Content That IndiCRNA Likes

Content That IndiCRNA Likes

IndiCRNA 3,695 Views

Joined Nov 22, '12 - from 'Rienlander Wisconsin'. IndiCRNA is a CRNA. He has '1' year(s) of experience and specializes in 'ICU, transport, CRNA'. Posts: 120 (63% Liked) Likes: 248

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  • Aug 17 '15

    This is what is so discouraging to me. In my hospital an experienced (10+ years) critical care RN who works nights and every other weekend will normally make about $115K- $130k/year without working any OT. RN with 20+ years are making $140K or so. This is a reasonable COL area of the upper Midwest.
    It makes the investment into NA school seem kinda iffy. I suppose there is the greater autonomy to consider. In addition the CRNA would be more portable with that income level where any of our nurses who move out of the area is going to find lower wages, or high COL or both.

  • Aug 17 '15

    Quote from IndiCRNA
    I can't really tell you how MDAs treat CRNAs. If one ever shows up around here I will let you know.
    This made me LOL!

  • Aug 17 '15

    Quote from elkpark
    Guess what? When I was in my MSN program 20 years ago, that's exactly what I was told my MSN was designed to do. That, and prepare me for the advanced practice role I was pursuing.
    Ahhh! Degree creep at its finest!

  • Aug 17 '15
  • Oct 7 '14

    I think there is enough evidence to suggest there will be plenty of jobs and job growth in the CRNA profession. There isn't a need to fear coming into the CRNA profession, but where this comes a problem is when someone wants to become a CRNA and will only accept a position in one demographic area. There are many regions of the country that are saturated with anesthesia providers, and it will be hard to find a decent salary as new graduate in those areas.

  • Oct 7 '14

    Five posts and already scolding people....

  • Oct 7 '14

    Passing boards is 75% the student, and 25% the program (I just made that up, but that's how it seems to me). If a program picks students who do well on standardized tests, and are motivated, they will have a high pass rate. Some excellent clinical practitioners are poor standardized test takers, but if the goal of the program is only to have a high pass rate then the poor standardized test taker might not be accepted into a program. If you look at the NCE scores over the past 20 years, there is a high correlation with younger age. For the past year, past rates by age were: < 30: 93%, 30-34: 89%, 35-39: 82%, and >40: 77%. You can see this at: http://www.nbcrna.com/certification/...t%20Report.pdf

    So, if a program doesn't require the GRE and looks for candidates with more clinical experience (older) their pass rate will suffer. But the program may have excellent faculty and produce excellent clinical practitioners that employers want to add to their practice. Pass rates are a poor measure of quality of instruction. I think [COLOR=#003366]UnfinishedSentenc is looking at programs with the correct attitude. Try to figure out how the clinical experience will be. That is very difficult. Numbers don't tell the whole story. Maybe a program lists a large number of complex cases, but if the students are in an environment where CRNAs aren't allowed to make independent decisions, it's still not a good experience. I do think a longer clinical experience is a positive and that is something that you can find out.

  • Oct 4 '14

    "Anesth Analg. 2014 Sep 26. [Epub ahead of print]

    Malignant Hyperthermia Deaths Related to Inadequate Temperature Monitoring, 2007-2012: A Report from The North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States.

    Larach MG1, Brandom BW, Allen GC, Gronert GA, Lehman EB.

    Author information

    Abstract

    BACKGROUND::

    AMRA (adverse metabolic or muscular reaction to anesthesia) reports submitted to The North American Malignant Hyperthermia Registry of the Malignant Hyperthermia Association of the United States from 1987 to 2006 revealed a 2.7% cardiac arrest and a 1.4% death rate for 291 malignant hyperthermia (MH) events. We analyzed 6 years of recent data to update MH cardiac arrest and death rates, summarized characteristics associated with cardiac arrest and death, and documented differences between early and recent cohorts of patients in the MH Registry. We also tested whether the available data supported the hypothesis that risk of dying from an episode of MH is increased in patients with inadequate temperature monitoring.

    METHODS::

    We included U.S. or Canadian reports of adverse events after administration of at least 1 anesthetic drug, received between January 1, 2007, and December 31, 2012, with an MH clinical grading scale rank of "very likely MH" or "almost certain MH." We excluded reports that, after review, were judged to be due to pathologic conditions other than MH. We analyzed patient demographics, family and patient anesthetic history, anesthetic management including temperature monitoring, initial dantrolene dose, use of cardiopulmonary resuscitation, MH complications, survival, and reported molecular genetic DNA analysis of RYR1 and CACNA1S. A one-sided Cochran-Armitage test for proportions evaluated associations between mode of monitoring and mortality. We used Miettinen and Nurminen's method for assessing the relative risk of dying according to monitoring method. We used the P value of the slope to evaluate the relationship between duration of anesthetic exposure before dantrolene administration and peak temperature. We calculated the relative risk of death in this cohort compared with our previous cohort by using the Miettinen and Nurminen method adjusted for 4 comparisons.

