Start NP school now or hold out for ICU experience and CRNA school?

Rekkashinorei · Nov 17, 2009

Hi there jerrylundergard,

I am neither an NP or CRNA right now, but am in a similar situation in deciding between the two professions. However, I thought I might share some considerations that I have had:

1. Does your employer provide financial educational assistance for both degrees and are both programs available to you nearby? If not, you have to prepare yourself to relocate. Check out the tuition rates for the programs you like and see which one would be most financially feasible for you.

2. Like you mentioned, ensure that the job market for NPs/CRNAs will still be in great need in the near future. I have come across about 2-3 articles (one of which was by US News & World Report) where NPs (and PAs) are often ranked in those "Top 10" lists for hottest job markets in the future. Now, how credible that stuff is, I don't know but with all these healthcare reform issues in the air, I am sure that NPs/PAs will play a large role in providing primary care for the future.

3. Are you financially stable in that you are ready to go back to school full-time without work? Most CRNA schools highly discourage or even mandate to not work - partly due to the rigorous curriculum. On the flip side, NP programs usually allow enough time for you to at least work part-time or per diem. In my situation, I am close to 3 years into my MICU experience. If I work 5 consistent years, I will be gauranteed a small pension during retirement. In case you are also in that situation, what you could do is enroll yourself into an NP program and continue to work at 0.5 FTE (or whatever minimum is required of you to still receive benefits). This way, you would be able to still make some money during school, continue your seniority, and ultimately receive a pension when you retire. See what your employer provides for educational advancement such as an educational leave of absence, educational reimbursement, or post-graduate contract.

4. Job shadow. The best thing is to see for yourself which profession you would very much be able to see yourself doing for a long time. I have been told of an NP who recently graduated enrolled himself into a CRNA program shortly after graduating and working as an NP (I think he worked as an NP for less than a year). As a CRNA, you don't necessarily have to be stuck in an OR all the time either. Many CRNAs can travel like travel RNs can while others work in dental offices, labor & delivery, and cosmetology departments. Sometimes, they do OR and also some side jobs like dental offices to keep the variety going. Compared to CRNAs, I will dare say that I feel as though NPs have a wider variety of careers to choose from. For instance, you can work for in internal medicine, dialysis, cardiology, or even just family practice. You can switch between more specialties than CRNAs can. (Fellow readers, correct me where I am wrong.)

My reservations of becoming a CRNA is becoming so specialized in only in the discipline of anesthesia. But, I suppose there are a lot of neat subsets within anesthesia that I don't know about yet. Anyhow, if you do decide to go towards the NP route, the key is to realize if you ought to strive for Adult NP, Pediatric NP, Geriatric NP, Family NP, or Acute Care NP. If you love the inpatient setting, I'd go for ACNP. (That's where I am deciding towards as well.) And make sure that the area you live in offers the hours you would like to work as an NP. For example, 12 hours shifts, rotating days and evenings, and weekends. And, when you job shadow them, observe what kind of autonomy each one offers. The nice thing about CRNAs is that you get to take care of one patient at a time in the OR setting. The ACNP must be ready to act as a fellow (MD) and manage a 10-20 patients at a time. What type of autonomy do you want? What are your work-style strengths and weaknesses?

5. Job shadow the ICU RNs if you want to become a CRNA. (Actually, it doesn't hurt for ACNP school either!) If you decide in transferring to an ICU, make sure you know which department you want to work in. MICU is generally like an intensive internal medicine specialty (pulmonary/sepsis/GI bleeds/end-stage liver/end-stage kidney) and you will not work with anesthesia/surgery as much. On my unit in particular, we barely ever have to use Swan catheters or measure PA pressures. Try Cardiac-Surgical ICU because you will have more contact with CRNAs who send the post-op patients to that ICU. Lastly, I would not try Neuro ICU and I only say that because, in my own research, many schools do not accept Neuro ICU as sufficient experience for CRNA programs.

6. Plan ahead. Even if you have one year of ICU experience and applied for CRNA schools, they may not accept you the first time you apply. You have to be ready for that and be willing to reapply year after year. It is not uncommon for people to apply to the same program 2-3 times before they get accepted. You may want to factor time into your goal plans. If you definitely want to be done with graduate school in the next 3 years or so, NP may be most promising with a more flexible schedule. But, again, the most important thing is to first realize which profession interest you the most.

