The best months to set up a “Shadow” day to follow a nurse anesthetist is now – between the months of September and January.  These are the months when our first year students are busy in the classroom and the clinical staff in the operating rooms are free to turn their attention to potential candidates entering the program of nurse anesthesia.  We do allow candidates to shadow all year long but the days are more restrictive.

Recently a persistent young man was able to come by and was shown around our dearly loved County Hospital.  It was a busy day.  Maybe that is for the best because it gave a realistic picture of whats its like to have a clinical practice in a large public hospital.  My kinda place.  What follows is the beginning of a screenplay I am sure.  The names have been changed to protect the innocent but the gist of the story is all factual.

Enjoy and let me know what you think.

Red Blanket?…What’s a Red Blanket?

By Hugh Adair

I met David at the double doors of the hospital entrance on the second floor. 6:30 sharp. The introduction was brief and to the point. “We need to get you into scrubs,” he said. Scrubs…awesome. I couldn’t believe this was actually happening.  I was so excited. I came across David’s blog Nurse Anesthetist, several months ago as I was scouring the web trying to find as much information as I could about CRNA’s.  At 35, I decided the life of a television producer was no longer going to fit. For 13 years, I worked in post-production for network and cable television. As a husband and relatively new father of two (a 3 year old son and a 1 year old daughter) I realized the 15-hour day, 6-day workweek was not going to work, plus I yearned to do something rewarding. A strong desire to help others drew me to my decision to become a nurse. I had always been interested in medicine – surgery specifically. When I found out there were nurses that provided anesthesia to patients in surgery, it seemed like a perfect match. Nursing and Surgery. After reading through David’s blog about his life as a CRNA and the journey that got him there, I was even more intrigued. I wanted to speak with him and ask him questions.

One particular page that leaped out at me was an entry on the importance of a shadow day. A shadow day is when a prospective student follows a CRNA from case to case. As a shadow, you are observing right alongside the anesthetist as he or she is working. Having an opportunity to shadow a CRNA for the day would be a good test to see if this was something I was truly interested in pursuing. I reached out. I sent David an email explaining who I was and that I was interested in talking with him about being an anesthetist. I wanted to ask questions like, am I too old to do this? What are the career prospects and opportunities? I also asked if it would be possible to shadow him for the day. I sent the email. I never heard back. I was bummed.  I moved on. I searched the web looking for other possible shadow opportunities. I contacted local hospitals that employ CRNAs to see if they offer a shadow experience, I even asked an OB/GYN friend if she could help, she tried with no luck. Every request was a no. How was I to know if I would enjoy being a CRNA if I couldn’t get a chance to see what it was like? What if I were to invest all of my time, effort and tuition (not to mention the personal toll on my family) to go through nursing school, work for two to three years in ICU and then go back to school for 2 ½ additional years to finally become a CRNA – only to find out it was not for me? I needed confirmation.

Months had passed and I had almost forgotten that I had even sent an email. Then I got the word. David emailed me that his blog had been attacked by a virus and that he was sorry it took him so long to respond. He told me to call him anytime. I was ecstatic. I phoned immediately and left a message. After several rounds of phone tag over a couple of weeks (I didn’t want to hound the guy), we were able to connect. After our conversation that was kind of like a phone interview (I was quite nervous), David spoke the words that sounded like music to my ears. “Well, you need to come down and have a shadow day.” Really? Was this really what I was hearing? “How is your schedule?” he asked. The conversation ended and I met him two days later.

After a brief introduction to the incoming fall class of SRNAs and other faculty members, I was given a set of scrubs and we were off and running.

David was covering one of the operating rooms reserved for the E.R. Since these rooms are used specifically for the E.R., there were no scheduled procedures on the board.  By 7:00 am we were sent in to relieve two Resident Anesthesiologists who had been in surgery since 10:00 pm the night before. An 18-year-old male with multiple gunshot wounds to the pelvic region. When David took over, the Orthopedic team was finishing up their work and the OR staff were preparing for the Vascular team to begin their work of repairing this kid’s veins. After the exiting residents briefed David, he signed on and took over the case. David immediately begins assessing the patient, monitors and medications. David works at a rapid, yet controlled and calculated pace. Impressive. Very impressive. The patient is stable and very lucky to be alive as he lies on the table with an incision from his sternum to his lower abdomen, an incision from his inner groin to his knee and several incisions on his hip. The operating room buzzes with adrenalin. David continually monitors and adjusts his medications. He gives me a complete play-by-play of what he is doing and the reason why he is doing it. David even throws out a couple of test questions as any good teacher would. “This is an applied science,” he says. “Anyone can regurgitate information, that’s not good enough. You need to be able to practice it.” This is life or death. No room for errors.

