Thought I'd post this for a fun response. What was your first day/days in the OR like as an RNAI. The only way we get through these instances is to laugh, otherwise we'd burst from embarrassment. It is such a hard thing for us smooth type A's to screw up in front of others, but humor me with your screw ups so I'm not hopefully the only one. Here's my screw ups:
1) Bumped into the sterile field very first case :uhoh21: even though had been drilled in lecture to STAY AWAY :angryfire from it at all costs. Surgeon yelled at me , CRNA yelled at surgeon and made me feel better :) (the sterile field was right next to the door)
2) Couldn't and really still can't mask a patient to save my life!! All the air comes out the left side of my hand. I was told I have small hands and would have to learn how to adapt. Stood there fumbling with the mask fit, pt apneic, no air in rebreather, and APL closed all the way just to try to get some flow ( jeez, what an idiot I am), while the MDA and CRNA laughed and joked with me.
3) Every intubation I have tried I have had some former surgical resident colleague/friend right there making fun of my technique, especially when I goosed the patient.
4) I actually cut my patient's lip the first time I tried to intubate.
5) Stupid lidocaine for IV starts!!!!!! My hand shook and it's like all of a sudden I don't even know what intravenous means. All of these stupid patient's veins have disappeared on me. What do you mean I have to put a 16 gauge needle in !?!
6) I was practicing intubating on the mannequeins, their heads are like the weight of watermelons! So I tried this like twenty times and the next morning I couldn't lift my arm to shoulder level, my shoulder was like cement. I thinkk I need to do some one-armed push ups.
7) It's been two months now and I can at least bag and mask, managed to get the tube in some tracheas, transport without hitting the walls, find my way to the ORs, squeak out my goals for the day to the CRNA, do the preop assmnt without looking like a nursing student, give report to PACU RNs without getting my head bit off, and chart without too many mistakes on those tiny tiny tiny boxes for vitals every five minutes.
It's amazing how much you learn in a short time, much at the expense of looking like an idiot :chuckle.
I don't know how to thank all of those who shared all of their "fumbling moments" here on this forum. I'm so glad that I'm not the only one feeling incompetent during my first week in the OR. Here's my first "screw up":
Eventhough we've been in school for at least a month, the overall OR exposure that we had was minimal. My first day in a case started early at 730am. I was in the OR by 6am. Worked on checking the anesthesia machine, calibrated the 02 sensor, etc. Managed to put out and label all the syringes on the cart. Went through the whole thing again over a second time. Seemed like everything was ready to go.
Went to preop my patient, waited outside the surgical room for my CRNA to arrive. I was doubly anxious to meet the CRNA, since we were all forwarned in advance that this CRNA was very meticulous and that "we better know our stuff", or she'll give us a hard time about it. Well, fair enough I thought, and so I eagerly waited that morning. The patient was already in the room, but I waited outside the room as we were instructed earlier on, that we were to wait for our CRNA to arrive before we could "touch" the patient.
The CRNA finally arrived at 7:25. Introductions were made, hands shook, and she said, "So, tell me about the patient". After having told her the patient's history, we entered the room. Here's where the fun begins (and when I mean fun, it means NOT FUN FOR ME).
I began to place monitors on the patient. I felt nervous, since it was my first case alone with a CRNA and started to tape the patient's arm on the armboard,
1. FORGETTING that it was a right hip replacement and that the patient will be turned onto the right side after intubation.
2. Everyone was present in the room, including the MDA who just walked in at the very last minute, expecting that all drugs were drawn up so that he could push the meds for induction (this MDA apparently was notorious for being "in a hurry"...scarry, I thought.
3. I took my place at the head of the table, preoxygenating the patient, as the CRNA was getting ready to draw up the meds. All of a sudden, her voice echoed throughout the room, asking me, "DID YOU CHECK YOUR ROOM?!" Why, yea, I said. After which, she pointed to an EMPTY drawer where a drug cart ought to be. I looked and shook my head in disbelief! She stormed out of the room and got a drug box.
4. Once all the drugs were drawn up, I heard another question from her asking, "AND WHERE IS YOUR SUCTION?" Oh NO! The yankeur was missing! Great! I thought to myself, as I nervously hold the mask over the patient's face. THIS IS NOT GOING WELL.
Finally, after the patient was intubated (CRNA intubated), the patient was repositioned. When the patient was put on the vent...the CRNA gave me a 10 minute lecture and BOY, did she make no attempt to lower her voice and instead, made everyone in the that room hear her tell me:
"This is unacceptable and you are unprepared. I oughta send you home right now. I should not tolerate this kind of incompetence!" And, while holding her right thumb and index finger close together in front of my face, she said, "You are this close to being kicked out of this room!" Would you like that? To which I said, (firmly looking her straight in the eyes) "No, I would rather stay".
