Am I going to miss the adrenalin of the ICU?

[Caroline RN]

Hi, everyone--

I'm pretty new to these boards and have spent a lot of time lurking. I'm in the process of deciding what my next step will be, career-wise, and have been reading a lot about nurse anesthesia. Now, please be kind, as I've not yet shadowed a CRNA, and am in the very early stages of this decision process. I have a few thoughts and would like a few opinions.

1. I am a hard worker and willing to do what it takes to get the job done to the best of my abilities. However, I am not interested in working 60+ hours a week for the rest of my career. Can you discuss the possibilities of a good work-life balance in this career?

2. One thing I love about being an ICU nurse is the adrenalin rush. I admit that I am an adrenalin junkie. Strangely enough, one slow night exhausts me far more than a night of constant running. I hear people talk about how adrenalin has no place in anesthesia, which I completely understand. However, I worry that I might not like the slow pace. I do love taking care of very, very sick patients, titrating drips, monitoring ABGs, and constantly thinking about what's wrong, and what could go wrong. Anyone want to comment on what appears, to me, to be a slower-paced career?

3. I worry about how I'm going to pay for school but that is another subject for another time and I see there are many threads on this subject. :)

I will have more questions at a later time, I'm sure. I plan to do some shadowing in the future, of course. Thank you very much for your input.

[thasweepa]

Funny, my A+P instructor touched on this subject yesterday. I'm in my first semester and he (being an MDA) stated that if one DOESN'T enjoy an andrenaline rush, this might not be the profession for them. Anesthesia takes CONSTANT critical thinking at a CELLULAR level, to be able to anticipate what physiologically is going on in the body, because the surgeon sure as heck isn't (to a point). If you like codes, great, cause you'll be at the head of the bed running them, calling the shots and being the primary line of defense for your patient when they are at their most vulnerable. It is truly humbling to think about the responsibility that comes with this position, and I'm very excited for the future.

[yoga]

If you need an adrenalin rush on a daily basis, stay in critical care. You need to be on top of your game all of the time in anesthesia, you need to be cool and keep a calm demeanor and save the high energy for when you really need it. Anesthesia is very much an intellectual profession, enhanced by technical skills. Most of the time, we make decisions based on staying out of trouble and a lot of OR personnel think we don't do very much.

I would like to add a personal note. Even though I am usually calm and cool when doing anesthesia, I have been told recently that we hide our stress. Mine manifested by four coronary arteries being 80% occluded and required a bypass. The only bout of angina I had was after a major altercation with a circulating nurse (long story). So anesthesia is stressful, but without that rush you are looking for.

Before you make up your mind, shadow some CRNAs for several cases and get an honest assessment of what anesthesia is all about.

yoga

[ethernaut]

Anesthesia is very much an intellectual profession, enhanced by technical skills.
:cheer2:

[Esper]

I agree with Jan that is a intellectual affair in anesthesia. However, the adrenaline may not be as often in anesthesia, nothing puckers a sphincter as much as an emergency in anesthesia.

[MmacFN]

Dude its a blast. The ICU will seem boring in retrospect.



Hi, everyone--

I'm pretty new to these boards and have spent a lot of time lurking. I'm in the process of deciding what my next step will be, career-wise, and have been reading a lot about nurse anesthesia. Now, please be kind, as I've not yet shadowed a CRNA, and am in the very early stages of this decision process. I have a few thoughts and would like a few opinions.

1. I am a hard worker and willing to do what it takes to get the job done to the best of my abilities. However, I am not interested in working 60+ hours a week for the rest of my career. Can you discuss the possibilities of a good work-life balance in this career?

2. One thing I love about being an ICU nurse is the adrenalin rush. I admit that I am an adrenalin junkie. Strangely enough, one slow night exhausts me far more than a night of constant running. I hear people talk about how adrenalin has no place in anesthesia, which I completely understand. However, I worry that I might not like the slow pace. I do love taking care of very, very sick patients, titrating drips, monitoring ABGs, and constantly thinking about what's wrong, and what could go wrong. Anyone want to comment on what appears, to me, to be a slower-paced career?

3. I worry about how I'm going to pay for school but that is another subject for another time and I see there are many threads on this subject. :)

I will have more questions at a later time, I'm sure. I plan to do some shadowing in the future, of course. Thank you very much for your input.

