CRNA 51 | ICU Experience


Choosing the right ICU experience for you can feel intimidating! However, your time in the ICU prepares you in many areas that are essential to your success as a CRNA. Today, we are diving into how your ICU unit can serve you, and how best to utilize your time during your experience.

In this episode, we cover how the right ICU unit will prepare you for:

  • Practicing critical thinking and considering cases on an individual level
  • Gaining experience making clear judgment calls during critical moments
  • The importance of learning how to delegate (and building your confidence!)
  • Getting familiar with ICU drugs that you will also be using as a CRNA
  • What to expect and how to handle the extensive exposure to critical care management
  • A first-hand look at whether or not CRNA is for you (and how to work under pressure)

Happy ICU-ing, future CRNA! You’ve got this, and we’ve got you!

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How Does Your ICU Experience Prepare You for CRNA?

Welcome back to the episode of the show. We’re going to discuss how the ICU prepares you for CRNA. Many of you are thinking about what type of ICU unit to work on and that’s all great. However, I encourage you to think, “How is my ICU unit going to serve me so I can become a CRNA?” We’re going to dive into how you should best utilize your time and some of the big takeaways from the aspects of critical care nursing that will serve you in your time as a CRNA.

Critical Thinking Is Key

Number one and probably the reason most of you are thinking of now is critical thinking. However, I challenge you, what is critical thinking? Do you understand what critical thinking is? If I had to put a definition to critical thinking, it is the why, the how and the understanding. It allows you to make an assessment and determine a diagnosis as well as a treatment.

There are several phases to critical thinking. First, you have to recognize there’s a problem. It’s going into, “There’s something going on here. Why is that?” There is also the how as far as, “If this is truly what I’m thinking, how is this unfolding?” Also, the why behind it. Once you can recognize it and understand the why and the how, the next thing you have to do is say, “Let’s pinpoint exactly what this is and how would I treat it.”

You have to also keep in mind that there may be a treatment method, but because of your patient’s unique situation, maybe they have other confounding comorbidities that would make treatment a little trickier. That means you would have to manage it in a certain way than a standard textbook answer. It’s getting down to the nitty-gritty of how you would treat this individual for their unique needs.


Critical thinking is the why and the how, and the understanding. It allows you to essentially make an assessment and determine a diagnosis as well as a treatment. Click To Tweet


The reason why this is so powerful and why critical care experience is going to serve you so well in your times as a CRNA is because this allows you to develop that independent thought process. Understanding that is going to allow you to become an amazing practitioner who can make judgment calls and know how to handle those critical moments that you have to be able to react quickly. That is the number one way that critical care can help prepare you for CRNA.

When you’re assessing what type of ICU unit to work on, you’ll hear people talking about level-one trauma. You don’t have to work at a level-one trauma. However, the reason why that’s commonly recommended is that they know that the acuity is there. They know that you’re going to thoroughly be developing these critical care skills because that type of unit has the sickest of the sickest. People get triaged into your hospital. Other hospitals can’t handle them because they are so sick. That is why you will hear people preach about level-one trauma, but you don’t need level-one trauma.

If you’re curious, I know I have another episode that goes over ICU experience. We also thoroughly go over ICU experience inside the academy. Richard Wilson, who is our expert contributor, is a faculty member. He also goes into guided Q&As on ICU experience and tells you from a program’s perspective what they look for in ICU experience. If you are a part of CRNA School Prep Academy, I highly encourage you to go to those resources to determine what type of ICU is the best fit. I wanted to point out the critical care thinking aspect of your ICU experience as far as how it’s going to serve you as a CRNA.

The Skill Of Delegating

The next way that ICU experience can serve you as a CRNA is by learning how to delegate. As a new nurse, this may seem very intimidating. Maybe you’re questioning whether you even have it in you to delegate. I promise you, the delegation comes after you gain the critical care understanding and confidence in what you know. Delegating is way easier if you know what you want. If you know exactly what you need and want, it’s pretty easy to ask for it and to know exactly who to ask and what to ask for. Delegating is hard when you’re unsure or not confident. This develops over time. It’s not overnight. Give yourself that grace and space to grow as an ICU nurse and learn to trust yourself.


CRNA 51 | ICU Experience
ICU Experience: If you need to ask for something that your patient needs, you have to be comfortable even if it is uncomfortable to ask for things, to tell people that you need something.


As a CRNA, you delegate and tell people what you need. They look to you for the answers. When something goes wrong, they expect you to tell them what they can do to help you. It’s important to start this fundamental skill as an ICU nurse. It doesn’t mean that you have to be a delegating pro. Especially when you go into the realm of anesthesia from ICU, you’re going to feel like a fish out of water. It’s completely new to you. It’s different. We don’t expect you to get in the OR on day one and start barking orders at everyone in the OR. That’s not what I’m saying. Please don’t interpret it like that, but you have to at least be comfortable doing it in the ICU, for example.

