bad clinical experience today

[FlGasman]

Im an SRNA. I was getting attitude from the circ all day today but as usual I just smile and nod. She was being rude, trying to point out what she thought were mistakes, whispering about me, and telling me how to do my job. But I just smiled and nodded all day and remarked to my crna and she said I was handling it just right.

So finally she got me

Well my crna told me to take the pt back into the room when they were ready and she would be in shortly. The pt was a 300lb m,an who takes dilaudid at home for pain control. As we walked into the room, as I had been doing all along with this CRNA I put oxygen on the man, started hoking him up and gave him 2 ml of fent. Its pretty stressful with all these people running around hooking you up and he was awake and talking so I thought it would relax him and it was part of my induction cocktail anyways. The nurse (circ) says" you cant push anything without a CRNA or MDA" So I say actually that is not true and soon Ill be doing cases with no CRNA in the room and my license wonth change between now and then" SO My crna doesnt come in yet and Im not ready as I have not put the patient in the optimal sniffing position, then the MDA walks in and starts grabbing my in duction agents. SO I am a bit flustered thinking he must be in a rush and as he starts putting the meds in line I say whoa my CRNA isnt here, (this was the last case and we were ahead of schedule so no rush) he looks at me a bit puzzled and then my CRNA walks in, well im not set up totally and the drugs start getting pushed, he was a tough inutbation and I could get it with him out of position, they give me the speech about proper patient positioning (I just listen but think, I know I know!!, You guys rushed me!) so my crna intubates with some difficulty. After the MDA leaves the circ tells me so my CRNA hears. " I told you you cant push any drugs without crna/mda present blah blah. Then I realized what happened. My CRNA didnt care but I was so pissd, and the patient had to undergo unnessesarry trauma because of her( i could have been moire assertive but i was caught off guard) She told me she called the MDA to on me for pushing the drugs. He didnt realize she was trying to get me in trouble because I wasnt doing a nything wrong, he just assumed I was ready for induction and came in to induce. When I told him I didnt know where my CRNA was he though I was planning on doing the induction without her and he was okay with it (her pager wasnt working, I was NOT going to do anythin g besides set up without my crna) so I thought he was rushing me, all because of that spiteful women. Being pretty new I am not used to everyone who is over me and I have been told to intibate without proper positiong due to time b4 so i though this was one of those cases. I am so angry about this, I felt like such a tool and MY CRNA didnt say anything after I was talked down to by the circ but she though the timing was off and said she would later. ARRGGGH thanks for letting me vent

[labcat01, BSN, RN]

I hate when people act like that. I'll be sure that if I ever have an inferiority complex to try and not take it out on people because I'm jealous and petty!

Sorry you had such a rough day!

[deepz]

Sorry for your bad experience. Next time, don't take the pt back until your room is 100% PREPARED.

The worst mistakes I've ever made were when I had been rushed. Don't let that happen. Be prepared. It is a patient safety issue. Assert yourself.

d

[CuttingEdgeRN]

FlGasman,

That circ was a wench! You'll run into those at some point. Usually means they are jealous of your achievements. Why in the world would you NOT be able to push some fent? The "RN" in your sRNa title says you can! I work in an OR with many SRNA's and have learned so much from them, especially when they find out I can help acclimate them to our OR, they are more than happy to do some teaching..It's much easier asking questions of the SRNAs than the MD's that might look down on us for not knowing something. You did handle the situation well though. Much better to keep your angry thoughts to yourself and soak up the learning situations, avoid the drama. Someone will surely let her have it soon, with that attitude! Keep your spirits up, you are on your way! :)

[paindoc]

Just use the old Harvard chant on her that the footballers use when any opposing team (and there are many) are beating the pants off them:

"That's alright. Its ok. You're going to work for me one day"

The Harvard guys are never wrong.

[GmanRN]

I so enjoy looking into the daily events of CRNAs and SRNAs. I hope more people share things like this.

Thanks.

[FLAreN]

Sorry to hear about your awful experience...I used to work in the OR and we were generally pretty nice to all the SRNAs but it did take time to know who were the errrr more "prepared" SRNAs vs not. I do remember being more watchful over some I thought took many liberties and who were too relaxed and "comfortable" vs a SRNA who visually looked very focused on the tasks at hand, i.e. no side conversations, no attempt at cel phone usage, being able to recognize SIMPLE things like the need to change an IVF bag, etc . . .and these were 2nd year students not even beginning students at the time. Not all SRNAs are created equal and it is WRONG to assume otherwise.

I am not trying to defend the circ by ANY means because she was just nasty to you, but I also know that in the hospital I worked at, SRNAs and MDA residents weren't allowed to do ANYTHING that remotely seemed like the beginning of induction. . .even giving versed had to be OKd with the anesthesiologist / CRNA prior to administration. Thus, please try not to take it personal because the circ was probably adhering to her policy.

You will probably experience many more days like this unfortunately because there are vicious circs out there. Not because they 'want to be you' but because they are just nasty people and are nasty to everyone most likely. I wanted to be a CRNA when I was working in the OR and I wasn't nasty to any SRNA whether good or bad. I totally understood that SRNAs were experienced RNs but reverting back to being a student makes you just that....a student again in everyone's eyes.

By the way, I would have been alarmed if a SRNA/MDA resident gave fentanyl without their preceptor in the room also. I wouldn't have been mean about it...but I would have been forced to tell you couldn't give fentanyl without the preceptor in the room because it was policy. Sometimes knowing what the policy is when being a student will help you in times like this. Every hospital is different so it is good to ask what you can do and what you can't do alone ESPECIALLY if you are beginning clinicals. Yes, your RN license should be enough to be able to give the fentanyl but unfortunately things change when you are a seen as a student.

None-the-less, hope you get to work with a different circ who is more supportive and helpful. It will definitely make your experience much more positive.

[miloisstinky]

Im sorry you had a such a crappy day, its frustrating I KNOW!! Being a student is painful, you did the right thing. My motto in school (although some may disagree) was "put up and shut up", mostly because if i fought every battle, nasty remark or condescending comment that came my way as a student, id be beyond exhausted.....and school is rough enough.

And remember, this circ is a b..... because her life sucks, nothing to do with you.

[London88]

Why should a circulator be alarmed because an SRNA gave fentanyl to a pt. That same SRNA was giving dilaudid and morphine to pts in the unit. What has changed because she is now giving a narcotic to a pt in the OR? I can understand the concern if the SRNA is pushing propofol or a muscle relaxant. Also as per the AANA, and for medicare billing purposes, a senior SRNA is allowed to to be in a room by his or her self doing a case without a preceptor being in the room. To the original poster I am sorry that your preceptor did not stick up for you because I would have sharply reminded the circulator of the RN in your title and would have told her to go take a hike. I have no problem addressing a circulator's concerns when it is done in a diplomatic manner, but when the sole purpose is to humiliate my student I will not tolerate it.

[snowboarderRN]

Haven't updated my profile but anyways hang in there - usually as a student just keep your head down and work hard and keep your mouth shut to avoid problems, its hard when you think you are right and patient saftey is involved... as a CRNA you will have plenty of occaision to put your foot down and speak your mind and people will usually listen. Its been my experience that OR Nurses are worse than surgeons and other anesthesia people, they are very territorial and act like they own the place and getting a CRNA student in trouble or worse doesn't even cause them to blink an eye... don't get caught up in the BS, just focus on giving good anesthesia.