ICU quality

[lookingup]

SO I recently started a new 12 bed ICU(general surgical, hearts but no trauma) position in Chicago. I was attracted to the position by all the "awards" listed on the website that the hospital got from Health Grades (top 5% in CV care, Crit. Care, etc.), and the interview where I was told I'd see certain cases, etc.

I left a level 1 trauma hospital with an SICU and a CVICU, both fast paced and nearly always full (12 beds each). After a yr. there things weren't working out and I needed a change in a big way, hence the move. I realize now that I left a place with good experience.

Now that I'm off orientation at the new place, I haven't seen what was "advertised" in the interview; AAA's, routine CABG/Valves, neuro's...They do come, but not nearly to any degree of the previous hospital, and I never get assigned them(I've been told more or less I have to earn it. understandable.) I'm seeing more Sepsis, ARDs, GI bleeds, Chest pain. I do however get vents, A-lines, gtts and Swans(which few of them know how to truly use/interpret by AACN standards anyway)

Some RN's there have said how it's a slow, routine kind of job, not the place to go to learn. My preceptor told me how some RNs told her I was too excited and basically I needed to back off. Our perfusionist RN, who picked up on my desire to learn, told me that it wasn't the place to prepare for Grad programs in general, that I'd do better at a university hospital. My preceptor who is totally for advancing education(and well traveled to diff. ICU's) told me it WOULD be a good place. I shadowed a CRNA/Clinical SRNA educator at my #1 choice CRNA program here in Chicago, he said " OH yeh, I've done Locum work there now and then...We've accepted students from there before, that experience is sufficient." There have been RNs here that get accepted to CRNA and APN schools also. :dunno:

Problem is I just don't know what to do anymore; part of me feels like I should leave for "better" exp., but then I risk starting all over, orienting, gaining trust/establishing relationships with potential references, getting the hard cases...

I'm focusing on taking the best care of my current pt's, asking well thought out questions, popping in to help/learn the hearts, keeping my mouth shut about CRNA. I plan on getting my CCRN, taking a few courses at my choice CRNA program, and applying(to several programs) this summer...Hopefully I'll have started the open heart orientation and have some cases under my belt. Should I stick with this or pack up and go somewhere bigger?


Sorry for the length! :boring:

[Scout]

If you are talking about applying this summer, I would stick it out. There are more important things like getting CCRN and GRE if you need it. I have found the assessment skills more important in the OR than actually operating the machinery. Technology is so different in the OR, you will be re-learning it anyway. If the programs you are applying to have accepted ppl out of your current ICU, stay there and learn what you can. That is my advice anyway. You are more likely to get some decent cases where you are now than starting all over and earning your way towards it. But then again, I have been wrong before.

[MmacFN]

I think scout has sound advice.

Hang in there, learn everything you can and teach yourself the rest. Take every class you can do the CCRN and the GRE then apply.

My experience is that asking people that work somewhere how "good" it is can be essentially useless. 50% of em will tell you its awesome even if they hate it so they dont look bad for staying there and the other 50% will be a mix of non committal, honest and clueless. Unfortunately there is no way to know what the truth is till you find it out yourself. ;)

[ethernaut]

i think also too that if/when you explain yourself to ad-coms about your situation and why you left to get increased experience, they will look at this as a positive.
you also have previous experience, so that counts too.
i agree with above posts too.
hang in there.
do the best you can, get CCRN/GRE, continue to prove yourself and to hopefully get the bigger cases.

[lookingup]

Thanks for the replies. I think I should stick around too. I've taken the GRE already and try to supplement my ICU experience by reading Pharm/physio. stuff, and trying to take in as much as I can from anesthesia texts. Hope that will be enough to get me thru the interviews, otherwise may need to look elsewhere if my experience isn't up to par...

[Mophet]

I think is sound like good experience. You can learn a tremendous amount about resuscitation those sepsis patients and GI bleeds. Throw in some complicated MI patients with swans and you get a well rounded experience. If you are doing Swans and Vents you are getting the kind of experience most CRNA programs are looking for.
Also, the majority of the CCRN is cardiac and respiratory with a little bit of everything else thrown in. Variety makes for a well rounded applicant.

I have worked in a 20 bed CCU for 3 years. Every year I would hear from people in other units that I needed there kind of experience to get in. Every year we have more people accepted to CRNA school than they do.

If your co-workers are pleasant and working conditions are good stick it out. If you have experience in a busy hospital you can put it to good use here. Volunteer to help out your co-workers with their sick patients when yours are easy. When you have easy patients and someone is getting an admission that is sick when there other patient is sick, offer to trade. The next thing you know you will be getting the sickest patients yourself.

Good luck in your endeavors.

[pilot424]

Another question in regards to time in the units vs quality of experience. There seems to be a popular opinion of most experienced srna's and crnas that one and even two years experience in ICU is not really enough. I would like to hear more definitive explanation as to quality of experience. Instead of talking years, what do you more experienced guys think specifically that us wannabee's should be looking to learn in our time building towards applying. I can easily see that even with 10 years of experience some people still don't have what it would take to make a good anesthesia practioner. So, get specific with what "experience" means. What do I need to glean from that one, two or three years of necessary experience?

[Scout]

I personally believe A&P, and patho. To see as many crazy diseases and critical patients as possible. All sick patients present so differently that when you are able to start to say WHY a patient "doesn't look right", then you are ready. All the technology changes so fast, learning a certain vent or swan doesn't help. But know the how and why it works and what it tells you is critical. That is my idea of experience. Looking at a patient and predicting the process of disease/ outcome is so important, and you only get that with building upon patient after patient. My .02, but others may disagree.

[MmacFN]

Pilot

Great question and well written. My reply isnt directed at one person but a general commentary on the issue.