[JadamR15]

Hi, everyone--

I'm pretty new to these boards and have spent a lot of time lurking. I'm in the process of deciding what my next step will be, career-wise, and have been reading a lot about nurse anesthesia. Now, please be kind, as I've not yet shadowed a CRNA, and am in the very early stages of this decision process. I have a few thoughts and would like a few opinions.

1. I am a hard worker and willing to do what it takes to get the job done to the best of my abilities. However, I am not interested in working 60+ hours a week for the rest of my career. Can you discuss the possibilities of a good work-life balance in this career?

2. One thing I love about being an ICU nurse is the adrenalin rush. I admit that I am an adrenalin junkie. Strangely enough, one slow night exhausts me far more than a night of constant running. I hear people talk about how adrenalin has no place in anesthesia, which I completely understand. However, I worry that I might not like the slow pace. I do love taking care of very, very sick patients, titrating drips, monitoring ABGs, and constantly thinking about what's wrong, and what could go wrong. Anyone want to comment on what appears, to me, to be a slower-paced career?

3. I worry about how I'm going to pay for school but that is another subject for another time and I see there are many threads on this subject. :)

I will have more questions at a later time, I'm sure. I plan to do some shadowing in the future, of course. Thank you very much for your input.

Every time you induce a patient, they're 5 mins from being a vegetable, or dead. Don't screw up :). Of course it's a rush!

90% routine, but 10% insanity. Worse than ICU codes. Far worse.

[ethernaut]

Worse than ICU codes. Far worse.

really? why? i've been to nasty codes in the ER and ICUs. things and shit and bile and puke are everywhere. ever put a tube in while compressions are being given and stuff is bubbling over in the mouth? i have. not fun.
in the OR, everything is controlled from the get-go. much easier, in my opinion. much.

[deepz]

Yah, all the above. But be forewarned: there are times when your vigilance WILL be tested, because a high tolerance for boredom is a valuable trait too.

[Caroline RN]

Thanks for the good input, all!

Anyone care to comment on the work/life balance of this type of career?

Thanks!

[Anthony]

Seen more disasters in the OR (trauma) that makes the ICU experience tame....

... on another note - I dont recommend this track for adrenaline junkies....

[J-Dubya]

I dont recommend this track for adrenaline junkies....

Tone, could you elaborate on this point. I'm about the opposite of an adrenaline junkie - I enjoy performing under pressure, but I don't get any pleasure from that adrenaline dump. In fact I try to always stay calm and avoid that reaction. However, I know CRNAs in that "like the rush" when SHTF, they seem to do OK though?

In my pre SRNA life, I was obessed with technical SCUBA diving. I knew a couple people that loved to push the limits. I avoided these people like the plaque.

[RN_CVU]

I have no relevant anesthesia experience to back up my belief but I would think that it depends on the type of adrenaline junkie you're talking about. If you're the type that loves to yell obvious shit during a code or emergency, ie "GIVE 1 MG OF EPI NOW!!!!" or "RESUME CPR!" and basically are a screaming train wreck under pressure then in my mind you would be dangerous in a leadership role such as a CRNA. But if you're the type that loves a challenge, loves to use your knowledge and skills to intervene in emergency situations and pride yourself on doing so in a cool, calm, relaxed, yet assertive manner then I can only see that as a positive trait for the anesthetist who is making the life or death decisions. Personally, I don't enjoy the experience of having my own patient crash and resuscitating them, but if its someone else's... yeah it can be fun.

[Anthony]

Hey John,

IMO, thrill seekers are the antithesis of anesthesia providers. Calm and stable is what is sought rather than the opposite. Not saying that doing large/complex/unstable cases arent professionally satisfying, but looking for the opportunity for the rush of adrenaline predisposes most to tunnel vision rather than the opposite.

Personally, I love doing trauma - it elevates my thinking - but Im as far from a gunslinger as one can get and have not met a good anesthesia provider who seeks out cases for the "thrill" ... they go for hard cases because they know they are good and can handle them with ease. And finally, going for the "thrill" is a bit debasing and comes at the expense of someone else's suffering.....


Tone, could you elaborate on this point. I'm about the opposite of an adrenaline junkie - I enjoy performing under pressure, but I don't get any pleasure from that adrenaline dump. In fact I try to always stay calm and avoid that reaction. However, I know CRNAs in that "like the rush" when SHTF, they seem to do OK though?

