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ICU experience is the foundation that propels aspiring CRNAs toward their dreams. It nurtures critical thinking, cultivates resilience, and shapes compassionate caregivers ready to navigate the complexities of anesthesia. In this enlightening episode, join host Jenny Finnell as she discusses the significance of ICU experience in anesthesia school admissions. She uncovers the types of critical care experience that are valued and recognized by different schools, offering insights and guidance for aspiring students. From understanding the preferred ICU specialties to recognizing red flags in the application process, Jenny shows how to make informed decisions about aspiring CRNAs’ ICU experience and its impact on their future endeavors. Join us and discover what ICU experiences actually mean to CRNA schools!
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ICU Experience For CRNA School
Introduction And Exploring Personal Growth
In this episode, we are going to discuss what the best ICU for CRNA school is. I know many of you who are early on in your pursuit know that you are required to have ICU experience, but you may be wondering, “How do I know what ICU experience is going to set me up for success to successfully gain admission into CRNA school and also be successful during my time as a nurse anesthesia resident?” That is what we are going to reveal. Let’s go ahead and get into the show.
We are going to discuss the ICU experience you need for CRNA school and what you should be aware of when considering what unit to pick as you get closer to graduation from nursing school. If you have time, if this has reached you at the time that you have not yet set up a job prior to graduating nursing school, or if you are very early on in nursing school and you are trying to decide what specialty you want to go into, whether you want to specialize in surgical ICU or medical ICU, or maybe you are exploring other pathways like ER and things of that nature, I’m glad you found this episode because I’m going to try to reveal what are some things you should be considering when picking your job outside of nursing school.
First and foremost, if you have not already, taking a position as a nurse’s aide is the best way to get your foot in the door as a new grad in the ICU. I have a lot of students reach out to me after they have already graduated from nursing school and they can’t even get an interview in the ICU. I ask them if they have ever had any experience working as a nurse’s aide, and a lot of them don’t.
It makes it hard to get your foot in the door after graduation. The best way to get your foot in the door is by working as a nurse’s aide. Working as a nurse’s aide is not a glorious position. I did it for two years. It’s very rough. It’s a hard job, but it allowed me to get into an ICU residency program. If I did not have that experience, I know for a fact I would not have gotten accepted into the ICU as a new grad. It was the big determining factor for me to get my foot in the door to make my name known and treat it like a long-term job interview. That adds a level of stress but also allows you to explore that unit.
Meaning if you take that position as a nurse’s aide and stay in the medical ICU and you hate it, or maybe the environment’s toxic, now you can easily and relatively risk-free navigate to the surgical ICU and see if that’s a better fit for you. It gives you the freedom to explore different ICU specialties when there’s no long-term commitment as a nurse, and also not truly yet starting your CRNA experience or your ICU experience journey for CRNA school. It allows you to see different things.
Exploring the pathway as a nurse’s aide is the best way. If you have already graduated from nursing school and you are getting the door closing your face for ICU residency programs or to get into the ICU, you might have to suck it up and start to do two options. Start on a med surg, and move to a step-down, which could take over a year to achieve because you may have to have six months of med surg experience before you transfer to a step-down, and then you may have to have six months of experience before you transfer to an ICU.
If that’s the only pathway that you can take because you keep getting the door closed in your face to get direct directly into an ICU residency program and directly into an ICU, then that’s what you have to do. You are going to have to start in med surg of some kind and work your way up in the step-down and then to the ICU.
Sometimes step-downs will take new grads as well. Again, not always. The ICU residency program I did also placed new grads in the step-down. They required all new grads that went to the step-down to have the residency program under their belt as well. They didn’t take new grads directly into the step-down either, but some hospitals will. Some hospitals will take directly into the ICUs, but know that the majority of hospitals seem to like to have new grads at least go through an ICU residency program.
This is something that you have to plan for prior to graduating from nursing school. It helps if you can get a good reference letter from someone who knows your work ethic inside the hospital. I will never forget this because she was our valedictorian, the smartest person in our entire nursing class of over 200 students. She couldn’t find a job after she graduated from nursing school as a valedictorian. She went to a nursing home to work afterward because that was the only position she could find. This was in a major city. It’s because she never worked as a nursing aide.
She spent all of her time making sure her grades were good. I don’t know if she ever worked, to be honest with you, but I know she never worked in the hospital. It hindered her, and I was shocked to find it out. She was devastated and had a lot of regrets for not getting that work experience while she was in nursing school.
It is something to keep in mind. I’m sure she’s fine now. I’m sure it has a happy ending, but I remember at the time we were getting ready to graduate, her sharing it with me and me being like, “I’m so sorry.” Let’s get into this episode by sharing a statement from the COA. What is the COA? The COA is the Council on Accreditation.
If you have been reading the show for a while, I hope you have read that I warned you that you have to be careful where you take your information from on the internet. Google will find the most high-performing SEO websites and put them in front of your face first and foremost. They are not always accredited sites, meaning they are usually bloggers and things like that. They are not always reputable sources. A lot of times, those websites are not updated very often and things of that nature. I’m even speaking for our own.