I can only give you my personal opinion and what I have heard many MANY times now in clinical from both MDAs and CRNAs alike. There is a huge difference between those who come with "good" experience and everyone else. I can tell you those those who dont have it are not told that directly, but it becomes a "generalization" by CRNAs and MDAs when teaching people who do have it.

Before i address your question let me say this, as I look back 10 years later there is a significant difference between what i THOUGHT i knew as an A-type new RN learner during my 1st year and what i ACTUALLY knew, its unreal. I think everyone can say this of something in their lives when they look back on it and see where they are now. It follows in just about everything.

So then what is the definition of "Good Experience" that will serve you well in CRNA school and well beyond? Its a 3 part equation.

Part 1: A-type, self motivated, self starter, researcher, reader and lastly hard worker

Part 2: Time in.

Part 3: The type of place you work and what experiences are avaliable.

Part one seems self evident. Many people think they fit this role but really do not. Ask yourself how many of the points below describe you to determine what degree of part 1 you are:

You never believe what anyone (doc, rn whoever) says about something medical until you have researched it yourself. Just taking someones word for it "Dr X says that..." is exactly the opposite of part 1 as it isnt evidence.
You subscribe to journals which you actually read.
You have or plan to get involved in publication or research, to you this seems like a lofty goal.
You didnt care that the cheap place you work for dosent pay for or extra for the CCRN or CEN because you just wanted to do it for yourself. You didnt just do it for school.
You take every class or cert avaliable that relates to what you do
You get actively involved in clinical practice changes which reflect new evidence where you work.
You are the resource where you work.
You are an educator/instructor
You read and study at home as well to increase your understanding and clinical knowledge
You are smart enough to know that "the way they do it at your hospital" isnt the only way or likely, the best way.
You actually goto educational sessions at conferences
You didnt stop all of these things when you got married or had kids, you have become a wizard at time management insteadPart 2 is really simple assuming everyone fits #1. The longer you work in the profession the more you will see. Practice makes perfect and the longer you interact with sick patients the more you will learn and the more comfortable you will be with it. You learn almost nothing from a vented pt who lays there and you gives meds and bath everyday. These patients wont help in the OR setting. What will carry you in your SRNA years and well beyond are the "bad thing" you see and deal with throughout your RN career. You cant know what you are seeing happen if you have never seen it before. "you dont know what you dont know" to put it simply. Like it or not, this is a fact not an opinion.

While many do not realize it, the 1st year of being an RN is when the actual education begins. This is a time when you have a long orientation with seasoned people. This period is the novice period where much of what new RNs do is follow protocols and "react". Very VERY few people "anticipate" more than the common complications. Critical thinking involves anticipating well in advance and understanding why.

Knowing the "whys" of as much as possible cant happen when your busy learning the paperwork, orientating, learning the equipment and getting the basics down. This takes a min. of a year. While some will read alot and be able to rhyme it off they often cannot put it into practice when the "shit hits the fan". Clinically nothing looks the same or happens the way it reads in the books. Every patient is different and adds to your clinical knowledge base.

Lets also not forget that every area of nursing offers a whole new knowledge set but ALL of these sets are apart of anesthesia. People with time in often move around hospitals and units/ER looking for new challenges and experiences to master. This is impossible over a 2 year period and so the person who is only in one place is limited to that knowledge set and experience.

Have you ever been to a mechanic who has "A's" in mech. school and clearly can state the info but spends hours trying to figure something out then, the old mechanic walks in and says "its this". Thats the difference only the cars are people.

Part 3: Pick the place which does the most.

There are many who fit part 2 but are clueless. They are the epitome of repetition and recognition. Because they have spent so much time working they often seem like they are part 1's since they have done some things so many times. However, when pressed for why they are usually unable to answer. Over time type 1's will surpass these people and realize they are not part 1s.

So after that long winded soapbox, here is my advice. Be part 1 with everything you do and know why. Spend 2-3 years doing this and move around units/ER to challenge yourself and add to your experience/knowledge. Dont believe a word anyone tells you about medicine. Look it up yourself and be the expert. Asking people is what leads to cyclic bullshit. Become an educator/instructor, you never learn as much as you do when you are responsible for teaching others. They ask questions which YOU dont know the answer to and make you learn as well!

Anyone can get "A's" on multiple choice exams in class and anyone can "go through the motions and skills" of anesthesia. You want to be the one in clinical hearing "your experience really shows" and then treated differently because of it (bigger cases, choice, skills etc).



Another question in regards to time in the units vs quality of experience. There seems to be a popular opinion of most experienced srna's and crnas that one and even two years experience in ICU is not really enough. I would like to hear more definitive explanation as to quality of experience. Instead of talking years, what do you more experienced guys think specifically that us wannabee's should be looking to learn in our time building towards applying. I can easily see that even with 10 years of experience some people still don't have what it would take to make a good anesthesia practioner. So, get specific with what "experience" means. What do I need to glean from that one, two or three years of necessary experience?

[nojrevorg]

I agree totally with M. He nailed it on the button. You in your first year will start to feel confident in taking what comes through the door, yet there is always something more. Benner did the whole novice to expert thing, and it is the one nursing theory that I actually held on to. Your quality experience has to be applied over some time in order for you to grasp both the physiology and care of the situation. I had only 3 years in the ICU, and I feel like that was not enough sometimes. I was the part 1 person, and people did come to me to help educate, and yet I am still amazed at some of the things that I thought I knew, where I was still off the mark. I had the opportunity of doing both trauma and cardiac surgery, and they are 2 different sides of the world when it comes to taking care of them. There is alot to learn, and if I were you I would print out Macs post and read it everyday. He was dropping pearls and you should take advantage of it.
Good luck in the learning process.

