Real Talk

CowboyMedic, DNP, APRN, CRNA · Oct 28, 2017

As unpopular as it is to say, a big part about training for advanced practice in general and anesthesia in particular is to begin to stop thinking like nurses are trained to think. A complete departure is absolutely required for success. That is so because the move is from waiting for instructions to writing the instructions yourself. Thinking creatively about solving problems that the patient presents is not possible in the Nursing Model.
The vast experience in CC that RNs bring to anesthesia is unique and irreplaceable. That is the basis on which everything else is placed. But a complete paradigm change is required for success.

I like the sound of this. The hardest thing for me when I first went into nursing was the switch from a medical mindset as a paramedic to the holistic mindset of nursing. I love nursing but miss being able to intubate. I'm truly looking forward to CRNA school soon. BTW I love the information in these threads and also Bluebolt's YouTube channel.

CardiacDork, MSN, RN · Oct 30, 2017

Undoubtedly took one of the toughest chemistry professors in the STEM department. Not one person finished their exam. Thankfully he knows his exams are extraordinarily hard and has a second portion that is collaborative. The independent and collaborative are averaged together.

In addition I'm proud to say I have the math down pretty good. I can convert from anything you tell me to do and solve all the problems, unfortunately the dilemma is the sheer volume of questions, with the allotted time. In retrospect, he said this is preparation for profsssional school type exams, which I'm bittersweet thankful for. Ha.

Just gotta keep pushing through this first "easy" phase, gotta get my acceptance letter. I will!

CardiacDork, MSN, RN · Nov 3, 2017

Follow up: I got a 97.10% on my exam!!!!

tigerlogic · Dec 5, 2017

Thank you for your thread, I'm also interested in the question you pose.

I'm nearly 4 years into nursing, first CICU now splitting time between ED and Neuro Trauma ICU. First degree in Biochemistry, later and AcBac BSN. I have a bigger and bigger interest in CRNA but Flight nursing is probably my next move.

The biggest complaints I've heard from other boards is that CRNA wages are pretty stagnant (like all of nursing?) and/or not as much money as people thought.

I worry about being able to sit still and, frankly, too many days being boring-- especially as I'd guess that jobs straight out of school are more likely to be with lower acuity surgeries.

The intellectual depth and problem solving very much appeals, as does not dodging punches. The autonomy and constantly evolving practice and science sounds awesome to my geeky side. The ability to do actually meaningful shorter term (i.e. less than a year) volunteer work with MSF and other international groups, is also a big draw for me.

CardiacDork, MSN, RN · Dec 7, 2017

Thank you for your thread, I'm also interested in the question you pose.
I'm nearly 4 years into nursing, first CICU now splitting time between ED and Neuro Trauma ICU. First degree in Biochemistry, later and AcBac BSN. I have a bigger and bigger interest in CRNA but Flight nursing is probably my next move.
The biggest complaints I've heard from other boards is that CRNA wages are pretty stagnant (like all of nursing?) and/or not as much money as people thought.
I worry about being able to sit still and, frankly, too many days being boring-- especially as I'd guess that jobs straight out of school are more likely to be with lower acuity surgeries.
The intellectual depth and problem solving very much appeals, as does not dodging punches. The autonomy and constantly evolving practice and science sounds awesome to my geeky side. The ability to do actually meaningful shorter term (i.e. less than a year) volunteer work with MSF and other international groups, is also a big draw for me.

I congratulate you on your aspirations. Although only a short while ago since I've posted this, I've recently found that CRNA is not where my heart is. For the better of my own happiness, and my future patients my place is in a role as an NP promoting wellness and health. The ICU has recently really struck a few strings in my soul and has shown me that I want to be involved in the community medicine, preventative medicine, and wellness. I also want to teach nursing students, as I truly love teaching. Kuddos to those that aspire CRNA and support to them however.

Dodongo, APRN, NP · Dec 7, 2017

I congratulate you on your aspirations. Although only a short while ago since I've posted this, I've recently found that CRNA is not where my heart is. For the better of my own happiness, and my future patients my place is in a role as an NP promoting wellness and health. The ICU has recently really struck a few strings in my soul and has shown me that I want to be involved in the community medicine, preventative medicine, and wellness. I also want to teach nursing students, as I truly love teaching. Kuddos to those that aspire CRNA and support to them however.

I think it's awesome you realized this. I know how hard of a decision it is to make. I was hell bent on CRNA, and went to get my BSN and worked in an ICU to make it happen. But I ultimately didn't like the role. 9/10 CRNAs told me they loved being an ICU nurse and wanted to take that role to the next level. I didn't enjoy being an ICU nurse. I wanted to diagnose. To prescribe. I was scared of being relegated to the head of the bed in the OR for the rest of my career. And, I'd be lying if I didn't say the salary discrepancy wasn't a huge factor in the decision. But, the NP role is waaaaaay more suitable for me. But, I had good friends (Physicians, NPs, PAs and nurses) who gave me good advice. And once I got over the initial shock, I was truly satisfied with the decision.