No matter what I did to explain what had happened with the missing suction piece and missing drug box in the cart, was utterly useless. She wasn't going to accept it.
I felt so little at that very moment. All eyes focused on me, including the surgeon who was probably laughing inside, enjoying this scene that was taking place before his very eyes.
After the case was over, I had 2 other cases with the CRNA. I stood my ground and maintained my composure. But deep inside, I was thinking to myself on how totally unprofessional she was to me for a minor oversight that I had done. THE PATIENT WAS NOT HARMED! This I kept repeating in my head.
I've been a nurse for over 8 years, and I have never encountered this kind of humiliation from another colleague. IS THIS THE NORM? I thought over and over. But, fortunately it is NOT.
I did learn from that experience. I make sure that it would not happen again. But, for some reason...the mere thought of being with her again (and I'm sure I'll be with her again) gives my stomach a rumbling now and then. But, I won't give in. I am here to learn. I won't let her beat me to a pulp! YEY! Whewwww....sorry for the long venting.
I'm not sure if I agree with the whole whale sh** attitude. I understand it's just a metaphor, but it is still kind of bothersome. One would hope that as nurses, CRNA's have had the experience of humbling themselves for difficult patients, and since good RN's do everything they can for their patients, good CRNA's would also do good for their patient by being a dignified and respectful teacher to other Students coming into the field. Vinny's description of the berading he received, hopefully is not typical. I have grinned and bared criticism a lot, but once you get to a certain age, it is extremely difficult to do, esp. what he went through. However, that is not to say you are always right. As I said, one should humble himself for the patient, and students should certainly humble themselves even more to get the most out of the learning process However, CRNA's like the one he described should think twice about how people learn the best, and get the most out of their education. I don't know about anyone else, but when someone is breathing down your neck or berading you, it is hard to concentrate on what you are doing. Just a thought for Nurse Educators.
There is no way I can defend the CRNA's behavior, but I must tell you that it is very important to be prepared in anesthesia. The stangest things happen to anesthesia equipment and your patient's life may depend ot it. I work by myself, no other anesthetists touch my equipment; I work with the same three RNs and have thing set-up my way. In the last week, I had an anesthesia machine develop a major leak in the middle of a long case and I had to quickly get another machine moved it and connected. Yesterday, the laryngoscope that I checked three times prior to induction, didn't work when I needed it and the suction fell apart at the end of the case when I using it. Things happen in anesthesia, so being prepared and double and triple checking equipment should be part of your routine.
It is worse when you are working in a large anesthesia department, so consider it a career long lesson.
Hey Vinny sorry to hear about your story. Like everyone has said, it will get better. But then, just when you think you are doing so well, something very humbling will occur. Like this.
Today I am performing the anesthesia for a whipple procedure. We talk to the patient and obtain consent for a thoracic epidural, a central line and the anesthesia for the case. All is good, we get into the room, and I get an epidural in (first ever thoracic for me) Do the induction without difficulty, and place a right IJ double lumen line in just under a half hour. As I am setting up an IV to run into the central line, what do I do but pop the cap from the IV tubing right into the newly created sterile field. Man was I pissed with myself. I have seven clinical days to go, and all I could think about was what if I had done that stunt after the incision had been made?
Fortunately the incision had not been made, and everyone in the roome was very nice about the breach in sterility. A new prep and drape were applied and the surgery started without a hitch.
Its amazing how humbling a simple incident can be.
Oh my gosh....your post sounds exactly like me the first month or so. I hated that lidocaine thing......and I still hit walls with the cart. Hang in there!! What is an RNAI (Registered nurse anesthetists intern?) Just wondering ...we are moving from the SRNA to the NAGS (nurse anesthesia graduate student) I don't like that either.
Thought I'd post this for a fun response. What was your first day/days in the OR like as an RNAI. The only way we get through these instances is to laugh, otherwise we'd burst from embarrassment. It is such a hard thing for us smooth type A's to screw up in front of others, but humor me with your screw ups so I'm not hopefully the only one. Here's my screw ups:
1) Bumped into the sterile field very first case :uhoh21: even though had been drilled in lecture to STAY AWAY :angryfire from it at all costs. Surgeon yelled at me , CRNA yelled at surgeon and made me feel better :) (the sterile field was right next to the door)
2) Couldn't and really still can't mask a patient to save my life!! All the air comes out the left side of my hand. I was told I have small hands and would have to learn how to adapt. Stood there fumbling with the mask fit, pt apneic, no air in rebreather, and APL closed all the way just to try to get some flow ( jeez, what an idiot I am), while the MDA and CRNA laughed and joked with me.