[armygas]

There seems to be a popular opinion of most experienced srna's and crnas that one and even two years experience in ICU is not really enough.

Hmmmmmmm.......... I had zero years of ICU...... (I was a labor and delivery nurse for four years at the New York Hospital). But I am one of the exceptions to the rule I guess, to me either you are a good clinician or you are not.

(Yes a male OB nurse).

Edit: Didn't have any trouble during school or afterwards, it just all "came to me" so to speak.

[CRNA09]

As a current SRNA in a Chicago program I would suggest going directly to the source and make an appt with one of the program directors for the program(s) you plan on attending. They will let you know if your setting provides adequate preparation. I know Depaul and Rush have information sessions if the group format is more comfortable. I've met with the program director for Rosalind Franklin before he started that program and I found him very approachable. If you have your heart set on one program you might want to take some classes ahead of time and give them your all so the admission directors know you can do the work.
Regarding the university setting (I currently work in CCU at a university hosp) I think it helps to see the learning process for medical residents. They don't know squat in July. When we start that's how we'll be and we'll survive the uneasiness of not knowing much just as they do. Also I find the physician rounds and emphasis on researched based practice interesting. However, a few people in my class didn't work in university settings before being accepted.

Hope that helps!

[ethernaut]

Hmmmmmmm.......... I had zero years of ICU...... (I was a labor and delivery nurse for four years at the New York Hospital). But I am one of the exceptions to the rule I guess, to me either you are a good clinician or you are not.

(Yes a male OB nurse).

Edit: Didn't have any trouble during school or afterwards, it just all "came to me" so to speak.

well, i just have to chime in here..
(forgive me army)..
i agree with you about the "rule" and you are a good example of a clinician making it without ICU experience.
it's funny how that segregation made the grade for the bylaws of ANAA to make it the requisite for entry.
mike has made many good points regarding ER as good background.
nursing has so many levels in so many directions, that you just can't get it all at any point.
i can bet that even my med-surg has some small role in my abilities as a provider, planner, learner, etc...
HOWEVER,
the thing that gets my goad, and again, forgive me army (i'm sure you'll sleep tonight anyway),
is the concept of "male nurse"..
i may be petty, but the true definition of nurse does not side with sex, and when i read journal/magazine articles signifying such, i just get irritated.
my response to ALL patients was always "yes, i am a nurse AND i am male"--
anyway, that was a side note to this thread, and i feel better now..
carry on all....
:)

[armygas]

is the concept of "male nurse"..

my response to ALL patients was always "yes, i am a nurse AND i am male"--
anyway, that was a side note to this thread, and i feel better now..
carry on all....
:)

Hehehe, try being the only guy in your particular area within the entire city of New York (and probably the entire eastern seaboard....)
;)

I get what you are saying, but I would get that all the time, "what you are an OB Nurse?.....but your a dude!!" and then inevitably came the question, "are you gay?"

[MmacFN]

You are a rare exception Mik.

There are very VERY few people who can do that. Plus, you got training that 90% of CRNAs do not get, military anesthesia training.

I dont want to give a false sense of security to anyone based on your situation.

To say that anyone could do that and do as well is like when smokers tell you they dont believe they will get cancer because their brothers friends sisters mothers Me-Ma smoked all her life and lived to 90 then died of happiness with a "cancer stick" in her mouth. :P

[m_playman]

Ditto. Well said M.
To expand briefly... Don't give someone who has "x" amount of years experience a free pass when he/she says this is how/what/why, etc. Exactly what Mike said, do the research yourself and own it. Also, too often, the "seasoned" player in the unit/ER, whatever, plays the intimidation card. Always pointing out what they know and what you don't. Try not to get caught up in it. They don't know everything you don't, they just learned it before you did. Best of luck.

[ed3]

You are a rare exception Mik.

There are very VERY few people who can do that.

I keep trying not to post, but...

A large percentage of practicing CRNAs have zero ICU experience. I don't quite understand how someone would think very few people could do that when until fairly recently people did it all the time... If I am missing something feel free to correct me (seriously).

[ethernaut]

I keep trying not to post, but...

A large percentage of practicing CRNAs have zero ICU experience. I don't quite understand how someone would think very few people could do that when until fairly recently people did it all the time... If I am missing something feel free to correct me (seriously).

i guess i'm missing what you are saying here..
i have met many a preceptor that don't have ICU experience, and i don't question much of which what they know..
but if i'm way off, ok..
my point is, is ICU may be nice and all, but that label is rather symbolic more than concrete..

[ethernaut]

Hehehe, try being the only guy in your particular area within the entire city of New York (and probably the entire eastern seaboard....)
;)

I get what you are saying, but I would get that all the time, "what you are an OB Nurse?.....but your a dude!!" and then inevitably came the question, "are you gay?"

well, i can't beat the "eastern seaboard" thing, but what i do hold near and dear to my overspent heart, is that i was offered the chance to see a yeast slide during my OB nursing education rotation within the BSN realm. you can't imagine, or maybe you could, the disdain i felt for my program and clinical facility in general...
if there's one thing i "hate" about my prior education, it is that...
now, no sex should be distinguished..
a nurse is a nurse..
and also, i am not gay, as i too have been asked and speculated about........... (not that there's anything wrong with that..)

[ed3]

i guess i'm missing what you are saying here..
i have met many a preceptor that don't have ICU experience, and i don't question much of which what they know..
but if i'm way off, ok..
my point is, is ICU may be nice and all, but that label is rather symbolic more than concrete..


That was a really lazy post. I can see how you misunderstood that.

What I was trying to say is that some people think it is rare for someone to be a proficient SRNA without obtaining acute care experience first. I was just saying that until fairly recently there was no acute care requirement.