I think a lot of ICU nurses have CRNA on their mind (again, salary is a huge draw). But many/most, once they do a little soul searching, realize that NP, informatics, remaining at the bedside, etc, is a better move for them. CRNA is not the pinnacle of nursing. It's one of many avenues available.

Bluebolt · Dec 8, 2017

I think a lot of ICU nurses have CRNA on their mind (again, salary is a huge draw). But many/most, once they do a little soul searching, realize that NP, informatics, remaining at the bedside, etc, is a better move for them. CRNA is not the pinnacle of nursing. It's one of many avenues available.

Being in CRNA school I feel like I've been slowly taught more and more in a direction that is different from my nursing education background. It took the valuable skills and independent critical thinking I learned as an ICU RN and built upon it in more of a medical model than a typical nursing one. While CRNA still contains the word nurse within it your training is designed for you to be able to work in the same capacity as a physician anesthesiologist independently. In order to do that you must be able to think and practice like they would, which is probably why CRNA programs are so different than all the other APRN programs.

A couple of my doctoral research courses include the nurse practitioners who are on a doctoral track and we have to work on projects with each other, do research, have conversations about topics weekly. There is a very clear difference between the perspectives, mindsets, training and often the professor will remark on it. The NPs are taught with a continuation of a nursing model. Not to mention they get to do a majority of their work online and all work full-time jobs, create their own clinical schedules, etc.

There's nothing wrong with either career path, they are just different.

Dodongo, APRN, NP · Dec 8, 2017

Being in CRNA school I feel like I've been slowly taught more and more in a direction that is different from my nursing education background. It took the valuable skills and independent critical thinking I learned as an ICU RN and built upon it in more of a medical model than a typical nursing one. While CRNA still contains the word nurse within it your training is designed for you to be able to work in the same capacity as a physician anesthesiologist independently. In order to do that you must be able to think and practice like they would, which is probably why CRNA programs are so different than all the other APRN programs.
A couple of my doctoral research courses include the nurse practitioners who are on a doctoral track and we have to work on projects with each other, do research, have conversations about topics weekly. There is a very clear difference between the perspectives, mindsets, training and often the professor will remark on it. The NPs are taught with a continuation of a nursing model. Not to mention they get to do a majority of their work online and all work full-time jobs, create their own clinical schedules, etc.
There's nothing wrong with either career path, they are just different.

And that's great - if the program was what I was going to do for the rest of my life, then I'm sure I would have chosen CRNA. But the school is 2 years out of a lifetime. You need to make a decision on the job, not on the schooling.

I should also probably clarify that in my neck of the woods (SW PA) CRNAs are dependent providers. It is all ACT practices - to the extreme. Anesthesiologists evaluate every patient and develop the anesthetic plan, are present on intubation/induction and on extubation, and actually check in periodically during a case to make sure their plan is being followed. It's a bizarre model. NPs, in many ways have much more autonomy and certainly more laterality in their careers.

It also seems to me, based on this post and other past postings, that you have a hang up about your training in general, especially compared to a physician anesthesiologist. "Independence" means very little. In half of all states NPs are independent and, according to you, their training is way easy compared to CRNA. So, arguing that you are being trained to work "independently" is an irrelevancy, and, I think you'll find that most people (apart from CRNA/NPs) do not equate MD and CRNA training on any level.

No one is arguing that being a CRNA isn't a great gig, because it is. But it's certainly not right for most people. People have varying passions and it's awesome when they find their passions and go for them.

Bluebolt · Dec 8, 2017

It also seems to me, based on this post and other past postings, that you have a hang up about your training in general, especially compared to a physician anesthesiologist. "Independence" means very little. In half of all states NPs are independent and, according to you, their training is way easy compared to CRNA. So, arguing that you are being trained to work "independently" is an irrelevancy, and, I think you'll find that most people (apart from CRNA/NPs) do not equate MD and CRNA training on any level.
No one is arguing that being a CRNA isn't a great gig, because it is. But it's certainly not right for most people. People have varying passions and it's awesome when they find their passions and go for them.

You use the term "hang up" about training in relation to physician anesthesiologists. With a non descript term like that I'm assuming you're referring to talk of the political interference that goes on at some rotation sites with MDAs. You listed a very restrictive anesthesia care team model near your hometown and that would be a prime example of a rotation site that would hinder your training due to the MDAs political power at that facility. Luckily heavily restrictive practices like that are not the norm and most MDAs will tell you CRNAs typically will do whatever plan they want because you are an independent licenced provider in all 50 states. Even when you have an MDA in house you must be capable of interpreting and immediately treating changes in the patient without them there. It's very different to walking out of the patients room, calling your MD you're under and asking his opinion about a diagnosis or prescription and making sure he's cool with it.

Being independent by talking to a patient and writing prescriptions, possibly not even controlled substances depending on the state, is a different animal to performing interscalene blocks, CVLs, spinals/epidurals, difficult intubations and manipulating the hemodynamics of all disease type patients independently. So I think the training that prepares you for independence and autonomy is very important, at least in anesthesia. We may just have a difference of opinion.