The best place to get truly get accurate information is always going to be from your school’s website and things like the AANA‘s website, NBCRNA, and the COA’s website. Even the COA’s website, I’m not going to lie, it’s outdated a lot of times if you look at it, but it is our Council of Accreditation, so it’s a legit website versus HowToBecomeACRNA.com. Be careful because people do these things because they rank on SEO, and then throw ads on their site to make money. They don’t necessarily even check the fact check a lot of things. They just know that it’s going to get good searches on Google. Be careful. That’s my warning to you.
When researching what ICU experience is going to be good for you, there are a lot of things to consider when it comes to that. You have to want to work on that unit and you have to know the culture of that unit. Even if it’s your dream ICU job, the culture may not be the right fit. You want to make sure you are picking an ICU where you are going to thrive and that you are going to have experience in leadership, and where your manager is going to be supportive.
I went over that in the last episode I did about there are some managers who don’t want to support CRNA-related career paths, and I think it’s because they are bitter, but I have met students who have had a big hindrance because their nurse manager will not write a letter of reference. Try to seek out environments that are least friendly towards going on to grad school.
Some will say, “I won’t give you a reference letter until you work here for at least two years.” If your plan is to go back to CRNA school that year, and that’s all you need for CRNA school, you don’t want to work at a place that’s going to hinder you. Trying to find out these things early is another great way to start doing as a nurse’s aide. Talk to the nurses on the unit and find out who is going to grad school and for what. If you find one of the nurses is going back for CRNA, make sure you stay in touch with them. It’s a good way to get that exposure early on and find out the little nuances of the unit.
The Best ICU For CRNA
Maybe it is time for you to explore other avenues if you find out the culture is toxic. It’s not all about what you do because you don’t have to be a CVICU nurse. You don’t have to be in a medical ICU or SICU. You don’t have to do any of those ICUs. It’s about what unit is going to support you the most as you get your experience and allow you to thrive not only getting advanced skills like ECMO, CRRT, and different life support modalities.
Who’s going to give you opportunities for leadership, research, and things of that nature, and who’s going to be supportive when you let them know you are going back to CRNA school? That’s also incredibly vital when picking your ICU unit and not just the type of ICU. As far as the type of ICU, we do have to get into that because that does matter, but it’s not, in my opinion, as vital as making sure that you are picking the right unit for you and one that you are going to thrive in and be supported on.
The ICU is hard and it’s rough. No matter what ICU you are going to go into, you are going to see a lot of suffering and death. It’s going to be a lot mentally, and so you have to make sure that you are going to find the support that you need and not be also put into a toxic environment on top of dealing with a lot of stress every day. Enough of that speech. I hope it rings a bell and I hope you look into that ahead of time so you can save yourself from extra stress.
I’m going to read this statement from the COA. It’s on critical care experience. CRNA schools, verbatim, go by the COA’s statement on CRNA or ICU experience, but it’s open to interpretation for the most part for CRNA schools. You will see that they will vary from CRNA school to CRNA school on what they consider ICU experience.
Not a whole lot of variation, but there is. I will cover what that is, but this is the statement from the COA. “Critical care experience must be attained in a critical care area within the United States in this territory or US military hospital outside the United States.” That’s number one. If you are getting your ICU experience outside of the US even if it’s Canada, I know we are neighbors, but it has to be in the US.
I have had Canadian nurses reach out to me saying, “I’m pretty close to the US. I’m in Whistler or whatever it is. Would my ICU experience count?” Unfortunately, based on the COA statement, no. You have to come to the US to get your ICU experience, so keep that in mind. “During this experience, the registered professional nurse has developed critical decision-making and psychomotor skills, competency, patient assessment, and the ability to use and interpret advanced monitoring techniques.
Critical care area is defined as, on a routine basis, the registered professional nurse managing one or more of the following, which are invasive hemodynamic monitors such as pulmonary artery catheters, CVPs, arterial lines, cardiac assist devices, mechanical ventilation, and vasoactive infusions”. You will see on a lot of CRNA school websites the requirements that you must routinely manage ventilators.
Respiratory therapists do a lot of the management, but you take patients on ventilators. You routinely see vasoactive drips and advanced life support modalities. They will specifically say those things sometimes because it specifically says on the COA’s website that they want you to have these types of experiences.
It says, “Examples of critical care units may include those that are not limited to surgical intensive care, cardiothoracic intensive care, coronary intensive care, medical intensive care, pediatric intensive care, and neonatal intensive care. Those who have experiences in other areas may be considered and provided they can demonstrate competence with managing unstable patients, invasive monitoring ventilators, and critical care pharmacology.”
