Archive for Anesthesia

Nov
11

What does the Shadow Know?

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GarretWhat does the Shadow Know?

Recently I had the chance to interview and conduct a day long orientation to a potential candidate to a Nurse Anesthetist Residency Program.  Good candidates are hard to find ala May West.  Some of you may know the reference.

There are SRNA programs out there that like young blond inexperienced candidates for their programs thinking that they can mold them into subservient technicians that could fit into their semi-national workforce.  Not so here at our facility.  Ideally, we are looking for experienced ICU nurses that can think, have the experience to give them some wisdom and those with leadership skills to direct and manage future anesthesia cases.  Do I ask for too much.  I would hope not certainly in the 21st Century with Health Care evolving into something none of us had anticipated nor expected.

The medical world is in total flux and non of us in “the Business” of health care know how the future will play out.  What is central in my thinking is patient care and what is best for our clients.  Who are our clients as anesthesia providers?  Certainly our patients come first but that is not all.  Our clients include the surgeons and nurses that work in the peri-operative arena as well as the families and visitors that come to our “peri-operative home”.  We serve them all but primarily it is the direct patient care in the operating room that defines our practice as safe and efficient Nurse Anesthetists.

This brings me back to the Shadow.  What do our candidates bring to the table.  What is it that we want for a base line level to go into nurse anesthesia training?  These are huge questions.  I get candidates that have one to two years of ICU experience and have been awesome and I get some with ten years of ICU experience that have faded and not up to the rigors or challenges academically or clinically for anesthesia training.  In a previously very popular post with the commentaries, Fire In The Belly, I talked about what I thought was the most important thing to look for in a candidate to nurse anesthesia school.  My thinking has not changed much.

If I were to give you the potential applicant the ideal credentials, here they are in my personal view.  I would look for an ICU nurse that has between 3 to 7 years of experience working is a SURGICAL setting not medicine.  Pediatric experience is a PLUS not a minus while NICU is a very special category all by itself.  If you have been an ICU nurse for several years and have not stood for the CCRN I have to ask why.  Is it that you do not have motivation to excel?  So the CCRN credential is important.  When was the last time you were enrolled in an academic program.  Have you forgotten how to study?  If it has been “years” since you have taken a rigorous scientific course take one and demonstrate excellence.  I look for driven motivated people that know what they want and are willing to make the sacrifices that it takes to get into a nurse anesthesia program and excel.  Are you willing to move to complete your goals?  These are questions only you can answer.

What I am motivated to do is to encourage the best and the brightest nurses to pursue a course of study in the field of nurse anesthesia.  It is not for every one certainly but the rewards are tremendous for you and our patients.

Here is a letter from Garret.  He is a wonderful example of what I consider an ideal candidate for our program. Maybe he would not fit into everyone’s program but he meets all of the criteria I have found to produce fabulous results.  This is not an endorsement that he will be accepted into our program only my opinion.

 

David,

As discussed I am writing this letter as a reflection related to my shadow experience with you in October 2014.  I had to put some thoughts together on paper for this response.

In order to provide you a better picture of where I am in the process of becoming a Nurse Anesthetist let me inform you as to how I got to meet you.  I am certain this process started when I was in junior high school.  Unfortunately like approximately 40% of American parents my mother and father divorced when I was young and eventually we left our hometown in east Pennsylvania and moved to Maryland.  While there we lived with my mother’s aunt until her job stabilized; she was a Nurse Anesthetist in Baltimore.

While living with her I had many enjoyments and challenges, going to work with her from time to time proved to be new and ever stimulating adventures.  I remember sitting in emergency and operating rooms watching patients come in with, various illnesses, gun shot wounds, stabbings, and all sorts of complex injuries.  I got a chance to meet other nurse anesthetists, physician anesthesiologists, and all sorts of surgeons.  I was always star struck, as these people were rock stars to me.  My aunt was typically calm during most of these circumstances and then like magic the patients were calm or sedated and having surgery.  She seemed like to captain of a ship so busy yet so in control of a large complicated circumstance involving the life of another person.  Every time I saw this I loved the complexity, the science she discussed, and our conversations related to what I saw.

