Large teaching hospital vs. Community hospital ICU experience- Chances of getting in?

[rcon]

Hello everyone! I have been in the ICU for a little over a year and I recently changed hospitals, from a community hospital general ICU to a level one teaching hospital in the SICU. I loved working in the general ICU. I always did my best to know everything about my patients, to critically think about their illnesses and pathophysiology, and to work closely with the intensivists. At this hospital, the nurses were highly relied on to report any trends, and I felt valued.

At my new hospital in the SICU, the atmosphere is different. Nurses give short reports at change of shift with no detail, they never write anything down (PMH, labs, meds, etc.), and they never know the plan of care/goals or what has happened to the patient since admission. Even though I now work in a level one trauma center, I feel unhappy and lost.

So my question is...has anyone gotten into CRNA school by having ICU experience in a community hospital? I know CRNA schools prefer the SICU from a large teaching hospital, and that is why I made the switch. However, I am constantly thinking of leaving. Do you think if I worked at a 400 bed community hospital I would blow my chances of getting into CRNA school. My GPA and GRE are good, and I have shadowed CRNAs in the past. I want to get another year or two in the ICU under my belt before I apply. Any thoughts would be greatly appreciated!

[CCRNDiva, BSN, RN]

I'm not a CRNA but I wanted to offer some support. I recently started in an ICU within a tertiary academic center after spending close to 8 years in the CV/ICU within a Level II Trauma Center (around 400 beds). I share your sentiments. I had much more autonomy at my old facility than I do now. I have to run everything by a resident now. We cannot place Dobbhoffs or pull lines. These are all things that I routinely did at my last facility. We were expected to know our patients and help develop the plan of care. We also worked closely with the intensivists and surgeons. Now, I'm lucky to know what the plan of care is. I have to ask the docs to find out what is going on, since they do not freely share such information. I never get a "thank you" for pointing something out, like "this pt w/ a failing heart reported a sore throat and now has a rash which may be indicative of an infection, have cultures been ordered?" or using the Valsava maneuver to convert a patient out of V-fib/V-tach before the resident attempted to defibrillate a conscious patient with a pulse with 150 joules.

I switched jobs for various reasons but one was to increase my knowledge. Sometimes, I actually feel that I've went backwards. I have to remind myself that I also switched for much better pay, benefits and opportunity for advancement. It is definitely a different culture so I must adjust. It is sad that having the name of this facility on my resume will carry much more weight than my previous facility simply because of name recognition. I worked with an excellent team and cared for truly sick patients there (we accepted far more transfers than we transferred out) but people think I worked in some boom-boom hospital in the back woods. Unfortunately, the administration I worked for was horrible and the pay, benefits and career opportunities left much to be desired. Such is life, I guess we can't have it all, lol.

That being said, I've had two co-workers gain acceptance into CRNA programs from my old ICU (they are the only ones I know of who applied). Both were accepted within 2-3 yrs of becoming nurses and during their first round of applications. They did a good job of describing our patient population. I think it can be done, you just have to be sure to present an accurate picture of your role, skillset, and patient acuity. Good luck!

[ckh23, BSN, RN]

I think it is going to depend on the school. Most schools in my area preferred experience from large teaching hospitals because they patients in general are usually more sick. I know that is not the case everywhere. However if you are getting to take care of some sick patients that have invasive monitoring, vents, pressors, etc then it may not matter. I think the best way to get the answer to your question is to contact the programs you are thinking about applying to and see what they say. Some may be fine with that experience and others may not. I know of some programs that go as far as ranking what ICU's they want you to have experience in.

[bloomRN]

I KNOW you don't have to work in a Level 1 Trauma Center to gain acceptance to CRNA school. I know this because I was accepted to multiple programs and the only hospital I worked at was a Level 3 that functioned as a Level 2. The hospital was not even 400 beds, but because it was a regional hospital we had a wide variety of very sick patients, and the doctors relied heavily upon the nurses to know their stuff and perform well.

I agree that you should contact the schools you are interested in and see what they like to see in applicants. But, I would say the type of patients you care for routinely is more importan than the type of facility you work in. During the interview process you will likely be asked to describe your typical patient, and that is your chance to demonstrate that although your facility may not be a Level 1 Trauma Center, you know how to take care of the sickest patients and your experience is not limited.

[rcon]

Hi bloomRN,

Thanks for the encouraging words! I was wondering, would you mind sharing how many years of experience you had when you applied/got accepted to CRNA school? I hope to apply either this year for next year start or the year after...I would have a total of 2 years ICU and 3 years nursing experience. If I waited to the year after, I would have 3 years ICU. Thanks!

[rcon]

Anyone else have any opinions on CRNA acceptance and ICU experience in a Level 1 Trauma center vs. Level II Community Hospital? Thanks everyone!

[bloomRN]

Hey rcon,

Ofcourse I don't mind sharing...at the time I was notified that I was accepted I had 1 year of med/surg and 2 1/2 years of ICU nursing experience. I am not suggesting that this is the norm, every program is different. I just think it is important that people understand that you can get accepted without tons of experience. As long as the experience you have is good quality experience and meets the minimum program requirements you should be fine!