Trauma level 1 or level 3 for future CRNA?

[violet87, BSN, RN]

I'm sorry if this has been asked before. I tried shuffling through past posts and didn't see anything for the last couple years but maybe missed something. I'm having conflict with what I should do as I'm currently at a cross roads and looking for advice from people who have experience with this.

So I currently work on the burn unit at a major trauma level 1 teaching hospital and have cross training to SICU. I have the opportunity to work in SICU full time here, and I also just got a call for an interview at a smaller trauma level 3 hospital with a 16 bed mixed ICU. My goal is to be accepted to CRNA school in the next couple years. My question is how much does it matter if I take the level 3 job over the level 1? And does a "mixed ICU" work for or against me? The reason I'm so conflicted is because the level 3 hospital will pay me almost 20k more a year. I'm willing to stay where I am and just move to the SICU full time if that's more worth it experience wise.

Thank you in advance for your input!

[ProgressiveThinking, MSN, CRNA]

Work in the level 1 SICU at the teaching hospital. Not to say that SICU experience at a level 1 would ALWAYS be better experience than the level 3 ICU (sometimes you have more autonomy in these smaller mixed ICUs), but you will likely be exposed to more in the SICU. 20k/year is a drop in the bucket if you really want to be a CRNA.

[BigPappaCRNA]

Ya, stay where you are. Level 3's can be pretty sleepy, at times. There are quite likely far more quality learning experiences to be had in the larger place. But..absolutely NOTHING wrong with a mixed ICU. Personally, I feel those are much better. Just my .02 The burn unit you are on is fine, as well, as long as you are getting some shifts over in the SICU. You should do fine.

Good Luck.

[guest769224]

Could you take fresh hearts at the other hospital? That would be good experience for anesthesia school. And then you could just stay per diem at your level 1 facility. You could get the experience at both facilities and make more at your new job.

[violet87, BSN, RN]

Thank you all for your advice. Any one with additional advice is still welcome to comment! I'm going to attend the interview next week and weigh my pros and cons after getting more information about the facility and patients

[PresG33]

I worked at a level 3 trauma hospital, but we did tons of super complicated cardiac and vascular, RNs in the unit ran ECMO, and we also took complicated medical patients. All of this was with tons of autonomy. Trauma level only applies to trauma cases which are, in terms of ICU management, only a small sliver of the other comorbidities you can see. Being at a level 1 center also can mean that much of the management is done by residents and fellows and very little autonomy is passed on to nursing. All of these are important variables that go beyond a simple level 1 vs. level 3 discussion. Best to get info from floor nurses in both units and make a decision based on that.

[violet87, BSN, RN]

Thank you I really appreciate your response. It made a lot of sense and was very helpful. I'm going to ask a lot of questions at the interview to assess the true acuity of patients and what I would be working with.

[subee, MSN, CRNA]

I came from a very small ICU setting where I was able to hone up on technical skills (came from administrative background) and it was adequate preparation for me. In real life practice, we mostly do bread and butter work and occasional trauma. I did, however, learn to make independent judgements in a smaller unit and get a feel for patients who come to the OR in direr conditions.

[ProgressiveThinking, MSN, CRNA]

27 minutes ago, subee said:

In real life practice, we mostly do bread and butter work and occasional trauma.

If you work rural, maybe. I took a job in a level 1 and seem to be getting stuck in a trauma, crani, transplant, or AAA on an ASA 4 at least weekly. The other day I did 3 cranis within 10 hours. After a couple of years of this I may need to go onto do some of these bread and butter cases you speak of.

I worked in a very busy level 2 MICU (more of a mixed county ICU) that actually took more traumas than our local level 1 (private hospital) and was given a lot of autonomy. I agree with PresG33. It's not always the trauma or unit designation that matters, but rather what you're doing on the unit and how you portray/convey it on your application.

With that being said, there are a lot of people that would love to get into a level 1 SICU specifically for school, and if the level 3 doesn't take hearts/ecmo, etc etc, then the level 1 SICU is hands down the safest bet. 20k seems like a lot of money now, but once you're a CRNA that 20k won't seem like much.

[subee, MSN, CRNA]

Don't have to be rural to do lots of bread and butter. Unless one chooses to work in a Level 1 or 2

On 5/9/2020 at 10:34 AM, ProgressiveThinking said:

If you work rural, maybe. I took a job in a level 1 and seem to be getting stuck in a trauma, crani, transplant, or AAA on an ASA 4 at least weekly. The other day I did 3 cranis within 10 hours. After a couple of years of this I may need to go onto do some of these bread and butter cases you speak of.

I worked in a very busy level 2 MICU (more of a mixed county ICU) that actually took more traumas than our local level 1 (private hospital) and was given a lot of autonomy. I agree with PresG33. It's not always the trauma or unit designation that matters, but rather what you're doing on the unit and how you portray/convey it on your application.

With that being said, there are a lot of people that would love to get into a level 1 SICU specifically for school, and if the level 3 doesn't take hearts/ecmo, etc etc, then the level 1 SICU is hands down the safest bet. 20k seems like a lot of money now, but once you're a CRNA that 20k won't seem like much.

Unless you choose to work in a Level 1 or 2 (which is a minority of cases done easy day), you don't have to be rural to do bread and butter most of the time. And it's probably more usual than not that the county hospital will always do more traumas than the private hospitals, regardless of the level of trauma ratings. Not everybody has the opportunity or desire to work trauma for a majority of the time. I needed more variety.