You will see this almost verbatim statement on a lot of CRNA schools’ websites because they took it directly from the COA. It paints a picture, but it leaves out some little nuances that I wanted to address on this show because I see a lot of people still running into questions about their ICU experience. MICUs can be MICUs, but not all MICUs are the same. Not all SICUs are the same. Some combined surgical and trauma. Some are surgical and burn.
They are all different and you may get put in little tiny subspecialties of an ICU, so I wanted to at least cover that. When I do my searches and education on what CRNA schools require, I go directly to the school’s websites. I will say that and tell you until I’m blue in the face. You have to go to your school’s direct website to get the best information. You can look at CRNA School Prep Academy’s blog and get an overview.
You can go to other blogs and get an overview, but promise me, myself included, do not take anything I say set in stone because your school could be different and you have to understand what your school requires. That’s going to require you to specifically go to their website, go to their open houses, and talk to the program faculty if you are concerned about your ICU experience.
ICU Experience: Your school could be different. You have to understand what your school requires. Do not make assumptions. Make sure you’re hearing directly from your CRNA school.
Do not make assumptions, and make sure you are hearing directly from your CRNA school. Don’t take anyone else’s advice on the internet and what they think what your experience is going to be like. If they are not your CRNA faculty or from your program, they ultimately are not going to be the ones who, at the end of the day are making decisions on your future. Make sure you are being careful with that and make sure you are doing your research from your school’s websites.
I’m looking at Loma Linda’s website. They take directly from the COA’s website. They list that examples, “Critical care units may include but are not limited to surgical intensive care, cardiothoracic intensive care, coronary intensive care, medical intensive care, pediatric intensive care, and neonatal intensive care. Those who have experiences in other areas may be considered provided they can demonstrate competence in managing unstable patients, invasive monitoring ventilators, and critical care pharmacology.”
As you can see, they took it directly from the COA’s website to express what units they cover. I would take it for what it is. If you have a unit that you are questioning or unsure about, you need to make sure that you are asking. Notice here how they didn’t mention things like PACU, ER, cath lab, OR, step-down, and LTACs.
I have heard a lot of people give me rationales. LTAC has ventilated patients. I’m like, “They are usually trach patients who are not critically sick. They are more stable. They are still critical if they are ventilator-dependent, but it’s not in the ICU.” Make sure you are not making assumptions. They want to make sure you are seeing invasive hemodynamic monitors.
You are not going to see a swan or an arterial line at an LTAC. That’s going to leave out invasive hemodynamic monitors such as pulmonary artery catheters, CVPs, and arterial lines. Mechanical ventilation is they are being ventilated. Not that trachs don’t count in the ICU, but it’s not just trachs. If you have a long stable trach patient, are they on vasoactive drips? Are they requiring FLOLAN? What’s going on? Are they having a massive GI bleed and requiring vasoactive drips? That makes a critically sick patient that would not be put in an LTAC.
Think about that. If you are a PACU nurse, you might be stabilizing or dealing with a patient temporarily outside of the OR, but you typically ship them to the ICU as soon as you can or within an hour, so you are not managing them long-term. You see A-lines, swans, and ventilators, but you are not doing long-term management whereas in the ICU, you are managing long-term. They want to see longer-term management throughout this shift, which is also why ER is not considered by a lot of programs because it’s short-term management. It’s stabilized and shipped out.
I have had someone come to me and they are like, “I have an ICU unit in my ER because we are always so full that we can’t ship to the ICU, so they have to be there for my entire shift.” I know that was true, but the CRNA school this person was applying to was not recognizing that on her application and giving her a hard time. There’s no point in arguing this. They are not going to budge. You have already reached out. They said they won’t take ER. It doesn’t matter if they are “tech” or in an ICU area of the ER. They won’t take it.
They had to be willing to move to different units if they wanted to keep applying to these schools. That said, no ER. Keep that in mind. Some schools will take ER, but you won’t know this until you do more digging into what your school’s requirements are. This school mentions neonatal ICU or neonatal intensive care. That is a unit that’s often not accepted because it’s such a subspecialty of an ICU.
Their pathophysiology is so very different than a true adult of any kind or even a toddler for that matter. It’s usually very unique circumstances that you would be put in a neonatal intensive care unit. You are going to be missing a lot of disease processes that are going on with the general population. You don’t necessarily see that as often in the anesthesia world. Don’t get me wrong. If you go to your peds rotation, you will manage neonatal ICU babies. That’s not the majority of your cases.
Most schools will say no to neonatal, but they will take PICU for example. They will take a pediatric ICU and you are like, “What the heck?” It’s because the PICU can see a much broader range of patient ages and disease processes than a neonatal ICU. Another thing a lot of students run into is they think that they are covered. There are some schools that won’t take PICU or neonatal ICU.
If you don’t know this and you are like, “I love kids. I can’t wait to work with babies. That’s what I want to do,” it’s heartbreaking to tell someone who’s so gung ho to work with babies because I love babies. I’m a pediatric CRNA now. I love every minute of it. It’s so much fun. It is heartbreaking to say, “If you want your best shot at getting into your CRNA schools, especially a variety of CRNA schools, adult is the best, widest coverage way to go.”
