Nurse Anesthetist

The Fall is here and a new class start their didactic schedule.  This season is a break for the clinical faculty here at the USC program of anesthesia.  The senior students are for the most part off doing advanced rotations such as cardiac or neuro surgery with Staff Anesthesiology in attendance for teaching and patient supervision.  The CRNA faculty is concentrating on lectures and rest from a long 8 months of OR teaching.  Of course we get to now do our own anesthesia cases which is really SWEET!

This year I have been really privileged to participate in the recent graduation of our 2008 class here at USC.  The slide show that was put on by JR included many of the pictures that I took over the past two years of this SRNA group.  They were great to work with and I am sorry that they are now all gone on to study for Board Exam.  One of the things that I have been working on for the past couple of years now is a CRNA board review class that is given to the seniors during their final year before graduation.  Dr. Michele Gold and I will be starting this review again next month and the series will run until graduation next August.  The preparation for these reviews in tremendous but wonderful.  It keeps me in tune.

What prompted me to write after a little layoff was a recent comment by Wes.  Here it is for your enjoyment:

Hello Everyone,

I’ve recently finished reading through most, if not all, of the blogs here on the site. I am really impressed and have enjoyed this personal perspective into the field that I haven’t found on other NA websites including the AANA. Reading through this blog has been a real treat and I consider it half pleasure reading and half personal research into a field that I have increasing interest in.

When I was a nursing student, I must admit that I found the profession to be boring and full of magazine reading. Now as a nurse working in a neurosurgical-surgical-trauma ICU, I admit that I had no idea of the awesome responsibility and greatly expanded knowledge base of the CRNA. Gaining experience with mechanically ventilated patients receiving anesthetic and analgesic drips, I am beginning to realize just how little I know and how much more I want to know about anesthesia.

This once seemingly “boring” profession is starting to become so very interesting to me as I read websites such as this and as I care for post-surgical ventilated and sedated patients. I also enjoy picking the brains of the anesthesia residents as they do rotations on our unit and find them to be quite knowledgeable.

I apologize for the long personal story, but I just wanted to say thank you for the great insight of all those who have contributed to this site from every step of the journey.

David, I must congratulate you on your hard earned achievements! Reading through the older blogs gives us an idea of how strenuous this journey really is. The great tips on applying to CRNA school and surviving once your in…have been helpful to many I’m sure.

Finally, living so close to USC in neighboring San Bernardino county I can’t help but inquire if you or your colleagues would be interested in taking on yet another “shadow.” Please e-mail me when you find some free time. Thanks again.

Wes

Thank you Wes for really nailing it for me.  Your perception of what this blog is all about is exactly right.  When I started out looking into becoming a CRNA there was nothing on the web where I could find real information about what it was like to be a CRNA, how to get in to a program or what it took to really shine as a student nurse anesthetist.  So I did it myself!

Now the torch is past along to those eager students willing to tell their stories and share their experiences with others.  I invite any interested in becoming a CRNA or those students already in programs to write to me and I will put it “up on the web” for others to read, learn from and be inspired by to become the best they can be.  For me this has been as a nurse anesthetist.  I have never regretted one moment of that decision to go for it.

DG

Today I will submit two letters that I have received in this last month. The subject of “desire” has come up frequently in those that have written and has caught fire as it were. The idea that a candidate must have a certain, “Fire in the belly” as coined by Wyne Wagaman, really seems to have ignited a response in those that have written to me recently. Here is a good example:

Dear David,

As I was eagerly reading your blog I could feel my pulse furiously pounding in my neck…. right before I read the part that said
“If you just take a self-check now and measure your pulse you will know.” ….and then I knew I wasn’t crazy, I just have a burning desire for the field.

I will begin my BSN studies at Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, MO this coming January. Upon completing my BSN I will then start the path of working my way toward my acceptance into the CRNA program at this same institution.

I am currently an IT professional with AT&T (4 years). I graduated with a BS in Information Systems from Maryville University outside St. Louis, MO in May of 2004. College was a long road for me as I was ill due to what was later discovered as congenital heart defect (ASD), which was successfully repaired mid-college career. This of course was a delay, thus I hastily settled for an IT major knowing my dream was to be a CRNA.

