Attn: CRNAs in Academic Settings

[Ms. Anesthetist]

Hello fellow CRNA colleagues,

I work in a traditionally non-teaching hospital setting, but not for the hospital itself. Recently, our MD group agreed to become a clinical site for a local CRNA program. This was not well-received by our CRNA staff, as we assume primary legal responsibility for these individual students who rotate through our facility without any source of insurance "back-up" as the hospital is not technically designated "teaching status" nor has the "benefits" (if there are any) of being affiliated with a University/academic institution.

The surgeons in our hospital have varying opinions on whether or not to allow SRNAs into their rooms. Usually, they are permitted, if the attending CRNA has an established relationship with the surgeon, and is willing to assume this responsibility. Unfortunately, amongst the 14 or so CRNAs, there are only a handful who are willing to take on students, and the number is dwindling for various reasons. Such reasons range from fear of liability, disinterest in teaching, prior bad experiences with students attitudes, and perceived threatened (future) job status. There are other reasons, but these are the major ones I have encountered.

As a seasoned anesthetist, I find myself among the dwindling number who is experiencing "preceptor fatigue" to the point where I find myself engaging only with those students I feel make a true effort to learn vs. those who just seem to "go thru the motions" in our clinical situations. In all honesty, I wonder how much longer my CRNA colleagues can continue in this role--there are only 4 of us now. I also wonder how much longer the group will continue their affiliation with the SRNA school if no CRNAs are willing to be preceptors, which is a possibility in a non-teaching hospital.

I feel the basic dis-interest from my CRNA collegues stems from the fact that a majority of the students who have rotated thru our site had expressed a "fast-track" mentality, i.e., minimal entrance requirements, minimal prior experience with only a sole focus on the perceived salary once they achieve CRNA designation.

The MDAs are basically clueless to the current situation. They were the ones who initially proposed the idea to take on students for future staffing purposes. At the rate this is going, the MDAs will be the only ones to precept students (and that won't last). A clinical rotation for SRNAs without CRNAs as the primary instructors just seems unnatural to me....

I am torn between sharing my knowledge and experience as a preceptor vs. maintaining the status quo with my CRNA colleagues in this situation. I am wondering if there are any CRNAs out there who are experiencing the same thing in your practice....??

[loveanesthesia]

Such reasons range from fear of liability, disinterest in teaching, prior bad experiences with students attitudes, and perceived threatened (future) job status. There are other reasons, but these are the major ones I have encountered.

First, thanks so much for your contribution to our profession. Strong clinical role models are vital to our continued success as a profession. It can be exhausting to preceptor a student in the clinical area, especially if, like many people attracted to anesthesia, you are an introvert.

Is there any way you can discuss your concerns with the program administration? I would think any program administrator would be happy to pick up the phone and have a conversation. As for liability, I haven't felt at increased risk. Each student also has Liability Insurance, or should. I know that several times the program that our students are affiliated with has taken care of tooth damage issues. Maybe you can get a clearer picture of just what your liability is if the student does something that harms the patient.

Many students I like, and have a good attitude, but there are others that I don't click with. If a student clearly isn't putting in the effort, then you should have the ability to have them leave the clinical area for the day, and come back better prepared.

The short cut mentality is a tough one, and I think you should strongly voice your concerns to the program. Can you be involved in the admissions process? The majority of the admissions committee should be clinical CRNAs in my opinion. The program should be prepared to let a seat go empty rather than just fill it with someone who meets the minimum. I think this is a real issue facing the profession. It seems like some programs are wanting to just take more and more students no matter what. A friend of mine had similar concerns and was able to convince their program to cut their class size for next year by 10%. I feel strongly that 2 years of critical care experience is necessary, not the minimum of 1. Putting that as an admissions requirement helps weed out the 'fast track' people, they'll go elsewhere if they can, which is fine by me.

Can the 4 of you, and hopefully some of the other CRNAs who are open to teaching get a meeting or something set up? This is our profession and your voice and experiences are important.