Fast forward through high school in Montgomery County Maryland, ten years of training (graduated top of avionics class), working, and traveling the world for the US Navy (5 years in uniform and 5 not), attending CSU Fresno (BSN Nursing 2006, Academic Deans Medalist for Department of Health and Human Services), completing a two year externship in Pediatric Critical Care (early acceptance based upon academic performance) as well as Burn and Trauma Nursing (Community Regional Hospital Fresno, CA), ten years of working in the Pediatric ICU, promoting to Pediatric Critical Care Transport  and Charge Nurse (Summer 2010), sprinkle in some adult post-op in patient care at a surgery center and here we are today.  I started talking to Dr. Gold in 2011 about how to become a candidate for selection into the Masters of Nurse Anesthesia program at USC.  Most of our conversations have been her advice for choosing required coursework and my decision to not pursue medical school in order to practice anesthesia.  She provided me with a solid course guideline in order to prepare me for the application process.  Admittedly I was following an academic track geared up for my own development in critical care and medical school in order to take an MCAT; a lot of math, chemistry, and physics, you know the drill.  I enjoy those sorts of courses and plan to continue some related education after the master’s degree.  That training and coursework has me a stronger critical care nurse and has provided a stronger foundation to my practice.  In order to further research my decision to pursue nurse anesthesia I have recently, through a close friend, contacted Dr. Jane Fitch, President of American Society of Anesthesiologists, whom used to be a practicing nurse anesthetist.  I wanted to get some advice on choosing a school in which to train and know why she decided to go back to medical school after so much training and academics in order to become a physician anesthesiologist.

A year ago I realized my window of academic opportunity was near based upon my family circumstances with one of our children nearing her college graduation at Davis, the other entering junior high, and my financial plans getting set for being a full time master’s student.  I again contacted Dr. Gold and reviewed my academic record to ensure I was on track.  We met in February 2013 and discussed not only my academic record but also the ability for me to sit in on one of the SRNA lectures.  After some emailing and date confirmations I was able to sit in on a OB lecture this past June with Dr. Jabbour.  For me this was the entrance to the Disneyland of an experience.  I could not sleep thinking about this and had to make sure all was perfect on my end (outfit, shoes, background knowledge search, timeliness, etc).  Since I had been to Dr. Gold’s office before getting there was not much of a challenge, but I was nervous as I waited for the students and Dr. Jabbour to arrive; this was a backstage pass for sure that I am extremely grateful for.

That day was exciting.  Dr. Jabbour and the other students made me feel welcome and I was able to ask a few questions to the students.  My biggest concern and still remains to a slight degree is my clinical background; PICU.  As I was researching the Master’s Degree of Nurse Anesthesia most of the requirements across the country contained adult critical care work experience, and some emphasized more specific areas within that were preferred.  At the end of the lecture I was able to speak to a student, a young lady, that was a PICU nurse prior to becoming an SRNA.  She expressed a great deal of comfort with much of the material throughout the program based upon her past work as a PICU nurse.  She further explained that everyone in the class comes from various specialized areas and their strengths are obviously a result thereof.  Not everyone was from some high profile, high acuity trauma and / or cardiac adult critical care area as I had previously imagined.  Between that information and the awesome lecture presentation my pursuit of this career was even further energized and more intrigued for applicable related knowledge.

After the lecture I was able to meet Dr. Norris at the program office.  She discussed with me some feedback of my experience and eventually recommended some related texts to obtain and read as a foundation to anesthesia practice.  Dr. Jabbour joined us and I was able to thank them both for the experience and their time.  I ordered the book from my phone on Amazon before I got back to my car (Stoelting and Miller).  As I was leaving we discussed what was available for me in terms of shadowing CRNA’s.  I explained that there was not a practice available at my facility and that we had only MD anesthesiologists; of which very few are supportive of CRNA’s.  We eventually decided to set up a shadow experience at LAC/ USC and that is how I got to meet you and Kari Cole.