Well… all that aside, the fire has kept burning and I am going to keep it stoked by pursuing my dream. I am VERY excited to begin my nursing studies. I realize I have quite a rigorous road ahead of me, but reading blogs like yours creates even more desire for the challenge.

I am thankful to have read your blog. Congratulations on your hard earned success. One day I will be in your shoes encouraging future CRNA’s.

C. J.

Hello David( aka Professor Plum)

Congratulations on living up to your true destiny, not only a CRNA but a professor also! Remember me, from the CTICU way back when you were down in the trenches? I came across your blog as recommended by one of your current students.

I am so proud of you! The reason for my email is a plea for help. I resigned from UCLA 12/2007 so that I could be with my love who moved to Oklahoma City. I now live in OKC , the transition was very tough but worth it. During that time I reflected heavily about what it is I actually want to do with my life. I have decided to once again pursue my dream of becoming a CRNA. I guess my ego was shattered by the one and only denied application years ago, I think you were still on the unit , 2003 I believe then.

Anyway, for years I watched many of my fellow coworkers pursue what I wanted enviously but didn’t have the “fire” or confidence in myself since my rejection. Over the years I have been on the front lines in CTICU, even moved up to the ranks of the especially strong- THE CHARGE NURSES- can you believe it? Anyway, enough babbling, I have the fire, the intense desire to pursue this dream. I plan to apply to several programs in Florida, 1 in Maryland, and 2 in Texas. Haven’t taken the GRE yet, but have a good GPA when I graduated form U of Maryl.

What do you think? Any words of wisdom? My experience is strong, I think I interview well, just scared about the GRE I guess. I remember someone, I think it was you, saying to not bother taking the review courses thru Kaplan or Princeton Review. Also, what most do you like to see in a personal statement? David, I know it’s been a long time, but as you hopefully recall, I always respected your input. You were one of my senior advisors then and I hope you can give me some pointers now. I hope all is well with you and am looking forward to hearing from you,

Respectfully, M. B.

Last Friday we were privileged to have several student nurses visit us from the California State University at Long Beach. Friday’s is our conference day with a late start in the operating rooms. This week’s presentation featured a couple of Residents presenting poster boards in preparation for their showing in a couple of weeks before a state assembly. Following the morning conference it was back to the Operating Rooms for the days cases.

The student nurses followed a couple of the CRNA’s until noon and were able to get a glimpse into what we do on a daily basis. For the students it was a good exposure to Nurse Anesthesia practice. This morning I received a note from two of them that I would like to pass along. I have slightly modified the letter to correct a couple of small things and to protect the innocent.

This first letter comes from Chi and details her experience with us at LAC-USC Medical Center:

Dear David,

I wanted to thank you for the wonderful and invaluable experience of shadowing you, your colleagues, and your SRNAs this past Friday. It was a great pleasure to be able to slip into the shoes of a SRNA for a day, an experience that only solidified my decision in pursuing the CRNA route.

From the early morning start to early afternoon, everyone in the program was warm, supportive, and provided a wealth of information. I was immediately drawn in by the warmth and comradery amongst the faculty and students all the while still upholding the impressive professionalism during morning conference. When we gathered for the morning presentations featuring resident speakers presenting their current research findings, I was impressed with how supportive the faculty was as the floor was opened to questions and comments on the presentations. I sensed a safe environment for learning which, in my opinion, can only foster growth and improvement. Even as visiting students on the campus, my fellow classmates and I were invited to participate in the open forums during discussion! As the morning progressed and we were each assigned to shadow a CRNA and his/her student, I was amazed to find how engaged, Karen, the CRNA was during my shadowing experience. I had expected to be her “shadow” instead, she was explaining and teaching me about the various equipments used, the types of drugs and their effects, and even going into “what if” scenarios with me, all the while not skipping a beat with her own SRNA and her patient. I was in absolute awe that one person can do all these multiple tasks and be so efficient in everything!

Aside from getting advice from the faculty and CRNAs about the career and field, I was extremely grateful for the SRNAs’ honest portrayal of the rigorous program. Despite hearing the students confess they sweat blood in the program and having it be the hardest thing they have ever done, every student that I spoke with also said that it was an awesome experience that is well worth the hard work. Again, I just wanted to thank you for this experience and I hope to come back and visit you soon in the very near future.

