To Kevin and other students and practicing CRNAs

kmchugh · Nov 25, 2002

Peeps

Quick answer. Yes, there is a much more scientific "mind set" to CRNA programs. There HAS to be. CRNA programs are heavy into pharmacology, physiology, pathophysiology, chemistry, physics, anatomy, and other sciences that concern the physical (as opposed to mental) being. Everything we do has a huge impact on normal physiological function, and every medication or herbal preparation patients take at home have some impact on the course of surgery. We must have knowledge of it all.

In the program I attended, there were no classes on the "psychosocial effect of anesthesia" or nursing theory. The program I attended, however, does not grant an MSN, but rather an MSNA. Since it is not a "nursing" degree (it is a "nursing anesthesia" degree), there aren't requirements for these courses. As you have figured out, there is a place for understanding psychology and lifespan development in nursing. But, it appears that you agree with me that it has been given far too much weight, to the point that nursing students' understanding of the physical sciences I mentioned earlier is often woefully inadequate. What happened today at work is a great example. A patient was scheduled for surgery, so he checked into the hospital, and was sent to the appropriate floor for prep. On arrival to the floor, he told the nurse he was having chest pain. The nurse had an EKG done (as per our anesthesia group standing orders for pre op), but did nothing else. At the appropriate time, the patient was sent to pre-op holding in the care of a transport clerk. Not an RN, not even a CNA, a transporter. I happened to be there when he arrived, and the transporter mentioned that the RN upstairs had said something about chest pain. When I asked the patient about it, he said it felt like someone was sitting on his chest, just like it felt when he had THREE previous heart attacks. I promptly put the patient on monitors, started an IV, gave the man sublingual NTG, and started an art line. Chest pain partially (but not fully) relieved by NTG and morphine. Had the anesthesiologist paged. Canceled the TURP, and sent the patient to CCU for cardiology work up. I half expect he will be on tomorrow's surgery schedule, but for open heart surgery, rather than a TURP. The RN on the floor should have caught this, the patient should have been monitored much earlier, and the patient should have never come to pre-op. Perhaps had her understanding of physiology and pathophysiology been better, the patient would have been better cared for. Who knows.

Kevin McHugh

l.rae · Nov 25, 2002

Kevin, the above mentioned situation is very troubling coming from my perspective as an ER nurse....Makes me wonder, a MD surely must have been consulted and looked at the EKG?... and released the pt for surg w/o further work up?..but l can say with this man's hx, l would never have sent him to OR with a transporter....l also wonder about the level of exp of the nurse....scarey, but that is another thread.

Just want to say that l too have a hard time with the touchy/feely philosophy of nursing that bloats a lot of cirruculum, and this hasbeen one of the reasons l have deferred getting my BSN...and now in my 40's, wishing l had that stepping stone to move on up. l had a strong over all GPA, probably could get into advanced programs without a problem.....now l just think how old l will be when l am finished, and primarily, now that l am older it would be harder to make that financial sacrifice.....so PeepsMc....from my perspective l would encourage you to suffer through the courses and try to keep your gpa up...l had a harder time making the grade with courses that bored me (such as the ones you mention) than l did in chem and A&P etc...so l can relate......can't get over the feeling l have waited too late now....don't you do the same....good luck...........LR

Peeps Mcarthur · Nov 25, 2002

Kevin,

That's a reassuring fact that the degree granted is not an MSN, but rather, MSNA. It seems as if I've found a usefulness for all this psych stuff. I'll just think of it as a pathway to travel through and not a preparation for practice. I don't find much of it to be practical to day to day practice. I looked at some school sites for Maryland and was very pleased to find that one of the first classes is Gross Anatomy:D .........That was one of the many disappointments about my nursing classes. Cat cadavers, pig hearts, sheep brains, and yes, the rat:o . I loved anatomy, so much that I completed an honors class in it for Anatomy II. I always wondered what human anatomy really looked like, but could only try to visualize it by placing the organs according to skeletal landmarks, since the only human anatomy in the lab was a box of bones.

The example of the nurse that whiffed on the chest pain is just the tip of the iceberg I'm sure. That EKG was filed according to protocol and the pre-op checklist was all checked off. The patients psychosocial needs were met with reassurance about the procedure and having him repeat the post-op goals. The pt was made comfortable and his religion was noted or some other garbage like that. There he was with hallmark subjective symptoms for angina ready to code being wheeled away with a transport tech. :rolleyes:

Your story reminded me of a situation where I ended up intubating a pt as a respiratory tech. I made the observation. I got the blood gas to assess his status(pt was not oriented) and finally ended up intubating him. We had standing protocols at our discretion for just such an occurence on noc shift. The nurses had more years of school than we did, but we had almost nothing but critical thinking skills, Anatomy, and physiology. We were not much more trained than that.

