HELP: Sedation RNs

mommyof2grls · Jan 21, 2004

Your post seems to have nailed it on the head! You stated your purpose, it was succint, to the point, and non threatening with an understanding of how some might feel about thissubject.

Build on the above!!!! You'll do fine. I would think that kind of experience would be very beneficial!

NCgirl · Jan 21, 2004

Hey there, I'm hoping I can help. I was a SICU/CVRU nurse for two years before going to the cath lab. In there, the RN basically functions as anesthesia does in the OR, but only with limits, and under the direction of a cardiologist. When I interviewed, I used that experience to the best of my ability. I learned all I could about versed and fentanyl, and then romazicon and narcan. Sure enough, I was asked about correct dosages, MOA, which one reverses what, etc. All three schools I interviewed at seemed impressed that not only had I been working with conscious sedation, but I had also been in the situation of giving drugs/ starting drips that I thought were appropriate in really bad cases, where the cardiologist didn't even have time to talk to me. Granted, those were skills I learned in CVRU, and most of it was either ACLS or CCL protocol....so I had the "authority" to do it without a direct order at that very second. So, as you can see, the RN in the CCL can resemble the CRNA in the OR, on a much smaller scale. When I interviewed, I said that although I had been functioning in this role, I knew that I only knew and understood the very basics of what I was dealing with. And THAT was my reasoning for being there, that I wanted to know all the little intricacies. Conscious sedation was not enough for me, I wanted to be an anesthesia provider. Another sidenote of advice from my interview of the school I chose (I'm in second semester now)....the MDA in my interview asked me of a recent situation in the cath lab where I thought a patient received less than adequate care. Oh my gosh, what a question!!! So I told a story of a pt who had rec'd some versed and was wigging out, really long story that I won't go into b/c of HIPPA. He asked me if it was b/c the pt had too much versed or not enough, to which I responded, "I don't know, but that's why I want to come here- so you can teach me." Obviously, that answer was liked. So, I guess what I'm trying to say is.....play up the fact that you have been involved with conscious sedation, but be humble. Let them know you have minimal knowledge as an RN, and that's why you want to be in THEIR program.

Best of wishes in your interview!

melrey11 · Jan 21, 2004

I "think" they are more concerned that you have worked closely with CRNA's, know their job description, have done similar related patient care, etc... They need to know that you are 100% sure that this is what you want, and that you are 100% sure of what you are wanting. I would emphasize working closely with them in such an environment, Im sure they'll like that a lot. Good Luck!

jebain · Jan 21, 2004

Thanks for the help-everyone! BTW, NCgirl-what school are you attending now? And which 3 did you interview with? I figure they will ask me some hemodynamics and vasoactive questions, but like you said I bet they will ask the sedation/airway mgmt questions mostly.

yoga crna · Jan 21, 2004

I'm sorry, but I wouldn't volunteer the information, nor would I lie if I were asked. I personally don't think that is a positive to admit you were doing something that may not be legal and is, in my experience, marginal practice. I would see you as someone who was good at following directions and not very good at independent judgement, which is so important to being a professional.

After you become a CRNA, look at this topic again, and honestly look at what you were doing with limited knowledge.

This should start a good discussion.

Yoga CRNA (who has bailed out patients too many times to count from RN administered sedation)

jebain · Jan 21, 2004

I do know that there is controversy with this subject. I am not going to lie-I have been selected for interviews at 4 schools so they must be interested in my experience. It is insulting that you would say this makes me a good order taker, and you obviously have no idea what I do day in and out. I have learned a lot in the lab that I would not have learned in a critical care area. BTW, we do run and manage many types of lines and gtts. The job does require independent thinking and constant attention to details. We also respond to codes. I am within my scope of practice as that has been established by the hospital and board of nursing. Also we have had a Professor of Nursing Anesthesia observe us for quite some time, and he said he is very impressed and pleased with our lab. But, I do realize there are a lot of things I don't know. I am really interested in learning that is why I have applied.

yoga crna · Jan 21, 2004

I am sorry that I offnded you, but you asked a question and I gave you an answer, based upon many years of anesthesia and as a member of an admission committee for about 10 years. If I were on a committee, I would ask many questions about how you selected the medications to use, determined the dose, did a pre-sedation evaluation. Then I would attempt to determine your understanding of the pharmacology of the medications and pathophysiology of the patients. I would worry that you may be too self-confident and would want to know how open you are to learing new things.

I am delighted that you have such a wonderful practice and you have every right to be proud, but you question was how valuble this experience would be in an interview for andesthesia school and I gave you the best answer I had. Others may have differing opinions.

Yoga CRNA

NCgirl · Jan 21, 2004

Yoga, you are right, this will be a great discussion. I'm kinda seeing both sides here, b/c I was that nurse just seven months ago, and now I'm in my second semester of anesthesia school. When I was in the CCL, I did plenty of things independently, and plenty of things as a direct order of the cardiologist. Nothing I did was EVER illegal. Every drug I pushed was in my scope of practice according to the state BON, and my hospital's practice. With that said-- knowing what I know now, after just five months of anesthesia training, me giving those drugs was a SCARY thing. It scares me that I risked my license every day giving drugs that I knew and understood so little about. Of course, at the time I had no clue I was so ignorant. And yes, we did have to call anesthesia for certain cases. Not everyone can be sedated to the level we need them with Versed. And my old hospital wouldn't let us push propofol in the CCL, despite running drips in the units. So I have to agree with Yoga, that my opinion on this matter has DRASTICALLY changed since starting school and taking some unbelievably deep pharm classes. And I will go as far as to agree that what I was doing was marginal practice. But it was not illegal, and I did certainly do plenty of independent thinking and judgement making. I also agree with Jebain though. Many people have no clue as to what CCL/special procedures nurses actually do, and the degree to which we work with anesthesia personnel. Hopefully this board will continue to be a source of enlightenment for us all!!!

In relating this all back to interviewing, remember the question I was asked by an MDA. My answer was "I don't know, that's why I want to come to school, so you can teach me." I think that's the bottom line here.

PS- Yoga, in the CCL, the cardiologist selected drug and dose, the RN was not responsible for that.

athomas91 · Jan 21, 2004

i agree w/ NCgirl and Yoga....

i think that as nurses we get into a practice of doing something as part of a routine w/o really ever understanding it or the consequences of it... in the ER we used to do tons of con. sedation...and although i knew to always have an intubation cart at bedside/ suction ready/ O2 ready....i never really knew all the ins and outs of the meds i was giving...and i KNOW that many of the docs i worked w/ didn't either....I don't feel Yoga was in any way attempting to slight the origional poster - he was just being honest in his opinion and assessment...if you are going to CRNA school - be prepared for the same !!

yoga crna · Jan 21, 2004

The difference is that in anesthesia you select the drug and calcuate the dose yourself.

YogaCRNA

PS- Yoga, in the CCL, the cardiologist selected drug and dose, the RN was not responsible for that.

jebain · Jan 21, 2004

Yoga, I do see your side of things, and that is why I asked the question. I have friends that are scrnas and I work with crnas so I know the thought of rn sedation. The job has really made me want to become a crna, and I look forward to learning all about the drugs. I just was pointing out that there is a lot going on in the labs-that is why you must have critical care experience before working there. I appreciate your input and have respect for the advanced knowledge you have regarding the matter. I actually have began working in the critical care float pool since I applied to crna schools. I still work in the lab some, but I do critical care as well. thanks again!!