I’m sure you don’t question the knowledge of the CRNAs who don’t have ICU experience (like you said, there are many)…which is kind of the point I was trying to make.

[MmacFN]

Hey edisto

It is a different time and the expectations are higher now, there is alot more to know in medicine as a whole including anesthesia. Those CRNAs with 20 years of experience got to learn about all these things we take for granted as they were introduced. Not to mention that the scope of an RN 20 years ago was significantly different than it is today.

I dont mean to sound condescending but this is a self evident concept. This holds true universally for any profession not just anesthesia. It seems to me the only reason you argue is because this includes you. I say that because you dont have any experience to base it on.

The majority of people are saying exactly what I am. They are both accomplished RNs as well as SRNAs or CRNAs. So they have been through the whole process and know what is expected. People in the clinical area say it over and over again, including some of those CRNAs you reference who had no experience when they started. Are all these people wrong and you right?

It isnt personal, just how it is.

[ethernaut]

Hey edisto

It is a different time and the expectations are higher now, there is alot more to know in medicine as a whole including anesthesia. Those CRNAs with 20 years of experience got to learn about all these things we take for granted as they were introduced. Not to mention that the scope of an RN 20 years ago was significantly different than it is today.

I dont mean to sound condescending but this is a self evident concept. This holds true universally for any profession not just anesthesia. It seems to me the only reason you argue is because this includes you. I say that because you dont have any experience to base it on.

The majority of people are saying exactly what I am. They are both accomplished RNs as well as SRNAs or CRNAs. So they have been through the whole process and know what is expected. People in the clinical area say it over and over again, including some of those CRNAs you reference who had no experience when they started. Are all these people wrong and you right?

It isnt personal, just how it is.

just to point out change and time,
a CRNA who graduated in '02 asked me what drugs were new, because he didn't know..
it's funny how little time has passed, and yet it seems so long ago..
it was mentioned to me how quick we lose our education, knowledge, and drive to learn once we graduate and certify...
it happens and i'm sure we will be the same front to the next generation..

[ed3]

Hey edisto

It is a different time and the expectations are higher now, there is alot more to know in medicine as a whole including anesthesia. Those CRNAs with 20 years of experience got to learn about all these things we take for granted as they were introduced. Not to mention that the scope of an RN 20 years ago was significantly different than it is today.

I dont mean to sound condescending but this is a self evident concept. This holds true universally for any profession not just anesthesia. It seems to me the only reason you argue is because this includes you. I say that because you dont have any experience to base it on.

The majority of people are saying exactly what I am. They are both accomplished RNs as well as SRNAs or CRNAs. So they have been through the whole process and know what is expected. People in the clinical area say it over and over again, including some of those CRNAs you reference who had no experience when they started. Are all these people wrong and you right?

It isnt personal, just how it is.

You know, I could make a long drawn out post, but I realize it really doesn't matter. What I will say is that people with 5+ years experience are the people who are normally the biggest proponents of more experience...and I can understand that because that is human nature. Just like there are people with less experience who say that ICU nursing and anesthesia are two different worlds, and you will learn everything you need to know in school etc. The more I think about it, the more I realize it really doesn't matter which belief someone holds. I guess everyone just needs to make the right decision for themselves, and stop worrying about what others think (I'm kind of talking to myself here :)). I don't quite understand the "It seems to me the only reason you argue is because this includes you" statement". I think it was a fair question, and I realize the only acceptable thing for me to do is pretend that it was a really long time ago (it wasn't that long ago) when there was no acute care requirement. I have noticed some things are kind of taboo around here, and that is one of them. No, I don't have experience, but I don't think it makes most of the things I say any less valid. I can guarantee you that you will find plenty of people with impressive amounts of experience who actually agree that you learn the most about being a CRNA in CRNA school.

I make observations based on what other people say, nothing less, nothing more. If someone doesn't like it, (I'm sure there are some) they can add me to their ignore list. :) I will totally understand...

BTW- I think you meant to sound condescending, but at this point it doesn't even matter. It’s like when someone says something mean and then says they are joking. Like that makes it better…

You try to make it seem like the majority of people hold this view, but I think it is pretty evenly split. I know this website (while I enjoy it) can be pretty one sided at times. You say its just how it is, and in a way I don't think we are on the same page (unless one of us has a distorted reality, and is too “caught up”…could be me). What I am saying is that based on evidence/past and facts, it is possible to be a proficient CRNA without acute care experience. I'm really not saying anything more than that. I'm not saying that 5+ years of acute care experience isn't beneficial, but according to many people (including those with many years of experience) it is not absolutely necessary.

Having said all that, I do understand where you are coming from. However, your, “Are all these people wrong and you” comment was a little strange. I don’t think it is a matter of right or wrong. I don’t ask questions to be “right”, I ask questions because I’m genuinely interested in seeing a logical explanation. Apparently, to you it is about right and wrong. Why else would you ask that?

I can understand that expectations are higher now, but I have a very hard time believing that “very few people” could become competent CRNAs without 3+ years of experience (even today). Really, I could have just said that ^.

Ok, so this did end up being a long drawn out post…and I omitted a lot (didn't want you to ban me, and I think you would have... :))


:focus:

Edit: You know...its not that I enjoy arguing about this topic (although I admit I always have to be doing 10 things at once, and it keeps me busy) its just that anytime I ask an innocent question, I get stuff like, "Well it really is a self evident concept" or "what makes you think you have it down pat, when you haven't even completed the first step" (arguably, I have)....and I'm like damn...did I ask all that? Was my question that offensive? I really don't like to argue ALL the time (when I argue 80% of the time I am not serious) but sometimes I'm thinking: Couldn't you just answer the question without all of the other bs? But I don't want to complain too much, because this website is great for who it is intended for (SRNAs and CRNAs).