In my pre SRNA life, I was obessed with technical SCUBA diving. I knew a couple people that loved to push the limits. I avoided these people like the plaque.

[BuckeyeRN]

Anthony,
I can see where you are coming from. My favorite nights in the ICU prior to school were the nights when I had some of my sickest patients. I loved how they made me think about everything I was doing and how much on my "A" game I had to be to keep up with what I had to do with them and for them. However, those nights were always bittersweet because I hated the fact that for that to occur someone else (mainly family at that point) was having one of the worst nights they could imagine.

Edited to add: But that's not to say I don't enjoy adrenaline from time to time. I was a whitewater raft guide at one time and I enjoy experiencing whitewater as often as I can.


Hey John,

IMO, thrill seekers are the antithesis of anesthesia providers. Calm and stable is what is sought rather than the opposite. Not saying that doing large/complex/unstable cases arent professionally satisfying, but looking for the opportunity for the rush of adrenaline predisposes most to tunnel vision rather than the opposite.

Personally, I love doing trauma - it elevates my thinking - but Im as far from a gunslinger as one can get and have not met a good anesthesia provider who seeks out cases for the "thrill" ... they go for hard cases because they know they are good and can handle them with ease. And finally, going for the "thrill" is a bit debasing and comes at the expense of someone else's suffering.....

[infidel]

Simple answer is.. Yes you will miss it. Stay in the ICU.

[Volatile42]

Anesthetist is the one that when the shit is hitting the fan, we look like a duck on the water....smooth on the surface (paddling like hell underneath).

[mummer43]

Anthony,
I can see where you are coming from. My favorite nights in the ICU prior to school were the nights when I had some of my sickest patients. I loved how they made me think about everything I was doing and how much on my "A" game I had to be to keep up with what I had to do with them and for them. However, those nights were always bittersweet because I hated the fact that for that to occur someone else (mainly family at that point) was having one of the worst nights they could imagine.

Edited to add: But that's not to say I don't enjoy adrenaline from time to time. I was a whitewater raft guide at one time and I enjoy experiencing whitewater as often as I can.

Whitewater is the ultimate adrenaline rush, in my opinion. If I want a thrill, I'll paddle the Upper Yough or the Upper Gauley. I would prefer to get my rush somewhere outside the OR.

[BuckeyeRN]

Whitewater is the ultimate adrenaline rush, in my opinion. If I want a thrill, I'll paddle the Upper Yough or the Upper Gauley. I would prefer to get my rush somewhere outside the OR.

Yeah we need to get together perhaps this spring or summer and hit the upper Yough or Upper G in my shredder

[RAYMAN]

I think a combination of answers is the correct. As Anthony said, this is not the place for adrenaline junkies...we like to avoid drama if possible. As Yoga said, there is a lot of stress, which is adrenaline manifested. One can't ventilate, can't intubate is plenty of adrenaline to last a long time.

[yoga]

I think a combination of answers is the correct. As Anthony said, this is not the place for adrenaline junkies...we like to avoid drama if possible. As Yoga said, there is a lot of stress, which is adrenaline manifested. One can't ventilate, can't intubate is plenty of adrenaline to last a long time.

Ray,
One of my patients from over 15 years ago died this past year. Was a celebrity and was a "can't ventilate, can't intubate" situation for me. My good luck (anesthesia angel), some great assistance and the situation was controlled. But all these years later, I still get an adrenalin rush when I think about that day. The other one that sticks with me was a malignant hyperthermia in a plastic surgery office setting. Also, patient did fine, but I still get that "feeling" when I think about it. In over 50 years in this field, I have had more adrenalin rushes than I ever wanted. Also, if that isn't enough, driving the California freeways is more than enough to test my new coronary arteries.

Jan

[Caroline RN]

OP here. Over the last few days, I've been evaluating what I consider "adrenaline" in the ICU. Perhaps I chose my words poorly (but I won't take it back because I liked the discussion!) I don't like codes; well, I don't like the utter flippin' chaos of codes because I find myself getting truly annoyed by the people who, as mentioned above, like to run around screaming "PUSH EPI!" and "START COMPRESSIONS!" I like well-run, calm codes with assertive, quiet leaders who are in control of the situation. (Ha! In my dreams.) In a non-coding situation, my favorite nights are like the one I had yesterday. One really sick, really busy patient with lots of wounds, drips, labs, blood, meds, etc. He certainly wasn't crashing so I didn't get the "adrenaline rush" in that sense. But there were lots of other things going on that I got to think about and chew on all night long. I get truly excited by busy, thoughtful nights like this one. The nights where I don't have time to check my Facebook account are the best ones for me. I wish I could do that for the rest of my life, truly, but I know that someday I will be ready to move on from the ICU. I also expect that my idea of a "good day" will evolve as time progresses. Anyway. Bottom line: boredom begets laziness for me. I have to avoid career paths that will be boring or overly monotonous.