SHADOW DAY

6 Oct 2014

After contacting Kari Cole and finalizing a date I decided to arrive in town a day early.  I stayed at the Marriott in downtown Pasadena.  The night before my shadow day I could not help but to think about what I kinds of cases I might get exposed too, what sort of questions will I be asked, how will my first impression come across, do I have my question list cleaned up, am I going to make myself look bad, etc.  I thought about every one of these things all the way across the bridge from the parking garage as I waited for Mrs. Cole and Mr. Godden at the security entrance.  I really wanted my hands to not sweat as I reached out to shake their hands.

David and Kari appeared from the side door near the entrance and Kari greeted me with a smile while David appeared in assessment mode, but welcoming.  I liked that.  After a few minutes Kari explained to me that I would be spending my morning with David and I hoped he would be accepting of my level of excitement and inquiry.  I knew there was something about him that smelled experienced yet government like. The more we began to talk the more we had in common.

After a stop at the Keurig machine he explained to me that we would be going to the fast track OR area to see some patients that he was preparing to do their anesthesia cases.  We started out by looking at their charts, recent lab data, reviewing any pertinent information with the bedside nurse, performing a physical assessment, and then waiting to speak to the physician performing the procedures.  Our first patient was a 76-year-old man having eye surgery for cataract removal.  He had some previous labs that were abnormal and his initial assessment did not support him being generally healthy, but David’s conclusion was that his clinical condition was satisfactory for his anesthesia plan.  It was this case that I learned about the narcotic Alfentanil; I had never heard of this before. We discussed this medication and some of its pharmacokinetic data as it related to traditional fentanyl that I was accustomed to using in my ICU.  We discussed this patient’s tolerance and level of comfort related to the medication’s David was using as well as the procedure itself.  As I asked a few questions David pointed out the importance as well as some vital aspects of his safety checks within his equipment.  I wanted to take apart the anesthesia machine in order to understand how it worked but as it was a shadow day, no time for that.  A ticket to that show would have to wait.  The most interesting concepts to me within this case was not only David’s competency but his logical approach to what his patient needed and tolerated during the case, what the physicians needed in terms of space and comfort, and me finding out the anesthesia table did indeed have a sort-of closed circuit system with regard to the respiratory circuit.

During the next cataract removal case David was considering a change in his original plan based upon the amount of deviance from the patients baseline vital signs and the patient’s tolerance to the procedure.  He called to confer with the chief anesthesiologist to conference in on his decision and they quickly decided to use more midazolam in order to provide the patient additional comfort.  In both of these previous cases David asked the patients if they were anxious or worried prior to entering the operating room.  Based upon their answers and his assessment he administered a small dose of midazolam as an anxiolytic prior to surgery.  As I sat in during the second case David continued to allow me ask questions and often elaborated into them displaying a much deeper understanding of medications and physiology that I not only admired like a teenager at my first rock concert, but that I truly craved as a lifelong skill; I did not want our discussions to end.  My top take away here were some text recommendations and David’s description of the stages of anesthesia; anxiolysis, amnesia, analgesia, hypnosis, plus / minus muscled relaxation, and blunting the autonomic response.  I was glad to find out there are a subset of nurses that believe in having a small working library within their possession.   I honestly thought I was of very few that had looked upon my bookshelf as an alter worth every dime invested and much more.  I am currently ordering a text called, “Watchful Care” by M. Bankert.

As an observation, I also noticed the amount of passwords and associated computer based systems David had to use in order to complete his documentation.  Unfortunately I believe this circumstance to be true in a lot of medical facilities.