The wait and indecisiveness certainly is no fun. But, as many have reassured me, it's worth the wait before you start investing in so much time, effort, and money into something that may end up being something you lose interest in. I had a friend who could not make it through the first year of CRNA school in Georgetown University in DC. She quit the program and all that she is left with were $800-$900 monthly repayment loans. After several desperate months in search of an RN job, she was offered a pediatric ICU position after 4-5 months of looking. Also, the longer you practice as an RN, the better your resume and overall clinical experience will be, and I am sure that it will play a large role in your professional advancement.

I hope this helps some.

Best wishes!

BmoreCRNP · Nov 18, 2009

Hi there jerrylundergard,
I am neither an NP or CRNA right now, but am in a similar situation in deciding between the two professions. However, I thought I might share some considerations that I have had:
1. Does your employer provide financial educational assistance for both degrees and are both programs available to you nearby? If not, you have to prepare yourself to relocate. Check out the tuition rates for the programs you like and see which one would be most financially feasible for you.
2. Like you mentioned, ensure that the job market for NPs/CRNAs will still be in great need in the near future. I have come across about 2-3 articles (one of which was by US News & World Report) where NPs (and PAs) are often ranked in those "Top 10" lists for hottest job markets in the future. Now, how credible that stuff is, I don't know but with all these healthcare reform issues in the air, I am sure that NPs/PAs will play a large role in providing primary care for the future.
3. Are you financially stable in that you are ready to go back to school full-time without work? Most CRNA schools highly discourage or even mandate to not work - partly due to the rigorous curriculum. On the flip side, NP programs usually allow enough time for you to at least work part-time or per diem. In my situation, I am close to 3 years into my MICU experience. If I work 5 consistent years, I will be gauranteed a small pension during retirement. In case you are also in that situation, what you could do is enroll yourself into an NP program and continue to work at 0.5 FTE (or whatever minimum is required of you to still receive benefits). This way, you would be able to still make some money during school, continue your seniority, and ultimately receive a pension when you retire. See what your employer provides for educational advancement such as an educational leave of absence, educational reimbursement, or post-graduate contract.
4. Job shadow. The best thing is to see for yourself which profession you would very much be able to see yourself doing for a long time. I have been told of an NP who recently graduated enrolled himself into a CRNA program shortly after graduating and working as an NP (I think he worked as an NP for less than a year). As a CRNA, you don't necessarily have to be stuck in an OR all the time either. Many CRNAs can travel like travel RNs can while others work in dental offices, labor & delivery, and cosmetology departments. Sometimes, they do OR and also some side jobs like dental offices to keep the variety going. Compared to CRNAs, I will dare say that I feel as though NPs have a wider variety of careers to choose from. For instance, you can work for in internal medicine, dialysis, cardiology, or even just family practice. You can switch between more specialties than CRNAs can. (Fellow readers, correct me where I am wrong.)
My reservations of becoming a CRNA is becoming so specialized in only in the discipline of anesthesia. But, I suppose there are a lot of neat subsets within anesthesia that I don't know about yet. Anyhow, if you do decide to go towards the NP route, the key is to realize if you ought to strive for Adult NP, Pediatric NP, Geriatric NP, Family NP, or Acute Care NP. If you love the inpatient setting, I'd go for ACNP. (That's where I am deciding towards as well.) And make sure that the area you live in offers the hours you would like to work as an NP. For example, 12 hours shifts, rotating days and evenings, and weekends. And, when you job shadow them, observe what kind of autonomy each one offers. The nice thing about CRNAs is that you get to take care of one patient at a time in the OR setting. The ACNP must be ready to act as a fellow (MD) and manage a 10-20 patients at a time. What type of autonomy do you want? What are your work-style strengths and weaknesses?
5. Job shadow the ICU RNs if you want to become a CRNA. (Actually, it doesn't hurt for ACNP school either!) If you decide in transferring to an ICU, make sure you know which department you want to work in. MICU is generally like an intensive internal medicine specialty (pulmonary/sepsis/GI bleeds/end-stage liver/end-stage kidney) and you will not work with anesthesia/surgery as much. On my unit in particular, we barely ever have to use Swan catheters or measure PA pressures. Try Cardiac-Surgical ICU because you will have more contact with CRNAs who send the post-op patients to that ICU. Lastly, I would not try Neuro ICU and I only say that because, in my own research, many schools do not accept Neuro ICU as sufficient experience for CRNA programs.
6. Plan ahead. Even if you have one year of ICU experience and applied for CRNA schools, they may not accept you the first time you apply. You have to be ready for that and be willing to reapply year after year. It is not uncommon for people to apply to the same program 2-3 times before they get accepted. You may want to factor time into your goal plans. If you definitely want to be done with graduate school in the next 3 years or so, NP may be most promising with a more flexible schedule. But, again, the most important thing is to first realize which profession interest you the most.
The wait and indecisiveness certainly is no fun. But, as many have reassured me, it's worth the wait before you start investing in so much time, effort, and money into something that may end up being something you lose interest in. I had a friend who could not make it through the first year of CRNA school in Georgetown University in DC. She quit the program and all that she is left with were $800-$900 monthly repayment loans. After several desperate months in search of an RN job, she was offered a pediatric ICU position after 4-5 months of looking. Also, the longer you practice as an RN, the better your resume and overall clinical experience will be, and I am sure that it will play a large role in your professional advancement.
I hope this helps some.
Best wishes!