If you’re running the code and you need to ask for something that your patient needs, you have to be comfortable even if it is uncomfortable to ask for things or to tell people that you need something. That is the skill that you have to be comfortable with prior to getting acceptance to CRNA School. It doesn’t mean you’re going to be feeling comfortable delegating on day one as a student nurse or a nurse anesthesia student. However, if you’re comfortable doing it as an ICU nurse, you’re going to easily become comfortable doing it as a student as well as a CRNA. That’s number two.

Get Familiar With ICU Drugs

Number three is probably another somewhat obvious one, which is drugs. You use a lot of drugs in ICU that you also use as a CRNA. A very common path to take in an interview is quizzing you on ICU drugs, especially drugs that would also correlate with your time as a CRNA like vasopressors or ACLS drugs. You have to be very familiar with why you would pick a certain drug. It’s not just why and how, but you also have to know how much to give and when to give it, or maybe any contraindications to a particular patient population. You have to know all the ins and outs down to the molecular level of pharmacology with ICU drugs.

The easiest and best way to start developing this knowledge is to go slow with it but repeat it and understand it. Don’t just memorize but understand. This works the best when you apply it to what you’re doing. If you have a patient on certain drips, understand why they’re on the drip, how to titrate the drip effectively to manage that patient, and understand what would be some contraindications around using this drug, and what are some bad side effects or potential side effects that you need to look out for.


The delegation comes after you gain the critical care understanding and confidence in what you know. Click To Tweet


For example, if you have a patient who needs to be emergently intubated but they’re a paraplegic, why would you not use succinylcholine? You have to understand why. They could be asking these types of things in the interview. Drugs are the third thing that you will gain from your ICU experience. You have to have a thorough understanding of pharmacology and why you would pick certain drugs over other drugs for certain disease processes as well as how they work with the disease process, hemodynamics, etc.

Expose Yourself To All Things Critical Care

Number four is exposure. What do I mean by this? These are exposure to critical care management codes, respiratory failure, intubations, putting in central lines, hemodynamics, fluid management and disease processes. It’s exposure to all things critical care. It means the more you’re exposed, the more understanding you’re going to develop over time. This goes back to why picking a high acuity unit is so vital to gain this knowledge and experience versus picking a small community ICU where when people get sick, they’re shipped or life-flighted to the nearest trauma hospital. This is why programs assess for this type of experience and also why you need to be seeking out this type of experience, because the more you’re exposed, the better you’re going to be able to understand when they’re assessing your knowledge in the interview.

Picture Yourself In That Role

I had the last thing that was the most important thing. The last thing I’m going to address is something that I find very important because this is something that could clue you into whether CRNA is the right profession for you. I get this question a lot. They’re like, “How do I know if CRNA is right for me?” I always say, “You need to shadow. You need to thoroughly understand what we do day-to-day so you can picture yourself in that role or not in that role.”

The last thing you want to do is to go to CRNA school, get into the clinical realm and discover, “This is not what I thought it was going to be like. I don’t like this type of environment. I don’t work well in this type of environment.” You have to do your due diligence and thoroughly research this profession. However, your ICU experience can clue you into this one thing.


CRNA 51 | ICU Experience
ICU Experience: You have to be very familiar with why you would pick a certain drug and not just why and how, but you’d have to know how much to give when to give it, and any contraindications to a particular patient population


I’m going to break it down a little bit so I don’t get misunderstood when I’m trying to explain this. Do you like or work well under pressure? When I say like, no one likes a code. No one likes when their patient is not doing well. It’s distressing and it makes your job stressful. You’re like, “Why would I like that?” I’m not putting it in that context. It’s in a sense that you can feel alive. You don’t freeze. You don’t close in and sit there, and rock and suck your thumb. You feel alive. You feel motivated to take action. You get goosebumps and you’re like, “I’m going to do this. I’m going to stabilize this patient. I can do this.”

You become alive in those situations. You don’t have to like it and be like, “I look forward to my patient coding today.” No one wants that. Even though I worked in a very acute medical ICU, I hated all the deaths and dying. It tore me apart. It was probably the only time in my life that I was clinically depressed to that extreme for that reason. Either way, I didn’t like that part of the ICU world. However, I worked well under pressure and I enjoyed trying my best to stabilize my patient. I felt alive. I knew that I had to be there for a patient. I enjoyed knowing I could be there for my patient during a life-threatening emergency.

