Wanting to pursue CRNA

ptier_MNMurse, BSN, RN · Mar 9, 2019

Hey Amisadai,

I have somewhat similar experience to you. I had 3 years EMT, 2 years CNA, then 1 year Pediatric Critical Care Float Team, where I bounced back and forth between PICU and CVICU, but got mostly IMC/Stepdown patients. I knew since before I became a nurse that I wanted to do flight nursing or CRNA. I ended on pursing the CRNA path, which I am currently in the application process for. From what I gathered from CRNA admissions counselors, I knew adult experience was important, and so I decided to do another year in a Trauma/Neuro/Surgical ICU at a level 1 trauma center and then moved to CVICU at a university hospital where we do PA catheters, VADs, Impella, IABP, CRRT and ECMO and have been here for 1.5 years now.

I think that the change, while it may seem daunting is well worth the advancement. My experience with PEDS helped me a lot as you deal with and have to know smaller, more particular doses of medications, they decompensate more rapidly, often have more vague symptoms, and are unable to tell you what is exactly wrong. So having that experience helped me to always look at the full clinical picture of the patient (as I imagine it would help you).

Moving to the ICU you should know a few things. I hear your concerns about sinking, and I felt that as well when I first moved there. It does stress you out for a while at first (at least it did for me) but it gets better. I think most people I have talked to express this, and I think that this is a good thing as it keeps you more on your toes around more tenuous patients. I think most ICU nurses would rather have someone who knows their limitations and feels more hesitant than someone who is overconfident who might brush off something subtle, as unimportant and be at risk for unintentional harm. I would just be open and honest and let people know your strengths and limitations. Most ICU nurses like helping other people learn and watch them develop!

Before you make the move I would suggest doing some research on which ICU to pursue. Look for an ICU with higher acuity (level 1 trauma center, university hospital, etc.). If you look on the blogs everyone has a different opinion on which one is best, but I would recommend something with a surgical background. That's going to be the type of patients you take care of with anesthesia: surgical patients. So whether that means SICU at a level 1, or CVICU at a hospital who does lots of open heart procedures, it doesn't matter. But I think (again, my opinion) CRNA schools look maybe slightly more for the surgical background. I know plenty of people who got in with PICU, Neuro ICU, MICU, NICU experience so at the end of the day it does ride more on what the rest of your background looks like (GPA, GRE, references, essays), but I would say a SICU/CVICU background with high acuity/volume is your best bet.

Also, I would recommend getting a few years of experience under your belt in the ICU before applying to school. ICU nurses, whether deserved or not, seem to not like the nurse who comes in for one year, gets trained to everything and then leaves for school. Lots of blogs out there about this issue too so I'm sure I will be upsetting someone, haha (personally, I'm for as much advancement as possible, and like seeing people learn and grow so I do not care about the turn over as much, just part of the job...). Having said that, the longer I spend in the ICU's the more I learn and the more I have grown. Looking back, I certainly feel that I would not have been ready for school when I applied after one year of ICU experience, though at the time I felt ready to go. Certainly apply as soon as you feel you would like to, because many people do not get in on their first try (I've known people who have taken 7 years to get in, though this is an outlier). All I am saying is the more time you spend learning and growing in this respect in the ICU, the more confident and prepared you will be to take care of people in the anesthesia setting (though school is where you will really learn all the more!).

Lastly, shadow as much as you can! This is a great opportunity to see if it fits you and see what CRNA's actually do! Many schools ask for this in your essay because they want to see that you actually know what you are getting into.

Here is a link to a great website which will tell you about all the schools around and gives a great overview of each school!

http://www.all-crna-schools.com/schools-by-state/

Hope this helps! Good luck!

Amisadai, BSN, RN · Mar 10, 2019

Thank you for your response! I am looking into SICU and I do already got at a very large, tier 1 teaching hospital. Doesn't mean I'll get into the SICU, but that's what I'm leaning towards. I do hope to stay in SICU for at least 2 years, all depending if I can handle it.

Another question, would I learn more in a SICU or CVICU?

Thank you!

ptier_MNMurse, BSN, RN · Mar 10, 2019

Good to hear! Glad you are taking the steps! I am sure you will be able to handle it!

Is the SICU at a level 1 trauma center? the reason I ask is that the SICU is where all the trauma patients would go. So you would get more vents, vasoactive drips, massive transfusion protocol, ventriculostomies, bone flaps, CRRT, C-spine precautions, etc. whereas you may not get that as much at a level II or III trauma center because higher acuity trauma patients are designated to go to a level 1 trauma center.

I think you will learn a lot at either, it also totally depends on the ICU. My experience was that the CVICU I work in has a lot more drips, and I learned so much more about hemodynamics (one of the cores of anesthesia) and which drips to start when, had many more devices and equipment than the SICU and I feel a lot more proficient as a nurse (but that's probably more with experience). I appreciated being able to start in the SICU and get acclimated to vents and art lines, and gtts and all the rest, and then be able to ease into learning about PA catheters, and balloon pumps, and impella devices, and VADs, and heart/lung transplants and ECMO. Personally, I think you would learn more in a high acuity CVICU who does a lot of open heart procedures, but there is even a spectrum there. There are some CVICUs who's highest acuity patient is a 1 or 2 vessel CABG, while some can do heart/lung transplants. I guess I would just do your research on the unit you are pursuing. Again, this is all biased because of where I work, but I think it holds true.

At the end of the day you aren't going to go wrong between the two. Some would argue CVICU is more focused on hemodynamics and misses the bigger picture, but I would disagree. I have had patients with ventriculostomies (though fewer than in SICU), and hanging hypertonic saline, patients with a bowel perf post-op, patients with stroke, and shock liver and kidney failure, all in CVICU. So I think you will see the whole spectrum there. But just get in the highest acuity unit you can around your area, whether that's SICU or CVICU it doesn't matter. Most job postings will state what sort of patients and devices they take care of, so that may also be helpful. Otherwise ask in your interview too.

Check around and maybe see what units many of your SRNA's in your area come from and then go check out those units and see if its for you! It may benefit you to wait it out for an opening on the right unit.

If you got level 1 SICU go for it, if you got CVICU with transplant do it, if you have either take your pick!

Amisadai, BSN, RN · Mar 11, 2019

Yes, I do work on a level 1 trauma center! I'll ask around and see if I can't find more information about each ICU we have here. Thank you so much for your knowledge!

Bunnybunbun · Mar 27, 2019

I m also trying to applying to crna school soon. It is hard to know what icu is best. I would interview the crna school that u have in mind and ask for more information. After all, this will for sure be right lol