Things I like about the ICU:
-The nights when I am constantly challenged.
-Being busy ALL the time
-Having to constantly and quickly make decisions based on the patient's overall picture.
-Working with the docs and feeling like they appreciate my input because I've shown in the past that I'm good at my job
-The great feeling that comes with knowing you kept someone alive for 12 hours.

Things I dislike about the ICU:
-Disappointing nights where all I have are low-acuity patients that should have been transferred but weren't. (Probably my least favorite thing.)
-The enormous amount of ego in the place, and learning each and every person's "switch" so I can know how and when it should be flipped. (My 2nd least favorite thing.)
-My whole body hurting after 3-4 shifts of moving heavy patients.
-Constant nagging emails about all the things we do wrong.
-That horrible feeling that comes with knowing you kept someone alive for 12 hours.

I know I will have to start shadowing a CRNA to get a better understanding of the pace of the job. Thank you very much for your input thus far, everyone.

[deepz]

.....I have to avoid career paths that will be boring or overly monotonous. .......

No prob, Caroline. Anesthesia is basically the proverbial hour of boredom interspersed with 60 seconds of pure panic. Enjoy!

[ethernaut]

Bottom line: boredom begets laziness for me. I have to avoid career paths that will be boring or overly monotonous.



well, then.. you won't like 6 hour spinal fusion cases, 13 hour crani cases, 5 hour re-vascular cases, etc... you might want to find another career path. as deepz asserted, anesthesia is 99% boredom and 1% pure and utter calamity. everything you yearn for, eh caroline? just sayin.

[Caroline RN]

Fair enough! :)

However, I am not willing to give up just yet. Truthfully, when it comes right down to it, I can't think of a single job I'd rather have than being a nurse. I love it when people ask me what I do; I love telling them that I'm a nurse, and I love being a nurse. However, I can't imagine being a nurse practitioner, a manager, or an educator. And I know I never want to get too far from direct patient care. Of course, I wouldn't choose anesthesia simply because everything else was ruled out. The process is way too arduous for that. You can't have action all the time, and part of me understands that. This career has a lot of other high points that I'm interested in, so I'm going to continue to ask questions, explore, and shadow at some point.

Who knows what the future may hold! Again, thank you everyone for your great input!

[Vents-n-gtts]

I strongly recommend you shadow a CRNA for many hours if possible, before you embark in this long and rough journey. NP, CRNA, educator and management are not the only ways to advance your career, you could become a charge nurse, CNS, etc. At this point the question is not what you like about the ICU, but why you would like to be a CRNA? or whatever else you decide to do.

[yoga]

Caroline, I don't know how old you are, but you are probably young. The importance of age when selecting a career cannot be overemphasized. Unless you are working for the fun of it and not because you must for the income, you should select a profession that will take you through the various phases of your life.

When I was young, I loved the adrenalin rush and doing anesthesia for emergency and other high risk cases. In the middle part of my career and while raising a young child, I found a lot of challenges outside of work, so I was less interested in those high stress times. Now that I am close to being at the end of my career, adrenalin rushes are nothing that I want or need in my life. The important thing is that this profession has sustained me financially and personally for over 50 years. I don't think there are many 72 year old critical care nurses who are doing hands on patient care.

Jan

[Caroline RN]

Jan,

I loved your response; thank you. I'm 28, with a couple of years of ICU under my belt. I think your advice is really spot on, and that's why I'm examining every aspect of every "next move" so carefully. In one of my previous posts on this thread, I mentioned that "...I know that someday I will be ready to move on from the ICU. I also expect that my idea of a "good day" will evolve as time progresses." I truly recognize that there will be a time in my life where like you, I want nothing to do with an adrenaline rush. I think you hit the nail on the head. I am looking for my next move as one that will sustain me for many years to come, as you said, both financially and personally. I don't think it could be said better any other way.

I will continue to ask questions during this journey.

Appreciate all the sound advice I've received on this board!