    RESULTS::

    Of 189 AMRA reports, 84 met our inclusion criteria. These included 7 (8.3%) cardiac arrests, no successful resuscitations, and 8 (9.5%) deaths. Of the 8 patients who died, 7 underwent elective surgeries considered low to intermediate risk. The average age of patients who died was 31.4 ± 16.9 years. Five were healthy preoperatively. Three of the 8 patients had unrevealed MH family history. Four of 8 anesthetics were performed in freestanding facilities. In those who died, 3 MH-causative RYR1 mutations and 3 RYR1 variants likely to have been pathogenic were found in the 6 patients in whom RYR1 was examined. Compared to core temperature monitoring, the relative risk of dying with no temperature monitoring was 13.8 (lower limit 2.1). Compared to core temperature monitoring, the relative risk of dying with skin temperature monitoring was 9.7 (1.5). Temperature monitoring mode best distinguished patients who lived from those who died. End-tidal CO2 was the worst physiologic measure to distinguish patients who lived from those who died. Longer anesthetic exposures before dantrolene were associated with higher peak temperatures (P = 0.00056). Compared with the early cohort, the recent cohort had a higher percentage of MH deaths (4/291 vs 8/84; relative risk = 6.9; 95% confidence interval, 1.7-28; P = 0.0043 after adjustment for 4 comparisons).

    CONCLUSIONS::

    Despite a thorough understanding of the management of MH and the availability of a specific antidote, the risk of dying from an MH episode remains unacceptably high. To increase the chance of successful MH treatment, the American Society of Anesthesiologists and Malignant Hyperthermia Association of the U.S. monitoring standards should be altered to require core temperature monitoring for all general anesthetics lasting 30 minutes or longer."
    http://www.ncbi.nlm.nih.gov/pubmed/25268394


  • Oct 1 '14

    I love the constant sexual harassment. And there is ZERO sarcasm in my statement, I LOVE it!

  • Oct 1 '14

    Being welcome nearly everywhere I go as an agency nurse. And the little things I can do without effort that make my co-worker's lives easier. Like shutting down perv patients/family members. De-escalating outbursts/violence by simply showing up (I'm not a small man).

    Though my favorite has been running down the hall assisting the aides/techs with their rounds. I get to teach them some of my methods and make things much easier for them. All while running away with their dirty linen and trash teasing, " yooou can't catch me - I'm the gingerbread man!"

  • Sep 30 '14

    The Price of Pastries

    Christina and Milton both love pastries. They both have dreams of one day becoming pastry chefs and making excellent pastries. Let's follow their respective journeys after high school graduation.


    Christina
    Christina decides to start taking cooking classes after high school graduation. She takes three years of cooking classes before becoming an apprentice cook for one year.
    After her apprenticeship, Christina passes a state board exam to become a Registered Cook. Christina gets a job working at a café where she cooks daily and becomes very familiar with different ingredients and how they interact. She spends four years working as a Registered Cook where she learns about and becomes comfortable working with the ingredients. Unfortunately, at the café, Christina works on a team and does not get to cook or bake independently. Christina loves baking, especially with really difficult recipes, so she decides to go back to school to become a baked-goods and pastry chef.

    Christina applies to the Pastry Chef Bakery Academy, where doughnuts were first created. The Academy is very selective, and only takes cooks with excellent experience in the kitchen. Each candidate must be very familiar with the ingredients and be comfortable in the kitchen. Christina is accepted at the Pastry Chef Academy where she will spend 3 years becoming an expert in preparing any type of pastry or baked treat.
    For 1.5 years, The Pastry Chef Bakery Academy teaches Christina everything she could possibly need to know about baking and pastries. She is tested on this specific knowledge many times before she is allowed to become a pastry sous chef.

    Christina spends the remaining 1.5 years as a baker and pastry sous chef where she learns to function as an independent pastry chef and baker. She graduates from the Pastry Chef Bakery Academy, passes the National Baker's & Pastry Chef Board Exam, and applies for a job at The Doughnut Shop & Bakery.

    Milton
    Milton decides to get a general education in the science of cooking. He spends two years learning about basic topics, and two years learning about cooking sciences. Milton decides to apply to Cordon Bleu to become a chef.

    Cordon Bleu is one of the most selective programs for chefs. It is very difficult to gain acceptance. Milton has made good grades in cooking sciences. But Milton is relieved that he doesn't need any cooking experience to get into Cordon Bleu because he has never stepped foot in the kitchen.

    At Cordon Bleu, Milton learns about many cuisines from all over the world. He gains understanding about many topics: Chinese food, steaks, salad, hot dogs, cookies, and more. When Milton graduates he is very familiar with many different styles of cooking, and even some ingredients. But, alas he has still never been allowed to cook.
    Milton is relieved when he is accepted to be a baker and pastry sous chef. However, the first year he is a sous chef, he is made to follow around many different chefs, not just the baker. He learns about various types of cuisine. Some of the chefs even let him cook as they watch.