Our last case of the day was a case that had already started. David took me to an orthopedic case in which a 59-year-old man with schizophrenia had jumped out of an open window and suffered a right tibia-fibula fracture that required surgery in order to facilitate stabilization and healing.  This was a general anesthesia case and the case was nearing an end as we entered the room.  The CRNA there was also a United States military Vet and had been an instructor for David when he was an SRNA.  She gave us a report of the patient’s clinical condition and anesthesia circumstances.  She was very encouraging and engaging with me; she thought best I stay close to David in the small area as he assessed the patient for extubation and what was going on with the anesthetics, monitoring, etc.  I was so amazed at the level of control and respect both CRNA’s displayed for the case.  I wanted to know how he dosed the anesthetic gases and how he monitored it.  He inferred that that level of discussion was not entirely for today but to my amazement he showed me how he could monitor the expired concentration of an anesthetic gas.  That was really cool, along with the BIS, capnography, nitrous oxide / O2 measurements, EKG, respiratory monitoring, constant patient assessment, etc.; I was completely grabbed like the best first date ever.  During the case a new MDA had been participating in the patient’s anesthesia management.  She later joined us and discussed the case thus far, asking a few questions with David she then proceeded to discuss some post-operative plans.  She seemed professional, non-confrontational, and kind in her academic approach.  David expressed a sincere supportive attitude as he spoke to her.  He later told me it was important to remain open and kind; especially to new professionals and those in training.  He said it was a priority that they had good experiences and memories while visiting USC/ LAC Hospital.  I could not agree with him more; as my experiences and memories are just that.  In the post-operative area I was able to see Dr. Jabbour again.  She remembered me from her OB lecture and our brief discussion with Dr. Norris related to indomethacin administration to expecting mothers.

Afterward David escorted me to Kari Cole’s office in order to complete my shadow day.  Kari and I reviewed the key points of my shadow day and discussed some details of the Los Angeles area.  I was able to ask Mrs. Cole and Mr. Godden a few questions related to my candidacy as an applicant to the USC Program of Nurse Anesthesia.  They both provided me with great advice and told me to keep doing what I am doing.  We even had some dialogue and some shared opinions on the future of nursing education and a belief that our baseline as well as advanced practice deserves an academic and professional upgrade.  As a second career nurse this is something I have long believed but could not label.  Due to this experience my confidence as an applicant has grown as well as my confidence within my own abilities as a critical care nurse and knowledge seeker.  It is very exciting to know there are nurses fundamentally practicing and approaching their practice as I do through a continued academic mindset with professionalism and applicable knowledge as priorities.

I am especially grateful for my time with Mrs. Cole and Mr. Godden as well as the administration at the USC Department of Nurse Anesthesia for organizing this experience and meeting with me for advice as I go through my journey to become a nurse anesthetist.

Garrett Kitt, RN, BSN, CCRN

Charge Nurse

Critical Care Transport Nurse

Pediatric Intensive Care Unit

Children’s Hospital Central California

So there you have it.  Go get um Garret.  I will be here for you all the way.

DG

Categories : Anesthesia, Student Life
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Oct
24

Money Issues

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At last I get my wish.  For several years now I have asked my colleague’s to craft a post on what they think is important for candidates to know before they apply to a school of  nurse anesthesia.  It’s been a hard sell.  To be blunt, I have been so busy working and teaching that it has been hard for me to write much as followers here can attest to.  However, there are so many good things happening that I think it is important to pass them along in a more timely manner.  With that in mind, here is what I hope to be another chapter in NurseAnesthetist.org’s future: guest writers.

This past week I received a letter from Nick Angelis, a CRNA and a writer.  He is actively working on a book, “How to Succeed in Anesthesia School.  I’ll let him tell you himself.  While I could nit pick a couple of his points, the overall focus of what Nick is saying is right on.