You are going to get more schools that say no to NICU and PICU than you will that say yes. You are not going to get it if it’s not to adult. It’s one of those things where it might be having to swallow a little bit and do the adult world while you are getting your ICU experience knowing that, in the future, you can specialize in becoming a pediatrics CRNA. It may not always be the case. If your school openly accepts PICU experience, then go get PICU experience and don’t even worry about it.
Keep in mind too that if you want to go to the PICU route, or even if your school takes the neonatal route, making sure you do still understand your adult physiology is key because you can’t neglect understanding adult disease processes or physiology. That’s a large part of what you are going to be doing. I have also had people who were like, “I need two years of ICU experience. I’m going to get a year in the PICU and then I’m going to go to the adult ICU so I’m well-rounded.”
If you want to go to the PICU route, or even if your school takes the neonatal route, make sure you still understand your adult physiology because you just can’t neglect understanding adult disease processes or physiology. Click To TweetThat’s fine, but when you are changing units, it’s going to be getting reestablished as a newbie and starting over again with establishing references and things of that nature. It is best to put your roots down that year leading up to CRNA school to make sure you have at least nine months or more with a nurse manager who knows you to get a good reference letter versus being like, “I’m only been here for two months, but I need a reference letter for CRNA School.” Maybe you are still in orientation.
Keep that in mind if you are thinking about trying to bounce around a little bit. It’s not terrible to get different experiences, but you shouldn’t be bouncing around so much that they are going to be questioning. Are you having a hard time picking a unit because maybe you are hard to work with? They see a bunch of bouncing around, and they might put a red flag up and say, “Is there a reason why you are moving around so much? Are you not able to get settled in on a unit and get along with your coworkers?” They may make assumptions. I wish that wasn’t human nature, but it is.
ICU Travel Nursing And CRNA
Keep that in mind if you are a traveler. Travelers bounce around. Historically, before the pandemic, they would worry about travelers for that very reason. Do they have a hard time picking a unit and staying put? It’s pretty obvious now. People do travel nursing for money, experience, variation, flexibility, and schedule. Things have changed as far as how schools view the travel experience, but some things that have not changed are the quality of your travel in the ICU nurse experience needs to be high.
Meaning they will question whether you have had good leadership roles or good sick patients because, usually, travelers do not get the sickest assignments historically. It’s not always the case. I know that to be true. However, I’m telling you that you are going to have to prove that through your resume and display that you have had leadership roles, display that you have taken critical sick patients, and display that you are trained in ECMO, CRRT, and others and that you are still a traveler.
Usually, if you can do things like CRRT and ECMO as a traveler, it’s because you have had a home base prior and you have gotten that training as a home base person. They don’t typically train travelers on ECMO and CRRT as a traveler. You typically have that prior to traveling. Keep that in mind if you want to travel and make money that you need to be getting at least some solid experience prior to traveling so you can still get high acuity assignments.
Getting leadership roles can be hard as a traveler, too, because you are not going to be a precept in doing charge nurse typically as travel, but not always. I have had some travelers tell me that if they have had previous charge nurse experience that they are given that role as a traveler. Make sure you are highlighting that on your resume if that’s the case. Trying to find other ways to have leadership experiences like getting involved in the AACN or things that are outside of your hospital are always good ways to still make sure you are getting leadership roles other than being a charge nurse or nurse manager of some kind.
Why ICU Experience Matters
That wraps up that portion. I wanted to go more into different types of units. I briefly mentioned some units, but I was looking at schools’ websites and I wanted to make sure that I cover how ICU acuity can differ and why the ICU experience is important for CRNA schools. All CRNA schools can require similar yet different types of ICU experience. I mentioned some of the big units.
ICU Experience: All CRNA schools can require similar but different types of ICU experience.
They want to make sure that they have a solid background, hemodynamic monitoring, invasive lines, ventilator support, and vasoactive infusions along with continuous echocardiogram monitoring on the COA’s website. They said here, which I thought was interesting, an article by Burns, which is dated from June 2011, so it’s old.
It concluded that the amount of critical care experience was negatively correlated to academic success and progression. Candidates most likely to succeed demonstrated a positive correlation with overall GPA and science GPA. The reason why I want to point this out is because schools love statistics and stats. If things have statistical significance, they are going to pay attention and say, “If this historically provides these types of outcomes, we are going to change our requirements to fit as such.”
You will hear things like, “If you have over five years of ICU experience, they won’t want you because you are tarnished goods.” That’s not true, but if you do have more than 5 or 10 years of ICU experience, you are going to have to prove that you are willing to be a novice again. You are going to have to show them that you are ready and willing to be a student again and know that you are not always going to be right and that you are willing to take the role of a preceptee instead of the preceptor. If you have been an ICU nurse for ten years and you have been a preceptor and nurse manager, are you going to be able to go back to being that novice again and be able to be respectful with authority and be open and willing to hear that maybe you are wrong? They screen for that during the interviews.
