Which ICU is best for CRNA? With so many different ICU positions to choose from, it can be challenging to find the placement that is going to serve your future CRNA path the best.
While it’s not possible to gain all your experience in one unit, there are steps you can take to ensure that your ICU experience puts you head and shoulders above other candidates as you apply to school.
In today’s episode, we dive into:
- How to research your particular school’s preferences and requirements for ICU experience (Spoiler Alert- You’re going to want to go ahead and start this process now!)
- Understanding why schools choose the requirements they choose (and why they don’t often make exceptions)
- Ensuring you get high acuity ICU experience
- The right questions to ask when you are interviewing for ICU placements
- The differences between NICU and PICU experience and adult ICU experience
- Units that may be problematic if CRNA is your dream
- How to optimize and leverage your ICU experience to help you stand out as a highly qualified candidate
Enjoy, and cheers to your journey!
Research your preferred school’s stats here! → www.coacrna.org
Get access to planning tools, valuable CRNA Faculty guidance & mapped out courses that have been proven to accelerate your CRNA success! Become a member of CRNA School Prep Academy here:
https://www.crnaschoolprepacademy.com/join
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Watch the episode here
Listen to the podcast here
Which ICU Experience Is Best For CRNA School
The topic that we’re going to cover is, “Which ICU is best for CRNA?” This is a very common question I get asked by my students. I figured I might go ahead and address it here on the show. There are lots of ICUs to pick from out there. There are also some misconceptions about what an ICU is. The CRNA school requirements are specific and tailored based on what school you’re looking into. I’m going to try to give you the best advice I can give you, but ultimately, I want to start all this off by saying that you need to be researching your particular school that you’re interested in. Even if you’re applying to more than one school, you need to thoroughly research every school you’re applying to see any differences between their ICU requirements.
The standard that is set for all CRNA schools across the country is that it has to take place in the United States. Your ICU experience needs to come from an ICU within the United States, and it needs to be high acuity. You need to be dealing with advanced life support and different hemodynamic monitor systems in your experience. It’s up to the schools to decipher what that means as far as what units they prefer. It doesn’t mean that a school prefers MICU over SICU, CVICU or NICU, or whatever all the ICUs are. There are many of them.
Ultimately, this is the school’s preference, and not all schools will take a NICU or PICU experience. These schools base their standards on what they think a successful student displays in their program. Historically, if you look at the data, students who come from the NICU-PICU pass boards for the first time, versus a student who came from the CVICU. That’s how they judge whether they accept certain units versus others.
I’m going to let you guys know that you need to be researching your school first and foremost to see what units they prefer. Essentially, the units that are the safest are any adult ICU. There can be many different types of adult ICUs out there. There’s the SICU, MICU, the CVICU, the CCU, and the burn trauma unit. You can combine those letters any way you want to make any ICU. There’s even a SICU-MICU combination ICU. It doesn’t matter as long as the acuity is there, that’s okay.
The reason why NICU and PICU sometimes don’t count is because they feel that’s a very specialized ICU experience. Maybe it’s not the best tailored for CRNA training. I don’t necessarily believe that to be true. I’ve seen plenty of NICU and PICU nurses be very successful. I’ve worked with NICU-PICU nurses before, prior to anesthesia they were NICU-PICU nurses, and they’re brilliant. One of the PICU nurses I worked with said that one of the advantages of being a PICU nurse prior to anesthesia was that she already knew weight-based calculation and dosing of drugs, which I definitely did not know coming from a MICU background.
What Is The Acuity Like?
Every background, whether it’s neuro or surgical medical, cardiac, NICU, or PICU, you’re going to have certain strengths. You’re also going to have weaknesses, but the reality is you can’t gain all the experience in one unit. The key to picking what unit is best for you to gain your ICU experience before CRNA school comes down to what is the acuity like? How often do you titrate based on active drips? How often are you managing vents? Do you manage vents at all? Most ICUs, especially the bigger ICUs, have respiratory therapists who manage vents. There’s nothing wrong with that.
