Should i switch ICUs??

Nursing Students SRNA

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Hey everyone, I've been doing a lot of hard thinking lately and would like some input on a decision I need to make. I currently work in a medium/large sized metro hospital in the med/surge icu. We see everything except for peds, burns, and transplants. I feel like this icu will prepare me for crna school because we take care of some cardio patients (CHF, arrests, MI, CABGS, valve repairs) and sometimes have patients on balloon pumps and arctic sun. I also see a lot of different gtts used in this icu including levo, epi, neo, vasopressin, dopamine, cardene, cardizem, and nitro. I would have to work in this icu for another year before i would start taking our heart surgery patients.

But here's where it gets tricky, I have recently been offered a job in another metro hospital that i wanted to work at before i started my current job. This job is in a transplant icu that does liver, kidney, pancreas and lung transplants. Here, i would not see such a variety in gtts. The only 2 they use on a common basis are levo, and vasopressin. However, in this icu I would see A LOT more fancy equipment such as ECHMO and CRRT. Occasionally, i see crrt at my current icu, just not very often. Also important to note- the transplant icu is in a larger hospital that also has cardiac icus so it would be rare for me to get cardiac patients.

Anyways, the main question I've been pondering and would like to ask all of you experienced nurses, SRNAs, and CRNAs, is what would prepare me better for CRNA school? Using a larger variety of drips in the icu that sees some cardiac patients, or having experience with machines such as echmo and crrt and caring for extremely sick pts pre/post transplant?

Thanks for reading!

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Another thing i forgot to mention, at my current job, resources are very limited. I may or may not get to take a class to be able to take crrt patients. The equipment is a lot older than that at the bigger hospital. And the bigger hospital has intensivists and ACNPs that help manage care of the transplant patients

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Specializes in ER/ICU/STICU.

Personally I would stay put. Dealing with suck patients and becoming familiar with those meds are more important that fancy equipment in my opinion. You seemed focused on CRRT, but in reality it will have not have much impact in the Anesthesia world.

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How long have you worked in the current unit? When do you want to apply to school? Realize that switching units may keep you in an ICU setting for longer. You'll want to become proficient in the use of new devices and patients prior to applying. Also remember that you need references and it may take some time to build a rapport with those at the new facility in order to gain a reference.

I would stay put. Vent settings, PA catheters, and drips that you are actively involved with, understand and wean / titrate would mean more (as it pertains more to anesthesia) than ECMO and CRRT which are run by perfusion or dialysis and don't necessarily strengthen your application.

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Thanks for the replies. Ive been in the icu for about 7 months.

Ckh23 and screen name, are you two currently crnas? Ive got a couple of questions ive been meaning to ask somebody and im currently in the process of finding a crna to shadow. I was wondering how many of these cardiac meds are used in the anesthesia relm? I know neo is used often on pts that come to our icu post surgery but what about levo, dopamine, epi, etc? Its kind of off topic but i was hoping to get some answers without starting a new thread.

Thanks

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Specializes in ER/ICU/STICU.
Thanks for the replies. Ive been in the icu for about 7 months.

Ckh23 and screen name, are you two currently crnas? Ive got a couple of questions ive been meaning to ask somebody and im currently in the process of finding a crna to shadow. I was wondering how many of these cardiac meds are used in the anesthesia relm? I know neo is used often on pts that come to our icu post surgery but what about levo, dopamine, epi, etc? Its kind of off topic but i was hoping to get some answers without starting a new thread.

Thanks

I am a SRNA and will be graduating in November. You will see the cardiac meds a lot in the heart rooms. You will do heart rotations while in school and see them all the time, however not all places do hearts and as a CRNA you may end up somewhere that doesn't and may not see them again for a long time.

I would say neo and ephedrine are the more common of the pressors we use, but everyone's practice is different and every patient is different. I have been with preceptorship that like to use epi, levophed, vasopressin, etc. It just depends on the situation.

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I am a SRNA and will be graduating in November. You will see the cardiac meds a lot in the heart rooms. You will do heart rotations while in school and see them all the time, however not all places do hearts and as a CRNA you may end up somewhere that doesn't and may not see them again for a long time.

I would say neo and ephedrine are the more common of the pressors we use, but everyone's practice is different and every patient is different. I have been with preceptorship that like to use epi, levophed, vasopressin, etc. It just depends on the situation.

Congrats! I hope to be where you are in a few years. Its cool to hear you say it depends on the person as to which meds they use. I guess I've never really thought about all the autonomy crnas have even though people talk about it all the time. Good luck, I hope you enjoy your last few months of school and your new career direction!

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I have one more question for anyone that is a srna or crna. Is it considered a positive quality in the application process to have more than average code blue experiences? Not that it is necessarily always MY patients coding. The icu I'm in has 22 beds and we take trainwreck cases from rural hospitals as well as sick patients from the impoverished area surrounding our hospital. Sadly, some of these patients do not have a chance of making it out alive, but the families usually want everything done, so we usually have at least one code every week in the icu alone. DNRs in these situations are the doctors call, and I'm not one to push families to make rash decisions that they will have to live with for the rest of their lives in such an emotional situation.

Anyways, Sorry i got off topic but I am curious as to whether or not all of these codes will look good or bad in my nursing experience?

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Specializes in CCU/ICU/ER.

If you really want to be a CRNA.. i would stay where you are and build a strong reputation there!! I honestly think either ICU setting will adequately prepare you because crrt and echmo pt's will be sicker and likely on a lot of hemo dymanic related gtts as well ... You will want to have a strong basis in cardiac related meds.. pressors especially because anesthesia so drastically effects hemo dynamics. The whole levo/vaso thing has been around for a while now.. but is only corrective in certain situations and most of them are not related to surgical issues ( mostly indicated in sepsis with metabolic acidosis).. you'll see a lot of other combos epi/neo blah blah blah used depending on the underlying problems and the doctors ordering the drugs. my suggestion is get familiar with them all !!! Make your self a flowsheet or something that has all the titrating cardiovascular gtts.. and write out what each one does ( vasco constricts one area while increasing heart rate. ex).. you'll be amazed how they all effect different aspects of the sympathetic system.. put the sheet up in your bathroom or somewhere you'll see it a lot and let it absorb in. .. if your staying in any icu.. you'll want to know this. this should be followd by an intense study of heart chamber pressures.. cvp/pap/pwp.. and what those mean.. what they really mean!!!

about the codes.. they will want to know you have some experience, but i wouldn't go out of my way to highlight how many code blues you've been involved in.. it makes you sound like a new nurse.

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Well, despite the general consensus agreeing I should stay where I am, I still think I want to go to the transplant icu. It may not be as good 'crna school experience' but it's a place I've always wanted to work and I figure I might as well take my shot for a year or two while I'm still working as a RN. Icumarshall, first off, thanks for the advice, I will study up on all the pressors and learn my swan pressures inside and out. When you said, levo/vaso has been around a while, does that mean that having a lot of experienxe titrating levo isn't necessarily going to look all that great in an interview?

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Almost every bad decision I made in my life followed this pattern.

-Ask for advice from people I trust.

-Be surprised when the responses don't validate my own preference.

-Go with my first inclination anyway.

-Get shocked when the expert opinion turned out to be right.

I'm old enough now that this type of response would make me pause for a bit. Then again, if you aren't 100% sure you want to go to CRNA school it would make sense to do a bit more exploring.

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Specializes in ICU.

I think you are way too focused on specific drugs or technologies as being the deciding factor. The best experience in my opinion is going to come from seeing a diverse collection of patients with problems encompassing every body system.

Based on your descriptions the unit you are in now sounds like the more well rounded preparation.

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