I may be misinterpreting your tone...

[armygas]

Hey y'all,

I didn't mean to start a ruckus!! I just wanted to say that there are exceptions to the rule.


ITZALLLLGGOOOOD!

[jcaSRNA]

Edisto

I agree with Mike. I know you post quite often on this topic and feel strongly about possibly not needing the experience required (ICU yrs.), but I guarantee you your mind will change as you grow. Believe or not, there is a reason the AANA requires at least 1 yr. of ICU experience and have more than entertained upping the requirement to 2 yrs.

As far as some CRNA's out there not having ICU/critical care experience, why don't you go ahead and ask them in this day and age of medicine if they think it's good to have it as a requirement now. I'd be curious as to what they answer. Mike was right on with this too in my opinion.

It is clear to me from reading all of your posts on this issue that you are never going to change your mind on this issue, but i guarantee you that once you get into an ICU and start gaining some more knowledge of what you actually "didn't realize that you didn't know", your mind will change. Hate to make guarantees, but I feel solid with this one. I know you get offended when your "lack of experience" is brought up, but sorry, it's relevant pertaining to this topic. It would be one thing if you were a seasoned ICU nurse telling us you didn't think this kind of experience was necessary for CRNA school, but your not. And for the record, I don't see ANY posts echoing the aforementioned sentence. I hope you keep posting after you start in the ICU, find out more about the parallels of ICU work (drips, vents, ABG's, etc.) and CRNA work, and see if your views might change.

I

[armygas]

Edisto

I agree with Mike. I know you post quite often on this topic and feel strongly about possibly not needing the experience required (ICU yrs.), but I guarantee you your mind will change as you grow. Believe or not, there is a reason the AANA requires at least 1 yr. of ICU experience and have more than entertained upping the requirement to 2 yrs.

As far as some CRNA's out there not having ICU/critical care experience, why don't you go ahead and ask them in this day and age of medicine if they think it's good to have it as a requirement now. I'd be curious as to what they answer. Mike was right on with this too in my opinion.

It is clear to me from reading all of your posts on this issue that you are never going to change your mind on this issue, but i guarantee you that once you get into an ICU and start gaining some more knowledge of what you actually "didn't realize that you didn't know", your mind will change. Hate to make guarantees, but I feel solid with this one. I know you get offended when your "lack of experience" is brought up, but sorry, it's relevant pertaining to this topic. It would be one thing if you were a seasoned ICU nurse telling us you didn't think this kind of experience was necessary for CRNA school, but your not. And for the record, I don't see ANY posts echoing the aforementioned sentence. I hope you keep posting after you start in the ICU, find out more about the parallels of ICU work (drips, vents, ABG's, etc.) and CRNA work, and see if your views might change.

I
Let us be clear...................

There is no AANA requirement for ICU experience.

This is directly from the AANA site:

Education and experience required to become a CRNA include:


A Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.

A current license as a registered nurse.

At least one year of experience as a registered nurse in an acute care setting.

Graduation with a master’s degree from an accredited nurse anesthesia educational program. As of September 2006, there were 102 nurse anesthesia programs with more than 1,000 affiliated clinical sites in the United States. These programs range from 24-36 months, depending upon university requirements. All programs include clinical training in university-based or large community hospitals.

Pass a national certification examination following graduation.


I don't want a ruckus but I don't want misinformation either.

[jcaSRNA]

Definitely don't want to cause a ruckus here either. I thought "one year acute care experience" referred to ICU experience. Is each program's interpretation of "acute care experience" different - thought that once ED experience was considered, but now it's ICU only. Give me the correct info. if I'm wrong. Do some schools except candidates with no ICU experience? Jason.

[armygas]

Definitely don't want to cause a ruckus here either. I thought "one year acute care experience" referred to ICU experience. Is each program's interpretation of "acute care experience" different - thought that once ED experience was considered, but now it's ICU only. Give me the correct info. if I'm wrong. Do some schools except candidates with no ICU experience? Jason.
Each school makes it own determination on the experiences they allow.


Some definitions of Acute Care
-treatment of a severe medical condition that is of short duration and at a crisis level.
-Medical care administered, frequently in a hospital or by nursing professionals, for the treatment of a serious injury or illness or during recovery from surgery. Medical conditions requiring acute care are typically periodic or temporary in nature, rather than chronic.
-is care received in an inpatient hospital setting.
-Acute care refers to necessary treatment of a disease for only a short period of time in which a patient is treated for a brief but severe episode of illness
-Medical treatment rendered to individuals whose illnesses or health problems are of a short-term or episodic nature. Acute care facilities are those hospitals that mainly serve persons with short-term health problems.
-a hospital stay less than 30 days.

[jcaSRNA]

Just curious. Do you know how many of the CRNA programs in the country don't specifically require at least one year of ICU experience? Don't need specifics, just a roundabout number or percentage.

[armygas]

Just curious. Do you know how many of the CRNA programs in the country don't specifically require at least one year of ICU experience? Don't need specifics, just a roundabout number or percentage.

I only know about USAGPAN, they allow Active Duty RNs to attend (after meeting the GRE, etc requirements). They no longer allow civilians to do so with the direct entry, but that may change because of the current shortage. When I applied several years ago, the stipulation was only 1 year acute care.

Again, this wording affords programs to accept the "extraordinary case".

I have been having this argument with people for years. ICU experience in my personal situation did not hurt me. I graduated with the "Colonel Ruth P. Satterfield" award for the outstanding nurse anesthesia student, was a member of the "College Bowl" champ team (http://www.nurse-anesthesia.org/photopost/showphoto.php?photo=126&ppuser=877) got 600/600 on boards, and handled my business very well in the sandbox (did the only retrograde wire nasal intubation in theater BTW... :))


When I am a program faculty member (OMG in less than 18 months....), I will understand that there are exceptions to every rule. But I will also understand that experience matters. I hope that make sense. One thing I do hate is when this sort of debate becomes, "my experience is better than yours....." I will take a great provider from a ER, OR, etc setting over a mediocre provider who festered in an ICU for years. After reviewing the record of the individuals and during the personal interview (THE MOST IMPORTANT PART), I will know who is the best fit. Again, each case is individual.....................

