SRNA's!!! How hard is it being a student!?!!

Specialties CRNA

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I cannot believe how incredibly difficult it is to be an SRNA (besides the obvious), but I am gettin yelled at for the most ridiculous things, like foley up or down, tourniquet above or below the elbow for the IV, to double chart or not to double chart, face mask vs. induction mask......the list goes on and on. I/we have to keep profiles of CRNA's, as to what type of tape they like, their narcotic preference,one loves it and the other is shocked that I would even think of using it......aaaaaah, im so frustrated! I am sooo willing to learn, but getting "scolded" for choosing the wrong type of "tape" is driving me nuts. Any other SRNA's experience this, I know.....go with the flow, but similar stories may ease my mind....a little. Story sharing anyone?

miloisstinky said:
I cannot believe how incredibly difficult it is to be an SRNA (besides the obvious), but I am gettin yelled at for the most ridiculous things, like foley up or down, tourniquet above or below the elbow for the IV, to double chart or not to double chart, face mask vs. induction mask......the list goes on and on. I/we have to keep profiles of CRNA's, as to what type of tape they like, their narcotic preference,one loves it and the other is shocked that I would even think of using it......aaaaaah, im so frustrated! I am sooo willing to learn, but getting "scolded" for choosing the wrong type of "tape" is driving me nuts. Any other SRNA's experience this, I know.....go with the flow, but similar stories may ease my mind....a little. Story sharing anyone?

I totally agree. You know what conclusion I have come to? I think that most CRNAs (at least the ones I have been with) have a very systematic way of looking at things - they have a system of how they set things up, check the patients, maintain them, etc. When a student comes along, and sets up the machine they way they were taught, or tapes a way they are used to that might be different from the CRNA, their system is 'broken' and it becomes difficult for them to get past that particular piece of the puzzle and move on. They have to do it "their way" so they know it is done 'correctly' and then they can focus their concentration on something else. I have had CRNAs tell me how they like their laryngoscope to lay on the table (handle left or handle right), whether they will allow me to use the BIS or not, whether I should use tape or opsites and tape to secure IVs, etc. Truly it is a matter of learning different techniques, and taking a 'piece; of each CRNAs practice with you.

I think a lot of CRNAs want to teach you their method, but sometimes forget that along with being a student comes needing the firsthand experience. For example, I had a preceptor who hates Nimbex, but he never told me that he didn't like it until I used it four or five times and had bad experiences with it. He allowed me to use it in the cases that I wanted, so that I could develop my own opinion about its usefulness, which was great. It is a lot easier to defend your rationale to someone when you say "I didn't want to use XYZ drug because I have found that it is not as effective" as opposed to "I don't use Nimbex because no one I learned from ever used it." I truly believe that our preceptors need to give us just enough rope to almost hang ourselves with...experience is the best teacher.

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And you know what...we might just end up like them someday:chuckle

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What I have found is that it gets harder and harder as time goes by to have somebody continuously telling you what to do. During my first year I was always with a CRNA at the one facility as I was there for a long time. The CRNAs there were awesome and they fostered indepencence in the student. Since being a senior student, at the two facilities I have been to 98% of the time I am with an MDA who normally leaves the room once induction is completed. Some leave the room before I can tape the tube, some do not come back for extubation which I take as a compliment, but they do check on the pt in PACU and come back and tell me that the pt looks good. I have no problem with this as long as they are accessible if I need them. So far I have not had a problem with this. It gets very difficult when I go in the room with a CRNA for the other 2% who is riding my a--- for BS. Last week I was in the room with a CRNA who was getting on me for such BS during induction that the MDA started defending me and they were arguing back and forth. You get to a point where it is impossible trying to be fifty different people. There are many ways to do anesthesia. If there is nothing wrong with the way I am doing something then let it be. Correct me when there is an error with what I am doing or my actions jeopardize patient safety. However, I still remain humble and when I get told "this is the way I like to do it," I calmy reply whatever makes you happy.

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Specializes in M/S, OB, Ortho, ICU, Diabetes, QA/PI.

I know it's immature but masks are nice for this reason: you can be sticking your tongue out or doing the "blah blah blah" motion with your mouth and no one can tell as long as you scrunch your cheeks up to make your eyes look like you're smiling - yeah, I know it's petty but it sure made me feel better when the ortho surgeon that I used to First Assist for was giving me the gears..... :p :p :p

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I had a preceptor once that had an emotional meltdown over the fact that I timed the syringe of succinylcholine wrong when preparing for a pedi case. She actually said to me, "Look at that. You are so nervous that you even put the wrong time on that label". I wrote 1430, not 1530. OMG, it literally took every ounce of self-restraint in my being not to respond.

