Travel CRNA opportunities for new grads-Realistic?

[allapeyre]

Is it realistic for a new crna to consider travel assignments/contracts? If so, what extra skills or experience should this person possess? Who are the best travel agencys to work for?

ALL:)

[WntrMute2]

I really have no complaints about the supervison level at my hospital but, it is interesting that we have to wait for the docs to supervise placing a SAB in the OR but we are expected to place epidurals without any supervision 24/7 in OB. I'm not really complaining but it does raise questions.

[Gotosleepy]

interesting point from deepz:

deepz's recurrent point is that CRNA=MDA, however, now deepz is telling us that a CRNA needs polishing prior to going for a locum - whereas locums are actually not a big deal for MDs fresh out of residency. Maybe there is a reason why some CRNAs should be supervised (especially those new grads fresh out of CRNA-school who have seen 1 lung transplant and then declare that they can not only do anything an MDA can, but also could do a lung transplant without difficulty). re: 3pm the IQ of CRNAs goes up... actually it never changes (in general most CRNAs have pretty high IQs to begin with)...

for the original poster: i agree with loisane, you will be thrown into many new environments with little time to adjust - so very similar to Nurse Travel jobs, you need to have enough experience to adjust to new environments and new situations quickly. One of the better companies doing locum tenens is locumtenens.com - search under CRNA posts. And also if you do eventually go through with it, just remember that you always have the upper hand in your negotiations (you are in demand)... Be a diva, request a rental-BMW instead of the rental-Chevy, request leather furniture in the rental apt... etc. Usually they give you what you want. Skill sets: primarily as a locum they are not going to give you very complicated cases from the get-go (primarily as the surgeons would prefer to work with people they know for the tougher cases), but you should definitely feel very comfortable with airway management and line placements (unfortunately that is how you will be judged in your first week). I have worked with several locum CRNAs in my short career, and the best were those who weren't cocky and would ask for help/advice on a regular basis (pre-emption is better than getting stuck in a bad situation and looking helpless)

[Gotosleepy]

interesting point from deepz:

deepz's recurrent point is that CRNA=MDA, however, now deepz is telling us that a CRNA needs polishing prior to going for a locum - whereas locums are actually not a big deal for MDs fresh out of residency. Maybe there is a reason why some CRNAs should be supervised (especially those new grads fresh out of CRNA-school who have seen 1 lung transplant and then declare that they can not only do anything an MDA can, but also could do a lung transplant without difficulty). re: 3pm the IQ of CRNAs goes up... actually it never changes (in general most CRNAs have pretty high IQs to begin with)...

for the original poster: i agree with loisane, you will be thrown into many new environments with little time to adjust - so very similar to Nurse Travel jobs, you need to have enough experience to adjust to new environments and new situations quickly. One of the better companies doing locum tenens is locumtenens.com - search under CRNA posts. And also if you do eventually go through with it, just remember that you always have the upper hand in your negotiations (you are in demand)... Be a diva, request a rental-BMW instead of the rental-Chevy, request leather furniture in the rental apt... etc. Usually they give you what you want. Skill sets: primarily as a locum they are not going to give you very complicated cases from the get-go (primarily as the surgeons would prefer to work with people they know for the tougher cases), but you should definitely feel very comfortable with airway management and line placements (unfortunately that is how you will be judged in your first week). I have worked with several locum CRNAs in my short career, and the best were those who weren't cocky and would ask for help/advice on a regular basis (pre-emption is better than getting stuck in a bad situation and looking helpless)

[gaspassah]

for go to sleepy, i am currently training in a hospital that also trains mda's. there arent any lung transplants going on there. are you suggesting mda's fresh out of residency are proficient at lung transplants even if they havent seen one?

i think every anesthesia provider needs some growth after residency or school prior to trying to work independantly. noone has seen or done it all right out of training.

d

[gaspassah]

for go to sleepy, i am currently training in a hospital that also trains mda's. there arent any lung transplants going on there. are you suggesting mda's fresh out of residency are proficient at lung transplants even if they havent seen one?

i think every anesthesia provider needs some growth after residency or school prior to trying to work independantly. noone has seen or done it all right out of training.

d

[deepz]

deepz's recurrent point is that CRNA=MDA

Where did I say that? I explicitly say that we are not peers, CRNAs and MDAs; we are colleagues in this profession of putting folks to sleep. No more 'equals' than are those poor deluded AAs who call themselves anesthetists.