[MmacFN]

Well Here are my replies:

Edisto: Bud, i think you are gonna be a great RN just because of your motivation but your arguments vs experience only prove my point. Yes there are ppl who can do it but there are also people who can recite pie to over 100 digits. We dont make rules based on statistical outliers. Armygas here is awesome. However, he will be the first to tell you he is a statistical outlier. So when ppl here come and ask advice we dont typically advise as if they are the 1%er.

AANA requirements:

Yes the AANA does not require anything but "acute care". On their website they say exactly this :


Registered Nurse licensure, a minimum of 1 year acute care experience (ICU, ER for example), a
to me that sets the stage as to what the expectation is. Not to offend anyone, but the OR, L&D, Floors and PACU do not count as acute care and do not fit in the same definition as ER/ICU. The reason nothing is written in stone is for individual programs to set their own requirements, however, you wont find them lower.

There is little doubt that the vast majority of CRNA programs want ICU experience and specifically SICU/TICU/CVICU where you can experience the most hemodynamically. In fact, there are many programs who clearly state on their website they accept nothing BUT ICU experience ignoring ER, flight nursing etc. To me that is narrow minded but you only need to look at the administration to see the reason (ignorance).

[MmacFN]

Hey JCS

I know people all over philly area and NJ who never worked a day in the ICU. They are all ER people. Many of the programs here see ER = ICU for application and decide based on experience, GRE/GPA and interview.

There are ppl in my class who have never been in the ICU.



Just curious. Do you know how many of the CRNA programs in the country don't specifically require at least one year of ICU experience? Don't need specifics, just a roundabout number or percentage.

[jcaSRNA]

Army

Whatever program you're going to be faculty at is going to be a better program for having you, no doubt. Good luck with that.

You, as you stated, are the exception to the rule. I think 1yr. ICU experience is a reasonable requirement for CRNA school for the average applicant. Of course you could become a competent CRNA (understatement for you) without ICU experience, but the knowledge base you form from that experience serves as great building blocks and a great foundation before beginning CRNA school. Even the average decent entry level job has some requirements, a bachelor's degree, certain licences, etc. Does that mean that someone without those things couldn't learn "on the job" and succeed, no it doesn't. It just give these CRNA programs a starting point.

An aside, thanks for the great google groups pando site. I'm a member and hopefully will come across some material in my studies to contribute to the site. Have a good one!

[jcaSRNA]

Thank for the information. I thought most programs were starting to shy away from considering ED experience and looking specifically for ICU. I just didn't have my information straight (damn I hate when that happens!). To be honest, I thought that every CRNA program (not consider military) did want the year of ICU specifically. I was wrong. Still think it's a good idea though. Jason

[armygas]

Army

Whatever program you're going to be faculty at is going to be a better program for having you, no doubt. Good luck with that.

You, as you stated, are the exception to the rule. I think 1yr. ICU experience is a reasonable requirement for CRNA school for the average applicant. Of course you could become a competent CRNA (understatement for you) without ICU experience, but the knowledge base you form from that experience serves as great building blocks and a great foundation before beginning CRNA school. Even the average decent entry level job has some requirements, a bachelor's degree, certain licences, etc. Does that mean that someone without those things couldn't learn "on the job" and succeed, no it doesn't. It just give these CRNA programs a starting point.

An aside, thanks for the great google groups pando site. I'm a member and hopefully will come across some material in my studies to contribute to the site. Have a good one!

I know that my case is an exception, my goal is to fight for that "diamond in the rough". I also know that ICU experience helps to limit the number of applications in the civilian programs and that each school makes it own criteria. I do think its a shame that most programs don't even look at an application without ICU experience. Hey I think there has to be outliers like me to keep reminding people that they are out there!!

BTW, I will keep adding little by little to the Pando (keep checking).

[Mophet]

I have been a Nurse in the CCU and the ED. I was a Paramedic for 6 years before becoming a Nurse and came to the CCU thinking I knew somethings. I quickly learned that a lot of what I thought I knew was wrong or very basic. I could respond great to the obvious emergencies, but the job of a nurse is to prevent those emergencies from happening in the first place.. I began to learn some of those things in my first year. Then I moved to the ED for two years. This is where my education really began. In the ED the diagnosis is unknown, the problem list can be long and you learn a lot of good assessment and investigation skills. You also must learn to do these things while stabilizing an unstable patient. You get good at multitasking and working quickly. When I went back to the CCU where I have been for another 2 years things have been different. I can see the big picture better. I am able to keep up with the pace. And I am a whole lot better at keeping patients out of trouble. I am definitely a proponent of experience. I like a good mix.

I will see next fall how this helps me in anesthesia school, but I believe experience does matter!