You still have to be able to troubleshoot the vent yourself to get an RT to take a look at things. Essentially, even though you’re not the one making the respiratory changes, you would have to be aware if there’s a problem with the patient, and analyze blood work to notify the team of potential ventilator issues if you’re seeing that their blood test came back and it was all out of whack, or whatever labs that you’re analyzing as an actual ICU nurse.
For the most part, ER experience is not equivalent to ICU experience in many schools' eyes. Click To TweetPicking a unit where you don’t see a lot of ventilators, you don’t titrate a lot of vasoactive drips, and see a lot of advanced life support like CRRT or ECMO or balloon pumps or VADs…you may essentially not be in a high enough acuity unit. If most of your patients are awake and able to talk to you, that’s probably not a good indicator that’s a high acuity ICU. A lot of people will tell you that you need level one trauma experience.
The reason for that is it’s not because it’s a level one trauma because level two trauma is essentially the same as far as acuity goes. The biggest difference is that level one tends to have more opportunities for research and tends to be more like academic facilities. The acuity essentially is usually about the same, but you can have a non-trauma hospital and still have high acuity; you have to still frequently see ventilators and patients who are on advanced life support, or as soon as your patient needs a ventilator or needs vasoactive drips, or maybe needs Prisma or CRRT, do they get shipped to the nearest trauma center? That’s what I want you to ask yourself.
When you’re interviewing for these ICU positions, you need to be asking the manager, “What’s the acuity like? How often will I be titrating vasoactive drugs? How often would I be managing ventilators? How often would I potentially get extra training and other advanced life support measures like CRRT or ECMO or opportunities?” It’s important to be asking these questions when you’re taking your ICU position.
Remember, based on what you work on, you’re not going to be able to get all the experience. You’re not going to have to do ECMO and Prisma and VADs and others. You can’t find a unit that has it all. It’s okay not to have it all. You have to have something that’s a little bit extra that puts you in a unit that says to the admissions committee, “They came from a high acuity unit because they were taking care of X, Y and Z.” As far as PICU and NICU experience, you have to know whether your school prefers that or not. If they say on an individual basis, what that says to you is they don’t prefer that experience. If you’re an overall good candidate in every other way, they’ll consider you.
I don’t necessarily think that’s putting your best foot forward going into your application. As much as it stinks, it seems unfair, and not that I’m not encouraging any of you to pursue pediatric anesthesia because I personally do pediatric anesthesia. I love pediatric anesthesia. Unfortunately, if you live in an area with one school, and that’s the school you want to go to, if they only consider NICU-PICU on an individual basis, you’re probably better off getting your experiences in an adult ICU before applying to school. You can make your shift into pediatric anesthesia after school.
The reality too in school is you only spent about three months of your entire training at a pediatric hospital. The rest of the time, you’re working with the adult population. I don’t think it’s impossible for NICU-PICU nurses to come in there and act like it’s an adult environment. It probably would be more of a challenge considering the vast majority of your training is all adults. Keep in mind too, even if you did NICU-PICU, that’s okay. Especially if the school says, “Yes, we take NICU-PICU,” by all means, get that experience. However, you’re still expected as a candidate to know the difference between a baby and an adult, cardiovascular wise or hemodynamic wise, and how to manage those two different types of patient populations.
You still need to have an idea of the fact that the physiology is different between a baby and an adult, and why that is. They could potentially ask you that in the interview. Just because your background is only NICU, and you understand a NICU, a neonate’s hemodynamics and fluid shifts, and how to manage them, you still have to know how that is different from an adult. I encourage you, if you do gain that experience from NICU-PICU, that’s okay, but make sure you understand the difference between adults and kids as far as hemodynamic monitoring and management.