Any layperson who is ignorant of the skills and training of CRNAs who would not equate them with MDAs can simply be shown research that shows patients have similar outcomes between the two providers. Then you could inform them that a CRNA is trained and licensed to do everything in anesthesia that an MDA does. If they are still skeptical you could point them in the direction of the many (and increasing) CRNA only anesthesia practices that offer full services of safe anesthesia to their patients. See, it's all just about simple education for our patients and layperson.

I have many friends that are NPs and would love to see great strides of improvement and advancement in the education and career field. I get the sense from your comments that you're feeling defensive. You won't be the first or the last NP (student) to get defensive when talking about the differences in training, education, autonomy or pay in relation to CRNAs. I suppose I'll learn as the experienced CRNAs already have to just keep quiet and nod my head in these types of conversations.

Good luck with your education and I wish you the best.

Dodongo, APRN, NP · Dec 8, 2017

You use the term "hang up" about training in relation to physician anesthesiologists. With a non descript term like that I'm assuming you're referring to talk of the political interference that goes on at some rotation sites with MDAs. You listed a very restrictive anesthesia care team model near your hometown and that would be a prime example of a rotation site that would hinder your training due to the MDAs political power at that facility. Luckily heavily restrictive practices like that are not the norm and most MDAs will tell you CRNAs typically will do whatever plan they want because you are an independent licenced provider in all 50 states. Even when you have an MDA in house you must be capable of interpreting and immediately treating changes in the patient without them there. It's very different to walking out of the patients room, calling your MD you're under and asking his opinion about a diagnosis or prescription and making sure he's cool with it.
Being independent by talking to a patient and writing prescriptions, possibly not even controlled substances depending on the state, is a different animal to performing interscalene blocks, CVLs, spinals/epidurals, difficult intubations and manipulating the hemodynamics of all disease type patients independently. So I think the training that prepares you for independence and autonomy is very important, at least in anesthesia. We may just have a difference of opinion.
Any layperson who is ignorant of the skills and training of CRNAs who would not equate them with MDAs can simply be shown research that shows patients have similar outcomes between the two providers. Then you could inform them that a CRNA is trained and licensed to do everything in anesthesia that an MDA does. If they are still skeptical you could point them in the direction of the many (and increasing) CRNA only anesthesia practices that offer full services of safe anesthesia to their patients. See, it's all just about simple education for our patients and layperson.
I have many friends that are NPs and would love to see great strides of improvement and advancement in the education and career field. I get the sense from your comments that you're feeling defensive. You won't be the first or the last NP (student) to get defensive when talking about the differences in training, education, autonomy or pay in relation to CRNAs. I suppose I'll learn as the experienced CRNAs already have to just keep quiet and nod my head in these types of conversations.
Good luck with your education and I wish you the best.

Look, you can attempt to equate CRNA training to Anesthesiologist training all you want. They are not the same. Nor is CRNA independence similar to Anesthesiologist independence. The vast majority of CRNAs practice within ACT models. There are varying degrees of restriction/independence, sure. But all anesthesiologists are independent. Anesthesiologists can supervise CRNAs. CRNAs cant supervise/don't need to supervise anesthesiologists.

The training model I described is not limited to my facility/system. It is regional. I have a couple close relatives who are CRNAs and have worked for all the major systems here - this area has many large systems - and the practice is restricted. There are also multiple CRNA training programs that do not train their students to be independent. If a student wants any autonomous CRNA practice they have to arrange a clinical elsewhere. Again, the vast majority of CRNAs practice in varying degrees of ACT models.

I'm certainly not arguing that NP education is as rigorous as CRNA. That's obvious to anyone I think. You took your response in that direction. But I am arguing that CRNA training is nowhere near as rigorous as MD. Further, my main point was, as a job, anesthesia is definitely not for everyone, and as a CRNA you are stuck doing anesthesia. You have to be ok with that. I was not. I need options. CRNA can be a great career. But so can NP, administration, informatics etc. The training is different as is the job. And the job is 100% more important.

Dodongo, APRN, NP · Dec 8, 2017

I get the sense from your comments that you're feeling defensive. You won't be the first or the last NP (student) to get defensive when talking about the differences in training, education, autonomy or pay in relation to CRNAs. I suppose I'll learn as the experienced CRNAs already have to just keep quiet and nod my head in these types of conversations.

Haha. I really just read this part. I think you should read through some of my other posts on this site to see how I truly feel about NP education. I don't know what I said to make you think I was defensive about the disparities in education because I'm an enormous critic of NP education.

Could it be that you were trying to redirect from your own defensiveness? Because I've go e through a lot of your posts and it's obvious you want CRNA to be seen as equal to physician.

Bluebolt · Dec 8, 2017

Haha. I really just read this part. I think you should read through some of my other posts on this site to see how I truly feel about NP education. I don't know what I said to make you think I was defensive about the disparities in education because I'm an enormous critic of NP education.
Could it be that you were trying to redirect from your own defensiveness? Because I've go e through a lot of your posts and it's obvious you want CRNA to be seen as equal to physician.

Of course. You don't come off defensive then. Like I said earlier, I'm learning why people in anesthesia just nod their heads and stay quiet when it comes to these conversations. I wish you the best.