Feb
19

There, I Said It Tells All

By

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

  1. David Godden says:

    CG you are awesome!

  2. Olivia says:

    I just started to work in ICU at a local VA hospital almost three months ago, with the goal to enter CRNA school within one year. I am thankful for the intensive training the VA system offers its employees but, knowing what I know now, which is little more than when I started, has helped me realize how much more I have to learn. After reading your article, I asked myself whether the knowledge and the experience I have gained in this last three months x 3, would be enough to prepare me to the task. Somehow I highly doubt it.

  3. David Godden says:

    Olivia,

    Do not let any thing deter your from your dreams. Hang in there and keep moving toward your goals is the best advice I can give you. Is it possible to be very successful with one year of clinical experience in critical care and then to go on to anesthesia training? The answer is yes for the right person. Remember that this is the minimum experience that is required by the AANA and “There I Said It” only is saying that for some this is not enough. Of course you see her logic is sound.

    All I can say is that for you – stay focused and motivated to pursue your dream. Do not let anything distract you from your goals and you too may be able to carry the CRNA tradition forward. The best of luck to you but most of all I wish you determination and persistence, which is what gets the job done.

  4. jmackie says:

    9 Months In
    I feel the need to reply to this old thread because it resonates with me. I am enjoying (i.e. surviving) my 9th month of a 33 month anesthesia program. I was accepted into more than one program after working nearly 3 years in acute care, including cardiac recovery. The words written above are true: a year is often not enough. In other words, if an applicant has the drive to only meet minimal requirements, they will probably struggle as a SRNA. This struggle is also a burden for instructors, patients, surgeons and staff.

    What I might confess, however, is that 5 years of acute care experience may not be enough to facilitate a smooth and safe transition from RN to CRNA. There is a dramatic leap in knowledge and responsibility from one to the other. I’ve assisted with dozens of rapid sequence intubations, but could not stop my hand from shaking during the first dozen of my own. Intubation is just a basic skill (not meant lightly), whereas volumes of compounding information must be committed to memory and practice. After a few months the shaking shifts to visceral organs, usually hidden to the outside environment. My only hope at this point, and i am very confident in myself and my instructors, is that 33 months of struggle will pay off – and i do not mean financially.

    To be straight, a year may be enough for somebody else. You must search and know your capacities for stress, learning, and interpersonal relationships. All of my preceptors are great. They all do things a little bit different from one another. They all want me to perform the delivery of anesthesia in their way (even if they say otherwise). All are detail oriented. All of them perform anesthesia at the highest level. Given these conditions, an SRNA can expect to feel the pains of being moulded and transformed into an astute clinician. I am most grateful for these aches.

  5. Charles G says:

    TISI took the words right outa my mouth. I knew this back in my training days in the early 90’s. The AANA will never change this reqirement because it facilitates more warm bodies at the head of the table. Now what the aana has created is a total lack of credibility when they froth at the mouth at how AA’s are unqualified to do anesthesia. What a crock. The asa will take that assertion apart limb by limb and use it to validate their own claims about CRNAs. Thank you AANA!!!!!

  6. Kendra R says:

    I am currently a student in the process of going from ADN to BSN in order to apply for CRNA school. I had the unusual opportunity to start in the ER and have been there for 2 going on 3 years as an RN (I was there for 3 years before that as a PCT). I am now transferring to the ICU because the school I intend to apply for does not consider ER a critical care area. Nor does it consider flight or PACU critical care. I can understand this because there is no other area or specialty that gives the type of experience that ICU does. I have to say that TISI is probably right. I can honestly say I’ve probably been through more than a hundred codes, and probably thirty or more level 1 traumas (I do not work in a level 1 trauma center).

    Our ER staff work very well together, communicating sometimes without words…its a special team when you can say to someone “give me that thingy” and they hand you what you want from a pile of “thingies”. Sometimes you just loose your words when you’re in a hurry. Most of us can hand our doctors what they need before they ask for it, knowing each doctor’s preferences. My point is that we have certainly developed the necessary interpersonal relationships.

    I can honestly say, though, that I’m never going to be bold enough to say that I heave “enough” experience in anything. I think more will always benefit, but that is how I feel about experience for me. As jmackie said, its a huge leap of knowledge and experience. I am hoping that CRNA schools are able to “weed out” those students who are truly not fit for the role of CRNA, or who are not yet ready for the field. I can honestly say it would hurt to be told I didn’t have the knowledge necessary to continue in a CRNA program, but I would appreciate not sinking myself eyeball deep in a situation where I can’t handle the situation and someone’s life depends on my insufficient knowledge, skill and experience.

    I think moving forward and doing one’s best is the most logical thing to do. If you want to be a Nurse Anesthetist, then go for it. There is always a chance that you’ll find its not for you, but you won’t know if you don’t try.

    These are the things I try to remember as I move forward toward my goals.

  7. Dan Belcher says:

    My only question is, why are AA’s so superior to CRNA applicants? The AA programs require Zero experience, yet they produce class after class of competent practitioners. What is the difference??? Are AA programs just much better?

  8. josh says:

    I couldn’t agree more. moving on.

    I do have a question about admission to a program as well as performance post grad from a CRNA program. Currently, i am working as a flight RN with 6 years rotor flight experience. prior to that, I worked as an ED/trauma RN at a level I trauma/burn center. Im looking into CRNA school (of course) and I’m curious if my experience is enough to 1) be a quality applicant and 2) to be a good CRNA. I would never want to be a marginal CRNA. (i just don’t work that way)

    I have an opportunity to continue flying for a new (to me) ICU heavy flight program and possibly pick up some per diem ICU work.

    thoughts?

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