NurseNelly24

To answer your question and allude to the sentiment of the other commenters, you absolutely do need BEDSIDE RN experience in order to qualify for any CRNA programs. By reading your 1st post, I’m assuming that you’re wondering if your EVENTUAL(since you don’t have it yet) FNP experience will suffice as qualifiable experience? It won’t. 1. You’ll only qualify for NP positions in primary care/outpatient areas (the most acute would probably be the ER) 2. It still doesn’t expose you to the hemodynamics, med management of vasosctive/sedatives, and the overall skill set required to care for critically ill patients. So if you’re considering CRNA, you’ll have to start from scratch with ICU RN experience, and sacrifice becoming an expert in the area you we’re educated in (NP in primary/outpatient practice). If you decide just stick with FNP, you’re losing the opportunity to be a competent ICU nurse. Either way to be a novice—> expert in BOTH areas is very rare and a waste of time to some capacity. Not your fault, but I think this is the flaw of many Direct Entry program-NP pathways. Students are only exposed to one “type” of track that they’ve decided is their “desired area”, until you graduate and you’re either questioning your choice or dismayed by the track altogether. You should definitely do more research about CRNA before you dive in, because most people who apply to these programs have had their mind set to enter this area years before, and have put in the work necessary to pursue it.

Thank you for your insight! I have quite a few NPs who I know I can precept with. However I’ve also—especially because of COVID—became wary of the stories of students whose clinicals were delayed or cancelled because they couldn’t find a preceptor; which I’m trying to avoid as much as possible. Also, having vetted preceptors I think makes a huge difference in the overall quality of a program.

Thank you for the compliment! And yes I’ve been doing a ton of research to narrow down my choices. I appreciate it!

Thank you for your insight! And I agree a solid education is worth sacrificing work/life balance.

Thank you for your insight!

Hi,  So I’m actively applying to schools to pursue a career as an ACNP. A little background, I have years of ER/trauma experience and I’m currently in the ICU as well; married, 5 month old baby, and supportive parents..    The 3 programs I’ve chosen to apply have pros/cons, but I’m at a crossroads at which one should be my “#1” choice or sounds like the best program. My plan is to attend Fall 2021. Some insight will be greatly appreciated!   Not in any particular order, School #1 B&M, meeting once or twice weekly 3 years PT runs concurrently (Fa, Sp, Sum) Clinical Hours: 840 (4 clinical rotation courses) Pros: 1. Schools sets up clinicals 2. Patho class and clinical immersion skills involves use of cadever  3. Faculty consist of NPs and MDs 4. Possible full tuition payment if you’re full-time or part time with the health system for 1 year (which I’m not but can be)  Cons  1. Commute 1+ hr and I live in the northeast 2. Clinicals are only assigned in school’s affiliated health system, wouldn’t be able to do clinicals in my home residence. 3. School is expensive (probably will spend about 60k by the end even with my jobs tuition reimbursement) -More difficult to have a work/life balance SCHOOL #2 Former B&M transitioned to fully online (asynchronous) 3-3.5 years, PT OR FT (not concurrent) Clinical Hours: 720 (240hrs per semester) Pros: -Reputable school, has one of the oldest of the 3 acnp programs that exist in the state. -School is much cheaper than school #1 (925/pc with no additional fees) -Ability to do travel nursing while in school to pay my tuition and home bills (can probably leave school debt free) -Online would provide a better work/life balance Cons: -This is the first time the program will be fully online, concerned for bumps on the road. -They no longer guarantee clinical placements, basically states on the website that you must find your own. -Only 3 clinical immersions throughout the program (is that enough to feel confident in your skills?) -Are fully online programs sufficient for the ACNP track? I’m NOT against it, I just want to know if it is enough to suffice the learning curves that exist with going from RN —> NP  SCHOOL #3  -Hybrid, online (synchronous/asynchronous), and in later semesters class meets 1-2/week -3-6(???) years PT or FT -Clinical Hours: 540 (180/per semester) Pros: -My alma mater; well acclimated with faculty and professors. -I like that there is a synchronous online portion (doesn’t feel like I’m just teaching myself) -Tuition is cheapest of all 3 (600+/pc, can easily pay my way through school, debt free) -School will help you in finding clinical placement, but not all placements are guaranteed. -Short commute to in-person classes (30-45 min)   Cons --This will be the FIRST cohort for the ACNP program (they have 2 existing NP programs ); concerned if there will be bumps on the road for it being a “new” track. -Requires the least amount of clinical hours for all 3.  -if the school accredited but the program track is new, is considered accredited? -Also only includes 3 lab intensives for clinical immersions. Sorry in advance that this is kind of long. Any advice would be appreciated because choosing a school has become more difficult that I anticipated. Please feel free to PM me as well. Thanks a lot!   

