Left alone in OR

We're independent during the last year of the program. MDA for induction, emergence. MDA or CRNA one-on-one for wee Peds, Open-Hearts.

We are 1:1 for the first seven months, then independent during the last 21 months. (Except for open hearts, those are still 1:1).

We're independent during the last year of the program. MDA for induction emergence. MDA or CRNA one-on-one for wee Peds, Open-Hearts.[/quote']

By left alone, I'm assuming you mean, you're the only anesthesia provider caring for the patient? Is this right? I actually have thought about it, but I kinda just assumed someone would be with you a majority if not all of the time. How else are you supposed to learn and ask questions. I would think the liability would be higher if something went wrong. To, me that sounds kind of scary, especially for during school. Thanks.

We're independent during the last year of the program. MDA for induction emergence. MDA or CRNA one-on-one for wee Peds, Open-Hearts.[/quote']Does this mean you aren't performing the induction/emergence or just that the MDA is "physically present"? I'm sure you are, but you never know with the politics in some places.

D.C.

being devil's advocate, we, as srna's, are working under someone else's licence and are not supposed to be alone at all. i do understand that this does happen and cant wait until im that way as well.

Those of you who are not in school yet need not be frightened about being "left alone". This is a natural part of the learning process.

Nobody is going to leave the OR unless they have absolute faith that the SRNA is capable of the task at hand. You always have a clinical instructor assigned to you, they just don't spend the entire case "looking over your shoulder". But the SRNA always knows how to contact them.

Graduate nurse anesthetists are expected to be able to hit the ground running the day after graduation. There is no gradual breaking in, and easing into it. The only way you produce a graduate capable of this performance is to allow/expect some independence as a senior student.

loisane crna

I agree Loisane. I am just finishing my second semester and there are many days that I am "left alone" now. All this means is that the anesthesiologist is there for induction, leaves and pokes his/her head in occassionally to see how things are going. They are also there during emergence. We run the rest of the case by ourselves but if I say I need help, I will have an army of anesthesia people in the room in seconds. Although there may be no one physically in the room with me, I am never truely alone!

This can be scary at times and certainly was the first few times I was "alone" but it builds confidence and independence. Being "solo" is not always the case, we often have a CRNA assigned to the room and they will spend most of the time with us but let us do the case. I like having the CRNAs there because they "pimp" us more and get us to think. They also ask questions likely to be seen on boards so it is good review.

Also, as juniors we are not flying solo with big cases, although even "simple" cases can be tough when the patients have a ton of comorbities (ASA 4 etc). I can honestly say that even though I have been in school only 7 months, I feel more comfortable and confident in the OR all the time. By senior year, I will be expected to be running almost all cases independently (except hearts). This does not include induction or emergence when we always have an anesthesiologist present.

This could make for an interesting discussion. I look forward to hearing about how other SRNAs' clinical experience is set up.

Just curious, but how does the surgeon and other OR personnel react to having a SRNA for anesthesia? I guess I ask because the only case I clearly remember from school is an open heart. Also, we didn't have SRNAs at the hospital I did my surgical rotation in that semester. I would think you would be sweating out the entire case if you're by yourself, but I know anesthesia is different from any other type of schooling. I also wondered like someone else, are the SRNAs/CRNAs actually doing induction, or does the MDA? I know at my hospital I work at, the MDAs do the preop clearance, induction, emergence, etc. and it seems like the CRNAs are pushed out of the way. Just hoping it's not that way everywhere.

Just curious, but how does the surgeon and other OR personnel react to having a SRNA for anesthesia? I guess I ask because the only case I clearly remember from school is an open heart. Also, we didn't have SRNAs at the hospital I did my surgical rotation in that semester. I would think you would be sweating out the entire case if you're by yourself, but I know anesthesia is different from any other type of schooling. I also wondered like someone else, are the SRNAs/CRNAs actually doing induction, or does the MDA? I know at my hospital I work at, the MDAs do the preop clearance, induction, emergence, etc. and it seems like the CRNAs are pushed out of the way. Just hoping it's not that way everywhere.

Even at hospitals where the MD's PARTICIPATE in the induction and emergence, most of them don't actually DO IT. Do your CRNA's literally stand off to the side while the MD intubates and extubates?

At our hospital, the MD is always there for induction. He/she usually pushes the drugs while the CRNA or SRNA manages the airway. Once the patient is induced, the MD moves on to the next case. The MDs are present for extubation as well. Even though I live in a relatively pro-MD state, the CRNAs at my hospital have lots of autonomy. The MDAs are respectful to the SRNAs and CRNAs and it is a good anesthesia care team environment.

For example, today I had done 6 MAC cases by 1 pm and other than the MDA dropping by to say hello on occassion, I was on my own. My final case of the day was a GA case, MD was there to push my induction drugs, I intubated, turned on the gases and was on my way. I was doing fine running the case and when I had a question, I had the nurse call the MDA (Non-stat) and I had a CRNA and MDA in the room in less than a minute.

As far as pre-op clearance, we always must have the MDA sign for that, however, I will interview the patient, fill out the anesthesia assessment sheet, start the IV etc if I get there first. The MDA double checks my stuff, talks to the patient briefly and signs the pre-op. We are taught to provide full anesthesia care, start to finish, and the MDAs are very supportive of our learning needs.

Most of the time I do not mind being left alone as a student as it gives you autonomy and helps you develop independent skills. The facility where I am at usually leaves senior students by themselves as long as they are comfortable with your skills. A doc responds right away if there is a problem. The only thing they do which I do not like is asking students to relieve for lunch breaks. I hate walking into the middle of a case at this point. However, I know I will have to do this as a CRNA.

i have been at two different clinical sites...

at one the MD is always present for induction and a CRNA has to be present for emergence when the student is running the room

at the other... the CRNA/SRNA do induction and emergence alone unless there is an issue that belies the need for add'l help...

on the "being alone" issue... we start that after our first year... and sometimes a little earlier if our clinical staff is ok with that... there is always someone there to help - yet it is like getting your wings a little at a time, which has to be better than trial by fire. From what I have seen and heard from my clinical coordinator - they have a pretty good idea of who will be fine and who needs another person in the room.