Test yourself and see how you feel about that. Make sure that you address any uncomfortable thoughts that come to mind when it comes to going back that route. That is what they worry about. They call it not being teachable or being hard to teach because you are so resistant to change. You are like, “No. It’s my way or the highway. You are wrong. I’m right.” Those types of personalities are incredibly hard to work with, especially in CRNA school. This is a whole new specialty that you are learning and there’s going to be a lot of things that you have to unlearn essentially.
They do screen for that. I would say still the average is right around three years of ICU experience for CRNA school admissions. It does not mean you need three years magical number. That tends to be the average. I would say in the ballpark between 1 and 5 years is where most people fall with ICU experience.
Another thing from the COA’s website is an article by Wong and Lee in a journal in 2011 concluded that personality characteristics such as confidence and commitment, I’m sure there’s more, are maybe more accurate predictors of academic and clinical success in a nurse anesthesia education. This is why a lot of schools are leaning towards emotional intelligence assessments these days because they want someone who has a growth mindset, loves learning, and doesn’t see it as a hindrance or roadblock to not know everything to be committed, and have that perseverance and diligence to show up every day, even when it’s hard.
They don’t need instant gratification to feel successful. They can be self-motivated. They screen for personality characteristics like this because if you always need reassurance that you are okay, you need someone to stay on top of you to get stuff done, or you get defensive easily, it’s harder to change that than it is to brush up on physics.
If you have a growth mindset and it’s okay for you to make mistakes, are okay with facing challenges and feeling like things are hard, and are not going to take that personally, you tend to be someone who can learn quicker and easier. Whether you are behind on chemistry, it doesn’t matter because you are going to have the right mindset going into a very hard course than someone who takes things very personally. It’s like, “I suck. I will never be good at this.”
We all go through checks and balances in life where we go through fixed mindset and growth mindset. I sure do. I have to check myself before I wreck myself sometimes where I’m like, “You are being a little too harsh on yourself.” We all can be that way. It’s important to recognize when you are doing stuff like that because it can lead you down a very toxic road and one that can hinder your long-term success.
It’s not about where you are now. That’s okay if you have flaws. You will. We all do. It’s more about, “Where are we?” Where do you fall in the big scheme of things between a fixed mindset and a growth mindset? How do you feel about challenges in making mistakes and who you are as a person? If you were stripped of all your titles, would you still feel confident?
That’s hard to do, and this is not easy. The more you start focusing on how you feel about yourself, the better you are going to be able to show up to the world and the better you are going to be able to show up for others including yourself. Schools want to screen for that to find someone who’s a little heartier because CRNA schools are going to be brutal. You are going to get beat up, and they want to make sure you are going to be okay and that you are going to thrive not only academically but in clinical. Getting a handle on where you are at allows you to make steps forward. It’s okay if you are like, “I have a lot of work to do.” The fact that you are willing to admit that is a very good thing.
If you think of a fixed mindset, it’s people who say, “The reason why I can’t succeed is because they are hindering me, because they are making it hard for me. They are doing all those things to me and there’s nothing wrong with me. It’s them.” That’s a fixed mindset. That’s something that says like, “There could be something in the outside world that’s not fair.” That’s always going to be the case. There’s never going to be a situation in life that’s always in your favor. Maybe on occasion. Cool. Take advantage of it. It’s not when you are like, “This is hard. It’s not fair. Why are they succeeding and I’m not?”
You have to eliminate all those thoughts and say, “I’m going to focus on me. How can I improve? I will keep working on myself.” Eventually, you will find a way. It’s almost like self-acceptance with whatever that may be. Whatever responsibility, accepting it for it’s your own, and maybe your own feels heavy and maybe that feels bad compared to what you see other people dealing with, but it’s your own and that’s yours. You have to own it. It’s about owning where you are even if it’s a hindrance and even if it feels heavy and hard. It is doing the best you can with it, knowing that over time you are going to mold yourself into someone who’s going to be able to defeat that hurdle or whatever it may be.
Sometimes it’s accepting that maybe you are flawed. It’s accepting that maybe you don’t handle criticism the best. Maybe you get angry too quickly or you make assumptions about others. Maybe you come across as defensive even though you are like, “This is how I talk.” Maybe it is assessing your tone of voice and your eye contact. Sometimes it’s cultural.
Sometimes you were taught to be this way and you are like, “This is still not fair. I was taught to do this. This was respectful in my culture. It’s not fair that they are seeing me as disrespectful. This was what I was born to believe is respectful.” Trust me. I feel for you. I do. I cannot imagine, but at the end of the day, it’s what you have. It’s who you are and that’s a beautiful thing, but that’s why I’m saying to own it. Accept it and say, “How can I do something different so that way, in the eyes of a stranger, I don’t get type-casted as someone disrespectful? I know in my heart of hearts that it is not what I want to achieve. How can I reflect on that in a way that I will be seen differently by those that I know I will be around in whatever it may be?”
