Really More Shadow DaysBy
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.
Most people have no idea of what General Anesthesia is all about. When I ask someone coming into the OR with me what they think the goals of a general anesthetic would be, the common answers are, “Sedation and no pain”. I have to guide them into a better understanding. I ask, “Is a sedated patient awake?”, and the answer usually takes a bit to tease out. So obviously sedation is not part of a general anesthetic but hypnosis is (medical term for sleep). It helps to think in proper terms.
In my taxonomy of general anesthesia I have a list which goes like this: 1) amnesia 2) anxiolysis 3) analgesia 4) hypnosis 5) plus minus muscle relaxation – patient does not move regardless 6) lastly, blunting of the sympathetic response. In the most basic terms General anesthesia produces a patient that does not move and does not remember the procedure. There could be some debate on this which is good. So, the Shadow person has an opportunity to observe this process irrespective of the surgical procedure which is a whole learning experience in itself.
Thats enough out of me. Here is a letter from a recent Shadow person with a couple of my comments which follow.
Thanks again for the shadow experience last Friday. This was just the beginning of my research regarding a CRNA career and finding the right school to provide an excellent education. I thoroughly enjoyed the time I spent observing patient care under anesthesia in the operating room with you and the ease with which you practice. The passion you have for your chosen profession is admirable—very few find that type of satisfaction in life.
After my shadow experience with you, I still have an extremely strong desire to pursue a CRNA career. As I discussed with you during our day together last week, I have always been an ICU nurse for a very particular and important reason. I promised myself to only work in a hospital environment where I am able to thoroughly understand and appropriately monitor my patients. The intensive care unit offers an environment of constant supervision providing a nurse with the proper tools to predict and prevent rapid deterioration in a patient’s status, similar to the culture of the operating room. As observed with you in the OR, I know that CRNAs have a job that offers not only critical thinking & increased autonomy but also an environment that pledges safety for the patient in need of a surgical intervention. The limited knowledge I have surrounding anesthesia was a bit intimidating during my shadow experience but this only makes me more determined to get back into school.
Additionally, I am in search of a culture of people that desire to acquire more understanding and knowledge within their specialty. During my day of observation, I was very impressed with the CRNA clinical instructor’s enthusiasm for teaching as well staying informed on the latest information regarding Nurse Anesthesia practice. Bedside nursing does not demand RNs to seek more knowledge. The status quo is fine and honorable for many nurses. I often find myself frustrated with the lack of complete knowledge I hold as a Bachelor prepared Registered Nurse. I seek the more intimate and comprehensive knowledge surrounding a patient’s pathophysiology and medical diagnosis.
As observed, you understood the patient’s medical history in order to proficiently administer and monitor the person under anesthesia. It is also noted, that there are many anesthesia cases that involve much more complex disease processes and patient care interventions (brun cases). All of this is very exciting and extremely frightening but I cannot imagine life without a challenge. CRNAs are trouble- shooters by nature—both technically and mentally. I would be honored to become a part of this autonomous and enthusiastic nursing profession.
Thanks again for taking a complete stranger under your wing for a day at such late notice. Your flexibility was greatly appreciated. At your recommendation, I have officially signed myself up for the CCRN examination and will be sitting for the test in the very near future. I hope you have a wonderful Summer/Fall and that your wife makes it back to the USA safely.
There you have it. I do have to comment about Libby’s idea of autonomy. I work in an Anesthesia Team practice with Anesthesiology and happen to enjoy the back and forth exchange of ideas. Team is always good. So where does the idea of autonomy come in? No one in the operating room is totally autonomous. All of us from the nurses aids that help bring the patient and the surgical scrub technician as well as the assistant and attending surgeon all work towards a common end. Nursing has a big roll to play as does our surgical colleagues. Anesthesia has its own team as well and we all work together. I will say it again, no one is an island.
I think what Libby was impressed with is the level of practice that CRNA’s have achieved. While there are some States and areas where CRNA’s truly are autonomous that is not what is happening in my practice setting and I do not try to engender that idea. I really don’t want to get any more political than that, period.
Enjoy, and as always, keep the goal in sight.