Which ICU for CRNA Experience?

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I'm a new graduate who is looking for my first RN position in an ICU. I have given my resume to various ICU managers and applied for many different ICU jobs. All of the Level 1 SICU/ CVICU managers have turned me down because I am a new grad, but I have been offered a job in a few different ICU's after interviewing and have narrowed it down to two. I would like your feedback on which would be better experience for myself and for a resume for CRNA schools in the future.

1) Level 1 trauma MICU. Strictly MICU patients. The manager said it is not the norm for her to hire new grads (especially since I did not work on this unit prior), but based on my academic performance, work experience, and clinical experience (precepting in a level 1 trauma CVICU), she is willing to take me on.

2) Level 2 trauma SICU. Has mainly SICU patients, some open heart patients, and some MICU overflow. I currently work as a nurse extern at this hospital on a different unit. The ICU manager said she doesn't normally take new grads, but after reviewing my resume and talking to my current manager, she is willing to take me on.

Both are in the same healthcare system and I may be able to transfer to the level 1's SICU or CVICU after a year (or a little more than a year) experience.

I was told by multiple people that CRNA schools prefer CVICU and SICU over MICU, PICU, NICU, Neuro ICU, and Coronary Care Units. I was also told by multiple people that CRNA schools prefer level 1 trauma hospitals over level 2. Based on these assumptions, I am between a rock and a hard place deciding which position will allow me to be admitted into a CRNA program in the shortest amount of time with an adequate amount of experience. Could you please input your thoughts to help me decide? ?

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I will personally choose SICU (level 2), then apply to SICU (Level 1 ) after one year. With SICU, you will communicate with Surgeons, ICU Team, RT, MDA, CRNA, OR RN, ect. U will take care of many sick patients with diffirent kinds of procedures... i believe people should have at least 2 years ICU experience before applying to CRNA School. I had one year MICU experience when I was a new grad. After one year... and 3 days, I got an offer job in Trauma/SICU in level 1 Trauma; was there for 2 years (AND I LOVE IT, fast-paced) before I got accetped into multiple CRNA schools. Then I've been doing 2 per diem jobs as a .... MICU RN Level 1 (i HATE it- Pneumonia, Resp.Failure, DKA, Sepsis, Hemodialysis...again and again.... but good pay. I REALLY miss Trauma/SICU Level 1 with chest tubes, open chest at the bedside due to emergency, Gun shot wound in the head, abd, Major Car Accidents with massive blood transfusion, pt hanging themself, drowning from the oceans .. with General surg, neurosurg, ortho, ID, GI, Nephro, ect.. got involved...

But any ICU in Level 1 Trauma is good !

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Specializes in CVICU.

It's hard to say. Obviously the level 1 trauma is good. I guess it depends on where you would like to go? What does the CVICU at the level 2 hospital look like. Level 1 trauma doesn't always mean the CVICU is higher acuity than anywhere else (applies more to the SICU). You could look at it in a few different ways I guess.

If you want to do level 1 SICU, it could be good to get the basics down in the level 2 SICU and then have a background for similar patients in the level 1 SICU, with a bit of a jump in adrenaline. you might be a bit better caught up to speed in this instance.

It could also be good to get into the level 1 hospital in the MICU to be able to know the facility and better be able to walk down the hall and make a personal impression with the SICU manager after a year there...

I guess either way though, you could shadow and get a current manager reference. But know people may not like it if you walk on as a new-grad and move on shortly thereafter (doesn't set a good precedent for them accepting other new-grads....).

The level 1 SICU is legit. I would also recommend checking out the CVICU's at both places and see if either one would be of interest to you. They can be very different in acuity between facilities regardless of trauma level designation.

I would say do the SICU route, because then you are getting surgical post-op patients and getting in the flow of that if you truly want to go CRNA. AND it sounds like they do some open-heart and MICU overflow, so you might get a little taste of everything and see what you like. I've done PICU, SICU at level 1 and research CVICU with all the devices (impella, IABP, CRRT, VADs, ECMO, heart/lung transplant) and I LOVE it. But I really can't speak to MICU, though I don't have much desire to check it out personally.

ALSO, have you shadowed a CRNA? Also, my advice to you would be, take it easy on getting into school and get a few years under your belt. When I graduated I had known CRNA is what I wanted to do for four years prior (having shadowed, talked with CRNA's and whatnot). I thought getting the minimum in and moving on to school is what I wanted to do, but after having done this for 3.5 years now, I appreciate EVERYTHING I have learned so much in preparing me for school. I would not have been ready after 1 years, or even 2 years, and the longer I wait, the more I learn and the more I realize how much I needed to know before going. I still learn every day and plan to keep doing so for the rest of my life! So, just enjoy the ride buddy. If you get in right away, great! If not, just soak in as much as you can!

