Advice for first CRNA job

[N_u_r_s_e]

Looking for advice for the best type of hospital setting for a first CRNA job.

Options: Should I be set on finding a large trauma/teaching hospital with high acuity (but are also care team model with supervision or direction) to get more experience and comfortable as a newer provider.. OR would a smaller hospital (200 ish beds) with more autonomy but obviously lower acuity and less variety of cases be adequate? I've read mixed reviewed on this.

Background: I'm looking to move back to my home state after school so I won't be familiar with any of the dynamics at any of the potential jobs sites. I trained at a good program but the state is heavily supervised so I did not really get CRNA only clinical sites. I just want to be comfortable enough and safe if going the more independent route.

I appreciate any tips!

[offlabel]

All depends on the level of support/backup that is available where you choose to work. That is just a matter of asking and seeing when you interview. It also rules out any indy/solo positions. You can count on getting into a situation where you'll need assistance within one month of your new job, and help can come from the circulator (or quasi helpful surgeon), clear up to an anesthesiologist and everything in between. What you're OK with needs to be determined before you step foot into an OR.

[jfratian, DNP, RN, CRNA]

I'd recommend a supervision model that enables full scope of practice (I.e. you do your own lines, blocks, and preops with the ability to phone a friend).  Billing and actual practice are not always the same thing, but it can be a clue to point to the culture of a place.  You always want to talk to CRNAs that work there.

Supervision and Medical Direction/ACT are usually entirely different things in practice.  Typically a true anesthesia care team (ACT) involves involves 4 CRNAs being supervised by a physician anesthesiologist; they bill medical direction (QK code) and the physician receives 50% of billing from the 4 rooms in exchange for meeting the 7 TEFRA requirements.  

Supervision has far less physician involvement and avoids TEFRA requirements.  Typically one or two physicians serve as 'board runners' and handle breaks and emergency backup.  The physician bills 'medical supervision' (AD code) and supervises more than 4 rooms (often as many as 6+) with less billing per case than QK.

Overall, I would try to ensure you get the support you need while still maintaining your skills across a variety of case types.  I know many Kaiser CRNAs who haven't done blocks, preops, or lines in years, and it really limits the jobs they can take.  You don't want to be job locked into a low paying role you hate.