Correct answer to interview question

Passin' Gas · Sep 28, 2004

What would you do?

RNKLTYM · Sep 28, 2004

What would you do?

My response was I would proceed as the Anesthesiologist wished and after the case inquire on why he changed the plan of care and try and learn from the experience.

Kiwi, BSN, RN · Sep 28, 2004

My response was I would proceed as the Anesthesiologist wished and after the case inquire on why he changed the plan of care and try and learn from the experience.

Why wouldn't you defend your plan??

Gompers, BSN, RN · Sep 28, 2004

Why wouldn't you defend your plan??

I agree. With any nursing position, you are the patient's best advocate. I have actually had this exact situation come up in practice many times (as a staff nurse though), so it is a very good interview question. If your plan was different and you had a solid reasoning for it, I'd ask the anesthesiologist for an explaination, discussing the pros and cons of each method of anesthesia and together find a solution that would best help this particular patient.

Maybe that's too forward of me, but hey I work in NICU and my babies' can't speak for themselves, and their parents trust our staff to advocate for their children the best we can. And if this was an interview question, I think they wanted to know if you'd advocate for your patients and if you were able to collaborate with others as a team. Plus if you are in school for CRNA they want to know if you'd ask questions and be proactive.

Kiwi, BSN, RN · Sep 28, 2004

I agree. As a nurse, you are the patient's best advocate. I have actually had this exact situation come up in practice many times, so it is a very good interview question. Since you are the one caring for these patients day in and day out, you probably know more about them than an anesthesiologist that just met them or read through the chart. If your plan was different and you had a solid reasoning for it, I'd ask the anesthesiologist for an explaination, discussing the pros and cons of each method of anesthesia and together find a solution that would best help this particular patient.
Maybe that's too forward of me, but hey I work in NICU and my babies' can't speak for themselves, and their parents trust our staff to advocate for their children the best we can. And if this was an interview question, I think they wanted to know if you'd advocate for your patients and if you were able to collaborate with the doctors as a team.

CRNAs do advocate, but anesthesia is different. You are not working UNDER the anesthesiologist. It's not like s/he is dictating orders to be checked off. CRNAs can medicate at their discretion.

Gompers, BSN, RN · Sep 28, 2004

CRNAs do advocate, but anesthesia is different. You are not working UNDER the doc anymore. It's not like s/he is dictating orders to be checked off. CRNAs can medicate at their discretion.

I noticed the forum name after I posted and changed some things - happens to all of us. But I still stand by my argument that to sit back and say nothing does NOT look good, no matter what kind of position you hold. Isn't it better to ask why things are being done differently, and to state why you think another plan of care should be considered? If anything, the ensuing discussion will be enlightening.

Dita · Sep 28, 2004

"My response was I would proceed as the Anesthesiologist wished and after the case inquire on why he changed the plan of care and try and learn from the experience."

I agree with this answer. No CRNA program wants to deal with a student that thinks they know more than the CRNA/MDA. Experience counts. Plus the MDA/CRNA have to be somewhat comfortable or familiar with the anesthetic plan inorder for it to go as smooth as possible.

I certainly would appreciate your intense preparation for the case. But I think they want to see that you are flexible, and are amenable to learning different anesthetic techniques.

Jim CRNA

Passin' Gas · Sep 28, 2004

First off, there isn't a truly 'right or wrong' answer. This question is intended to gain insight how you will respond in difficult situations. It's also one of those 'depends on the situation' type questions.

This could go either way. Hypothetical example: You are three weeks into clinical and dutifully look up and compose the optimal care plan for a 58 year old male for transverse colon resection, hx of diverticulitis and recently discovered colon CA. Otherwise, fairly healthy, actually ht/wt proportionate. You want to use propofol, cisatracurium, sufenta infusion (case expected to last 3h, slow surgeon), desflurane in air 2L flow and oxygen 2L flow rate.

The MDA decides to use pentothal, pancuronium, fentanyl, isoflurane in 1L air and oxygen 1L flow rate. Both are acceptable techniques. The MDA's plan will be less expensive for the patient who is going to be 'in-house' for a few days and for the underfunded county hospital. Propofol? Great, but he's not heading home after surgery; pancuronium, need muscle relaxation for the whole case; fentanyl is less expensive than sufenta; running lower gas flow rates reduces loss of body heat plus,you guessed it, isoflurane is cheaper. Again, patient ain't going home in three hours postop.

So, I wouldn't have a great heartache with the change in plans.

But say the patient had chronic renal insufficiency, elevated BUN and Cr plus a history of CAD and the doc still wanted to use pancuronium. In that situation, I would defend the use of cisatracurium.

Pick your battles wisely.

PG

RNKLTYM · Sep 28, 2004

Thanks Jim, I thought I had a reasonable answer showing I was flexible and able to change gears quickly but didn't want to hold up progress so I would choose to inquire and learn why he changed the plan after the case was complete. Thanks for responding.

"My response was I would proceed as the Anesthesiologist wished and after the case inquire on why he changed the plan of care and try and learn from the experience."
I agree with this answer. No CRNA program wants to deal with a student that thinks they know more than the CRNA/MDA. Experience counts. Plus the MDA/CRNA have to be somewhat comfortable or familiar with the anesthetic plan inorder for it to go as smooth as possible.
I certainly would appreciate your intense preparation for the case. But I think they want to see that you are flexible, and are amenable to learning different anesthetic techniques.
Jim CRNA

Kiwi, BSN, RN · Sep 28, 2004

"My response was I would proceed as the Anesthesiologist wished and after the case inquire on why he changed the plan of care and try and learn from the experience."
I agree with this answer. No CRNA program wants to deal with a student that thinks they know more than the CRNA/MDA. Experience counts. Plus the MDA/CRNA have to be somewhat comfortable or familiar with the anesthetic plan inorder for it to go as smooth as possible.
I certainly would appreciate your intense preparation for the case. But I think they want to see that you are flexible, and are amenable to learning different anesthetic techniques.
Jim CRNA

Oops. I thought that the scenario was that you were already a CRNA and you were working professionally with an anesthesiologist.

apaisRN, RN, CRNA · Sep 29, 2004

Caveat: I am neither an SRNA nor a CRNA.

I would assume the question is asking what you would do as a CRNA. As a student you'll listen to the MDA if you want to stay in school!

I would ask the MDA why he preferred his plan. If I saw his point or had no reason to disagree, I'd go along. If I thought mine was better, I'd advocate for it and explain why. This is assuming that we have a few moments to discuss. If this was immediately before the surgery . . . well, I'd probably go with the flow unless there was really a problem, like a drug with renal implications and a patient with borderline renal function. No sense ruffling feathers for no reason.