Sometimes it feels heavy and unfair, but it’s the cards you dealt. You have to make the most of it, but you have to be willing to accept the fact that maybe your card is not the best card and you have to be willing to work on that card to make it better, even if that means swallowing your pride and realizing that maybe you have to work on some things yourself. That could have been stuff that you developed as a child, teenager, or adult that feels more natural and normal to you because that’s what you have been around and It’s what you have been exposed to. It’s time to assess that, and it’s okay.
It doesn’t mean you are a bad person, not worthy, or not capable of change. Everyone is capable of assessing who they are. You have to be willing to do it. It’s hard to look in the mirror sometimes. It really is. I know when you are faced with a hard thing, you want to ignore it because it feels easier to neglect it than it does to face the harsh reality of, “This is what I have to deal with.” I get it.
The Role Of Self-Assessment And Seeking Support
I find myself guilty of that a lot, too, but the reality is that will never go away if you don’t address it. It will always hinder you. It’s better to face the hard things and face it head-on as painful and as hard as they may be than it is to let it be in the background and always hinders you. At least that’s how I feel about it. It’s okay to get help too. If you need friends and family support, try to find people to support you to help you through these things. Have them help you assess yourself if you are struggling with that.
I went off on a tangent. Sorry. I know you guys know I do that a lot, so you are probably used to that by now. I’m going to leave it at that for discussing that ICU is a big deal. You have to have the right ICU experience, but know that they don’t just look at ICU experience. A lot of people think, “I have to be a CVICU nurse to be good for CRNA school.” It’s not the case.
Any fellow NICU nurses out there, high five to you. Dr. Richard Wilson is part of CSPA. He was a neuro ICU nurse. He went on to be successful and has been a CRNA faculty member for years. He has a wealth of information. He was a neuro ICU nurse. He didn’t work in a CVICU or anything like that. Embrace the experience you have and be careful you are not bouncing around too much.
It’s okay if you want to change from the medical ICU to the CVICU and you still have a solid year before you are applying to CRNA school. Cool. Do it if that’s what you want to do. It’s okay to broaden your horizon. Own the ICU experience you have, whether that’s the PICU or neonatal intensive care. Own what you have and find your strengths. I know a lot of PICU nurses are anxious to go into that CRNA interview because they are like, “I’m a PICU nurse. I’m the minority here.” They are going to think, “I don’t have vast enough knowledge.”
Embracing Experience And Finding Strengths
Brush up on the adult ICU knowledge so if they do ask, you are prepared and they are like, “Cool.” Embrace the strengths that you have. Maybe that’s weight-based dosing. Maybe that’s understanding the different types of physiology between a 1-year-old and a 10-year-old and different types of physiology with respiratory fluid management. You should own the strengths you have with the experience you have.
A NICU nurse is not going to have the same experience as a CVICU nurse, but that’s okay because NICU nurse has their strengths too that they should own. Similar to the CVICU nurse, they’d have their strengths that they should own. Focus on that. Don’t worry about being everything because if you try to be everything, you are going to be nothing. You can’t specialize in every single thing and be at the top of your game in every single area.
That’s another problem too. When you jump around, you are going to be starting from the bottom of the barrel again. When you are new in the ICU, whether you have been a SICU nurse for two years and you go to the CVICU, they are not going to give you the sickest CVICU patients. They are going to make you earn it. They are going to make you get trained and start all over again.
It could take 6 or 9 months before you start getting the sickest of the sickest patients and getting trained in things like ECMO and balloon pumps. Keep that in mind. You may not be able to wing it into a new ICU and be top of your game there. You are going to probably start over again. It’s not necessarily always the best thing to be jumping around.
I’m not unencouraging it if you plan it right with timing-wise if you have a good rationale for wanting to do it. Maybe this unit is more supportive and can give me more opportunities for leadership roles and advanced modality management and things like that. Cool, do it. Just know why you are doing it. Don’t do it because you think it’s going to help if you have solid ICU experience already. It’s almost better, in my opinion, to get solid ICU experience at least in one area and own that area, and get leadership experience and things like that than to jump around and start over again in a bunch of different units.
ICU Experience Red Flags And Individual Consideration
I want to read one last thing before we end this episode. It will be a little bit shorter than my normal. This one is from Columbia’s website. I told you guys. I like to read CRNA school websites. That’s always where I recommend you to go too, to read information and take it seriously. For any other website, you should always question the authority of the website before you take it for a fact.
What type of critical experience is required? This was in their FAQ area. It says all critical care experience including pediatric ICU is acceptable with the following exceptions. I love it when schools do this. This is exciting. I wish all school websites had stuff like this. A lot of them do, but not all of them. Some will just give you that COA statement and they leave you the rest up for debate.
They say they accept neonatal ICU, so they do not take NICU. They do not take an ICU float pool. They do not take PACU and ER experience. I have also seen people think that the cath lab or the OR will count. Those usually do not count. It says here that the neonatal ICU, ICU float pool, PACU, and ER will be reviewed on a case-by-case basis.