If the school says on an individual basis, I would see that as a red flag. If you want to try it, that’s totally fine. Plenty of people get in on an individual basis. Knowing that going into your application, make sure that you’re highlighting what your strengths are coming from that background, and sell your experience. Make sure your resume highlights the attributes you’re bringing to the program. Try to think of ways that even if they try to say, “How are you going to handle this if your experience is only this? How are you going to acclimate to the adult world?” Make sure you’re thinking about those hard questions they could ask you and potentially catch you off guard when you’re in the interview. As long as you have a way to sell yourself, you’re going to be okay.
Some Units To Be Cautious About
Some of the units I want to caution you about. The main one that’s probably the most common unit that people don’t realize is not considered ICU in a lot of settings is ER experience. They get a lot of traumas. You see the realistic patients coming in the door. You’re the first responders. You’re right there in action, but you simply stabilize the patient and get them up to the unit. You’re not managing them long-term. They like the ICU experience because you’re managing these patients for an entire shift, and that you’re not stabilizing and shipping out.
For the most part, ER experience is not equivalent to ICU experience in many schools’ eyes. I’ve heard of nurses who have an ICU bay in the ER. They keep patients longer because the beds are full in the actual ICU. Unfortunately, if the school is not super familiar with that hospital and that system, they may not understand what that’s like and understand how that qualifies as an ICU. That’s where it takes your resume to display that to them. If the school only considers ER experience on an individual basis, it’s not going to be exactly what they’re looking for. It’s not going to be their preference. They’ll consider you, but it might not be ideal.
The only way to set yourself apart is to sell your experience on your resume and make sure you’re knocking your interview out of the park. A vast majority of schools out there say no completely to ER experience. This is something that I see a lot of students struggle with when they get all the way to the application process. They realize this when they go to apply. It has to be gut-wrenching. They realize you spent the last few years working in an ER, and your school does not even accept ER experience. I don’t want to see that happen to you.
Please, I’m stressing to you, make sure from the day you decide you want to do CRNA that you’re thoroughly researching your school, go to their website. There’s another website called www.COACRNA.org, and you can look up your school’s stats on that website. Most of the time, these schools list their accepted ICU experience on their website under the admission requirements. You could also give your email to these schools, and they can send you more information. Please do that early on in your path to CRNA. Although, I understand there are some people who don’t necessarily choose CRNA until they see CRNAs at the bedside in the ER, placing central lines or doing airways. I get it. Sometimes it happens.
Sometimes you don’t know that you want to go on for CRNA until you’ve experienced being around some CRNAs. At that moment, I encourage you to start researching your schools. If you’re even questioning CRNAs, start researching your schools. That way, you make sure you’re getting the experience they want. Will they make exceptions? No, they don’t have to make exceptions. They get plenty of applicants. They don’t need to accept someone with what they see as a less than ideal experience.
Remember, they’re looking at data, board passing rates, and going back and seeing the characteristics of the students who pass boards the first time. Historically, the students who pass boards on the first try have adult ICU backgrounds. PICU does very well. When you look at the data, PICU nurses tend to do very well, but ER NICU tend to be on the lower side as far as board passing rates for the first time. Who knows if it truly 100% correlates? All they have is the data and the statistics to go by. These schools are all looking at things like that. It’s how these schools make their decisions based on what units they accept.
The only way to set yourself apart is to sell your experience on your resume and make sure you're knocking your interview out of the park. Click To TweetI’m also going to say that units such as Cath lab, PACU and OR that do not count at all. Some of you may be thinking, “I know a nurse who got in with Cath lab experience.” That can be true, and this is why. Some schools do not require current ICU experience. If a nurse has previous CVICU experience, then decides to work in the Cath Lab, then from there applies to CRNA school and gets accepted, that counts because they’ve had CVICU experience in the past.
