Recent bad experience with a program director.

suzanne4, RN · Mar 19, 2006

My best friend in the world, worked for over 10 years in a very advanced PACU, everything under the sun was in there prior to going to the ICU, and many had PA catheters, etc. And multiple drips. Aneurysm clippings, Fem-pops, you name it and we had it.

She also had more than 12 years of ICU before that, but to get into a program she has to get a job in an ICU to meet the requirements, and at one facility, she has only one patient with a PA catheter in over 8 months or so. Then she moved onto a CVICU in another state to get the best of what they were looking for.

Programs have very strict guidelines that they follow by, and do not move an inch from them. Bottom line, if you want that program, you are going to need to bite the bullet and get the year of ICU experience that they want.

If you don't do what they want, there are plenty of others that will.

MmacFN · Mar 19, 2006

Hey Suzanne

well that hasent been my experience since then. I have talked to many programs who thought the experience as a FN overshadowed that of the ICU. The differences in practice are signifigant and it simply seems to be a "perception" of one individual.

Nitecap · Mar 19, 2006

Hey Suzanne
well that hasent been my experience since then. I have talked to many programs who thought the experience as a FN overshadowed that of the ICU. The differences in practice are signifigant and it simply seems to be a "perception" of one individual.

I think your Flight nurse exp would help you out but maybe lacks a few things that a ICU offers. Then it all depends on how much trauma you flew. Also depends on what type of ICU you work in. Large urban ICU that does hrt and lung TP, VAD insertions ect is pretty hectic.

1-Aggressive vent weaning

2-Vast exposure to postop surgical pts who you will one day be putting to sleep.

3-Exposure to a plethora of drugs not just "40".

4-Exposure to pt more critical devices and management of - IABP, VADS, CVVHD, BIS monitoring to TOF with muscle relaxant drips, along with any vasoactive drid you can think of, cardiac out put and svo2 monitoring, CSF pressure monitoring with spinal drains and high thoracic epidurals.

Sorry you guys arent gonna pick up my pt with a IABP on dopa, epi, nor epi, vaso, millrinone, dobuta, CAcl, fent, nimbex, ativan infusions that is epicardial paced with an open chest that is packed and oozey and a temp of 102, with no urine output that cant tolerate CVVHD, and is swoll up like a freaking balloon. and pressures are all over the place b/c is third spaced and vascularly dry but not peeing and in puml edema on bilevel ventilation sats 88% on fio2 100% with pink frothy goods pouring out ETT.

5- More family and physician interaction

6-Solid time mgmt skills since you are dealing with not only ICU type things but pt needs as well as family needs.

Now dont get me wrong the flight nurse exp is great no doubt. But these skills you speak of such as intubating, placing central lines ect will be learned in school by the ICU nurse that hasnt done them.

As far flight nursing over shadowing ICU nursing like I said it really depends on what ICU you work in and how much trauma you see. In my experience having recieved both trauma and cardiac pts from flight nurses many times I found the pt to be still in pretty bad shape. You know that pt you drop off in the ICU is the same pt you picked up of the road crushed. And many times its in the ICU that you really are dealing with the Multi organ system failure post trauma that often causes death or tons of other issues. The flight nurses start lines, give fluids, push drugs maintains viability and drops off. The ICU nurses stabalize the pt, progesses the pt, pushes the pt, adminsters and over sees a ton of therapeutic interventions, cares for the post op trauma pt, feeds the pt, strengthens the pt, hopefully ambulates and transfers the pt and if not crys with and comforts the pts family when he doesnt survive.

Both have vital roles. I cant say that one over shadows the other.

changed1 · Mar 19, 2006

nite cap that was well said...It is a fine transition from a first responder role to an acute care role...It all will help in anesthesia school. Mike..I think that now you know what you want out of a program director there are plenty of other places with similar requirements that will fit your needs. This is a blessing in disguise...You are shopping for your future and without the "BAD" you might not have known the difference from "GOOD". The philosophy of schooling you want to come from is still a choice no matter how difficult it is to get in. Good luck with the application process...The venting always helps.. Thank goodness for the website to discuss such issues...I am sorry this has happened to you but, your post will help many.

MmacFN · Mar 19, 2006

Changed1 : thanks, i agree, i learned a lesson there about what i DONT want!