It’s 9:00 am. Time is flying by and I am loving every minute of this experience. David needs to be relieved from this case to take over the room next door. He briefs the Doctor taking over the case. Once finished, David grabs his MP3 player and we move next door. David plugs in his music player and begins prepping for what is coming down the pike. David’s preparation is articulate and precise. Remember, no room for fuck-ups. David checks, double checks and triple checks his medications.  Once satisfied and set-up we take a quick break for a burrito. “You eat when you can,” he says. During our brief breakfast David asks if I’m still interested in pursuing the career. “Very much,” I replied. David, under no uncertain terms, makes it very clear how hard a road it is to become a CRNA. Preparation seems to be a paramount prerequisite for anyone considering applying to the USC CRNA program. In addition to courses taken during nursing school, David recommends taking additional semesters of physics, upper division chemistry and an epidemiology course. Breakfast was brief. We head back upstairs.

A 17-year-old male came in the night before with a clean fracture to both the ulna and radius. David showed me the x-ray on the computer screen. “This could be very complicated,” said David. Hardware was probably going to be needed. The boy’s mother passes by the nursing station as they wheel the patient into the pre-op room. She is visibly shaken and scared for her son’s pending operation. Her English is broken. David speaks to her in Spanish. Her eyes fill with tears. David’s words comfort her. She tells David she will pray for God’s guiding hand over him and the operating staff. I get a little choked up myself. This is real. This is exactly why I want to do this.

I follow David into the room for the pre-operative interview. The patient seems alert and lucid. David asks him how he ended up in the ER. “Skateboarding.” he said. David runs through a battery of questions. “Have you had any kind of surgery before? Any known allergies? Was he born naturally or by caesarian?” The mother had a natural birth, but premature. This was important information. David was writing down his notes when a nurse came in and said they were sending up a RB from the 6th floor. “RB? What’s an RB?”  “Red Blanket,” said David. A Red Blanket is an emergency call for surgery. An RB is a life or death call that apparently supersedes any scheduled or lower acuity procedure. David apologizes to the fracture case and tells them he will be back later.

A 55-year old female was six days out from colorectal surgery. On rounds, a resident was examining the patient and asked her to cough. The patient coughed, her abdominal sutures break and her intestines herniate. Surgery is definitely needed.  After reviewing her chart, David preps his workspace. David works expediently, yet remains cool. The OR is prepping. He turns on his music. David has an eclectic taste in his tunes, mostly British pop. I wondered if his music choices held any significance or if it was just white noise while he worked. The patient arrives, distressed. As described, a small portion of her intestines are protruding out of her stomach. The patient’s gut is severely swollen (gas). She looks like she is nine months pregnant. David reassures her and givers her something to calm her down. The patient begins to relax. As the team transfers her to the table, the patient loses control of her bowels and makes quite a mess. A slight distraction. The nursing staff make quick work and move on. David introduces another medication and the patient quickly falls asleep. Once asleep, the patient is intubated and put on the ventilator. By the way, if I haven’t mentioned this in a while, this experience is incredible. I am mesmerized, like a kid in a candy store. But I digress. The attending surgeon arrives. He and the resident get to work. It seems the patient’s fascia was not strong enough to hold the sutures. Before long, the patient is made whole and the surgery is over. I follow David as he escorts the patient to recovery. Once in recovery, David gives the post-op nurse a run-down from the surgery and follow-up orders.  This case is finished.

David makes tracks to prepare for the 17-year old with the fracture. I follow. David stops and tells me I need to go eat. My day in the OR was over. I was bummed. I was hoping he would say, “Ok, let’s go”, but I was done. Then I realized that it must be tiring having someone looking over your shoulder for six hours.  I thanked him once again and changed out of my scrubs.

David escorted me to the door where I met him. He told me once I was actually in nursing school that I should call and do it again. He was very gracious. We shook hands and he went back inside. What an experience. Thank you David.

There you have it straight from the horses mouth.  I think Hugh should stick to writing screenplays what do you think.  Just kidding.