Sincerely,
Chi D. Huynh
SN, CSULB

The second letter comes from Lisa and reveals her strong desire to pursue graduate level studies. What is important for these nursing students is to have a goal. It is very difficult to reach for such a difficult level of practice such as Nurse Anesthesia so it takes a lot of motivation and time to achieve. These visits and shadow experiences hopefully will provide incentive to keep them driving on through to the next several levels.

Dear David,

It was a genuine pleasure meeting you, Kari, Jim, Karen, Stephanie, JR, Diane, and Hill yesterday. From the very get-go, the CRNAs and SRNAs were warm and welcoming - even with the many questions my classmates and I had!

You patiently and thoroughly answered my questions about USC’s CRNA program, and I greatly appreciated the valuable information and advice you gave me. From the different experiences I would get at a surgical vs. medical ICU and contacting Alice a nurse manager at UCLA; to reading Paul Marino’s “The ICU Book” for preparation as an ICU nurse, I feel more informed in setting up a strong pathway to CRNA school.

What still amazes me about my CRNA shadow experience was not just how knowledgeable and intelligent the CRNA and SRNAs were, but also how supportive and enthusiastic everyone was about our interest in the nurse anesthetist profession. Even at 0530 hours, Kari was excited about us being there and shared different CRNA books and websites to further our knowledge. JR, Stephanie, and Diane (the SRNAs who walked us over for the anesthesia residents’ presentations) were so willing to provide thorough and honest advice about getting into a rigorous CRNA program and also what made them excited to be a part of USC. Also, the morning conference presentations confirmed to us the high level of research and involvement in the anesthesia department at the University of Southern California Keck School of Medicine. We were impressed with the involvement and encouragement of the CRNAs and SRNAs in the department of anesthesia.

Later on in the OR both Jim and Karen were simultaneously focused on teaching their respective SRNAs as well as us observers; I am still excited about seeing my first carina via the fiber optic! How awesome is that!

Thank you again for an experience that has further solidified my decision to pursue the CRNA profession. And if it is OK with you, I hope to keep in touch for advice on my journey to “CRNA-dom.”

Sincerely,

Lisa Chong
CSULB SN

In the future I am hoping that there will be more opportunity for others to come and visit us. If there are those that would like this experience I encourage you to call the LAC-USC anesthesia department office at (323) 226-4597. Ask for Kari is the best bet and tell here I sent you. I’m sure she will appreciate that!

Till next time keep focused on your goals and pay attention to all of the messages you receive. There may be a key somewhere in there that will open the next door.

David

This past week I had the privilege to participate in candidate interviews for our Nurse Anesthesia Program here at the University of Southern California housed in the Keck School of Medicine program. Beginning this process started with reading through long dossiers from each of the candidates including transcript records and personal statements. After reading 35 or so of these collections, the process of evaluating each of them individually began. This whole process was inconsequential without meeting these wonderful people and putting a face and personality to the paper facade that I had been poring over for so long. Now for the hard part that has been put before us, the personal interviews.

What amazed me the most about the interviews were the surprises that I found in the potential students that were interviewed this past week. Some of people that looked great on paper were marginal face-to-face or just plan incongruous with their written profile. Other candidates that looked to have just an acceptable ICU experience on paper were absolutely fabulous in person with knowledge presence and charisma. As one of the seasoned faculty members reasoned with me, “You will find clear examples of candidates that will fit with our program perfectly and others that do not fit at all. The trouble comes in the middle and that’s where the debates will come among the faculty members each championing their personal favorites for those last remaining few spots.” Hmmmmm, I am thinking now that there is more than enough truth in this. We will all decide together which candidates will be best for our program in the class starting in this fall. There are several more interviewing days and many more candidates to see so its back to work reading and thinking about what it is that makes a candidate for a Nurse Anesthesia Program shine.

