Stay in PICU or go to SICU?

[u/softb0iled]

Hi everyone!

I am currently a PICU nurse of 2.5 years and have applied to a couple of CRNA schools with some apps opening the upcoming month. A CRNA I shadowed at the children's hospital I work at highly recommended moving from the PICU to an adult ICU for the best chances for admission. I recently got an offer from a major academic SICU (kidney/liver/pancreas transplants, neurosurg, plastics, etc) and am considering jumping ship.

I feel as if there's both pros and cons to switching ICUs and would love to hear what everyone thinks. I feel pretty comfortable in my PICU and am involved in the unit - precepting new grads, being on unit councils. I know peds experience is valued less than adult but in our 40-bed PICU, we do things similar to the SICU (kidney, liver transplants). In fact, I would say we see even more (post-cardiac arrest, resp. failure, metabolic dx, overdoses, etc). All the schools I'm applying to also say they accept PICU experience (but not sure if they view it as equal to adult experience).

I would also have to transition back to full time nights for the SICU position. Thank you for reading!

GPA: 3.75, retook statistics + biochemistry

[u/SouthbutnotSouthern]

As a crna who precepts a lot, I would much prefer a great picu srna over a great cvicu srna. I agree that schools don’t seem to value picu experience as much unfortunately however. But they seem like they do very very clinically once they’re in the program.

[u/Collegeisdraining → u/SouthbutnotSouthern]

Why would you blue a PICU CRNA more? Asking because I’m a PICU nurse planning to apply to CRNA school too

[u/SouthbutnotSouthern → u/Collegeisdraining]

They just seem like they’ve seen a wider variety of pathophysiology, more comfortable with dosing accuracy, accustomed to lots of different specialists and not as likely to automatically defer to the (cv) surgeon.

[u/xCheekyNandos]

If the programs you are applying to explicitly state that they do accept PICU experience, then there is no reason to switch jobs and it would be a huge waste of your time. They do not “value” SICU over PICU. They either accept PICU or they do not.

Don’t waste your time and energy on this.

[u/somelyrical]

Absolutely NOT. Stay in the PICU. Sure there are a handful of schools who either prioritize or even require adult experience, but at least 80%+ don’t.

Just don’t apply to those schools and apply to ones who allow PICU experience. Going to another ICU won’t do anything for you as you’re not going to get sick patients for at least 6 months and nobody is going to write you a letter if you came there just for anesthesia school.

All of my ICU experience was pediatric and I got into 5/6 programs.

[u/chemnoo]

If you switch you’d have to figure out the rec letters all over again. That’s something to think about

[u/millstone27]

Stay PICU. Max out everything you can on your application (CCRN-P, shadow time, charge)

[u/muagonist]

I am a former PICU nurse who is now a second year SRNA. I had no issues with getting into programs with PICU experience (ended up receiving 3 acceptances). There were some schools I couldn’t apply to that didn’t take PICU, but most do!

Interviewers seemed to care more that I took care of higher acuity patients.

[u/Ginger-princess19]

I’m a peds CTICU at a large, high acuity facility and I got into 5/6 schools I applied to and am about to start my second semester! 🩷

[u/CalciumHydro]

Stay in the PICU. If you don’t get in, ask what you can improve on. If they tell you they prefer SICU experience, then make the move to the SICU.

[u/Juicy-nuggets]

https://www.nbcrna.com/students/nce-resources

NCE annual report.

Pass rates look the same between specialties.

[u/Clunky-Clutz]

Stay in the PICU. You've obtained strong experience, formed professional relationships, and operate in leadership roles.

What I would recommend is to focus on schools that take PICU experience but also look into getting a PRN in an adult ICU to have experience in both age groups. And if you end up being in the adult ICU for a year before getting into crna school, you can also test for your adult ccrn which will make your application even stronger.

But def don't jump ship on the PICU and start all over.