The opposite is also true. The fact that you can have four years of SICU experience, then you can go to the OR. You apply to school and be told, “No, you need current ICU experience to apply here.” You’ll be forced to go back and work in ICU prior to applying and interviewing for school. All schools can have a slightly different viewpoint on whether they want their students to have current ICU experience versus within the last 2 to 3 years. When schools say they want ICU experience within the last 2 to 3 years, I think the most competitive candidates are ICU nurses.
I don’t want you to be fooled by that leeway they give you because I still think the best thing to do is to have ICU experience to be competitive, considering how competitive these programs are. I can’t tell you how many times I hear students talk about when they get feedback from the schools about why they get wait-listed. The one thing they had to say is it was a competitive application cycle. It was competitive. They had way more qualified candidates than they could take. That being said, you want to have that competitive edge. That could be potentially a slightly more competitive applicant who has ICU experience and hasn’t been out of the ICU for the last two years. Keep that in mind.
It does not mean it’s impossible. It means that preference-wise, they probably still prefer a current ICU experienced nurse over someone who has been out of the ICU for 2 to 3 years. Unless you interview and you knock it out of the park, and your resume and everything else shines, to put your best foot forward, you need to have that ICU experience at the time of application, but don’t feel discouraged if you don’t.
If your school only says within the last 2 to 3 years, go ahead and apply. It’s worth applying, but I want to make sure I point that out. Nurses who only have OR, PACU and Cath-lab experience would be unlikely to ever gain acceptance in anesthesia school with just that background. I can’t say 100% that has never happened because I don’t know everything that’s ever happened in the history of acceptance to anesthesia school.
I do know a lot of networking goes a long way. Meaning if you’re going to the open houses, touching base with the program director, showing your interest, and if you can display good critical care ICU knowledge, or maybe you were an EMT once in the past and now you’re a Cath lab nurse, maybe the EMT, potentially a program might overlook that and say, “They do have EMT experience. They rock their interview. They have good ICU knowledge. Maybe we’ll let this one slide.” I can’t say that has never happened because I’m sure it has, but that’s the outlier. That’s not the most average or common thing to happen; I don’t want you to count on that essentially.
We’ve addressed those units of experience at this point. I also briefly touched on it doesn’t need to be current. That’s something that you need to be looking into. I had a student who had SICU experience, and his only saving grace with this whole experience he went through was that he had a lower GPA. He didn’t know if he’d ever get into CRNA school, but he wanted to. He was facing burnout out in the ICU and didn’t want to do ICU anymore. He made the change to the Cath lab after he applied to CRNA school, even though he had no hopes of getting in. He said he didn’t think he’d ever get in, but he figured he’d give it a shot. The student got an interview with his program. He did awesome in his interview and gained acceptance.
To his surprise, he gained acceptance, but he currently worked in the Cath lab. After he gained acceptance and this program found out he currently worked in the Cath lab, they said, “If you don’t go back to this SICU where you originally were, you’re going to lose your spot. We’re going to give your spot to another student.” At that moment, he only had a month or less to get back into the surgical ICU. His saving grace was that he stayed PRN in the SICU when he went to the Cath lab. He still occasionally moonlighted over there.
He was able to easily get back into the SICU full-time as a nurse from the Cath lab, which saved his spot in his program. I’m telling you that story because that would have been so awful if that was not the case. He had to go through all of that and get in, and then not be able to go forward with it because he changed jobs. That’s a big deal. I want to make sure you know that going forward so you’re not making these decisions without knowing what their policy is. You have to know your program’s policy and what they expect from you. Some programs expect you to be full-time in the ICU until the month or two before you start school.
Leadership Opportunities
Does this mean you have to work up until the day you start school? No, it definitely does not. A lot of students quit a month or two before starting school to get everything in order and maybe go down to PRN at that time so they can gather everything and make sure they’re ready to start school. It doesn’t mean you have to work up until the day you start class. Going back to the acuity issue, when you’re looking at acuity, don’t look at levels 1, 2 and 3. Analyze what tasks the nurses do on the unit? What opportunities exist for you as a nurse for leadership, research, and advanced training on different advanced life support systems? Some units don’t promote leadership in any way. There are no committees or anything for you to join.