So I’m actively applying to schools to pursue a career as an ACNP. A little background, I have years of ER/trauma experience and I’m currently in the ICU as well; married, 5 month old baby, and supportive parents.. The 3 programs I’ve chosen to apply have pros/cons, but I’m at a crossroads at which one should be my “#1” choice or sounds like the best program. My plan is to attend Fall 2021. Some insight will be greatly appreciated! Not in any particular order, School #1 B&M, meeting once or twice weekly 3 years PT runs concurrently (Fa, Sp, Sum) Clinical Hours: 840 (4 clinical rotation courses) Pros: 1. Schools sets up clinicals 2. Patho class and clinical immersion skills involves use of cadever 3. Faculty consist of NPs and MDs 4. Possible full tuition payment if you’re full-time or part time with the health system for 1 year (which I’m not but can be) Cons 1. Commute 1+ hr and I live in the northeast 2. Clinicals are only assigned in school’s affiliated health system, wouldn’t be able to do clinicals in my home residence. 3. School is expensive (probably will spend about 60k by the end even with my jobs tuition reimbursement) 4. More difficult to have a work/life balance SCHOOL #2 Former B&M transitioned to fully online (asynchronous) 3-3.5 years, PT OR FT (not concurrent) Clinical Hours: 720 (240hrs per semester) Pros: 1. Reputable school, has one of the oldest of the 3 acnp programs that exist in the state. 2. School is much cheaper than school #1 (925/pc with no additional fees) 3. Ability to do travel nursing while in school to pay my tuition and home bills (can probably leave school debt free) 4. Online would provide a better work/life balance Cons: 1. This is the first time the program will be fully online, concerned for bumps on the road. 2. They no longer guarantee clinical placements, basically states on the website that you must find your own. 3. Only 3 clinical immersions throughout the program (is that enough to feel confident in your skills?) 4. Are fully online programs sufficient for the ACNP track? I’m NOT against it, I just want to know if it is enough to suffice the learning curves that exist with going from RN —> NP SCHOOL #3 1. Hybrid, online (synchronous/asynchronous), and in later semesters class meets 1-2/week 2. 3-6(???) years PT or FT 3. Clinical Hours: 540 (180/per semester) Pros: 1. My alma mater; well acclimated with faculty and professors. 2. I like that there is a synchronous online portion (doesn’t feel like I’m just teaching myself) 3. Tuition is cheapest of all 3 (600+/pc, can easily pay my way through school, debt free) 4. School will help you in finding clinical placement, but not all placements are guaranteed. 5. Short commute to in-person classes (30-45 min) Cons 1. This will be the FIRST cohort for the ACNP program (they have 2 existing NP programs ); concerned if there will be bumps on the road for it being a “new” track. 2. Requires the least amount of clinical hours for all 3. 3. if the school accredited but the program track is new, is considered accredited? 4. Also only includes 3 lab intensives for clinical immersions. Sorry in advance that this is kind of long. Any advice would be appreciated because choosing a school has become more difficult that I anticipated. Please feel free to PM me as well. Thanks a lot!

Just passed my CEN this week and concur with the above statements. The ENA review questions book is what I basically used in the last 3 weeks of studying. End up doing 750 questions. Whatever I got wrong, I went over the content. The online modules from ENA I didn’t find helpful, the instructors were basically reading off the review handouts word for word. Solheim’s review course is extremely helpful in terms of understanding the “why”—patho and brief pharmaco—about the diseases so you understood exactly why you’re doing a certain nursing intervention. the only downside I found the videos to be way too long on certain chapters and then for other topics like Professional Issues he glossed over. Since the test itself doesn’t go too much into detail on a topic, I think you should use the ENA book for practice and Solheim for review for only areas you’re weak in So I

I fully agree!

