Aug
13

Really More Shadow Days

By

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.

Dear David,

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.

Sincerely,

Libby Patton

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.

Categories : Anesthesia, General

Comments

  1. Brooke says:

    Great post. Never thought about shadowing but I think I’ll look into it now.

  2. JC Jones says:

    Dear David,

    I have been referring to this blog for some time now. I don’t know you, but I wanted to thank you for the time you spend posting this invaluable information. I graduated from an accelerated Bacc2 program in Galveston, TX in 2010. I have always had an open mind to the various possibilities in nursing, more specifically an advanced practice role. I absolutely love my job in the SICU at a level-one trauma facility and if I didn’t have this innate aspiration to advance my education and my families welfare, I’d stay there forever! I’ve looked into both NP roles and CRNA and can’t help the strong desire I have towards pursuing anesthesia. I took your advice and read Marianne Bankert’s “Watchful Care” (Fantastic!). I also utilize Paul Marino’s “The ICU Book,” amongst others, in my current practice in the ICU to help me better understand findings and possible interventions in patient care.

    Shadowing and conversing with numerous CRNA’s, I can honestly say I have never met one that didn’t say, “It was the best career choice I have ever made.” As much as I want to engulf myself in anesthesia readings, for the mere curiosity and infatuation with it, I try to stay on track with my ICU readings in order to strive for perfection in my care. I am inexperienced compared to my rivals but love the challenge of a fresh heart or setting up for a bedside ventric that’s being life-flighted in.

    I know I’ve rambled on a bit, but I wanted to share a little about myself and mainly just thank you for the inspiration and recommendations you’ve provided in your blog.

    Thank You David!

    JC Jones
    (Aspiring CRNA)

  3. Jag says:

    Thats awesome! Can’t wait for that moment to come. Still got some way to go!! Good luck!

  4. smith says:

    Shadowing and conversing with numerous CRNA’s, I can honestly say I have never met one that didn’t say, “It was the best career choice I have ever made.” As much as I want to engulf myself in anesthesia readings, for the mere curiosity and infatuation with it, I try to stay on track with my ICU readings in order to strive for perfection in my care. I am inexperienced compared to my rivals but love the challenge of a fresh heart or setting up for a bedside ventric that’s being life-flighted in.

  5. Annette Shannon Smith, CRNA says:

    Shadowing is the way to go! I shadowed a Nurse Practitioner for a day, then shadowed a CRNA… with my 12 years of ICU experience… I knew immediately becoming an anesthetist was a perfect fit for me. I recommend to anyone that is considering putting all the time and money into graduate school, definitely shadow for a few days to be sure. Pursue your dreams!

  6. Briana Smith says:

    I was wondering if anyone knew how to get in touch with a CRNA for a shadow opportunity. I have 4 years ER and 6 months ICU experience but my hospital does not employ CRNA’s in San Diego and I am having a hard time getting approval from other facilities.

  7. pam says:

    Do you allow non USC employees to shadow you?

  8. Hugh Adair says:

    Even though my shadow experience was back in September of 2009, I can recall the details as though it was just yesterday. I believe the shadow experience to be invaluable and a must for anyone considering the journey to becoming a CRNA. I am extremely grateful to David Godden for granting my request to shadow him at LAC USC. The fire for me is still burning. At the time I shadowed Mr. Godden, I had newly entered nursing as a second career nurse in an accelerated Masters program. I am proud to say that I am now working as an RN in an ICU, gaining valuable experience daily. Currently, I am on track to graduate with my MSN in July. I will continue working for one additional year to gain further ICU experience before I start applying to schools. I am as inspired today as I was back in 2009 and I often recall my day spent at LAC USC. Thank you once again David for being so gracious in your willingness to shadow those interested and thanks also for continuing to maintain this invaluable website. Regards,
    Hugh Adair – aka “Red Blanket, What’s a Red Blanket?”

  9. David Roy says:

    Hugh,

    I too remember, and you have come so far. Please do not short change yourself on the experience you will NEED in caring for patients in the ICU. We see too many that think that one year of ICU experience is enough and start applying to programs to become a CRNA. Some may be successful with one or two years of ICU experience at a teaching hospital but MOST will not. What is your goal. Focus on that.

    Again, be patient and attend to the goal which is excellence in clinical practice as a CRNA. So, place yourself in learning opportunities that will teach you the assessment skills and practice excellence. Keep in school and learning more science while you work. Take one class a semester after you graduate in advance chemistry and physics. Stretch yourself a bit. If necessary get a masters degree before applying.

    The thing I look for as a minimum is the CCRN certification. For an ICU nurse that has been working for a couple of years and has not even thought of taking the CCRN and is now applying to a CRNA program………what a joke. Do you think I will look kindly on them? NO.

    Keep it up and you will get to the place where you will be running the “Red Blanket”.

    All the best Hugh from DG

Leave a Reply

Feedburner

Enter your email address:

Delivered by FeedBurner

website security