Just so its clear, what Hugh did not notice is the communication and team work in the anesthesia department at the Big House.  We work in a team setting with M.D. anesthesiology and CRNA’s.  This is one of the great benefits for our patients.  Without being political, two heads and four hands are often better than one.  Get it?

As you can see by just looking around that the look of the web site is different.  This comes from a new format, thanks to iThemes and updated software from WordPress.  With all of the revamping going on, the work has spurred me into more diligence in keeping things rolling here.  The result is that there should me more frequent updates and added content to the web site in the coming months.  Stay tuned and again thank you to all the well wishers.

Now, lets eat!

First I believe you have to make a commitment to what is important to you and your education.  Most of us have complex lives and can not simplify and dedicate to one thing only.  Even with busy lives family and multiple commitments you have to say, “This is my time.  This is my time to be selfish for OUR future and dedicate myself to this course of study”.  If you can not do this then maybe you have chosen the easier way that will not lead to the promised land.

Here is the small list of things I try:

Immersion

Writing out your ideas or lists to remember

Making note cards to carry around

Taking naps

Reading a lot!

Rereading more.

Ok, so this is the short list from a non expert in the field.  If you want to get the real low down on learning follow the link to an article that just is better than sliced bread for the student.  I highly recommend reading the article Hacking Knowledge.

Before the immersion process into anesthesia practice many of us had assumptions about what the world of anesthesia care is and what it takes to be a nurse anesthetist. Its only by being in the mix can it be demonstrated.  It’s only my opinion now – every one has their place in the world where they can be their best and do good work.  Where is it for you? For me its in the operating room giving kind attentive care with anesthesia and mentoring others to do the same.  Only you will be able to know if this a field that you have enough passion and drive to sustain you in order to attain the necessary skills to excel as an anesthesia provider in today’s world.

Here are a few comments from two “Shadow Experiences”.  What will yours be?

Dear David,
My observation experience was pivotal in understanding the dynamic practice of a CRNA and increased that a fire in my belly pursuit for this field of nursing.  The moment I met Kari Cole, I was greeted with warmth and welcomed to the new state of the art LAC + USC Medical Center facility.  I met various individuals on my observation day such as the anesthesia attending Dr. Leipzig, and CRNAs Charlotte Garcia and David Godden.  Everyone was extremely friendly and receptive to my presence in the OR department.  The CRNAs that I met enjoyed teaching and it proved to be a great learning experience for me.

Through speaking with David, I learned about the goals of anesthesia and received a mini lesson on respiratory physiology.  Thanks David for taking the time to teach and give advice to me.  I spent the morning and afternoon shadowing Charlotte Garcia CRNA and gained further insight into the CRNA profession.  She provided a holistic approach to the plan of care starting with a very thorough preoperative work up that included a review of history and physical, consents, labs, EKG, x-ray films, and assessment of the patient.  CRNAs possess exceptional knowledge and astute skills which enables them to respond to the dynamic patient changes in the operating room.  On this particular day, I saw those attributes come into play as the Charlotte demonstrated diligence with induction, intubation, and positioning of the patient.  During surgery, she manipulated various medications and fluids to maintain hemodynamic stability and to ultimately achieve the goals of anesthesia.

I learned a plethora of new and interesting concepts from Charlotte such as MAC, calculating blood loss, and reversal agents.  I also received advice about the educational rigors and expectations of the USC Program of Anesthesia.  While in the OR, Kari and Charlotte taught me about anesthesia and the elderly, an approach that is unique because geriatric patients respond to anesthesia very differently than adult patients.  I would like to thank everyone for taking the time to teach me about the CRNA profession.  My shadowing experience was extremely positive and I hope to return to this facility for another observation day in the near future.

Sincerely,
Mabel RN

Thank you Mable.  You were terrific and I am looking forward to seeing your application and encouraging you during the interview process.  Mabel demonstrated the attributes that potential candidates need to succeed.  Good luck and keep the fire burning.

Here is another letter I received and held back a couple of weeks trying to figure out what to do with it.  Should I edit it a bit….Hmmmmm.  In the end here it is – another example of work from a great candidate that idealizes so many of the great qualities of nurse anesthesia practice; attentiveness to detail, patience and sound judgment.  Lisa I am looking forward to seeing you again and I know that you will do well what ever program you choose to join.  The only reason I held back on posting your letter without editing is that it seemed a little too much about me which I do not want.  So here it is.

