Active Duty CRNA v Guard , HPSP, and Autonomy

[silvrsnoflake]

Hello,

My husband is currently a flight nurse in the Air National Guard. He is a Captain and has been in for almost 11 years. He is now 1 year into CRNA school (3 year DNP program) and has researched his opportunities for jobs after graduation. He is not planning to get out of the military until he retires, but is trying to make a decision about active duty versus staying in the guard after graduation. Currently he is trying to balance school and still attend drill weekends, which is becoming increasingly difficult and I'm sure will be harder in the thick of clinicals over the next 2 years.

Here are our options for after graduation:

1. Take a civilian CRNA job and stay in the Air National Guard (probably just as a flight nurse, which will be a big pay cut on the weekends). This option will require considerable loans and will require balancing drill and school over the next 2 years.

2. Go active duty and get the HPSP scholarship for the next 2 years. This would require two years of active duty after graduation, but would mean no loans and no drill while in school. Currently he is going to drill one weekend a month while in CRNA school, but with the HPSP option, he would have no military requirements until after he graduates. (We already know he qualifies for the HPSP).

Making the decision to go active duty versus stay in the guard is very challenging. The biggest question we have is:

If he goes active duty, we are aware that active duty CRNA's are very autonomous. Being a one year SRNA, this makes him very nervous. Any active duty CRNA's, do you wish you would have been LESS autonomous upon graduation? My husband is very hard working but doesn't want to graduate and feel lost or unsupported as a new CRNA. He's in a very good program, but I'm concerned that it may not prepare him for that level of autonomy, as it is preparing students for civilian CRNA jobs. We also were informed the case load for active duty AF CRNA's is very high, which makes him nervous as well. Did anyone feel prepared after graduating from a civilian CRNA school to be an active duty CRNA??

I'm a nurse and educator and we have 2 little kids. My job is flexible and I would be okay with the 6 month active duty deployments. I'm actually pushing him to do active duty, not only for the money from the HPSP, but I've always wanted to be active duty. I feel like he's on a deployment right now since he's so busy with school, so it would mean 2 more years of sacrifice from a family perspective, but it also means I could quit my 2 current jobs I'm working to put him through school and we would come out of CRNA school with no loans at all.

Anyone who can help, we really appreciate it!

Janelle, MSN, RN, CEN

[jfratian, DNP, RN, CRNA]

I can't speak to the deployed surgical environment, but this is my stateside experience with the surgical suite.

As a current active duty AF nurse who worked PACU for 2 years, I don't really agree that CRNA case load in the AF is particularly heavy. I worked closely with active duty AF CRNAs for that whole time, and their jobs are pretty sweet. You work your 8 hour room 5 days a week and take call a few times per month; often your 8 hour room finishes in 5 or 6 hours and you can go home early. The average AF hospital is a small community hospital with a few dozen inpatient beds; they aren't doing any major surgeries at most of them.

When I worked PACU, my 50 bed hospital only did very routine cases: hernias, gallbladders, ORIFs, knee/hip replacements, etc. All of the patients were pretty darn healthy. These are mostly active duty military with their spouses and children. The vast majority (80% plus) were ASA class I's or II's. Very few were IIIs. Anybody remotely sick got shipped off base to a civilian hospital.

Yes, the CRNAs run their own rooms with no required supervision. However, there is always an MDA or an experienced CRNA shift lead who can support and assist.

[silvrsnoflake]

Thank you so much for the information. That doesn't sound too bad. I guess it just depends what type of hospital you are at. I'm wondering how doing those types of cases would prepare you for deployment. From everything we've heard, CRNA deployment can be pretty intense with limited resources. I just keep thinking that no matter how bad it might be it's only a 2 year commitment. I know he'll be able to survive it even if he doesn't love it.

[Lunah, MSN, RN]

I'm wondering how doing those types of cases would prepare you for deployment. From everything we've heard, CRNA deployment can be pretty intense with limited resources. I just keep thinking that no matter how bad it might be it's only a 2 year commitment. I know he'll be able to survive it even if he doesn't love it.