There are too many dynamics with the modern “new grad nurse” to paint such a generalization. There are the traditional, straight from HS to college, 22 year old new graduate nurses with no experience in a health career outside of their program. Then there are the second career/nontraditional degree new grads anywhere between 25-50 years old who have experience working ina professional environment but are just new to nursing. Then you have the nurses who entered the field in nontraditional role (e.g. home care, Utilization management, clinic nursing) who are adjusting to working in a hospital setting. Basically, it’s many variances to presume that nurses w/ 20+ years and over 30 do not contribute to a toxic work environment. I’ve worked with older nurses whom, yes have a wealth of knowledge & experience, but are also the ones to nitpick at you during report, have difficult w/ time management and often make gross errors or essential tasks unfinished. Not to mention some who complain about unit specific changes that don’t work in their favor (I.e. the charge nurse who refuses to have more than 2 patients while the rest of the unit is slammed, or the one who refuses to work weekends despite weekend requirements). Granted the new generation of nurses are often super optimistic and naive to the reality of nursing (blame nursing programs, the idealized image of travel nursing and social media) but one thing I always notice is that they are VERY eager to learn and are self aware of their limitations. They take self care extremely seriously, they understand the biases and corruption of corporate health systems, and they aren’t afraid to say what we often have complained about behind closed doors. While I do think there needs to be more guidance from older nurses’ end—-b/c come these are our future managers, educators, NPs, and administrators—I think we need to find a little more grace in our approach. Nursing wasn’t the same 50, 25, 15, 10 or even 5 years ago, it’s constantly evolving. So I think we have a responsibility as seasoned nurses to guide them in a way that’s effective and most importantly safe/competent for our patients.

In this order. 1. Apply for Nursing School and get accepted into a program 2. Get your nursing degree (if you go to an Associate program eventually you will need a Bachelor’s, or you can go straight into an Accelerated BSN or traditional BSN) 3. Pass your NCLEX after nursing school 4. Find a nursing job in the ICU (preferably level I trauma centers) 5. Get at least 2-5 years experience in the ICU. Attain certifications (I.e. CCRN, TCRN etc.) 6. Shadow a CRNA to see if you really like it. 7. Apply for CRNA school. 8. Get accepted into CRNA school. 9. Survive CRNA school. LOL. (No but seriously) 10. Graduate, pass Certification exam, and become a CRNA. There is definitely more to it, but if this is a career you truly desire, you absolutely need to be doing more research about the role.

Agreed. I’ve noticed over the years that management, out of the entire “web” are the ones that are least likely to take risks and make changes for improvement the unit. You could hit them with hard-core evidence, and they’ll still find a way to limit resources. The staff nurses will have tons of ideas to improve the unit (many of which are evidenced-based) and they are either never executed or watered down to meet budget requirements or because they’d straight up don’t care.

This sounds like something you def want to approach management about. Is there a committee within your unit to discuss some of the problems with staffing and behavioral health pts? Just something to consider. But as far as advice, here’s a few things to consider: -The layout of your ED: Is there an area/room section where psych pts can be cohorted instead of being placed in random spots in the hallway or rooms? At one of the EDs I worked at, whenever there was an overflow of psych, patients, we opened up our “D” section in the back of unit so that they were all placed/or transferred to that area. This was especially beneficial when we closed off certain parts of the unit at 3am, we would keep that area open exclusively for psych patients. -Piggybacking from the first point, if you have that pop. placed in one spot, it will be better for you to utilize your techs. At my hospital, we have 1:1 for our actively SI/HI who any form of destructive behaviors in the ED. Other patients who are depressed, psychotic, etc. but calm, cooperative for the most part would be placed on a “Line of sight” observation. This means that you’re constantly observing the patient, doing q15 min checks, but we do not have to be side by side with them (e.g. observing them at the nurses station as opposed to the bedside) This allows techs/nurses to observe more than one patient; and this would probably prove benefecial if you have a patient who was chemically sedated. -Another point: Do your restrained patients still need to be in restraints? I know hospital dictates how long a patient can be in 4 locks, but I’ve had situations where I took over for a nurse who was taking care of an initially combative patient, was given ATI/Haldol combo, restrained, and then kept in restraints for hours despite them being pretty much asleep the entire time. When asked, the nurse had no rationale. If your patient is in 4- points restraints but obviously sedated, you’re wasting a resource by having that patient as a 1:1. I’d say unless, they were failed attempts at calming the patient despite meds/restraints, a patient shouldn’t be in restraints for more than one hour. -Utilization of Psych nurses to cover in ED: this can be a future convo for your mgmt team, but utilizing psych nurses can be a big win on your department’s end. For one, they’re better at managing psych patients than us ER nurses do, and they are able to address some of their needs, while we take care of our medical pts. Remember why some of these patients get agitated: they spend hours on a stretcher, sometimes no TV, phone, or their belongings, waiting hours to be evaluated by a psych doc, unfamiliar environment, eating cold sandwiches, not on their home meds, etc. Having psych nurses in the ED as a resource to address some of those issues can help with can take a load off for the nurses and techs. -Collaborating with nurses, techs, management and physicians to create a possible algorithm for evaluating which patients require a 1:1 can also be a future project. This way the process is cohesive and consistent on all days during all shifts. Hope this helps!