David,

It was a true pleasure meeting you, The Average Man, behind the making of a terrific website for people who are interested in pursuing an advanced degree in Nurse Anesthesia (NA). A few months ago I did a web search looking for sites that could answer some of my questions regarding the NA profession, without all the boring political information, and came across yours. When I arrived at LAC + USC for my shadowing experience and Mrs. Cole said I would be with you I was ecstatic, had goose bumps and was jumping for joy on the inside. I said to her David the one that developed the nurse anesthetist website. She simply said yes. I had the biggest smile on my face that I would like to think made the sun shine brighter that day.
I would encourage anyone who is thinking of going into an advanced degree of nursing to shadow a practitioner in their chosen field.

Personally, I have shadowed a few times which just reinforces my desire to become a CRNA. By far, shadowing at LAC + USC has been the most rewarding for me. Probably because they are a strong teaching and research institution. Along with their expertise staff.

As a seasoned critical care nurse I feel confident in the excellent care I provide. I enjoy and embrace learning and increasing my knowledge base because it allows me to better serve the patients I encounter. During my shadow experiences, I must admit, I am amazed at how little I really know. This in turn just gives me more motivation to continue my professional career growth along the nursing continuum. Although I know that CRNA school will be painstaking rigorous, I am eagerly awaiting the challenge. The coined term a fire in the belly is what I felt at the beginning of my journey. That burning feeling has now become an engulfed fire running through my body.

David, thank you for your guidance and all the wealth of information you had shared regarding the profession, preparing for it and becoming a CRNA. You patiently and thoroughly answered all my questions. In addition, I would like to thank your colleagues for being enthusiastic, warm and welcoming when I was introduced to them. All of them (including you) gave encouraging words and advice. I value and greatly appreciate the experience I had during my visit

Sincerely,

Lisa

There you have it.  When will you call for a Shadow experience?  You have to remember that only The Shadow Knows for sure.  When you do interview for that coveted spot in an anesthesia program no matter where it is the one sure question that will be asked is if you have “Shadowed a nurse anesthetist and what did that experience teach you?”  That is a guaranteed question and one you must be prepared to answer.

The next step is yours.

Mel never lost here enthusiasm through loss of sleep and all the struggles SRNA’s go through.

Here is her letter to Dr. Michele Gold the program director at USC that puts it all in perspective:

Hi Dr Gold,

I just needed to drop you a quick line to Thank You and all of my preceptors and teachers at USC. As you know, I am out here in Florida, and it has been a real eye-opener as to the superior education and training that I have received at USC compared to (unfortunately) a lot of new graduates and students that I have come in contact with.  It has made me appreciate my “painful” two years even more….and I never thought Id say that Hope all is well with you and the program, we are loving our new life in Florida.

Sincerely,
Mel

Its a good thing for current students and candidates to any nurse anesthesia program to hear the stories of others however brief.  During our time in “The Program” at USC Mel and I did struggle more than a few times with what seemed at the time to be unreasonable expectations.  To say that its tough to become a CRNA is a true statement.  Think about it.  Would you want some lazy inattentive provider giving anesthesia to your grandmother?  Wouldn’t you want the brightest most vigilant anesthetist with the experience to handle any difficulty during the anesthetic to be at the head of the bed.  That’s what all anesthesia providers strive for whether physician or nurse anesthetist.

A case in point.  Yesterday afternoon a gun shot wound victim was “RB’d” to the OR.  Three CRNA’s and a first year resident were on hand to start the case that very quickly required all the standard lines, arterial central and multiple large peripheral IV’s.  We began the case immediately when the guy arrived with a Level One rapid infuser in the room.  We ended the case the two Level One’s going for volume resuscitation, I was giving a lot of blood products.  After an hour and a half the surgeons were mopping up and the attending anesthesiologist walked back in the room and smiled saying what a great job we all had done. Thankfully these kind of cases are not common out in the community.  But here at the largest level one trauma center in Los Angele’s we see a variety of crazy things from massive trauma from train wrecks, car crashes and of course the “knife and gun” club action.

I am glad that the training we received has prepared us to handle these as well as the routine.

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 neuro-surgical-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

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 through 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 advisers 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.

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

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 toget 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 in the contact section.

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 “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 anecdotal instances 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