one of my strong points- I know because my manager told me. Don't underestimate the importance, and utilize the myriad resources and examples out there to help you craft the letter that works for YOU. Whew, I told you it would be long-winded, but hopefully there is something helpful to you in here based on my personal experiences. If not, I had a fun time reliving the process through this journaling. If you have any questions, aside from "couldn't you have made that shorter" (No), feel free to reach out, and best of luck to you!

As a student nurse I had this older, country gentleman that wasn't exactly excited that the student he was getting was a 30-something male, while the neighbor got one of the seemingly unlimited blonde females my program had. As I'm going through his health history, which includes amputation of several toes due to diabetic issues, he suddenly blurts out "Oh yeah! I also have the tickerlitis". To this, his wife of over 60 years says, without any regard for the double entendre, "his doctor says that means he can still eat his bacon and eggs, but our favorite nuts are off limits". Thank you old time country couple- I shared that in post conference that day. My absolute favorite was years before I ever imagined becoming a nurse. Had a great friend from Massachusetts (until the pancreatic cancer took him a few years ago), that was the most street smart guy ever, but I am certain he was mostly illiterate. It had been a while since we got together for lunch to catch up, so I asked him how things were. "Well, mostly good, but I'm not sleeping well. I asked my doctor, and he told me it's probably sleep napnea." After I choked on my beer, I asked if he meant sleep apnea? "Nope, I'm pretty sure he said napnea." Here's to you, Super Mario- God knows it always gives me a good laugh to remember, and I could use a good sleep napnea myself...

Congrats on your selection into this clinical opportunity! As a new grad ED RN (started Jan 15), I will offer you the advice that I got as a student going to ED clinical, as well as that which I got when I started on my unit. It happens to be the exact same advice, despite coming from a few different people: Be eager, excited, ready to move, and don't say no! Obviously, if you are not entirely comfortable with something, say IV sticks, don't turn down the opportunity- instead turn it into the chance for your preceptor to show you their tips and tricks. A couple of months in, despite poking a dozen veins per shift and I still grab my preceptor or a co-worker if I am not certain or if I have no luck after a couple of tries. The thing that drew me to the ED full time after school, aside from a couple of awesome ED instructors during my ED experience, is the fact that there is a constant pace to things, and you get to see lots of different kinds of disease processes: cardiac cases, neuro/stroke cases, GI/GU illness, maybe some trauma, and the rest of it too- so even if you end up not liking the ED, maybe some specialty area will start to tug on you just by seeing these patient presentations. While the skills practice part is always cool, absorb as much as you can, since the focus of the ED is different from the rest of the hospital. It's a great opportunity to work on your communication skills, and your focused assessment skills, as well as see the variety of patients that visit an ED, and what "sick" can look like. There might be a homerun ischemic stroke patient one moment that is going to get TPA. Right after you will get your version of the patient that comes in with chest pain starting this morning, a bruise on their knee, back pain, and a toothache that has bothered them for five years, and they'll get the full cardiac workup that returns negative and suddenly remember that maybe their chest is sore because their kid kicked them yesterday when they were pushing them on the swing. They'll chuckle, you'll grab the discharge paperwork, and send them home with an NSIAD prescription and a dental referral. All the best on your opportunity! I hope it's as exciting for you as my student ED experience was for me- we can always use more ED nurses.

We struggle with this in my ED as well. Depending on the chief complaint, the age of the patient, and the status of the patient, there are times with non-emergent cases where the provider can do a reasonable job of ruling out without the urine if all of the blood and imaging are back, and we don't necessarily worry about it. Otherwise, as long as things aren't entirely nuts in the unit (funny, right?) and a fluid bolus is ordered, I'll hook them up and give a few minutes to see if they are inspired to provide the sample. If it's a frequent flyer situation (where we can strongly suppose what the complaint and result are likely to be based on history), or if it's an elderly patient that might have a prostate or shy bladder issue, we will give the (sometimes firm) alternative of a straight cath to capture if the provider really needs the urine to rule out. When I first started I was a little taken aback at the directness of the cath option, but patients that truly cannot get the urine out and want to know what's wrong (or not wrong, as it were) are more amenable to it than I would have imagined. I'm gonna have to put meanmaryjean's idea in the suggestion box though, because I am digging the promise that has at increasing bladder productivity!