At what point should you start denying yourself the simple pleasures of four dollar coffee or blowing a hundred bucks every weekend?  When do you really need to start saving?  The truth is, it could take decades to dig yourself out of debt if you don’t take the necessary steps now.  There is absolutely no point in putting yourself and your loved ones through years of essentially monastic living if you’ll still be living paycheck to paycheck with a higher salary once you graduate. As I’m writing this book, student loans are at such low rates that financing your life with them (and skipping the next few rambling paragraphs) is a viable option.  I previously recommended that students pay off their undergraduate loans before starting anesthesia school, but it’s an individual decision.  As much as it depends on you, keep your other debts to a minimum.  For example, don’t make illegitimate children—child support really adds up.  Chronic illnesses tend to be expensive too, although avoiding carcinogens may be more difficult than wearing seatbelts, selling your motorcycle, or resisting the urge to sled down an icy hill on a skateboard.  The last time I had such an urge, I at least had the presence of mind to increase my life and disability insurance first–which is a must if you have a family, once you become a CRNA.

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Categories : Anesthesia, Student Life
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Aug
13

Really More Shadow Days

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The academic year is winding down and the senior SRNA’s are getting ready to graduate while the new incoming students will be arriving soon.  Next week we have a welcoming party for all of the incoming and outgoing students along with their families at the Chief’s house.  It will be a good time to meet the new ones and to congratulate the graduates.

It is a little early to be talking about the Fall season but already the calls for Shadow days has picked up.  Traditionally, the Fall is the time when most prospective candidates that are seeking positions in the nurse anesthesia programs are looking to hone their interview skills and catch that all important Shadow experience.  I have written about this before but feel that the Shadow exposure is really invaluable for those wanting to enter the profession as a nurse anesthetist.  So, what are some of the things that could be learned through this contact with a CRNA in an operating room.  Thats a big topic so lets keep it simple for now.

The Shadow experience is a two way street.  You get out of it only as much as you can bring.  Put another way; what I would teach or explain to a nursing student would be different from the discussion that I would have with a Nurse Practitioner wanting to go back to school to become a nurse anesthetist.  I had the chance last week to precept someone in the OR with a pHd in pharmacology.  Our discussion went back and forth and undoubtedly I learned more than he did during the day.

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Categories : Anesthesia, General
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Sep
30

Recent Comments and Reply

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The first thing that needs to be done is to congratulate the graduating class of 2010 Keck School of Medicine nurse anesthesia graduates from the University of Southern California.  What a great class.  Good luck to all of you.

We all received news today from Sean CRNA (left) that he passed his Board Exams this past week.  How wonderful is that!  After all of the hard work blood sweat and tears to finally reach the Board Exam and pass.  Awesome.  Sean was a very talented student excelling in clinical rotations.  Good luck dude.

Its been a bit since I last sat down to write for the Nurse Anesthetist Org blog.  In the intervening time there have been several comments that some of you have been so gracious to send in.  There have been a few questions too.  Here I will attempt to answer some of the questions that have come in about Nurse Anesthesia.  First, I wanted to start out with a question about general anesthesia asked by Jeff in a comment from the last post.  He asks,

“Any chance you’ll let us in on how accurate the author of last note was regarding the components of anesthesia? And perhaps fill us in on the missing 6th component?”

What Jeff is referring to is what a “Shadow” person wrote as he remembers it concerning the goals of general anesthesia that I tried to impress upon him.  As far as the accuracy of his memory is concerned I make no comment.  The validity of what I teach has often been called into question.  But no matter, you make up your mind.

One of the things that I try to do when having a candidate for any anesthesia program in the OR with me is to try to get them to think about what the goals of general anesthesia are. Spend a couple of minutes to think about it yourself. What would your goals be for someone undergoing general anesthesia?

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Categories : Anesthesia
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Mar
16

New Students in the OR

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It is a new year and a new group of first year SRNA’s are starting in the OR.  Now the “Art and Science” begins.  The end of January starts the clinical rotations for the Students in “The Program”.  After the first four months of didactic theory its hands on time now.