I have been chided about the way I bend my stylet, prepare my tubes, where I put the laryngoscope blade after it has been in the mouth, place the tape that goes over the eyes, and yes, I have even had to switch pens with a preceptor who felt that the pen I was using did not have a fine enough line. It becomes funny with the passage of time, but at that moment, it is so frustrating.

I started a journal with all the good-bad-funny things that have happened to me during clinicals. It's pretty cathartic, especially to look back on the episodes that

ticked me off so much in the past that are now so laughably absurd. A journal gives you great perspective.

Everyone is right. You play the game and eventually it gets better.

I will say this, though. Potential SRNAs need to consider carefully the following two things when they are choosing a program:

1. The amount of rotating sites. In my program, we switch every month to two months. This gives you great exposure to how things are done in different institutions, but the significant drawback is that they never get to know you, and they really don't have an investment in ensuring that you learn anything unless they think you might work for them. Hence, the piddly nitpicking just goes on and on and on, month after month, because you are never doing it "their" way, and you are just another anonymous student that will come and go in a month or two.

2. The amount of independence that you can expect as a senior. This is crucial. I am nearing graduation, and I am very rarely left alone. It is always a 1:1 CRNA/MDA:student pairing. Some sites even have a policy in place that prohibits the preceptor from leaving during the case. By their nature, anesthesia providers are quirky and compulsive people, and it is very difficult for them to sit on their hands while you perform an anesthetic "your way". For those SRNAs in heavily supervised and directed environments, this can significantly impact your learning, because you can't formulate your own routine or make your own snap judgements (for example, you are in a case where they are slowly losing blood. BP is trending down. What is your first action? More fluid, or pressors, or blood replacement? If you have someone dictating every step, you never get to the point where you need to make a decision, for better or worse, using your own judgement).

It's an old anesthesia adage that the best anesthetic is the one that you give skillfully, and it's difficult to get to that point as a student when the anesthetic plan changes every day!

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hey - being a srna is awesome. when you work c the same preceptor for a while, they know you, you know them. it's the tits. there are a few drawbacks though...

basically - wag your tail, it's what they told us first day, and we tell each other every day "wag your tail"

if you can take being told how to put on a bp cuff properly - you are wagging your tail. (i've been taught twice)

gc.

ps. know the difference between a pile of dog poop and an srna?

people step over the poop.

:)

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Specializes in NICU.

Just subbing to this thread for future, future, future reference :)

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miloisstinky said:
I cannot believe how incredibly difficult it is to be an SRNA (besides the obvious), but I am gettin yelled at for the most ridiculous things, like foley up or down, tourniquet above or below the elbow for the IV, to double chart or not to double chart, face mask vs. induction mask......the list goes on and on. I/we have to keep profiles of CRNA's, as to what type of tape they like, their narcotic preference,one loves it and the other is shocked that I would even think of using it......aaaaaah, im so frustrated! I am sooo willing to learn, but getting "scolded" for choosing the wrong type of "tape" is driving me nuts. Any other SRNA's experience this, I know.....go with the flow, but similar stories may ease my mind....a little. Story sharing anyone?

Hi,

I experienced the same type of treatment in anesthesia school. It is just bad behavior on the faculty's part. Take them aside and tell them to stop being abusive. If you have to, keep a journal of all the incidents. By my last 6 months of school, I confronted my program director and told him that I wasn't taking the verbal abuse any more. It never happened again. At that point, I didn't care if I got kicked out of school....it made me hate anesthesia. I would like to tell you that it gets better in private practice..it does some... but be careful of which job you take. Email me at my private email and I'll give you my phone number, so that you can have someone to talk to. I will be supportive and help you get through this.

crnagirl

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gravitycure said:
if you can take being told how to put on a bp cuff properly - you are wagging your tail. (I've been taught twice)

Well, it's a very complex skill. You're at a new level now, don't you know? :rotfl:

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Specializes in CRNA, ICU,ER,Cathlab, PACU.

I know how you feel. be grateful you are getting chewed for stupid stuff, and not important stuff. If it is over what tape you use, or whether or not to use an oral airway early during emergence, or how much you deflate or dont deflate an lma before pulling it dont sweat it.

On the flip side if you are getting chewed for nasal intubation with a Leforte III fracture, maybe you better listen. I am sure that is not your problem. Just be respectful to your instructors, then at the end of the day make fun of them with your classmates....I am sure they did the same thing when they were in school.

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