We have a full-time police officer at the intake desk, and armed facility security are always immediately available to the ED. Safety is what it is. We all have those aggressive patients, but it's all about keeping yourself physically safe until they can be subdued if that is needed. I work every day at honing my spider sense in this regard. The families usually are not a problem- again the PD or security are available to take on the more aggressive issues that may arise. The entry at the ambulance bay is keypad secured to entry, and there aren't really issues with interlopers entering through the EMS doors. I work days so it is often dark when I arrive and dark when I leave, just like night shift. That said, I always scan the area as I am walking toward my vehicle, particularly if there has been a difficult patient/family. Armed security is also available to escort any employee to their car at any time if there is a concern. Management takes everything employees report seriously, and our department nurse practice council does a great job of addressing the unit-wide issues at meetings. No deaf ears from the folks in the offices.

I am a new grad (December) RN that is currently working in the ED directly out of school, but I thought I'd chip in. 1. The ED where I work is almost always busy. We try to have a ratio of 4:1, though the unit goal (when it's not cold and flu season) is to get it down to 3:1. We are a stroke center and a chest pain center, but not rated for trauma. That said, we get the gamut of everything from upset stomach due to eating too many hot wings, stable MVA trauma, strokes, and active codes as the ambulance is pulling in. Because my unit is not specialized in any one area, it's a great chance to see lots of different disease processes. 2. I am on day shift (by some small combination of luck and serendipity), and the standard work week is three days (12x3=36), though there are usually additional hours available. Days worked can vary, and sometimes they are together, while other times, like this week, I am on Monday, Tuesday, and Saturday. Any time at a "desk" is spent quickly charting patients while moving between rooms. I average 4-6 miles of walking per shift, even with my four rooms immediately next to one another. It doesn't bother me because I purposely chose the ED for the combination of not being floated around to other units, as well as being busy enough to make the 12 hours go by quickly. Bottom line is that it is sometimes a grind, but always a hustle. 3. I left a previous career of 13 years in logistics management, attended a 15 month accelerated BSN program, and fully intend to continue my education. I passed my NCLEX last Wednesday and already have started studying resources to take my CEN exam in the near future. My plan has always been advanced practice and possibly teaching, but this was my compromise to medical school. While med school would have been great had I started that path in my 20's, it just seemed like too much to take on in my 30's. Not to mention, with a spouse that is a physician, her loans to become a physician are enough without taking on another $500k for me to also do that. I enjoy my specialty and being a nurse greatly- otherwise I would not have paid in time, money, and effort to go back to school and do this! I still have tons to learn, but the great thing about nursing and medicine is that there is always something to learn, regardless of how long you've been in the business.

I am 5'6 average build and I am a big fan of the WonderWinks men's Honor scrub top and Loyal scrub pant. Just enough pockets for my ED gig, a nice bit of give and stretch, and I'm not completely swelteringly hot wearing them. The pants also have belt loops, which fit my Blackhawk! CQB/Rigger's belt perfectly (for those that, like me, prefer to wear a belt over the included draw strings). Had to have the pants hemmed a little, but that's my issue. Pretty good prices on Amazon.

As a new grad nurse resident working in the ED for all of two months (with a prior career and lots of life experience), working at the flagship facility for one of the large organizations in the hospital business, I can say that I am grateful for the way that our residency is organized. We are divided into tracks, one of which is the "Critical Care" track, and this includes ED, ICU, Step Down, and Cardiac/Tele. Naturally we all work on our assigned units, but we all have periodic didactics together, with instruction by a variety of nurses and physicians from different specialty areas. I feel like this has allowed for all of the new "critical care" nurse residents to form a camaraderie and rapport that allows us to see one another as equals, while working against the established attitudes on the units of "ED nurse vs. ICU nurse" that we all know exist. It is already making a difference from my end in the ED when it comes to calling report to fellow residents in other critical care areas, since we know one another, and get along. I understand the OP is more about recognition for the purposes of CRNA schools, but I thought I'd chip in simply because, as someone in the middle of this attempt at unit culture shifts, it definitely seems like things are moving in the right direction toward recognizing the similarities in the critical care areas, rather than the differences.