I deployed with CRNAs as part of a forward surgical team, and yes, it can be intense. Besides the obvious airway stuff, they are the gurus of resuscitation for traumas, determining requirements based on patient status (base deficit, pH, coags, etc.). They will have surgeons in the OR with them, but they really run the massive transfusion requirements as well as all the meds - sedation, analgesia, paralytics, pressors, abx, etc. - during initial resus and in the OR. We were in a remote location so yes, very limited resources.

I think working in L&D in Army hospitals would prepare a CRNA for this kind of resus because OB tends to use massive transfusions more than any other department in non-trauma hospitals, and very few Army hospitals are true trauma facilities.

One of my besties is an Army CRNA who did her schooling through USAGPAN after commissioning from ROTC as an Army nurse and working in an ICU. She is awesome! She will retire soon and take a civilian CRNA role in an Army hospital, where it's fairly predictable and low-stress. One of the other CRNAs I deployed with described their typical day as 99% of "the usual" and 1% sheer terror when patients have actual issues in the OR.

Only two years? I thought three was the minimum time required for active duty at this time, with the other five of the required eight being IRR at a minimum.

[silvrsnoflake]

Thanks for the additional information. That sounds much like what we have heard. I think there is an element of fear with any new career, but the limited resources and high stress of a deployment environment make it extra challenging. We originally were told 2 years for every year of HPSP tuition, but now we were informed it is 1 year per year of tuition. I'm not sure about IRR, but I don't think they mentioned that for CRNA's. He'll probably go back to the guard anyhow after active duty, so it doesn't really matter to us.

[Lunah, MSN, RN]

I see. I am pretty sure that any active duty commission is a total of 8 years with a minimum of 3 done on active duty, but a healthcare recruiter can confirm that.

I am not sure that a new CRNA would deploy with little experience. All of the ones I deployed with had at least 3-5 years of experience, so they were more comfortable in those crisis situations. I think he should go for it!

[jeckrn, BSN, RN]

I am not sure if you husband can go on active duty to finish his school is available to him since he is already in school and in the reserves. Even though he is in the reserves he will have to go through the board process again if it is like the Army. I am not sure how easy it is in the AF to switch from reserves to active, he needs to contact a healthcare recruiter to find out his options ASAP.

[offlabel]

Big difference in "autonomy" in the civilian world and "stateside" military facilities. Military patient population is largely young and fit and not having the "big three" type procedures (vascular, thoracic, cardiac). Even the trauma patients in theater are young and healthy with heavy surgeon support. ASA 1 and 2 mostly in AF "autonomous" positions. If he's military trained he's more than able to be independent in those settings. Wouldn't give that a second thought.

[Lunah, MSN, RN]

Even the trauma patients in theater are young and healthy with heavy surgeon support.

Except for local nationals - usually not so healthy. We had some older patients (hard to know their age) who were definitely not among the typical young, healthy demographic of our military. And during a MASCAL too! Good times.

[silvrsnoflake]

I'm not too sure about the details, but he already talked to a healthcare recruiter as well as the head of CRNA placements and they were ready for him to sign up. So it is definitely doable. They liked that he wouldn't have to attend COT since he already did that. In a lot of ways it is an easier transition for someone who is already serving in the military. But you know how it is, I'm sure there is red tape we are unaware of. We are used to that. They seem to be pretty desperate for active duty CRNA's.

[silvrsnoflake]

Thanks for the information. Yeah I think he would be able to handle that for sure. Just not sure about some of the deployment situations.

[silvrsnoflake]

Except for local nationals - usually not so healthy. We had some older patients (hard to know their age) who were definitely not among the typical young, healthy demographic of our military. And during a MASCAL too! Good times.

Oh wow. Yeah, I think there is always the unknown and that's what worries him as a new CRNA. Obviously with experience that type of situation may not be so daunting.