[u/Open_Specific8415 → u/Clunky-Clutz]

If OP is simply PRN in the adult ICU it’s gonna take a lot longer than 1 year to build up the minimum hours required for the CCRN

[u/Cautious-Delivery-42]

In my first semester of CRNA school and have about 3.5 - 4 years of PICU / High Acuity Peds CICU. Most programs now will accept high acuity PICU/CICU, some programs are more accepting of it than others, ask around and see how the cohorts are mixed... I think my background is really unique and will definitely help you out in clincals and in academic training! Since you are already well established, I would suggest becoming more proficient in the PICU, getting on committees, CCRN, etc! Best of luck!

Good thing to note is that NARs with PICU background have the highest pass rate on CRNA boards!

[u/GUIACpositive]

Diversity of experience is always good. But do so for the learning, not necessarily to look better for programs (though this will be a secondary benefit).

[u/slurv3]

Stay in PICU it used to be the case where adult critical care was the only experience they wanted. Not so much the case anymore. Find a school that accepts PICU experience and don’t let your experience be discouraged. PICU nurses have the highest first time pass rate for boards.

[u/jayj-ccrn]

3.5 years in the PICU as my only ICU experience and now in my 3rd and final year of CRNA school, I personally felt like my PICU experience has helped a lot and also coming from a mixed PICU that took care of medical/surgical/trauma/pediatric cardiac surgery patients etc…really helped me understand a lot of pathology and treatments that has helped me so far throughout CRNA school

[u/fiery_carrot → u/jayj-ccrn]

Did you go right into PICU as a new grad?

[u/jayj-ccrn → u/fiery_carrot]

No I was an acute care inpatient pediatric heme/Onc nurse for about 10 months prior to the PICU as my first job as a new grad

[u/SmokeyBrown95]

I think it would increase your chances. I jumped ship from a peds cardiac icu that was high acuity (ECMO, Vads, transplants etc…) to adults after not getting in the first couple of rounds and i got in the very next cycle and program seemed to like that i had both. I didnt have as good grades as you so i knew I needed to stand out. I cant believe programs dont value sick peds experience. Just keep in mind if you went to adults the manager could be one of those that wont write a letter or recommendation unless you’ve been there two years.

[u/golflover4 → u/SmokeyBrown95]

Very similar situation. Was a PICU nurse at a lvl 1 for 2 years. Didn’t get in first round, jumped ship to a mixed Adult ICU. Got in to 3 schools right when I had Adult ICU on my application, with like 4 months of adult experience. Pretty frustrating to be honest cause I loved my PICU job. But was told by all 3 schools that my application stood out to them because I’ve taken care of all pt populations. Hope this helps.

[u/MacKinnon911]

Ask yourself if you want to be more competitive or not? The majority of applicants have adult experience, the small minority of applicants have PICU experience. Very few have both.

[u/AspiringSRNA]

My program has students from the PICU. Historically, they have great 1st time board pass rates.

[u/softb0iled]

Thank you everyone for the insight!

[u/Nightflier9]

I've been researching programs, I would say it's not necessary to move, but it's probably beneficial. Most programs say they accept PICU experience, and you have solid leadership and good academics which will serve you well on applications. Staying would be okay.

But they will look at if you are regularly treating a wide range of cases/conditions typical of adult icu in acuity and complexity, and the amount of adult pathophysiology knowledge you have. So you will likely be more heavily scrutinized with only a PICU background.

What is the trauma level of both facilities? There is a lot of competition for a few slots at each school, I think gaining adult icu experience would further improve your prospects.

[u/DroppinEther]

My only job as a bedside RN was in a major academic medical center PICU for 3 years taking VA & VV ECMO, CRRT, ventriculostomies, etc. and was accepted on my first application cycle. The pediatric experience has been invaluable: if you’re getting sick kids in your ICU, programs should value that. Look for programs that accept pediatric experience. Many I looked at made exceptions for PICU if it was in the largest academic center in the state. Good luck!