Its one thing to have a book understanding of concepts and basic science theory about anesthesia; it is another matter to deliver anesthesia care for a live breathing patient.  I guess that is what makes what we do so much fun.  The clinical rotations now are in addition to continued class room work.  I want to discuss more about what its like to start clinical rotations but first.

Here is a little digression.

There are basically two types of Nurse Anesthesia programs out there.  There are those that “Front Load” with all of the didactic and class room work up front and then put the clinical rotations at the end.  These programs are usually longer because the clinical applications and specialty rotations take at least 18 months of solid work.  Then there are programs that start some clinical rotations immediately combining class room study and clinical rotations.  The USC approach is to give at least one semester of didactic then start the clinical rotations.  What we have been doing for the past two years now is to expose the new students to the operating room environment through the use of “Shadow” experiences and now “Simulation” during the first semester to ease the transition to the Clinical sites.  This seems to be working really well.

Simulation work is the frontier for learning new skills and crisis training.  There are some programs that have really jumped on the Simulation Bandwagon.  The University of Pittsburgh Nurse Anesthesia program has one of the largest Simulation Laboratories in the country.  I was fortunate to visit their fabulous institution during my search for a program for myself.  Pittsburgh or just plain “PIT” is an awesome program.  Fortunately, we have one of the former clinical professors from Pit now as part of our department.  One of his passions is to get the LAC + USC simulation room up and functional.  We have all the equipment but the whole simulation package here is improving with Lou’s help.  Last month we had an all day event with the first year students in the simulation room.  We all learned a lot about what it takes to make it “real”.  One of the “patients” died during the simulation.  It was real “Art”.

Samuel Merritt University has a simulation center as well.  A couple of our faculty here went up to visit their facility to see how they are progressing in their simulation work.  You can read about Sam’s Health Science Simulation Center here.  Samuel Merritt University is one of the great Nurse Anesthesia programs here in California.  They are our San Francisco cousins, sort of.

First Year Nurse Anesthesia Students in the OR

Combining physiology and pharmacology in a hands on application is what the practice of anesthesia is all about.  I have heard it said that anesthesia is an Art and a Science.  For the first year student nurse anesthetists here at LAC + USC in their first clinical rotation it’s more like Effort and Guidance.  The Art comes later maybe way later.

For me as a clinical instructor, watching the growth of the students over the first several months during their clinical trials is like watching your first born learn to crawl then stand.  Crawl mostly, the standing is a little shaky right now.  The first walking steps with minimal if any assistance will come later in the second year of clinical rotations, hopefully.

Airway management is on every one’s mind and developing the needed skills to maintain an airway is something that takes time effort and practice.  Eventually the skills in assessment improve to the point where surprise is a rare occurrence.  For the First Year SRNA’s, just Hand Mask Ventilation can be a challenge, depending on the patient.  I think its important to note that the students are never left in a position where there is any risk to a patient.  A fully trained licensed CRNA or anesthesiologist is with the patient at all times during the first year of nurse anesthesia training at our institution.

Here is a former USC student during anesthesia training.  He was late to a very early mandatory student meeting.  He was setting up his room when he should have been in conference.  We work them hard.

After passing his board exams recently, Geoff is now part of the USC anesthesia team.  We are glad to have him.

Categories : Anesthesia
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Sep
06

Fall Lecture Series

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Graduation_DayThe 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!

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Categories : Anesthesia, General
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May
21

Do You Have The Fire In The Belly?

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David in OR2Today 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.

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Categories : Anesthesia, General
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Apr
06

Student Nurses Visit the OR

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David_Karyn_ORLast 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.

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Categories : Anesthesia, Student Life
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Feb
24

Jim's Pediatric Sheet Update

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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!

Categories : Anesthesia
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Feb
19

There, I Said It Tells All

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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

Categories : Anesthesia, Student Life
Comments (8)

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