It is odd to me and I find it very unusual, but I have talked to a couple of nurses on units like that where there’s very little opportunity to get involved. These would be great questions to ask during your interview because some schools put a lot of emphasis on leadership roles. Do you precept? Do you take charge? They like seeing those types of roles. What kind of committee work have you done within the unit?
Research is another thing too. Not all hospitals will have opportunities for you to do research. Level 1 trauma hospitals usually always do. Go up to your attending or a fellow on your unit, and ask them what they’re involved in. They’re probably doing some type of research or literature review that they’d probably be happy to have help with. If you offer your help and your services to do a literature review, that would count as being involved in research.
There’s always something you can do. Talk to your clinical nurse specialist on your unit, see what projects they’re working on, and maybe see if you can take the lead. Maybe talk to your nurse manager and see if you can survey all the nurses on your unit about a particular topic that needs to be addressed. Maybe survey your unit and see what they’re unhappy with. Whatever the consensus is, maybe come up with some system or game plan to address that issue. That’s taking the lead in that role. Those are the types of experiences that can set your ICU experience apart.
Back to the beginning, research your school. That’s probably the most important aspect of it. Know what they’re looking for. Go to the open houses and talk to CRNAs that are there. It’s not about whether it was a NICU, SICU or CVICU. I’ve heard so many students say, “They prefer CVICU.” I’ve had nurses who have had three years of Surgical ICU experience and good experience, question whether they should leave to go to the CVICU because they think that’s what the schools want.
The longer you work somewhere, the better reference you're going to get in an ICU. Click To TweetThat’s upsetting because I don’t think that’s what they should do 99% of the time. You’re going to be starting all over again in a new unit with no leadership experience in that unit. You’re going to be the brand-new person on the block, meaning you’re not taking the most acute patients. It takes time to build your presence in a unit and be that nurse who takes the sickest of the sickest patients. When you’re giving up an experience of three years in a Surgical ICU where you’re probably getting some of the sickest patients to go to a brand-new unit and start taking not the sickest patients again, I don’t necessarily think that’s the right move right before you apply to anesthesia school.
Usually, the CVICU nurses who get trained to do things like ECMO have been there. Do you want to spend another year gearing up in the CVICU when you could have increased your leadership activity already in the Surgical ICU that you already worked in for three years? Remember references, so the longer you work somewhere, the better reference you’re going to get. Some ICUs won’t even give references if you’ve been there for less than two years.
Keep that in mind, if you’re leaving a unit you’ve been on for a while to go to another unit that you think is better, how long do you plan on being there? Do you know their policy on giving references out? Maybe that’s something to ask in the interview. Do you give out references? You don’t have to say that it’s because you’re going back to anesthesia school in a year, but you could say, “I eventually would love to further my career.”
All I have to know is that you want to further your career. You want to become an advanced care provider or advanced practice nurse. Ask whether they can provide references and maybe tell you, “Yeah we do but we require you to be here for a minimum of two years before we will provide you that reference.” That’s a big red flag, especially if your new CRNA school is right around the horizon. I wouldn’t go to that unit.
Make sure that you can potentially stay PRN at your other ICU so you can ask your old manager for the reference. If you come from a unit that’s not high acuity and you need to leave, and you want to apply to CRNA school soon, and you know the unit you’re going to doesn’t give references for a certain period of time, stay in touch with your previous nurse manager, maybe still moonlight there so you can still say you are currently at that facility, and get a reference from them while you’re gaining better ICU experience.
Travel ICU Nursing
One last thing I’m going to touch on is travel ICU nursing. That’s a very common thing these days, and it’s very well paid. It’s a great way for students to save up money before school. However, there could be a little bit of a debacle on whether that’s a good or bad idea. I’ve heard from several different program faculty and various responses. It’s interesting to me that it’s not universally looked upon in a good or bad way. Some programs wonder, if they see you traveling, if you can’t commit to one unit, that maybe you’re running from something, or maybe you have a hard time with long-term relationships of some sort. That’s silly-sounding in my mind.