[nojrevorg]

I was thinking after reading these posts, If I were a program director, Which I am not even remotely close to ever even thinking that, and I had an applicant who applied, and wanted to be accepted but wasnt ready to go the extra mile and go into a new type of care setting like ICU, I would wonder about intentions. Army is more than an acception to the rule. He is the Diamond. Think about it. He was in the HUGE minority in OB , and he stayed there for 4 years. That to me says (huge amount of sand), and that he is someone that as a nurse was fully able to go against the flow, and excel in his area of specialty. That to me would get him an interview automatically just to see what makes him Tick. And I am sure he knocked the socks off his interview panel. There are acceptions, but He made himself stand out amongst a multitude of applicants. Showing that you are able to do something hard and uncomfortable must come into play.
I personally am 100% firm on that as a Nurse I learned so much in the ICU, and CVICU, and it has helped me even in the first semester of school. Anyone can study and regurg, It is when I am able to build on the knowledge base that I already have and hopefully bring it to patient care that is important. I could not have done that without my experience.
Anyway that is my opinion.
not trying to be an armygas fanboy, but He is a real great addtion to the field of anesthesia and soon academia, and has been an awesome resource. He is still going the extra mile, I am sure that is a personality trait that made him the diamond in the rough.
Edisto Be that diamond, or in my opinion get into an ICU and get some of the experience that we all have had and are proud to say that it is priceless. Really there are many things to learn. After that come back and tell us if we are wrong.
Interesting topic by the way I love Ruckus

[bk117rn]

[QUOTE=MmacFN]

Not to offend anyone, but the OR, L&D, Floors and PACU do not count as acute care and do not fit in the same definition as ER/ICU.QUOTE]

I am afraid I disagree with this statement. Also from the AANA website: "A minimum of one year of acute care nursing experience. (Each program determines what constitutes "acute care" nursing.)" Bottom line is acute care may be any subspecialty residing within the confines of the acute care facility. Now I am not saying that these areas adequitely prepare candidates for CRNA school, but I am merely stating a fact without reading between the lines. Everyone has there own definition of what acute care means to them, which is why different programs have different standards. That being said, I believe the best candidates come from varied backgrounds. Someone who has worked in multiple acute care settings/areas/subspecialties will have better critical thinking skills, more flexibility, and a better ability to think outside of the box than someone who has worked in the same unit their entire career.
I interview with some programs that completely discounted my experience in a level 1 trauma center emergency department in the 4th largest city in the US (BTW only 2 level 1's in Houston). They also did not think flight nursing mattered either. Actually I was accused at one school of being an adrenaline junky and subsequently informed that I would not succeed in school because I would become bored r/t the fact that 95% of anesthesia is repetition and boring. I can now say after completing school and interacting with various CRNA's and classmates that all of my experiences played a huge part in my ability to succeed in CRNA school (CVICU, med-surg ICU, flight nurse, paramedic, manager, ED nurse, small hospitals, large hospitals, community vs tertiary care/teaching facility, medical product educator, consultant) and will continue to play a part in my future success.

[ed3]

Edisto

I agree with Mike. I know you post quite often on this topic and feel strongly about possibly not needing the experience required (ICU yrs.), but I guarantee you your mind will change as you grow. Believe or not, there is a reason the AANA requires at least 1 yr. of ICU experience and have more than entertained upping the requirement to 2 yrs.

As far as some CRNA's out there not having ICU/critical care experience, why don't you go ahead and ask them in this day and age of medicine if they think it's good to have it as a requirement now. I'd be curious as to what they answer. Mike was right on with this too in my opinion.

It is clear to me from reading all of your posts on this issue that you are never going to change your mind on this issue, but i guarantee you that once you get into an ICU and start gaining some more knowledge of what you actually "didn't realize that you didn't know", your mind will change. Hate to make guarantees, but I feel solid with this one. I know you get offended when your "lack of experience" is brought up, but sorry, it's relevant pertaining to this topic. It would be one thing if you were a seasoned ICU nurse telling us you didn't think this kind of experience was necessary for CRNA school, but your not. And for the record, I don't see ANY posts echoing the aforementioned sentence. I hope you keep posting after you start in the ICU, find out more about the parallels of ICU work (drips, vents, ABG's, etc.) and CRNA work, and see if your views might change.

I


JcaSRNA

First and foremost, I DO NOT get offended when people bring up my lack of experience…People know I have no experience because I chose to share that information. So clearly I would not have a problem with people bringing it up. What I do get a little irritated with is people thinking that just because I’m blue (:)) that I obviously must be an idiot (maybe I am an idiot…I don’t know). I also get irritated when people accuse me of saying things that I have never said.

Now…

I have NEVER said I didn’t want/need acute care experience. I think I will throw my computer at someone if I read that on here again. I never said it… I don’t know how many times I have to say that. I will say it again just in case someone missed it…I NEVER said I didn’t need/want acute care experience.

What MmacFN says is logical (and true)….the expectations are higher now….but
1. It wasn’t that long ago
2. The CRNAs who had no previous acute care experience didn’t have any difficulty adjusting to the higher expectations. In other words, experience as a CRNA teaches you more about being a CRNA than anything else. To me, that is the real “self evident” concept. If I were going to have a CRNA for my family or myself, I don’t care how many years they worked in the ICU, I want to know how long they have been practicing as a CRNA (if anything).
3. More than likely, the people responsible for educating CRNAs had no acute care experience, and they are clearly capable of teaching at “higher expectations”.

Its like a pharmacist or PT being self-righteous because their profession requires a doctorate, when most practicing pharm/PT don’t have a doctorate. My frustration and somewhat antagonistic posts are not in response to the acute care requirement. My frustration lies with people who found out about being a CRNA after they already obtained their experience, and then question those who knew they wanted to be a CRNA ahead of time… (and possibly end up with less than 3 years of experience).

From my understanding, the great strides in this profession took place at a time when there was no acute care requirement. Even then, CRNAs were able to prove they were competent and deserved (whatever).

I normally don’t get irritated when reading ANYTHING on the internet….but your post is just :aargh4: ….mainly because you are way off base on what “I think”.


Are you saying that no other person (besides myself) has ever stated that one does not need 3 or 5+ years in the ICU to be a proficient CRNA? Really that’s all I am saying. Once again, I’m not saying acute care experience isn’t important.