I enjoyed the teamwork. I enjoyed being part of that well-organized oiled machine in the sense that you delegate and you get things done. It is amazing when we could stabilize a patient and bring them back after coding three times, especially when you see them being transferred out two weeks later from the ICU and they’re waving goodbye to you. To me, that was why I did it. I know the situation of the world and people are not seeing those types of results nearly as much as we intended to see the results.

You go into nursing wanting to help people, not wanting to put people in body bags. That wears on your emotional well-being. If that is you, I encourage you to please seek out help, therapy and guidance. A lot of hospitals offer things like this to their staff. Don’t go through this alone. If you’re struggling mentally, please take action. However that action looks like, you have to take action. You need to cope. You are going through something that can create a PTSD scenario. You need to address it before it gets too bad. I want to make sure I’m clarifying that too.


You need to thoroughly understand what CRNAs do day to day. So you can picture yourself in that role or not in that role. Click To Tweet


However, as far as working in the realm of CRNA, working under pressure is vital because you do a lot. It’s not all the time. They say anesthesia is 90% boredom and 10% sheer terror. That is similar to the ICU. It is always busy. You’re always on your feet. You’re always doing something and then managing critical events probably more so than what we do in anesthesia. However, the difference is we maybe don’t manage codes as frequently as you do in the ICU or have an acute patient decompensate and feel like, “I can’t personally intubate it myself. What do I do?”

In anesthesia, it happens more frequently to the less extreme. Your patient may have bronchospasm or go asystolic. It happens so quickly and it’s over. You manage it and it’s over. It’s not this ongoing spiral. You quickly take action and it’s over. It’s a controlled environment. I enjoy that. It’s rewarding because anything can happen in a split second, and you may not even see it coming.

You always try to see it coming. You always try to prepare, but sometimes things happen that you’re not expecting to happen in surgery. Some surgeons could hit something unexpected. The patient could acutely decompensate. Whatever it may be, stuff like that happens. You have to work well and be okay with being put under an immense amount of pressure that is life-threatening. Do or die, take action. You have to be okay with that.

Where I’m going with this is the working under pressure aspect of becoming a CRNA is intense and frequent. However, it’s controlled. It doesn’t feel out of control. That’s why they say it is 90% boredom and 10% sheer terror because 10% of the time, things can get a little crazy. It’s like, “Call in the troops. I can’t manage it by myself,” whereas 90% of the time, you can manage it by yourself. It will be okay. It’s a quick in-and-out scenario where you’re like, “I got to clear my airway. I got to re-intubate. I have to break this bronchospasm. I have to break this laryngospasm. I have to stabilize this low blood pressure.”


CRNA 51 | ICU Experience
ICU Experience: The more you’re exposed to, the more understanding you’re going to develop over time which is also why picking a high acuity unit is so vital to gain knowledge and experience versus picking a small community ICU where patients are shipped or life-flighted to the nearest trauma hospital.


Things are happening all the time, but it feels controlled and it feels manageable. The other 10% of the time, it’s like, “I need a lot of help. All hands on deck, we got to get this.” It’s 40 blood products an hour kind of scenario where you need all the people that you can get to help out, but that’s it. When you do have that 10% of times where things are out of control, you have a whole team managing the patient, and you work together beautifully.

We did a malignant hyperthermia scenario in the OR. I could tell the OR staff was very uncomfortable more so than anesthesia. We had three anesthesia providers in the room managing the scenario. We were like, “We got this.” We were not nervous. We were like, “Let’s do this.” We did have to review dantrolene and how much to give, and the bicarb. We did have to do some reviews ourselves, but we felt very comfortable delegating, asking, and telling people what we need. We’re letting the OR staff know what was going on and saying, “Go get this. You do that,” and organizing the room.

I could tell the other staff wasn’t as comfortable because they don’t practice that type of delegation as often. We also work under pressure all the time in tiny bits. When we do have a scenario that is much bigger, we’re more able to handle it because we’ve routinely been comfortable being put under the fire intermittently throughout our entire day every day. That’s the best way I can explain it to you, but I still encourage you to see it in action.

Go shadow a CRNA. If you’re not able to get a shadow experience, we have a virtual simulation experience that you can check out. It’s a good gateway for you to get your first experience. If you watch our virtual shadowing experience on general anesthesia, it will give you ideas on how to make your actual in-person experience more useful and get more out of it. We even tell you what kind of questions you should ask a CRNA. I hope you guys enjoyed this episode. As always, thank you for tuning in. I appreciate you. Leave me a review. I love hearing back from my community. All of you guys have a wonderful day. We’ll see you in the next episode.


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