The vast majority who do travel ICU nursing do it for the money. I wanted to point it out because our assistant program director said that. It was a new spin on how they potentially can see travel nursing. I’ve had plenty of programs who think nothing of it. It’s fine. As long as you have solid references, travel nursing is very common these days. That’s a very common method that SRNAs use to save money before school.
The vast majority of SRNAs I know get their travel experience from the time of their acceptance until right before school, meaning applying to school, looking at travel positions, and trying to time it. You will start your travel ICU experience after you gain acceptance. They mostly do this because they want to make sure that they have solid leadership experience and references before applying to school. It’s hard when you’re traveling every three months to gain those things. It’s hard to get involved on a unit leadership committee when you’re gone every three months and then on to a new assignment.
If you want to travel sooner than later, the other option is to get a home base established, maybe get a year of experience on a home base and stay contingent there. You can come back and work for a week or two between assignments. Technically, there’s still a current employer that can offer you a reference when you apply to an anesthesia school. You could still do your travel and go back home and work for a week or two in between assignments. That’s an option. They get around that a little bit.
I’ve had a lot of students who wait to travel right before they start school. They take maybe 2 or 3 travel assignments in that time and save up money that way, versus the entire time they’re an ICU nurse. I see that being the most common route. It’s a great idea. I don’t think it’s wrong to travel. You need to be smart in thinking about leadership opportunities and unit committee work. As a traveler, you’re more likely not going to get the sickest of the sickest patients.
Another mistake I see travel nurses make is they take these travel assignments, but they’re not to Level 1 ICUs or any trauma level ICU. They’re in an ICU where maybe the patients are not that acutely sick. Potentially, you could lose your ICU skills over time doing travel ICU. It’s important when you seek out travel assignments, that you seek out the sickest travel assignments. The way to do that is to already have a solid ICU background.
If you’re a relatively new ICU nurse with less than six months under your belt, chances are you may not get the sickest travel assignment. If you already do things like ECMO or Prisma, and then you look into travel ICU nursing, you’re more likely to get assigned to these sicker patients because you already have some good experience. You’re already trained additionally for other life support measures. Keep that in mind too.
When you’re looking at travel positions, make sure you take high acuity units when traveling. One last thing with the travel is that you didn’t stay contingent at your first home-based job or you went to travel shortly after you graduated. You could always travel for two years, let’s say. Maybe think back to what was your favorite hospital that you enjoyed? Not only the location and the work environment, and the acuity was high.
Go back to that location and then stay there for 6 to 8 months prior to anesthesia school, get that reference, and go to school afterward. The next most common way I see students get around this debacle is to pick a travel assignment they like the most, then sign on as staff there, and stay there for 6 to 8 months prior to applying to school and gaining a reference.
I hope that helped clear the air a little bit on an ICU experience. I know it’s a tricky area, but your best bet if you’re not sure is to ask your program what their thoughts are on particular units, especially if it’s unique like an ICU holding bay inside of ER. Make sure you’re reaching out to your program, asking these hard questions, and hearing it straight from them. Go to open houses, network with current CRNAs at your program. That’s always the best way to get information. I hope you have a good week. We’ll see you next time.
Important Links
Get access to planning tools, valuable CRNA Faculty guidance & mapped out courses that have been proven to accelerate your CRNA success! Become a member of CRNA School Prep Academy here:
https://www.crnaschoolprepacademy.com/join
Book a mock interview, resume edit or personal statement critique:
Join the CSPA email list: https://www.cspaedu.com/podcast-email
Send Jenny an email or make a podcast request!
Hello@CRNASchoolPrepAcademy.com
Join us at the CRNA School Prep Academy Conference!