....now deepz is telling us that a CRNA needs polishing prior to going for a locum - whereas locums are actually not a big deal for MDs fresh out of residency. Maybe there is a reason why some CRNAs should be supervised .......

Wow. 'Locums is not a big deal for MDs fresh out of residency.' There you have it: the bone-headed arrogance that gets so many docs in big trouble. But of course it's not really the docs deep in trouble -- they don't pay the consequences; it is their patients who suffer. And yes, GoTo, there are MANY anesthesiologists whose lack of wisdom indicates they need stupervision.

JMHO

deepz

[Gotosleepy]

you are right deepz... we aren't peers, we are colleagues. and i don't know what is wrong with calling an AA an anesthetist. They get about as much Anesthesia experience in AA school as a SRNA gets in CRNA school.

you can call my statement boneheaded arrogance.... Or you can call locum tenens companies and ask them what percentage of their hires for MDAs are straight out of residency. In fact, most of their hires are straight out of residency (because that is when MDs are most mobile - way before they settle down into a financial partnership). Then ask them what percentage of their CRNA hires are straight out of CRNA school... you'd be surprised. So am i being arrogant? or are all of these locum tenens companies putting patients lives at risk (as you suggest).

[georgia_aa]

you are right deepz... we aren't peers, we are colleagues. and i don't know what is wrong with calling an AA an anesthetist. They get about as much Anesthesia experience in AA school as a SRNA gets in CRNA school.

Actually, the minimum number of clinical hours for AA's is 2615 which is more than the majority of CRNA programs.

[deepz]

you are right deepz...

Of course I am.

Try this from MedScape for a perspective on arrogance. Note particularly the next to last sentence of the next to last paragraph of Dr Egan's column.

"Learning Experiences

Daniel Egan, MD

As I think about what topics I will cover in my column each month, it strikes me that frequently what comes to mind are not incredibly positive experiences. I suppose that one could argue all of the experiences I am having in residency are, on the whole, positive in that they are helping to shape me as a physician. However, more often than not, I recall times when patients did not do well or, in my opinion, when I did not do well as a resident. My recent trip back to the intensive care unit provided me with a ready story that served to confirm these judgments.

The past month has been slightly complicated for me. I wrote about my father's MI several months ago. The end result of that incident was an anticipated CABG that occurred 3 weeks ago. Since my father's heart attack, my brother has been deployed to Iraq as a member of the Army. I felt that my presence at home during this time was even more important because of his absence.

My father sailed through the operation itself, but my mother and I received the phone call in the surgical waiting room less than 3 hours after the procedure began informing us that the doctor was coming up to talk to us. The doctor, we were told, was on his way. I commented to my mom on how weird that phrase sounded to me since I suppose many people probably tell their family members what "the doctor" -- meaning me - told them about their loved one.

A very brief interaction with the cardiac surgeon followed, and we were taken shortly thereafter into the ICU to visit my father. That is, to visit my intubated father, who was hooked up to a Swan Ganz catheter, low doses of pressors, and multiple intravenous lines. My instincts were to check out the contents of what was hanging in each bag, look at the tracings on the monitor, and check his urine output. Suddenly, it hit me that at that point I was "son," not "doctor."

I was struck again by that reality when, after spending the day at the hospital, my mother and I went home only to receive the dreaded phone call. The surgeon called to say they were taking my dad back to the OR because of bleeding from his chest tube, and suggested that we "come back to the hospital." How often had I told families that they should come to the hospital without knowing that those same words soon would haunt me? Thankfully, the source of his bleeding was nothing serious and he pulled through the second procedure just fine.

