4 Essential ICU Skills to Master Before Starting CRNA School

Before starting CRNA school, mastering essential ICU skills like difficult IV access, ventilator management, EKG interpretation, and interdisciplinary communication is important. These skills form the foundation for success in CRNA clinical residency and help build confidence in high-pressure clinical settings. If you’re curious what CRNA schools are really looking for, we actually talked about this on the podcast (Ep 1: "What CRNA Schools are REALLY looking for in an applicant").

You’re ready to retire from the bedside and go back to school to become a CRNA? ICU experience is a prerequisite for CRNA school for specific reasons. Honing in on your skills during your time in the ICU will make you all the more prepared for starting clinical residency in CRNA school. If you want a structured overview of the profession, the Profession Overview lesson in our Learning Library is a great place to start,

How Can You Master Difficult IV Access Before CRNA School?

Prior to CRNA school I was on the Difficult IV Access (DIVA) team at a large teaching hospital. This allowed me to use an ultrasound to get IV access in patients with a history of difficulty such as dialysis patients, cancer patients etc. Familiarity with an ultrasound and gaining venous access in challenging situations are two skills you will use often in CRNA school clinical residency.

So if you can get that exposure during your ICU training that would be awesome! We dive deeper into what I wish I’d done differently before applying in Ep 2 of the podcast.

What Should You Know About Airway Management for CRNA School?

As anesthesia we are regarded as the “airway experts.” This means understanding deeply how to best ventilate and oxygenate a patient, the foundation of which starts with ICU exposure. The ventilators you use in the operating room will not be the same ones you saw in your ICU but certain ventilatory modes and features will. What’s the difference between pressure support and pressure control?

This you will see in the operating room and have to differentiate. As an ICU nurse, your respiratory therapist (RT) can be a wealth of knowledge in this area. My time in the ICU, after I knew I wanted to become a CRNA, was spent talking to my favorite RTs and understanding airway management better.

Tracheostomies, CPAP, BiPAP all these things will reappear in the operating room, make sure you have a thorough understanding of why we make these kinds of airway management interventions and it will put you ahead of the curve. If you want to brush up on the history of CRNAs and the different types of anesthesia, our CRNA History + Types of Anesthesia lesson in the Learning Library is a helpful resource,

How Do You Read an EKG Before CRNA School?

Surgery is regarded as your body’s stress test. This provides a significant strain on the heart, but healthy individuals usually have uneventful experiences in the operating room. As providers we aim to improve our patients before surgery, but the reality is that most of the anesthetic drugs we use do impact the heart’s normal functioning.

So being able to read, interpret and determine differences in an EKG is a skill that can be first developed in the ICU. As a CRNA, monitoring and noticing the changes in your patient’s EKG is a part of what we do in the OR. Understanding these changes, when to call for help and how to best treat them is part of your scope of practice as a CRNA.

Get familiar with EKG interpretation at the bedside because its a skill you will further build on through your training. For a deeper dive, our Learning Library has a full lesson on Hemodynamics,

Why Is Interdisciplinary Communication Important for CRNA Students?

There are so many soft skills in anesthesia that the textbooks could never teach you. It’s not until you are in the clinical environment that you realize that effective interdisciplinary communication can make all the difference. As ICU nurses, we know that we spend most days paging for interventions, getting different teams to talk to one another and coordinating care for our patients.

During a high stakes code situation the leaders in the room help with the closed loop communication and provide a productive environment for providing patient care. Anesthesia is a constant high stakes game, when dealing with a patient’s health in a service focused field time is of the essence most days. Learning how to best communicate using closed loop communication, open-ended questions and even the SBAR (situation, background, assessment, recommendation) techniques during your time in the ICU, will strengthen your skills for when you reach the OR. If you’re curious about CRNA salaries and how these skills translate into career growth, check out Ep 4: "CRNAs make HOW MUCH?!" on Apple Podcasts or our Learning Library’s Salary lesson,

Which ICU Procedures Should You Get Your Hands On?