In these past few days I have been pondering this question. What makes a candidate perfect for Nurse Anesthesia? This kismet for the candidates has been occupying my mind for more than this past week. Personally I have spent years positioning myself to do well in preparation for anesthesia practice and now as a faculty member in a great teaching institution I am challenged to keep growing and setting the standard for the students and potential students to rise to. That is why I write now dear reader to tell you what it takes to prepare for Nurse Anesthesia School and eventual Nurse Anesthesia practice. This is no small undertaking. If you will allow me to share with you both personal and professional opinions about “getting in and doing well” in the profession of Nurse Anesthesia practice you will note that these are my opinions and do not represent any official word from any program. Also, please take into consideration that what I have to share with you may apply to your personal situation or it may not. Finally, take these suggestions a grain of humor in the middle of your struggles to rise to something new in your nursing practice.

First, you must know that I am on your side and want all of you to succeed and shine in your chosen field of Nurse Anesthesia Practice. Knowing that, you have to understand that not all will reach these goals. This is painful for many I know. It has taken me a long time to attain my own personal goals so I am very sympathetic with those that have a vision of what they want to do and become, a vision that at times seams so far away and unreachable.

First, you must have a “Fire In the Belly” to come to nurse anesthesia practice. Simply put, you must have an overwhelming desire to do this or you will not have the energy or stamina to complete the journey. This is a personal characteristic that I have seen in all successful candidates that enter into anesthesia study as a nurse. The competition is huge on all sides and the determination to prevail is required. So right now ask yourself, “Am I up to this. Do I have enough inner drive to get me over all of the hurtles that will be in the path?” If you just take a self-check now and measure your pulse you will know. Are you getting excited yet? If not then maybe you should just settle for another area of practice. Nurse Anesthesia is not for everyone and as you will see the road does get narrow. So motivation is the first requirement. Desire to put this goal first are really important. Motivation is one of the things that we look for in potential candidates for our program; so ask yourself, “Do you have enough”? This is a personal characteristic you can do something about. Motivation comes from inside of you and does not depend on how old you are, how young, what color, ethic background, religion you follow or any of that stuff. None of those external trappings matter. What matters comes from inside; its what will drive you to excel and shine as a nurse anesthetist.

My second suggestion is reasonable as well. Do you have the required clinical background that will ensure your success in a nurse anesthesia program and are you willing to change jobs, move or do what ever necessary to get the best experience before entering graduate education in a nurse anesthesia program? This links the motivation to where you are now. Maybe you are in a very comfortable community hospital ICU that has sick patients but most of them are of the garden variety. Are you getting the experience in your present work place that is needed for you to be successful in Nurse Anesthesia School? Additionally, how long have you been working in an intensive care setting? The minimum requirement set by the American Association of Nurse Anesthetists (AANA) is 1 year of ICU experience. Often I find that this is simply not enough for the average candidate coming in to our program. We encourage more than the minimum and based on the individual often this will require more than two years. This is not always the case and occasionally there are those that through extreme effort and desire will get the experience and knowledge in one and a half years or so before coming into anesthesia training. During the interviews this past week there was one such individual that really shined with a year and a half in the ICU but for most candidates it requires more time. So question number two asks you if you have a good enough experience before planning a career in anesthesia. If you do not think your experience is very strong, trust me your interviews will not think so. I encourage you to look for an academic Teaching Hospital where you can really ramp up your skills. For those candidates that come to us with all of the right stuff but lack enough clinical experience we set goals together and require the CCRN certificate before they reapply for the following year.

Academic preparation is always required. Our program requires coursework that other programs may not require. We require a college physics course as well as the Graduate Entrance Exam which other programs may not ask for. Based on the program that you plan on attending it makes sense to contact them directly and find out what the individual requirements are for the school that you want to attend. Planning and preparation are really important. Get all of, “your ducks in a row” as they say! Find out what your program requires in the way of course work and finish it all up. One way you can do this is to go to the AANA web site and look up the programs in your area or where you want to go to school for their individual requirements. All of the top programs have web sites that you can peruse. You can examine their prerequisites and evaluate their programs to see if they are a fit for you. These are tangible things you can do to minimize your stress. Find out exactly what you have to do and your chances of success will go up. This makes sense.

Perhaps you took organic chemistry a few years ago and were preoccupied with working and personal relationships and you did not do well in the course. You can take it again and improve your grades. Often we find that students did not do well in their undergraduate studies for any number of reasons. Now a couple of years later you have new goals and are motivated to get into graduate study. You can now go back and take a couple of science courses, do well and demonstrate that you are focused and ready for the academic rigor of anesthesia didactic. These are things that you can do to improve your chances of getting in and improve your ability to do well once you are studying more advance topics that require a strong basic science base. I will refer you back to requirement number one, “Do you have the Fire” to do what you have to do?