    In the final 3 years of his training, Milton finally gets to start baking. He works exclusively as a Pastry sous chef and learns everything he could possibly need to know about baking and pastries. He is tested many times on this specific knowledge before he graduates. Unlike Christina, Milton does not have to pass board certification to bake or make pastries. He is allowed to work independently just because he graduated from Cordon Bleu. Milton also applies for a job at The Doughnut Shop & Bakery.


    After Graduation...

    Milton and Christina both get a job working at The Doughnut Shop & Bakery. Because Milton went to Cordon Bleu, he gets a job as a supervisor. He watches over Christina and three other Pastry Chef Academy graduates while they make doughnuts and other pastries. Christina is dissatisfied with this situation because she knows how to make doughnuts very well (without supervision). In fact, many of Christina's fellow graduates are the only pastry chef at their bakeries and work without supervision. Despite her qualms, Christina embraces her new position and enjoys making doughnuts, cupcakes, and other pastries all day every day. She can make different varieties and flavors and becomes an expert at her job.

    Christina and the three other Pastry Chef and Bakery Academy graduates make $2.00 for each doughnut. Since Milton is supervising them, he also is paid $2.00 for each doughnut. They make 1 doughnut each hour, so Milton makes $8.00 per hour. Milton will occasionally make doughnuts, but he mostly runs the cash register and talks to customers.

    One day a loyal customer comes in. She is recently engaged. She loves doughnuts and wants The Doughnut Shop & Bakery to make her wedding cake.
    Milton immediately assumes that he is more qualified to make the wedding cake because of his advanced knowledge of international cuisine and Cordon Bleu education. Christina feels more qualified because she bakes and makes pastries every day. Both Christina and Milton are pastry chefs and they use the exact same cookbook. Ask yourself:
    1. Who do you think is more qualified to make the wedding cake?
    2. Do you think the doughnuts would be less tasty without Milton's supervision?
    3. Who do you think makes better doughnuts?
    4. Do you think doughnuts would be cheaper if Christina and her fellow Pastry Chef Academy graduates were not being supervised? Would you be willing to pay Milton's price for his services?
    5. Does this system make sense?

    Here is the Bottom Line:
    What if you were told that this scenario exists every day in the American healthcare system? Certified Registered Nurse Anesthetists (represented by Christina) provide safe and effective anesthesia that has been proven to be of the same safety and quality of their anesthesiologist colleagues (represented by Milton). Did you know that an anesthesiologist can "supervise" four CRNAs at one time and bill for 50% of each case (doughnut) that the CRNA performs? This means that the supervising anesthesiologist can make 2 times more money if he or she supervises a CRNA rather than providing anesthesia--even if he or she never steps into the room. The anesthesiologist does not even have to see or talk to the patient to bill for services. To continue with the analogy, the anesthesiologist's role in this setting (Anesthesia Care Team) is to be "available" in case someone wants to order a wedding cake (anesthesia emergency). If any party is more qualified (which may not be the case), wouldn't it stand to reason that the pastry chefs who bake every day would be better able to make a wedding cake? That is for you to decide. There is no state in the United States that requires anesthesiologist supervision over CRNAs. The interest of many anesthesiologists is not the patient's outcome but their own income$$.

    Inform Yourself.
    I wrote this analogy to help friends and family understand the role of CRNAs and other advanced practice nurses. I hope it helps you to understand as well. As you do your own research, I encourage you to stay away from opinion and focus on facts. There are many campaigns and opinion-pieces that are designed to elicit an emotional response and scare the public without producing facts based on patient outcomes and cost-effectiveness. Focus on the EVIDENCE.

  • Sep 29 '14

    The clinical rotations for MDs are necessary because they begin the anesthesia residency with no patient care experience. I had 5 years of caring for patients prior to beginning anesthesia. I came with a significant knowledge base to anesthesia. I've worked with 1st year anesthesia residents-they don't know the basics of patient care. So no, I don't buy that the clinical rotations gives the anesthesiologists a better clinical background that me.

  • Sep 29 '14

    Getting a MSN is a waste of time in my opinion. Most programs only allow 2 classes to be transferred anyway. I took Advanced Health Assessment and Advanced Patho and my program didn't accept those classes because their assessment class, for example, is specific to anesthesia. I'm in a MS program, so I believe those classes would have been accepted in a MSN anesthesia program. No need to get a MSN, especially if your GPA is respectable. Maintain a high GPA, good GRE score, great ICU experience and you'll be fine. CRNA school is expensive as is, no need to waste money.

  • Sep 29 '14

    Quote from BCRNA
    They still make it sound like RNs with BSNs are giving anesthesia.
    There are still thousands who do just that.

  • Sep 29 '14

    I can almost always tell by walking in the OR and looking at anesthesia setup whether it was/is being done by an MDA or CRNA. CRNAs tend to more methodically in their setups and a lot of MDAs setups are down right sloppy. It seems that some MDAs are expecting people to clean up after them. There are outliers in each group but this seems to hold true for most CRNAs and MDAs.


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