Hey Nitecap

I appreciate the response. I think, however you made some good points and some misinformed ones. Dont forget, I have already worked in a level 1 CVICU & TICU in the past running VADS and IABPs. I know exactly what happens in the ICU afterall, I have been at this 6 years longer than you have.

I might be a bit defensive of my profession after my recent experience, so take anything i say in a nice way

While I may only carry 40 drugs, i make the decisions which ones to use and how to dose them. No protocols or doctors like there was/is in the ICU making that decision. That is much closer to the CRNA practice than taking orders. We have both seen the ICU RN's who know nothing but simply call the Doc for everything and follow what they say verbatim, you cannot survive in flight that way and neither will the patients, critical thinking and an expanded knowledge base is mandatory.

Sorry you guys arent gonna pick up my pt with a IABP on dopa, epi, nor epi, vaso, millrinone, dobuta, CAcl, fent, nimbex, ativan infusions that is epicardial paced with an open chest that is packed and oozey and a temp of 102, with no urine output that cant tolerate CVVHD, and is swoll up like a freaking balloon. and pressures are all over the place b/c is third spaced and vascularly dry but not peeing and in puml edema on bilevel ventilation sats 88% on fio2 100% with pink frothy goods pouring out ETT.

You mention this patient as if your aware of exactly what I do and you clearly are not. I have, on many occasions, taken extremely unstable patients on 6-10 drips from facilities that do non interventional caths get themselves in trouble, slam em on a pump and call me to transport them. We carry our own IABP's and our own vents along with any drug that can be used in any hospital anywhere. Remember, ive worked in the ICU.

From my perspective the biggest change an RN will have when they transition to a midlevel role (NP/NA) is autonomy. While I may have extrememly sick patients in the ICU it is absolutely protocol driven and physician run. As an ICU RN I have little to no decision making authority in the Tx of the patient, it isnt hospital specific, its a matter of law (practicing medicine without a liscence). In flight I have a totally autonomous role where decision are made my solely by me. I am used to that role both with critical patients (ICU to ICU or ER to ICU) and trauma patients.

I agree that they are both vital roles. I do feel that being in flight will prepare me better for CRNA school than my ICU experience did (which has been echoed by many FN friends who have gone that route). The skill side, while something that can be learned, is honed with experience. I have intubated well over 1000 people in my career. Not the airways might be seen in the OR but much more complicated crash airways. I feel very comfortable with that skill and since the mangement of airway is the total pervue of the CRNA, between my FN and ICU experence, i think im well prepared to transition into that program.

In anycase, I was just dissapointed with the attitude i got from that individual which was clearly ignorant and misguided, sorry to say this, but the isolation of the ICU often creates this unfounded primadonna attitude toward the rest of nursing, ive seen it many times in my career.

toobemall · Mar 19, 2006

hi all, just wanted to vent and bounce this off you.
1st, let me say that i have experience in CVICU, TICU, ER, Trauma Team and the last 4 years as a flight RN.
Now onto the story. So i went to talk to a program director about the CRNA admission reqs and what i might be lacking. The individual seemed happy with everything except the fact that my ICU experience was a bit dated (5 yrs ago). I told her yes, but ive been doing the most advanced critical care nursing in my career as a flight RN. She waved her arms in a show of flying and said "thats is not ICU experience.".
Now this attitude is what i have come to expect from Nursing Instructors who's background (10+ years ago) was only in the ICU (which is this individuals story). Practice as a flight nurse is covered under the advanced practice act. I dont know any ICU RN's who are intubating, practicing rapid sequence induction, managing and placing central lines & chest tubes etc etc. Moreover, we carry about 40 drugs all given at our disgression.
This individuals response was "well, you know how it can be at ngiht in the ICU". I almost died. Yes i know how it is, but we all know when that happens there is a fine line being walked which is called practicing medicine without a liscence. This isnt the sortof thing you expect from a program director.
In anycase, i was angry and decided not to even apply to that program based on how much of an idiot this individual was.
Thanks all for allowing me to vent!
MM

Mike, I know how you feel. I have been a nurse for 14 years- ER, flight, cath lab, CICU/MICU, CVICU. Also did EMS before nursing school.

Dude, you are going to have to, as another post said, "bite the bullet" and do what these schools want you to do in order to become a CRNA. If you won't there are about 4-6 others competing for your slot who will.