3) Every intubation I have tried I have had some former surgical resident colleague/friend right there making fun of my technique, especially when I goosed the patient.
4) I actually cut my patient's lip the first time I tried to intubate.
5) Stupid lidocaine for IV starts!!!!!! My hand shook and it's like all of a sudden I don't even know what intravenous means. All of these stupid patient's veins have disappeared on me. What do you mean I have to put a 16 gauge needle in !?!
6) I was practicing intubating on the mannequeins, their heads are like the weight of watermelons! So I tried this like twenty times and the next morning I couldn't lift my arm to shoulder level, my shoulder was like cement. I thinkk I need to do some one-armed push ups.
7) It's been two months now and I can at least bag and mask, managed to get the tube in some tracheas, transport without hitting the walls, find my way to the ORs, squeak out my goals for the day to the CRNA, do the preop assmnt without looking like a nursing student, give report to PACU RNs without getting my head bit off, and chart without too many mistakes on those tiny tiny tiny boxes for vitals every five minutes.
It's amazing how much you learn in a short time, much at the expense of looking like an idiot :chuckle.
Yeah, RNAI is RN Anesthesia intern, actually I'm kind of fond of it. "You are not student registered nurse anesthetists" (One of our coordinators told us this). HA! I can see a lot of people making fun of the NAGS though :chuckle. Anyway everyday gets better and better in the OR (fumbling around wise anyway). I was intubating a guy the other week and the muscle relaxant hadn't had enough time to work (MDA pushed and told me to intubate), so just as I get the tube in I feel his hand on my head (the patient's), as everyone else in the OR is trying not to laugh so they don't disturb me. Great memories.
Yeah, RNAI is RN Anesthesia intern, actually I'm kind of fond of it. "You are not student registered nurse anesthetists" (One of our coordinators told us this).
What's his rationale?
I don't like "NAGS" but the other titles all sound okay.
I'm not sure if I would want to be called a "NAG"! All the other titles for anesthesia students are fine...it's just symantics.
I had an interesting day today because the MDA kept introducing me to the patients and staff (I'm on an outside rotation at another hospital) as the "nursing student"! No mention that I have anything to do with being an anesthesia student. Although also just symantics, I felt it was condescending and it left people wondering why I was handling the airway. I was a "nursing student" 12 years ago, and although I am once again a student, it would be nice to have been recognized as an SRNA. I have been at this hospital for a couple of weeks and this is the first time anyone has refered to me as a nursing student.
I think it is the equivalent of introducing a medical resident to a patient as a student doctor. I guess my point is, although just symantics, there are times when the terminology can have an influence on how you are perceived.
The MDA was otherwise very helpful and easy to work with so although I was a little annoyed at first, I let it roll off and moved on. It's all part of the learning experience.
I had a terrible day in the OR today. Those have been few and far between for awhile....then today happens and I wish I could bury my head in the sand and cry!! Sometimes i want to just be done!:angryfire
I'm not sure if I would want to be called a "NAG"! All the other titles for anesthesia students are fine...it's just symantics.
I had an interesting day today because the MDA kept introducing me to the patients and staff (I'm on an outside rotation at another hospital) as the "nursing student"! No mention that I have anything to do with being an anesthesia student. Although also just symantics, I felt it was condescending and it left people wondering why I was handling the airway. I was a "nursing student" 12 years ago, and although I am once again a student, it would be nice to have been recognized as an SRNA. I have been at this hospital for a couple of weeks and this is the first time anyone has refered to me as a nursing student.
I think it is the equivalent of introducing a medical resident to a patient as a student doctor. I guess my point is, although just symantics, there are times when the terminology can have an influence on how you are perceived.
The MDA was otherwise very helpful and easy to work with so although I was a little annoyed at first, I let it roll off and moved on. It's all part of the learning experience.
No worries. It happens. And it will likely happen several more times before you finish your education. The peaks and valleys are just a part of anesthesia school.
I had a bad week, too. In fact, one of the cases I had primary responsibility for is going to the QA/M&M conference next month. When you are getting close to graduation, the pressure to perform well every single day is intense. So, as bad as your day was, believe me when I tell you that there are plenty of us in the same boat...
, CRNA yelled at surgeon and made me feel better :) (the sterile field was right next to the door)
UCDSICURN
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