There are several other things you can do to improve your chances of getting in to your program of choice. Most of these are personal interview and follow through skills that we can comment on in other editions of the Nurse Anesthetist Blog. For now I wish all of you great success and the strength of perseverance to reach your goals. If there is any thing that I can do for any one of you just drop me a note at my email address David (at) nurseanesthetist (dot) org.

Recently I have been in contact with Heather Wilson of Peer Assitance Fame, a National Speaker of Note and good friend. I asked her to send something for the web site and she chose to discuss a little Q and A. Here it is and if any one further questions about Peer Assistance please do not hesitate to call her or anyone involved.

Q: I am a CRNA in the CA BRN Diversion Program. My contract requires me to attend a variety of 12 step program meetings. I don’t feel like they are helping me because I don’t believe in God. In fact, this is exactly why I do not want to attend anymore.

A: You raise an interesting point, and you are certainly not alone. There are some key points to consider here. First, Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) do not mandate anybody to believe in God. Twelve step programs also have 12 Traditions, necessary for the cohesiveness and effectiveness of the group. The Third Tradition states, “The only requirement for membership is a desire to stop drinking/ using,” therefore the atheist or agnostic cannot be denied. Next, the Second Step states, “Came to believe that a power greater than ourselves could restore us to sanity.” We believe in a “Higher Power,” and yes, the vast majority of members choose to believe that God is their Higher Power. Many have even taken the word “God” and made their own acronym, such as “Good Orderly Direction.” It is also common to see members using the AA or NA group as their Higher Power; or nature. In the Third and Eleventh Steps where “God” is mentioned, it is immediately followed by, “as we understood Him,” because this is highly subject to personal belief and interpretation. Lastly, the only suggestion I would like to offer is to try to have an open mind. If you focus on what makes you different from everyone else in the group, then you will feel isolated and alone. If you focus on the similarities and concentrate on identifying instead of comparing- then you will start to feel “a part of” rather than “apart from.”

Q: I am a newly recovering opiate addict/ CRNA. The counselor at my treatment center tells me that I cannot drink alcohol. I don’t even like alcohol! I would much rather do “other” things. I’ve never had a drinking problem, so I don’t understand why I cannot have a glass of wine with my dinner every now and then.
A: I can sum up the answer in one sentence: “If you can’t have the drug you love, you love the drug you’re with.” What does that mean?
The basic pathophysiology in the brain can be explained very easily. Anything that is addicting, whether it is opiates, ethyl alcohol, benzodiazepines, cocaine, et cetera- all follow the same final common pathway. At the base of the brain is a structure called the ventral tegmental area (VTA) which projects dopamine to the nucleus accumbens in the frontal cortex. Therefore, whether you are tickling mu receptors, enhancing GABA, or blocking the reuptake of norepinepherine- it will invariably result in a rush of dopamine in the frontal cortex. This rush of dopamine is what we seek; it is the “high” that addicts crave.
Interestingly enough, whenever there is activity associated with procreation or survival (such as sex and food), the pathway of dopaminergic projection is identical. This is a deeply embedded, primitive pathway. It explains why addicts and alcoholics will do whatever it takes to get their fix- because it is as important as procreation and survival. It becomes a primal drive.
Back to the original question of why an opiate addict cannot drink alcohol: the brain does not know the difference. Even if alcohol is not your drug of choice, you are still “pushing the dopamine button.” There are countless anecdotals of people who, for example, are primary alcoholics who relapse on hydrocodone. Or primary opiate addicts who become full-blown alcoholics. (As a side note, taking pain medication on a short term basis for injury or surgery is an entirely different Q&A.)
If anyone is interested, I would be happy to share some scientific articles via e-mail. Abstaining from all mood and mind-altering substances is an evidence-based suggestion for all addicts and alcoholics. The disease is cunning, baffling and powerful. It is also very patient. It will wait a lifetime for you to pick up again.
Heather Wilson, CRNA, MS
AANA Peer Assistance Advisors Committee
Co-chair CANA Peer Assistance
mocrumbo(at)sbcglobal.net

For the senior class members that will be graduating soon, board preparation is on everyones mind or else it should be. I have been doing a little searching around the web for resources for the nurse anesthetist board candidate and found a couple of interesting web sites. Listing these sites does not confer endorsement by me or anyone here. However, I think that checking these things out could prove helpful to you. Not everyone learns, studies or needs the same things. These various resources offer a range of products and services that if they suit your style then will help you to reach your goal of getting that Pass letter in the mail.

