How often do you do nerve blocks and PA Cath insertions?

[Bluebolt]

So I just interviewed at a CRNA DNP program and during the process they told me that while we will do a semester rotation at a rural hospital doing spinal blocks and PA Cath insertions we wouldn't do it often in practice. In fact they said at their university hospital and many other facilities the CRNA's don't put in CVL's, PA Caths and nerve blocks.

I've heard that some programs don't focus much on these skills at all. Did your program train you how to do these skills well and how often in your professional practice do you perform these skills.

Also if it's not common for a CRNA to be proficient in these clinical skills would that be a bargaining chip for higher pay when searching for employment?

[wtbcrna, MSN, DNP, CRNA]

Top of the World Highway | Yukon Territory Alaska Northern British Columbia One of my favorite trips.

[PMFB-RN, RN]

I've never worked at a facility like this but know of a friend who worked PRN at one. In the ED they didn't even have RT's or PCA's it was just a couple RN's and one MD, outdated machinery, etc. That's a level of rural that is far beyond what I'm comfortable with.

I guess if I was doing a mission trip to Honduras I'd end up in an environment like that.

A couple RNs and one MD? That is posh staffing! I am casual at a 15 bed rural hospital. It is often the case that there are no patient in the hospital overnight. When that happens we go down to ONE RN after 2330 until 6Am, with another on call if we get an admit. In addition some of the family practice docs who cover ER at night a few days a week take ER call from home and are not physically in the building.

I have been sole RN, and one of only two people (the other being a CNA / lab tech), and the only one awake in the building.

For example had a 15 year old kid brought In by his father with suspected arm fracture. I assessed him, took the x-rays (in Wisconsin rural RNs can get a limited use radiology technician certificate and I have one), uploaded them to the computer. The doc looked at them from his home, called me and told me what kind of brace to apply, entered some prescriptions into the computer that printed out at the ER nurses station. I applied the brace, handed the father the prescriptions, did the discharge teaching and they went out in to the hall to fill the prescription at the drug vending machine, and went home. I also made an appointment for him to be seen by ortho the next day. That's it, kids comes in with a broken arm and the only person he sees is an RN.

One summer night I was again the sole RN in the building and the physician was 3 blocks down the street asleep in her bed. 1AM a blood smeared guy walks into the ER carrying his 12 year old daughter, who was unresponsive and white as a sheet. Mom comes in right behind him with the girl's right arm in a plastic bag. I was alone with her for nearly 20 min. Rural nursing isn't for the faint of heart.

Usually when we do have a provider in the building (4 nights a week) its a NP. They have 2 NPs who do solo ER practice at night and on some weekends. They are it and both are superb. In my experience much better at handling trauma and critical situations than the family practice docs that cover on other nights. But of course solo ER practice is the only thing these two NPs do and they have been doing it for years.

Occasionally we will get a resident who is moonlighting in to cover ER. They are always LOST. Many have a very hard time adjusting from a full service hospital to the very limited resources of a tiny rural hospital. They are always asking things like "Hey PMFB, can we _______?".

I have to remind them that the "we" is him and I. If he can't do it, and I can't do it then no, we can't get _____.

[guest478081]

I do not really go on the floors to put lines in but depending on the surge we do put cvls in the OR in. Was trained for arts and all the above mentioned stuff to but doesn't happen too often where I am.

[Dranger]

Anesthesia is our go to for lines the pulm guys can't get. Mostly it is an MDA but sometimes a CRNA.

The majority of CVLs are placed by the ER doc, pulm or ACNP though. I haven't seen a Swan in forever...to be fair I work in a MICU though.

[jwk]

The term rural hospital is a relative term. I worked at a "rural" hospital that did CABG's, complex heart cath, CRRT and IABP. I'd say 60% to 70% of their 23 bed ICU had CVL's, all the CABG's had PA cath's, etc. The nearest big city hospital was in Atlanta which was an hour away.

I worked a 14 bed MICU/SICU in a small 200 bed hospital in rural Georgia, probably 30% had CVL's, no PA caths or IABP.

Hopefully that helps answer your question traumaRUs.

I'm sorry - there is no such thing as a rural hospital with 200 beds in Georgia. There is no such thing as a rural hospital in Georgia doing hearts, etc. Any hospital within an hour of Atlanta is IN metro Atlanta. Rural is NOT Lagrange, Rome, Gainesville, or Valdosta. Rural is Blue Ridge, Toccoa. Americus, or Donalsonville.

[subee, MSN, CRNA]

Among the totality of CRNA's, few work in independent practice. In 35 years of working, never worked in hospitals that permitted CRNA's to do central lines (surgeon did it) and haven't seen a PA catheter in decades. My first year our, I did a few central lines but worked independently during nights and weekends. Next group took over two years later and those privileges were dropped for us. This is in NYC area.

[Bluebolt]

I'm sorry - there is no such thing as a rural hospital with 200 beds in Georgia. There is no such thing as a rural hospital in Georgia doing hearts, etc. Any hospital within an hour of Atlanta is IN metro Atlanta. Rural is NOT Lagrange, Rome, Gainesville, or Valdosta. Rural is Blue Ridge, Toccoa. Americus, or Donalsonville.

An hour was an approx term. If you're doing the speed limit exactly it would probably be 1 1/2 hours to reach my original hospital in ALABAMA via I-20 that I was referring to.

You shouldn't presume to know so much when it just makes you look foolish by showing you the flaws in that loose logic. Not to mention your entire point has no meaning or use in the thread? Are you studying to be the name police on "rural" Georgia? lmao.