I attended the Virtual Open House last week and here's a few highlights I was able to grasp from the session (btw it was informative, and Dr. Greco seems extremely kind, welcoming, and passionate about this program). -The Purpose of the combined CRNA/ACNP program is to expand the advanced practice nurse role so that he/she is able to utilize their skills and knowledge set in various areas of the surgical setting (pre, intraop, and postop). NY currently has many restrictive practices on advanced practice, and depending on where you work, CRNAs/ACNPs have limitations on what they can and cannot do; with this program being the first of its kind, the goal is to address those limitations. -Experience: two years of full time critical care experience in at LEAST the last two years. He stressed heavily on what is acceptable Critical care experience: MICU, SICU, CCU, CTICU, Neuro ICU and also PICU. Unfortunately, ER, Stepdown(whether it be Cardiac, trauma, etc.) Medsurg, NICU, OR, are not considered acceptable specialties for the program. There may be exceptions for PACU, or if you've had critical care experience in the past and currently work in another role (I.e. Nurse leader) but basically ICU nurses will be the highly preferred candidates. Also part of the admission requirement is to be CCRN certified, so that's probably another way to ensure nurses with critical care experience are the status quo for the program. GPA: He had a very lighthearted take on the GPA requirement (3.0 or higher) by mentioning how many of us probably didn't do well in our undergrad years because we were probably partying a lot LOL. He said that if your GPA wasn't the best, it would be in your best interest to retake some courses (Chemistry, Organic Chem, A&P, Micro) to show that you're interested in being a proactive learner and are prepared for the rigor of the program. -Program Length/Clinical Hours: The program is full time and runs concurrently in Fall, Spring and Summer. All students complete ~2900 clinical hours. 2500 for the CRNA Portion and I believe about ~400 for the ACNP role. Dr. Greco emphasized the INABILITY to work full time or part time during the program. He states that with practicum and didactic classes it will be very difficult due to the program commitment. Clinical Experience: Dr. Greco highlighted the structure of clinical practicum in the different anesthesia specialties. Since the program is affiliated with Northwell, all clinicals would be assigned at Northwell hospitals around LI, NYC, and Staten Island. He stated that in most instances, he'll consider a student's home location when placing them in clinical, but to ensure students receive a well-rounded experience they may have to travel . My take on it was, while he make some accommodations, expect to travel far at some point during the program. LOL Admissions: I forgot he mentioned a specific deadline, but there will be 20 seats for the Fall 2021 cohort. Applications will be on a rolling admissions basis and done through NursingCAS (all that info is on the school website) Selected candidates will go through and interview conducted by either Hofstra faculty or Dr. Greco. Professionalism: He stressed heavily on selecting nurses who were continued learners in their current role and have proven interest in the area of anesthesia. It seems like he wants individuals who are up-to-date on current issues in critical care and anesthesiology, active in hospital committees or organizations, etc. He wants you to be committed to learning the role of the CRNA by shadowing, becoming familiar with the Anesthesia's role in intubation (supplies, technique, special considerations), being proficient in IV skills, understanding the different dysrhythmias and their interventions, etc.; basically he wants to ensure you are acclimating yourself to the duties and responsibilities of the advanced practice role even before you apply. Most importantly, I think the biggest takeaway is that Dr. Greco is looking for flexibility. Since this will be a new program at Hofstra, and a new type of program in general, there may be bumps on the road that will occur along the way. IMHO, it seems like he is willing to address all those issues as promptly as possible. Being that he was faculty at Columbia U's CRNA program, served on CRNA organizations, and his passion Nurse Anesthesia, I think he'll have a great gasp on leading the program in an exponential way. I wouldn't be able to apply until Fall 2022 but for those of you considering the Fall 2021 cohort I would definitely tell you go for it. It seems like a great deal of commitment but in the end being dual certified as an ACNP and CRNA will give you an edge amongst CRNAs from other programs. Good luck!

Exactly, COVID has only been prevalent for approximately one year. It wasn’t until March, that we started seriously wearing masks and taking precautions. So my question is what were they doing before then? Definitely scary.