The first place to start is to narrow down your reading material. The large text books like Barash and Miller are great for general study and case preparation during your clinical years. When it comes down to the wire and time is getting pinched look for other reading material to help you prepare for boards. I suggest a couple of books. The Basics of Anesthesia, 5th ed edited by Stoelting and Miller is a great start as well as Morgan and Mikhail. Anesthesia Reivew by Faust is really top notch as well as the question and answer books like Anesthesia Secrets. Two books that I feel really are essential are Anesthesia and Co-existing Diseases by Stoelting and Review of Medical Physiology by Ganong. What I suggest is to read these two texts again during the last 6 months of clinical rotations. There is an amazing amount of physiology on the board test as well as stuff found in the Co-existing book.

Other review material and courses are listed below that I have found.

Valley Anesthesia review is a long time standby for board prep offering both review courses and valuable study material. Highly recommended.

Core Concepts Anesthesia Review On line course. I just ran into these folks the other day and they seem legitimate. I poked around their web site and found some interesting stuff like the Question of the Day. Recommend checking their service out.

Prodigy Anesthesia Review is an interesting web site presence. Like the Core Concepts place, here you can find pracitce exams that look very close to the real thing. Check them out and let me know what you think.

CRNA Secrets is another one that I need info on. Please check it out and let me know what you think of this guy!

Good luck and keep me informed about your progress.

One of the pleasures that I have today is to work with really great people. One of those individuals is Jim Carey who just happens to be the Vice-President of the California Association of Nurse Anesthetists (CANA). Jim has revamped his pediatric reference sheet and I just put the new version up on the web site here under Clinical Documents. The new version of Jim Carey’s Pediatric Sheet in PDF format can be reached here for your downloading pleasure. This little sheet is very helpful as a reference and general guideline when considering pediatric anesthetic choices. It must be remembered that anesthesia is an every changing applied medical science and any reference sheet is just that - a reference and does not replace sound clinical judgment so user be forewarned.

I was in the local court house the other day fulfilling my Jury Duty summons. While passing through the check point the security guard commented on the book that I was carrying at the time, “Basics of Anesthesia” by Stoelting and Miller who are the editors of the current edition. The security guard perks up and asks me, “Could you do anesthesia after reading that book…….its like Betty Crocker right?” I had to laugh and answer that, “No it would take a lot more than just reading this little book to be able to do safe anesthesia.” So I guess the pediatric sheet is like that too. Having the sheet will help you out Students but will not replace studying the big texts, clinical mentor-ship and years of experience.

Thanks Jim for the update I will save a copy and put it in my little folder which I carry with me in to the OR. Small note: Jim recently sent me a couple of pictures from last Halloween and I have enclosed one of them for your amusement. Pardon me Jim it is just too good to pass up!

I just found a link to an on line review course that publishes on line an anesthesia Question Of The Day.  The course at Core Concepts Anesthesia Review is something that I am going to check out in the near future.

Enjoy!

The longer I am exposed to the great anesthesia practitioners the more respect I have for what we do in the OR. I feel so privileged to be where I am today with the opportunity to do anesthesia and to teach - I am really blown away every day. One of my former clinical instructors and true mentors has confided in me concerns about what it takes to do well as an incoming anesthesia student and I wanted to share their concerns with you. If you want to know the truth it may hurt but it will set you free. Thank you so much “There, I Said It”. You rock TISI! For those of you that want to be CRNA’s take heed and follow the advice of a pro and you will be well prepared for clinical residency.

Why I think year ICU experience isn’t enough by “There, I Said It”.

I am a Nurse Anesthetist and a Clinical Instructor of Anesthesiology at a large metropolitan teaching institution.