If I didn’t state it explicitly, chances are that’s not what I think.


I guess it seems strange to people that I would “question” people who are more experienced. But from my personal experience, it is always best to use my own judgment….because at any given level of experience; most people are full of it. That is a fact. I am also very selective about who I consider a mentor (I know…they are doing me a favor, and I have the nerve to be picky). That has nothing to do with anything, but maybe it will give you a better idea of where I’m coming from. Its not that I am being mean or intentionally antagonistic, its just that I like people to back up what they say. Like I have said before, I make observations based on what I see and what others say, nothing more. If you focus on what is being said, instead of who is saying it, I think you will see my comments for what they are and not read them with false expectations. i.e: thinking I feel acute care experience is unimportant, just because I don’t have experience (when I have never stated that). (I actually had the opportunity to work in the CVICU as an extern, but I changed my mind because I will be working my whole life)

Armygas- you didn’t start a ruckus. MmacFN and I have this discussion once every few months. (but he started it) :)

MmacFn-Army (or anyone else) was not the exception to the rule at the time…that’s all I’m saying. He is clearly very intelligent…but I’m not going to sit here and pretend he is the exception when there are thousands of people who did the same thing. Please don’t hurt me army.

[armygas]

IThere are exceptions, but He made himself stand out amongst a multitude of applicants.
First of all, thank you for the kind words!

You made my point better than I could (thank you), I was trying to make the point that certain non-ICU applicants will stand out. I just want them to have a "look".

The OP originally wanted to know about ICU quality, that will always be a subjective measure.

[armygas]

Please don’t hurt me army.


;)

[jcaSRNA]

Totally agree with that. That's my thought process. If ICU is required by the program's standards, then go get the ICU experience and come back and apply when you have it. I'm sure alot of us did that. If you make the exception for one, then what? Then you as a program are entering into some gray area and alot more interviewing and digging. That's fine if that's the road they wish to travel, but it seems tough.

[armygas]

Totally agree with that. That's my thought process. If ICU is required by the program's standards, then go get the ICU experience and come back and apply when you have it. I'm sure alot of us did that. If you make the exception for one, then what? Then you as a program are entering into some gray area and alot more interviewing and digging. That's fine if that's the road they wish to travel, but it seems tough.
Good Post

[lookingup]

Wow, that was quite a volley there...good points all around and well argued.

:focus:


MmacFan, your explanation presented towards the beginning is enlightening. I have always found myself to be one that questions what I'm told, not as a rebuttal but rather as a question inside my own head, because I've seen in nursing and other areas that people are often hesitant to say "I don't know...good question." I make it a point to look up anything that piques my interest enough to ask a question.

It's funny how you mention the types that read scholastic material "for fun" or out of desire; I thought I was one of few odd ones who do that! Good to know that this is intrinsic in most CRNA's.

My experience at my original hospital is congruent with my current hospital in that my thirst for knowledge tends to put most people off. It gets back to me in one way or another that "I'm too eager...ask too many questions...need to take things one at a time". To me, that's crap. In only 1.5 yrs of RN experience, I've seen way too much robotic nursing. Complacency, jealousy, fear...it keeps people stagnant and those types are usually intimidated by the go-getters who want something more. It frustrates me every time but then some level headed colleagues will tell me to keep my eye on the prize and don't absorb any of that crap. I've heard of people saying how great their place is and how helpful/understanding everyone is with them going to CRNA school, I have yet to have that experience.

To add to my original post...I've heard of "selling your experience" at the interviews, but if don't know what you don't know, your embellishing will only get you so far. Does explaining how you supplement (reading pharm/physio/anes. stuff, questioning MDs/residents, CCRN) your potential lack of experience/exposure even matter? Is it okay to say it plainly, "I know I may not have the ideal experience being so young
but I've done my best to overcome it with XYZ?" Or would that look like an attempt to get around the requirements and scam my way in? Like those people who post "what's the quickest way into school, how do I get around having to take this or meet this requirement?"

Thanks for everyone's input and good discussion. This site helps immensely for me because I feel I have very few people, if any, in my life who both A) truly understand what it takes for the CRNA path and B) who wouldn't compromise my chances of getting there (jealous co-workers, cost/resource focused manager, ICU program director). Anyone else feel that way during the pre-SRNA phase?

[MmacFN]

Hey Lookin

To answer the questions you posed below i would say this:

1) its always good to highlight what you have done to overcome what you may be lacking. As long as you can back it up.

2) Programs directors are all different people. What one sees as acceptable another may not. If the PD was a CVICU RN before CRNA school it is likely they will give preference to CVICU RNs. If they were in the ER they will likely allow ER RNs in.

I understand peoples interest in getting into CRNA school. On the otherhand, I wonder if the question should be:

"What will benefit me, my patients and make me the best CRNA I can be?"




To add to my original post...I've heard of "selling your experience" at the interviews, but if don't know what you don't know, your embellishing will only get you so far. Does explaining how you supplement (reading pharm/physio/anes. stuff, questioning MDs/residents, CCRN) your potential lack of experience/exposure even matter? Is it okay to say it plainly, "I know I may not have the ideal experience being so young
but I've done my best to overcome it with XYZ?" Or would that look like an attempt to get around the requirements and scam my way in? Like those people who post "what's the quickest way into school, how do I get around having to take this or meet this requirement?"

[pilot424]

Thanks for you thoughtfull reply and also thanks to the others who replied. It does take time to get some things down. The amount of quality experiences also is important. That one point itself can shorten or lengthen the time element. I believe I've got Part three down without a doubt. Part two is just going to come by not quiting. Part one is determined by what type person you are. I'm forty six years old and hopefully by now I know who I am and what I want to do.

This board is great and I can't wait to post my acceptance to school! Keep coming with the advice!