Off topic, but I used to work in the PACU at Georgetown. I remember the CRNA students talking about how strenuous the program is. They are also VERY strict about grades and maintaining a certain GPA. I know of one student who was told they couldn't graduate at the very end of the program. Why? Her GPA was too low by one point. I can't remember what the minimum was, but we all felt sooo bad for her. She tried to fight it, but I heard that she didn't win. And you know how things are in nursing. You can't transfer the credits and enter another program. She would have to start over at another school. I'm not sure what she ended up doing.

TreehuggerRN · Nov 18, 2009

At 35 I feel pretty over the hill. I know a former state trooper who is in CRNA school now and he is 37. I know there are some older than that who swing it but I feel like I've missed enough of my childrens' lives working and going to school as it is. I have to choose one or the other, and it's them. I'm enrolled in an NP program for Spring 2010. If it wasn't for so many responsibilities and agonizing over spending so much time away from family I'd be a medical doctor by now. I'm just going to make the best out of what I have, and I figure becoming a nurse practitioner is about as far as I can attempt to go, and I'll be thankful if I can accomplish that.

Rekkashinorei · Nov 18, 2009

BmoreCRNP,

That further affirms what my friend who dropped out of the Georgetown CRNA program said. Her fiance is currently studying at Northeastern in Boston and did not have the kind of issues she had about strict GPA scores. He actually had a day or two off during the weekdays between didactics whereas she had a Monday-Friday schedule. She made it sound like she was constantly challenged by an onslaught of unsurmountable assignments/exams/quizzes/papers. Now, I must also be fair and add that her fiance has his own unique challenges at Northeastern such as a very mean clinical instructor who is very hard on her students, will call them out on their mistakes, and suggest flunking anyone whom she does not see fit. Again, this is his personal challenge. I'd hate to taint any program.

So, on the topic of CRNA programs, jerrylundergard, it's important that your academic personality will "fit" the CRNA programs offered to you nearby. Different schools definitely have their own mission/values/culture that they impose/teach to their students. I would use this time to do thorough research on both programs and see what you like best of each.

One last thing about ACNP, although it depends on your State Board of Nursing, ACNPs can have a ton of autonomy such as intubating, placing central lines, performing lumbar punctures/bronchial lavages, and make vent changes. If it's the procedural tasks that appeals to you, know that ACNPs can do what CRNAs for the most part. But again, it depends on your state regulations and hospital culture.

Do you want to manage the diverse care of numerous patients in the critical care/inpatient setting and share the responsibility with the doctors or do you want to have a structured environment purely in the discipline of anesthesia? Ask yourself that and start emailing NPs and CRNAs in your hospital and see where it takes you.

Rekkashinorei · Nov 18, 2009

PS: To be on the safe side, also avoid ER, just stick with ICU if you are gung-ho for CRNA. Double check the application criteria for such RN experiences for all of the programs that interest you. Some may accept ER, some may not. I think the most popular ones are cardiac/surgical ICUs.