A lot of schools will say not “yes” to these units. They are saying they will review on a case-by-case basis. If you don’t have your job lined up yet for the ICU and you are like, “They will review it on a case-by-case basis. I’m good. I will take that neonatal ICU position,” the reality is that this is not preferred. Whenever they say “on an individual basis, on a case-by-case basis”, what they are essentially saying is, “This is not our preferred situation or experience, but if you are a stellar applicant, it doesn’t mean you are going to get an interview, but we will still review your application.”
I don’t know if that’s how you want to choose to go into your application cycle. If it’s all the choice you have because you didn’t know any better and you randomly decided to apply to Columbia and you are like, “They don’t take ER experience but my other school does,” then take the risk. If this was your dream school and the one school you want to go to and you knew they only considered these units on a case-by-case basis, I would not pick the ER as your mainstay experience because they don’t necessarily prefer it. They also state that operating room, telemetry, step-down, cath lab, and interventional lab experience are not acceptable. They completely do not take any of those, but they will consider the ICU float pool, PACU, ER, and NICU on an individual case-by-case basis.
These are the types of golden nuggets that you should be looking for when you are doing your school research for what types of ICU experience make for CRNA school admissions. As far as ICU experience goes and how it plays out in anesthesia school as far as clinical performance, I have been a preceptor for several years now, everywhere from newbies on the first day to senior students during very hard rotations like cardiac and pediatric rotations.
I don’t know what ICU they came from. It doesn’t even matter. I don’t even ask most of the time. I want to know usually whether they are freshmen or senior anesthesia students because that gives me an idea of what their knowledge base is. That’s usually all I care about. I don’t care where they worked as an ICU nurse as long as I ask out of curiosity, but it doesn’t matter.
What matters more about the type of unit is the attitude you bring. Are you open and willing to be a novice again? Are you open and willing to learn? Are you curious? Do you take self-initiative to look things up versus asking questions all the time? Asking questions is not bad, so don’t take that the wrong way. You also have to be willing to look things up yourself. If you are always going to be dependent on someone else to tell you what things are, you need to help yourself sometimes.
What matters more than the type of unit you worked in is the attitude you bring. Click To TweetYou need to dig into the textbook, read through your resources, and try to find answers. If you show that motivation to look things up and to try to learn yourself, you may not always find the right answer, but you at least show initiative to try. Night and day, you are always going to get a better response from your preceptor or from whoever colleague you are working with than if you don’t know and you don’t care to look up and you are going to ask. Some of them might say, “Go look it up.” They won’t even tell you. It’s like a slap in the face.
When it comes to being prepared to start CRNA school, it’s more about taking self-initiative and motivation to do some self-education. Depending on what program you go to, whether you are integrated or front-loaded, you may not have had a lot of anesthesia knowledge upfront especially some of your specialty rotations and things of that nature. Maybe you have, but it’s been a year since you have touched it. It’s about preparing yourself and taking the initiative to do it on your own even if it means doing it before you even get to it in class or maybe it’s a year after you have gotten into it in class.
ICU Experience: A Key Factor In CRNA School Admissions
The ICU, in my humble opinion, is what it does the best. It doesn’t matter what unit you come from. It prepares you to critically think and essentially troubleshoot. It allows you to say, “Something doesn’t seem right. Why is that?” Also, “They are doing this test in this lab, why is that?” It allows you to think those whys through because when you are in the operating room, you are going to be doing the same thing all the time. “This happened. Why is that? What could I do? What are some of the things that I could try to mediate the situation? If this happens, what would I do? If the surgeon does this, what would I do?”
You always ask yourself, “This is how I see this playing out in my mind. This is how I want to go. This is my plan A, plan B, and plan C. Maybe I even have a plan A, B, C, D, F, and G.” You always want to have some things in mind like emergency situations things as what would you do if X, Y, and Z happened are worst-case scenarios, and you do those things in the ICU. No matter where you work in the NICU, SICU, or CVICU, you are doing those things because you are taking very critically sick patients who can shift at any moment and go from being stable to very unstable.
You are titrating all kinds of different drugs, taking different orders, seeing different treatment modalities, dealing with different pathophysiology processes, and allowing yourself to critically think like, “What’s next? How can I stay ahead of this train wreck so I can keep them going on the track?” You are practicing those skills as an ICU nurse. Sometimes surgery turns into that, too, where you are trying to keep the train on the track before it goes off the rails.
You are trying to think like, “How can I make this? How can I build the track as the train is going,” situation. You get that practice as an ICU nurse. The majority of anesthetics are relatively smooth sailing, but having that background, thinking critically like that, and allowing you to troubleshoot and work through difficult situations under stress and pressure is what you are getting as an ICU nurse and getting exposed to.