The four skills above are the foundation. These are the procedures that build them, and the ones you should be volunteering for instead of watching from the back of the room.

Vasoactive drips. Norepinephrine, phenylephrine, vasopressin, the whole cabinet. Knowing you're titrating to a MAP of 65 is not the same as knowing the receptor, the side effects, and what happens when your patient is also acidotic. Interview panels love this material, and so will your CRNA school pharmacology exams.

Rapid sequence intubation. RSI has a lot of moving parts: medications and doses, timing, cricoid pressure, equipment setup, the Glidescope fogging at the worst possible moment. Volunteer to push the meds. Volunteer to set up. Then ask questions afterward about what you saw. This is the single procedure in the unit that most directly previews your anesthesia clinical year.

Central lines. Intimidating and messy the first time you watch one go in. Learn the anatomy, the sequence, what can go wrong, and how it gets fixed, because at some point it will go wrong. Even assisting counts.

Ultrasound. Covered above through difficult IV access, but it deserves repeating: getting comfortable with the probe, reading vessel anatomy, and watching a vein collapse under pressure moves you out of poke-and-pray and into how anesthesia actually works.

Why Rounds Are Free Interview Prep

Most people zone out during rounds. Don't. Rounds are where the "why" behind every order lives: what the team is actually worried about, what they're ruling out, what they'll do if the next lab comes back wrong. That reasoning is exactly what an interview panel is probing for when they ask you to walk them through a patient.

Rounds are also where you get noticed by the intensivists who may eventually write your letters of recommendation, and where you get free practice speaking up in a room full of people who know more than you do. Which, incidentally, is a fair description of your entire first year of clinicals.

How Do You Make the Most of Your ICU Year?

Skills are one half of it. The other half is what you do with the year itself.

Go deep on patho and pharm, not wide. Flip your brain back into student mode. Don't just note that your patient is on heparin; know why, and know what's failing system by system. If renal failure is on your assignment, understand what CRRT is actually doing. Epinephrine versus phenylephrine isn't a preference, it's a mechanism. This is the knowledge that carries you through interviews and then straight through your first semester.

Grab the leadership that's actually available to you. Join the Clinical Practice Council. Volunteer for a committee, including the unglamorous ones. Email your local AACN chapter. Collect data on a research project even if you didn't design it. Precept students and new hires. None of that requires a title, and all of it says something on an application. It also builds the exact mindset you'll need when you hit your DNP project.

Start with the end in mind. The year evaporates. CCRN, shadow days, letters of recommendation, transcripts, the essay: each one takes longer than you think, and they collide if you don't stagger them. Write the plan down, even on the back of a report sheet, and map it against our CRNA school application timeline.

For the long-form versions of all of this: Ep 16: "What is the BEST type of experience for CRNA school?" (Spotify), Ep 22: "Things you MUST do while you're getting ICU experience" (Spotify), and Ep 24: "Making the MOST out of your year in the ICU" (Spotify).

How Should ICU Nurses Prepare for CRNA School?

Wherever you may be in your CRNA school journey, if you are just getting exposed to the career field now, preparing for interviews or getting ready for clinical residency. Thinking back on these skills of obtaining difficult IV access, ventilator management, EKG interpretation and interdisciplinary communication will help prepare you for the next step. CRNA’s use these skills everyday so be prepared to show the strength of your ICU experience. If you want to know more about how to stand out in your application, we cover this in depth in Episode 1 of our podcast.

Ready for more tips on how to get into CRNA school? Check out our community here!

For more information, check these trusted resources: American Association of Nurse Anesthesiology (AANA), Bureau of Labor Statistics.

Our Final Thoughts

Mastering these essential ICU skills before starting CRNA school will significantly ease your transition into anesthesia clinical residency. The CRNA Club is here to support you every step of the way, offering resources and a community dedicated to your success. Embrace your ICU experience and use it as a foundation for becoming a confident and skilled CRNA.