Two days after my dad was out of the surgical ICU (SICU), I returned back to Boston to begin my delayed start in the SICU. Technically, it is the trauma/burn ICU, although historically it has been called the SICU even though there is one with a separate resident team next door. I began my call on a Sunday, a weekend day with minimal staff around. Arriving at 7AM, my stomach sank as I realized that a full 29 hours lay ahead of me.

Apart from my father's stay in the SICU, I had not been in an intensive care unit for quite some time. We take care of critically ill patients all the time in the ED, but their long-term management is different, requiring frequent ventilator adjustments and medications that I do not work with very often. The beauty of this rotation (interpret this both literally and sarcastically) is that we are alone in the 10-bed unit. No other physicians to bounce ideas off of, although the fellow is easily reachable by phone. To our benefit -- and likely the patients' -- the nurses are right on and for the most part ask or tell us what needs to happen.

One such example was Mr. E, a middle-aged man with advanced metastatic cancer. A palliative surgical procedure caused an acute lung injury in the setting of horrendous underlying parenchyma. As my call night went on, his oxygenation grew worse and worse. To say that I was nervous at 10 AM after rounds doesn't begin to capture the anxiety I felt when his condition began to deteriorate. I can still hear the nurse saying to me, "Talk to me. What do you want me to do?" In my mind I was thinking, "I have no idea what to do. Doesn't anyone else have any ideas?" Despite increasing amounts of oxygen and PEEP (positive end-expiratory pressure to keep his alveoli open) on the ventilator, his arterial oxygen level failed to budge. My calls for advice to the fellow turned into a plea for help -- which he responded to by heading to the hospital. Only with measures that frankly I did not even understand did the patient's status begin to improve. It definitely had nothing to do with what I could offer.

There is nothing quite like that feeling of increasing fright as you stand in someone's room observing them spiraling downward and being unable to do anything about it. More often than not, I have found myself in that situation knowing that we have done everything and understanding the options. This was different. I did not know what to do next.

I kept wondering if this only occurred to me or whether other people felt the same way in their SICU rotations. The rotation is billed among my fellow residents as a "great" month, but I kept waiting for the great part to begin. Perhaps it's great because I could not walk across the room and ask someone else for input, but it certainly was not great for inspiring confidence. Even as I write that, though, I wonder if that is really true. Someone in a lecture last week said that if you do not have a complete sensation of panic once a week, then something is wrong. To hear that from a seasoned attending physician was reassuring, to say the least.

I am on call tomorrow -- my panic quota for the week has already been met, so I am hoping for a quiet night.

---- Daniel Egan, MD, 2002 graduate of Mount Sinai School of Medicine, New York, NY; second-year emergency medicine resident, Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts"

[athomas91]

Go2sleepy- the AA thing has been hashed - let's leave it alone...alrighty...

i think it only makes logical (if you are of that mindset......) sense that ANYONE starting out should probably get some sound individual "non-student" experience before venturing out of their own...that stands for Doc, Nurse, or AA....if you follow such a thought - that same individual would also know when to ask for help rather than allowing harm to a pt...

another question for you....

as a new grad - would you stay where you are comfortable to get your wings - or would you venture to a new setting/new people/new learning experiences for the start of your career??

[TejasDoc]

Deepz,

While I think that anecdote from the resident is educational in sheading light on the experience of training physicians, it does not really apply here. You're comparing the experience of a second year resident in emergency medicine as they practice ICU medicine for the first time to an anesthesiologist who has COMPLETED a 4 year residency in anesthesiology.

Sorry, the comparison is weak.

TD

[deepz]

......You're comparing the experience of a second year resident in emergency medicine as they practice ICU medicine for the first time to an anesthesiologist who has COMPLETED a 4 year residency in anesthesiology. Sorry, the comparison is weak......

Ahh, to be young and ignorant and so full of oneself again.

I compare nothing in that citation. You may read into Dr Egan's column whatever you wish. Again, kiddos, take to heart the next to last sentence of the next to last paragraph. Sometimes we earn the worth of our entire year's salary in only a few critical seconds in the OR.

deepz