When you are exposed to this acutely in the OR, you are not going to freak out because you are like, “I have done this. I have dealt with critically sick patients before in critical situations where I have had to have good team communication. I have had to delegate. I have had to use closed-loop communication. I have had to assess the situation and determine what would I do for a second and third.” Know why you would do those things.
Understanding The “Why” And Taking Initiative
Understanding the why behind why you are doing certain things and how certain drugs work and different pathophysiology processes work is what you are gathering out of your time in the ICU. To me, whether you are in the NICU, SICU, or CVICU, you are getting a lot of valuable experience as long as the acuity is there. You are getting exposed to those critical, highly intense, and situations. That’s what it is about at the end of the day.
While a lot of schools prefer that you have some type of exposure to cardiac, everyone has a heart. In the NICU and neuro ICU, you have a heart. People can have neurological injuries and still have heart conditions. People can be in the NICU or SICU and have heart conditions. While they would go to a different unit for ECMO, you may still see a swan in the NICU and you still dealing with significant heart failure for sure.
You are not going to get that fresh post open heart. You are not going to get a fresh thoracotomy. You are not going to see that. While some fresh open hearts are very sick, they usually bounce back pretty nicely. From my time doing open heart and working in the medical ICU, I feel like the medical ICU patients were on their last thread and hanging on by just a string.
They had multiple comorbidities, renal failure, or heart failure. Maybe they had a brain tumor on top of that. They had everything under the sun like sepsis, GI bleeding, thyroid storm, and all kinds of stuff. They had all kinds of stuff. It is always involving cardiac usually to some extent. Was it a bad place to get experience? No. It was a wonderful place to get experience, but I owned it.
Choosing The Right ICU Specialty And Broadening Horizons
I didn’t have ECMO experience, but I had CRRT. I dealt with a lot of renal failure. I also had the HFOV, the High-Frequency Osculating Ventilator experience, people who have severe ARDS, those types of things. Own the experience that you get where you get it and don’t worry about the rest. Make sure that whatever ICU you are picking that it’s something your schools will consider open-handedly like, “Yes. We take you. No questions asked.” That’s the best way to go into your application.
Remember, a red flag is on an individual basis. On a case-by-case basis, that’s a red flag. If it’s all you got and it’s too late to make a change, the applications are due and you try to throw in an extra school for the heck of it, then go for it. If you have a choice and you are planning for it, I would avoid those red flags if you can give yourself the best chance possible.
Acuity matters. If your patients are getting shipped out because they are getting too sick for your ICU, get in your car and follow the ambulance and go apply for a job at that hospital. Some people are like, “That’s 1 or 2 hours away.” I’m not saying you need to do this, but I am saying I know people who have traveled over an hour away to get good ICU experience because they didn’t have the option to move or relocate.
I have also known students who maybe do relocate, so they are only maybe 45 minutes from family and 45 minutes from the hospital so they can at least not have a terrible commute every day so they can still get that valuable ICU experience because where they are from, there’s nothing to pick from. People do make those sacrifices.
It’s as unfair as it may seem. The students who tend to make those sacrifices tend to find success or the ones who stay in the very low acuity hospital and barely ever see a ventilator usually don’t get an interview. There are some rural remote hospitals that are very high acuity that have very little resources that are a great experience so I’m not poo-pooing that at all. Make sure that if that’s your situation that you are making sure that you are highlighting on your resume, the experiences you are getting and what type of drips, ventilators, and advanced life support you are seeing.
If you are questioning at all, whether it’s good enough, talk to your program faculty. Go to the open houses. Come to our CSPA conference, which already passed. Sorry, it was a teaser. Talk to your program faculty. It’s always the best way to clear the air. I have always said that when you send emails to program faculty, make sure you are not putting it as an open-ended question.
Make sure you are saying, “This is my experience. This is what I routinely get in my ICU. This is where I work. I want to make sure I’m putting my best foot forward in applying to your program in the upcoming year. Now is the time if I’m able to switch, these are my options,” or, “I don’t have much of an option to switch. Would you consider this a good ICU experience? Would I be setting myself up for not the best odds or whatever it may be?”
That’s my recommendation if you are questioning all your ICU experience. Thank you so very much for reading. I will see you next episode. I hope you have been enjoying the guest episodes. I mentioned it in the last episode since I’m only doing one episode a month at this point. I am taking a break or a hiatus from the show. We are in the process of having twins. I had to get admitted to the hospital for very close monitoring. You can google it, but these are called monoamniotic twins and they share one amniotic sac, and their cords are all tangled.
This is a day-by-day pregnancy. It’s incredibly stressful, so good thing to have critical care experience. It’s a little bit different when you are on the other side of things. All that being said, funniness aside, I’m still here for you, guys. I still plan on continuing the show. I have been doing the guest episodes. I hope you have been enjoying them. Hopefully, things will come back to a more normal course. I’m still here for you. Don’t plan on ever giving up this show. I appreciate you. I love you all. Thank you for reading and I will see you next episode. Take care. Until then.
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