Best of luck to you!

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35 minutes ago, ptier_MNMurse said:

What does the CVICU at the level 2 hospital look like.

ALSO, have you shadowed a CRNA?

The level 2 just has a SICU and MICU in the hospital, no CVICU. They do open hearts, but not things like LVADs, ECMO, etc. The level 1 does all of those, but only in their CVICU. I also learned that the level 1's MICU is broken into pods and I would always be in one or two pods that mainly focus on a single type of patient (i.e. sepsis and DKA) and the other pods within the MICU focus only on other MICU patients. This seems like it's going to inhibit the range of patients I will be able to take care of. Even though the level 2 does not have any ECMO, LVAD's, etc., I think it might be better for me as a new graduate to learn the ropes without those complex patients and then transition to it after a year or so.

I have shadowed CRNA's multiple times and I love what they do. My cousin is a CRNA and I was going to shadow her at the hospital she works at this summer to get more shadowing experience. I know it is important to me to learn as much as I can as an ICU nurse, but if I could get into CRNA school sooner rather than later, I am willing to study more and work harder while in CRNA school.

The CVICU and SICU at the level 1 require a minimum of 1 year ICU experience before they will even consider taking you on, and you have to display adequate knowledge of the ICU during your interview process - my friend works in the CVICU at the level 1 hospital and told me about the process of getting a job there. They are one of the best hospitals for ICU's in the state and are very serious when it comes to hiring nurses.

Thanks for the input!

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Specializes in CVICU.

Sounds like you got things figured out. Yeah, I would say go SICU. It sounds like it would be a good place to get your feet wet, get some patient diversity and then have a great background for transitioning. (just be careful what you say.... if you tell everyone you are trying to go to CRNA school right off the bat, you might make some enemies.) Personally, I think if you get in great! I would genuinely be happy for you! I love seeing people go after their aspirations, and am pursuing that myself. I am just trying to give you a heads up that some people may treat you differently on the unit if you tell them that (give you poor assignments, not advance you, etc.). It sucks, but that is what I have seen happen a lot. So, just be careful what you say at first.

Good on you for shadowing! Keep it up! Schools seem to like it when you get a few 8-12 hour shadowing shifts under your belt. Maybe try to get a level 1 trauma hospital, a university/research hospital, and a rural/critical access hospital. Then you could speak to the diversity of the job in an interview!

At the end of the day too, VADs, ECMO is great to know, but isn't totally necessary for CRNA school either. The SICU doing some open hearts should also give you a good background for the CVICU at the level 1. Having a background taking post-ops is awesome for our new CVICU nurses. I know I appreciated having it myself!

Good luck buddy!

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I agree with ptier_mn on being too vocal about your CRNA aspirations. Icu is notorious for being a breeding ground for CRNA’s and ICU nurses will be put off by hearing a new grad saying they are there for a quick icu detour.

As for the issue at hand, I can speak to my experience as a nurse at a level 1 trauma teaching hospital in Chicago. MICU is the unofficial dumping ground of the ICU division-you will get experience with everything under the sun including cardiac, surgical, trauma, neuro cases. My unit always has EVD, CRRT, paralytics, PICCO, swan ganz, I have 2 intubated patients per shift. You will admit patients from from ED for abdominal pain walking and talking and then your next shift you see they are maxed on 4 pressers, with multiple central lines open abdominal ex lap and fighting to keep them alive. Nobody enjoys coming to MICU when they get floated there but that is because you WILL get worked. In my opinion MICU is the best option for you to develop as a new nurse. The exposure in MICU is amazing at a trauma center. If you understand the way EMS works- they feel comfortable taking ANY patient to a trauma center because they know it will be handled even if it’s suspected trauma d/t fall of MBT May still end up in MICU. That is why your patients will be more complex with more inotropes/pressers and you will see more of that. However you will see more swan ganz in sicu but a level 2 trauma sicu is tame.

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Specializes in Anesthesia.

My MICU was the same, and I feel like it gave me the best possible base I could have had for CRNA school. I sometimes feel like MICU doesn't get the credit it deserves. Lots of patho to be learned in MICU that will be very applicable to the patients you give anesthesia to. It sounds like this particular MICU isn't that varied, and I'm a firm believer that the most general and broad ICU experience you can get is the best experience. For this reason, option 2 sounds better.

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You should be fine either way. As a general rule, big is better than little, busy is better than slow, acuity is better than anything. As far as the myth that CVICU is preferred, it is just that, a myth. A busy, acute, trauma/surgical ICU would probably be the very best, but it really just does not matter. Get experience. Period.

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