I have been a clinical instructor for some years, and have seen many students come and go. We have so many applicants to our program, and each time the interviewing process becomes more and more difficult, as each applicant appears to be cream of the crop. The difficult decisions as to who will be accepted into the program come from a comprehensive process that involves input from many individuals of varying levels of practice; from student nurse anesthetists to department chairs.

According to the AANA, requirements for admission to an accredited program of nurse anesthesia include a minimum of 1 year of acute care experience, such as in ICU or ER. Herein lies my beef. Applicants or students who think 1 year of acute care experience is enough to perform at an acceptable level, in my view, are sorely mistaken. I feel this requirement should be changed. Can one truly master the art of ICU or ER nursing in 1 year?? Is a year enough time to glean an adequate level of skills or experience in adult critical care or ER nursing? After one year, can you throw up epi, levophed, dobutamine, dopamine, nitro, etc. and truly be comfortable with what you are doing?? Do you think you’ll be able to insert a swan and know what in the hell you’re doing? How much code experience occurs over 1 year? Is a year time enough to mature the development of interpersonal relationships with other members of the health care team much less the patient? Ask yourself these questions and I bet your answer will be no, no and no!

The students who have slithered through the interview process with what looks good on paper but have never been realized in practice have a hell of a time in residency. The clinical instructor has to work overtime to protect the patient from the student. I daresay there are those individuals that just have met the minimal requirements and are truly stellar students. However, these are few and far between.

I suggest the minimal requirement in an acute care setting be increased to at least 3 years. Applicants, if you barely have the minimal requirements for admission, ask yourself if you truly have enough experience to entertain delivering anesthesia care to an elderly individual with an aortic aneurysm, a child with epiglottitis, or an individual with multiple gunshot wounds to the chest and abdomen.

Signed,

There, I Said It

Well - it’s been several months now since passing boards and vacation time is over. Since November 1st 2006 the gainful employment thing has been happening in full stride. I could not be happier as a nurse anesthetist! All of the hard work and struggle is worth it more than double. There was a running joke about the last year of clinical rotations that goes something like this. “If you can make it through this gauntlet still standing you are a winner.” Let me explain.

Most graduate education is difficult. I should know, this last effort was a second post graduate degree. However, in nurse anesthesia education the stakes are higher and many people feel its their duty and privilege to make life difficult for the prospective candidate for the Certifying Nurse Anesthesia exam. The gauntlet that the student runs is like a small alley way lined on both sides with angry frustrated preceptors that are wielding long bamboo sticks. Any unworthy student trying to run down the alley is beaten from both sides as they try to make it through. You think I am kidding - well maybe the allusion is too graphic but the idea still holds. In the words of one old timer mentor, “Yup, we love to cull the herd!” So its taken me a little time to recuperate from the last two years of very hard work getting through clinical residency. All of the bruises are healed but the scares still remain.

Now I am one! One what you ask. Well now I am one of the mentors and the bamboo is put away.  You’re laughing I am hoping, yes? Actually I have been very fortunate and have been appointed to a faculty position at a leading Medical School that houses a nurse anesthesia program. Just little over six months ago I was a student and now I hold a faculty position with my own students to ed-u-ma-cate. I am humbled by the position I am in and having the time of my life. Love it! The perspective from the other side is of course different but I try to hold on to the kindness for others that suffering produces.

One of the questions that was asked of me during my interview process for the faculty position at the University of Southern California was how I would deal with a difficult student one who is not progressing or one that is not safe clinically. To be honest I do not feel that I am ready to deal with this case scenario and told them so. I can handle the new student and the ones that are a quick study. Maybe next year I will have a bit more experience to handle the difficult student. Just as an aside I do have many years of as a preceptor in another capacity so teaching and mentoring is not new for me.

So whats it like to be in practice now as a nurse anesthetist. Wonderful - I love my job and what I do. In our practice setting we work in a team collaborative practice with anesthesiology. The joint practice is great when the Staff are good. Every day is another learning experience which I can talk about in the future. For now I just wanted to touch bases with you and let you know that the NurseAnesthetist.org web site is still going strong. I will be recruiting new writers in the months to come and adding links that should prove helpful to the prospective CRNA or clinical resource for the practicing nurse anesthetist.

Your feedback is always encouraged so let me know what your ideas or concerns are. Thanks for reading.