Also, a piece of tough advice. The attitude reflected in your posts ( I also read flightweb) will kill you in anesthesia school. You would be lucky to get thru the interview process. Flight nursing is great, but I must disagree with your belief that it is the "most advanced critical care nursing". Yeah, you get to do alot of skills, but you could probably teach a monkey how to intubate. While these skills are important, they don't make up the whole package. If you think ICU nurses don't manage CVLs and chest tubes, then you need to think again. Really, when you are flying, are you with the patient more than an hour? I doubt it. Flight nurses are there to stabilize as best as possible and provide rapid transport. When I was flying, we didnt shoot C.O.s and adjust gtts based on values, we didnt autotransfuse from chest tubes, we didnt draw labs and adjust vent/gtts accordingly. The management expereince that you get in an ICU is goona help you manage you patients during surgery.

Certainly I came into anesthesia school ahead of some what with having intubation skills and being used to working independently. I chose, however, to let my clinical skills speak for themselves instead of offering up what I had already learned to do or done a different way. Anesthesia school includes biting your tonuge and being a peon for a couple years. I would probably not even apply to the program that was the basis of this post either becuase if the director caught wind of your attitude you have already lost points and you have'nt even interviewed. There is a fine line between confidence and arrogance. Don't cross it.

Good luck.

Mike

MmacFN · Mar 19, 2006

Hey

Well if youve seen my posts on flight web then hello!

In anycase, I agree with you. Im not at all devaluing the ICU experience. Im saying that there is a very different role in the helicopter which prepares you for the autonomy. I dont intend arrogance, just facts (though if could come off that way im sure).

Im not new at either job, ICU or Flight. I was just angered by the perceptions of someone who clearly didn't know what they were talking about. I dont make assumptions about what its like to work High Risk OB and I expect others don't do the same, especially when it comes to an admission process.

Dont worry about my eligibility for a program. There are many programs out there interested in different types of experience. I did not go in giving this director a run down of my credentials, as you suggest. I asnwered her questions and when I told her i was an FN, thats where she decided what that meant. There was no exchange about clinical history, competance or level of expeirence at all. In fact, her first comment was that i would have no experience with swans, IABP's or artlines.. which isnt true.

As for how i will manage in CRNA school, I'll be fine. Whenever you enter into a new role you always have to set aside how "it was done when i was at ....". I had no difficulties doing that from ICU -> ER or to flight, i dont anticipate any in another venture.

Have a good one!

Mike, I know how you feel. I have been a nurse for 14 years- ER, flight, cath lab, CICU/MICU, CVICU. Also did EMS before nursing school.
Dude, you are going to have to, as another post said, "bite the bullet" and do what these schools want you to do in order to become a CRNA. If you won't there are about 4-6 others competing for your slot who will.
Also, a piece of tough advice. The attitude reflected in your posts ( I also read flightweb) will kill you in anesthesia school. You would be lucky to get thru the interview process. Flight nursing is great, but I must disagree with your belief that it is the "most advanced critical care nursing". Yeah, you get to do alot of skills, but you could probably teach a monkey how to intubate. While these skills are important, they don't make up the whole package. If you think ICU nurses don't manage CVLs and chest tubes, then you need to think again. Really, when you are flying, are you with the patient more than an hour? I doubt it. Flight nurses are there to stabilize as best as possible and provide rapid transport. When I was flying, we didnt shoot C.O.s and adjust gtts based on values, we didnt autotransfuse from chest tubes, we didnt draw labs and adjust vent/gtts accordingly. The management expereince that you get in an ICU is goona help you manage you patients during surgery.
Certainly I came into anesthesia school ahead of some what with having intubation skills and being used to working independently. I chose, however, to let my clinical skills speak for themselves instead of offering up what I had already learned to do or done a different way. Anesthesia school includes biting your tonuge and being a peon for a couple years. I would probably not even apply to the program that was the basis of this post either becuase if the director caught wind of your attitude you have already lost points and you have'nt even interviewed. There is a fine line between confidence and arrogance. Don't cross it.
Good luck.
Mike

toobemall · Mar 19, 2006

Hey
Well if youve seen my posts on flight web then hello!
In anycase, I agree with you. Im not at all devaluing the ICU experience. Im saying that there is a very different role in the helicopter which prepares you for the autonomy. I dont intend arrogance, just facts (though if could come off that way im sure).
Im not new at either job, ICU or Flight. I was just angered by the perceptions of someone who clearly didn't know what they were talking about. I dont make assumptions about what its like to work High Risk OB and I expect others don't do the same, especially when it comes to an admission process.
Dont worry about my eligibility for a program. There are many programs out there interested in different types of experience. I did not go in giving this director a run down of my credentials, as you suggest. I asnwered her questions and when I told her i was an FN, thats where she decided what that meant. There was no exchange about clinical history, competance or level of expeirence at all. In fact, her first comment was that i would have no experience with swans, IABP's or artlines.. which isnt true.
As for how i will manage in CRNA school, I'll be fine. Whenever you enter into a new role you always have to set aside how "it was done when i was at ....". I had no difficulties doing that from ICU -> ER or to flight, i dont anticipate any in another venture.
Have a good one!