Peeps Mcarthur · Nov 25, 2002

Irae,

I'm 41 y/o. I know what you mean about the financial sacrifice. I was comfortable with my income and now I'm screwing it all up with all the missed income and tuition..etc. I look at it as fulfilling my destiny. I was comfortable financialy, but not personaly, so I'm going to keep seeking that and I hope I've found it.

Brenna's Dad · Nov 25, 2002

I agree with you Kevin, that the floor nurse should have been able to recognize these symptoms and treat the patient accordingly. Perhaps a lack of focus on medical science is a contributor to his/her negligence.

However, I worked on the floors for about a year-and-a-half before going back to school and focusing on critical care. I believe the biggest contributor to the lack of action and lack of critical thinking rampant in the nursing "profession," is caused more by the lack of autonomy given to nursing as a whole. This lack of autonomy causes stagnation in both clinical practice and education.

For example, yesterday at work a colleague pointed out that they needed a Doctor's order to give a Dulcolox suppository to their patient. She could override any manner of emergency drugs from the pyxis, titrate vasoactive and potentially lethal gtts at her discretion, defibrillate if a pt went into VT, but a Dulcolax supp was out of the question. Just think of the ramifications if nurses administered Dulcolax independently. (Perhaps the hospital environment would be filled with far less stool.)

The point I am trying to make, is that because of this lack of autonomy, nurses neither learn to, nor are encouraged to make decisions, especially if involving medicine. Indeed, nurses are educated to follow orders and for many this is as far their clinical practice takes them. It is only after leaving school that some recognize the ridiculousness of this proposition.

And Peeps, Nursing school is a means to an end. It is a shame that it doesn't live up to its potential. But focus on maintaining the GPA.

nilepoc · Nov 26, 2002

Peeps, Thanks for the compliment on the blog. I love doing it, but do not always have time for it. But when I do write, I find it very cathartic for me. Anyway

You wil find that the world of CRNA education is much more scientific than the world of the pre graduate school RN world. Anyway, good luck in your quest, and stick with it. If you continue to read my blog, you will see my views on this topic.

Craig

Peeps Mcarthur · Nov 26, 2002

Brenna'sdad,

That's a good point. I think the situation I found myself in as a CRTT and having to take charge to save a pt that was CTD was a combination of nurses bound both by scope of practice guidelines, and the policy's like the one for the suppository you mentioned.

Taught not to think in any medical way whatsoever, only allowed to memorize algorythms for ACLS and be in charge for one glorious megacode..........whoopdeedoo :rolleyes:

I will hang in there, thanks for the encouragement. When I do enter practice it will be in an ICU so I don't end up like that. I'm afraid of losing that medical side of me.

I think I may shadow during the winter break to see where I'm headed and stay focused.

Peeps Mcarthur · Nov 26, 2002

Nilepoc,

When I go to the blog, I lose track of time.............not good for the GPA, but good for a break when I need it..........which is often now:rolleyes:

MICU RN · Nov 26, 2002

Peeps:

Hang in there, although I am not a crna or srna yet, I know I needed to hear the comments that were posted in regards to your question. I also often wonder if it is worth it as I go down this journey to become a crna and if being a crna will be much better than a RN? I have been a RN for 4 1/2 years and am finally going to receive my BSN this semester, I will then be applying for anest. school in the fall of 2003. I still need to take the MAT or GRE and a grad. stat. course in the spring. I have been lucky in the sense that I have gained some good experience working in teaching hospitals, but have regreted not going the MD route many times. Bedside nursing can be very frustrating to say the least and many times I can't stand it. However, I often get recharged when I hear others who have went this path share their experiences. My only advice would be to go right into the ICU and then start the shortest RN/BSN program you can find. This may sound obvious, but based on my experience most people who get an ADN don't go back and get their BSN eventhough many state that they plan on becoming crna's and even MD's. As a matter of fact, if I had a dollar for each one I have met I would rich. Also, try to get yourself on a strict budget avoid big car notes and house notes this is the other major reason most don't go back to school they have created too many bills. Good luck!!!!!!!!!

l.rae · Nov 26, 2002

Peeps, l am not trying to hijack your thread or anything, but l have noticed that when it comes to topics in this forum.....it's strictly, uh....testosterone?...LOL.....where are the females in this area of practice?.....oh if l were younger!...good luck to you peeps!....LR

nilepoc · Nov 26, 2002

Currently, our instructors are saying that more than 50% of CRNA's are male. Unlike regular nursing where only 6% of the population are male. Also, males are usually more technologically oriented, and would have the drive to seek out this type of forum. So I am guessing this is why you are seeing so many men. Like medicine, I would predict that those ratios will change to include more women, as more than half of my class is female.

Craig