New Students in the OR


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


  1. Hugh Adair says:

    Please keep the posts coming; they are definite fuel for the “Fire in the Belly”!

    Thanks, Hugh

  2. David says:

    Hugh, Keep studying and eye on the goal.

  3. Sarah says:

    Congrats to Geoff on joining your team.

    I am just a registered nurse, but if I ever go back to school it would be a tough choice between going for a nurse anesthetist or a nurse practitioner.

    I think I would be the type to get stressed if a patient started coding or something though lol.

  4. Jenn says:

    Hi David I have a question or 2 for you!

    I graduated from an ASN program in Dec 2009 and have been working as a med-surg RN since at a very small (25 bed) rural Iowa hospital. I also have a BS in Interdisciplinary Sciences emphasizing psych, sociology and biological sciences. I have all the prereqs and general ed/support courses for a BSN finished from my first degree, have the nursing license. What I really want to do is be a CRNA.

    I am wondering what your recommendations would be as far as 2 things are considered:

    1) RN work experience- I know I need critical care experience to even apply to a CRNA program and I am applying to every ICU position I find. In the meantime however, are there any other areas of nursing that are more beneficial than others in preparing for a CRNA program or areas that would increase my chances of being hired in an ICU role?

    2) I know there are programs that require a BSN and ones that just require any BS degree and an RN license…is it worth it to do the RN to BSN completion before starting a CRNA program?

    Any other tips you would have for a fledgling RN trying to navigate the best course to the promised land of anesthesia are greatly appreciated!


  5. Shell says:

    Hi.. I am a filipino nurse assigned in the OR for 6months now..
    Since I am assigned there, I have become interested with anesthesia and thought of becoming a nurse anesthetist.
    I am actually gathering some requirements in order to study BSN again in australia.
    Is there anyone who could help me find my own path in becoming a nurse anesthetist?
    I don’t know where I should start and when.. I’m not even sure if my experience
    In OR is enough already or if I really still need some experience in ICU.. I’m glad I’ve
    Found this site. Thank you.

  6. smith says:

    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.

  7. Annette Shannon Smith, CRNA says:

    CRNA programs are definitely very demanding and tough, but worth every drop of the sweat and tears! A strong ICU foundation is extremely helpful.

  8. Rose Hozanna says:

    Hi my name is Rose Im a current student at Florida A&M University and Im majoring in Respiratory therapy.I had a chance to be in the OR and worked with an CRNA for the first time a month ago. Im very interested of becoming an anesthesiologist assistant. I just need more advice about this new field that I am about to inter.

  9. David says:

    Florida has different laws which I am not familiar with.

    Here is a quote from Wikipedia
    In the United States, anesthesiologist assistants (AAs) are graduate-level trained specialists who have undertaken specialized education and training to provide anesthesia care under the direction of an anesthesiologist. AAs typically hold a masters degree and practice under anesthesiologist supervision in 18 states and the District of Columbia through licensing, certification or physician delegation.


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