Flight nursing was the best job I ever had. In fact, I actually visited my former program last night and started having withdrawls......If for whatever reason CRNA school ended tomorrow, I would have to go back on the helo.

You are right......autonomy is certainly a byproduct of flight nursing and it will serve you well in school. Absolutely.

Again, I have had to bite my tongue several times in clinical situations and jusy say yes sir, yes ma'am, thank you, never thought of that, that's a great idea..........you know........a$$ kissing. You have docs grabbing the scope from your hand and what not. You will not know how to put on a BP cuff. You will not know how to mask ventilate a patient.You will not know how to tape an ETT. One person wants you to set up airway stuff on the ploss cart, one wants you to put it on the gas machine. Just wanted you know get a little idea of what to expect.

Fly safe.

Mike

MmacFN · Mar 19, 2006

hehe

yah i totally have to bite my tounge! The crash stuff we do lacks all the finess of the CRNA. I have alot to learn thats for sure, and im excited!

Im ready to not be responsible for much and be a learner again. The whole process is exciting! How has your expereince been so far?

Flight nursing was the best job I ever had. In fact, I actually visited my former program last night and started having withdrawls......If for whatever reason CRNA school ended tomorrow, I would have to go back on the helo.
You are right......autonomy is certainly a byproduct of flight nursing and it will serve you well in school. Absolutely.
Again, I have had to bite my tongue several times in clinical situations and jusy say yes sir, yes ma'am, thank you, never thought of that, that's a great idea..........you know........a$$ kissing. You have docs grabbing the scope from your hand and what not. You will not know how to put on a BP cuff. You will not know how to mask ventilate a patient.You will not know how to tape an ETT. One person wants you to set up airway stuff on the ploss cart, one wants you to put it on the gas machine. Just wanted you know get a little idea of what to expect.
Fly safe.
Mike

toobemall · Mar 19, 2006

hehe
yah i totally have to bite my tounge! The crash stuff we do lacks all the finess of the CRNA. I have alot to learn thats for sure, and im excited!
Im ready to not be responsible for much and be a learner again. The whole process is exciting! How has your expereince been so far?

Other than being tired, I am really having a good time. I am in an integrated program that puts you in clinical pretty quick. I mean we started last August and were in the OR three days a week by the end of October. I cannot speak for front loaded programs, but being able to get into clinical early has been better for me, I think. I don't learn tasks by reading about them, I have to see it done and then learn it myself. Being able to see concepts that you read about in the text quicker helps me get a better handle on them. Definitely something to consider when looking at the various programs.

yoga crna · Mar 19, 2006

Mike,

I am reluctant to offer my thoughts on this topic, because I am an "old" CRNA who did not have to have any experience, just an RN to get in anesthesia school.

But, I would like to offer a little different perspective. While I am in awe of your experience as a flight nurse, there is another dimension that is important when programs make decisions about admitting students. It is whether the individual, as a student and later as a CRNA will understand the politics, economics and business of anesthesia practice. I have known many clinically adept CRNAs who were not team-players, always stirring the pot and never understood that there is more to anesthesia practice than clinical skills.

Many of you on this forum state that one of the reasons you want to be a CRNA is financial rewards. Being in private practice, I can tell you that I spend a lot of time in marketing my services to the surgeons, administrators, nursing staff and patients. Anesthesia is a highly competitive business, and probably the only one where doctors and nurses compete for the same business. Program directors are probably not concerned about where you decide to practice when you graduate, they do want to educate anesthetists who are savvy about professional and business issues.

While I don't know you or the program director, when I was in education, we frequently tried to stress the applicant during the interview. How they reponded to that stress gave us some perspective as to how they would handle themselves in the operating room. You may have been baited.

Remember anesthesia is very different from any other type of nursing.

Yoga CRNA