amiandjim 886 Views
Joined: Oct 5, '07;
Posts: 20 (25% Liked)
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We have 9 operating rooms in our main hospital and four in our ambulatory surgery center. In the main, we generally have 15 minute turnover (at least, that is goal) and we do pretty well, I think. Our enviromental services staff and our anesthesia techs do a great job facilitating this. In addition, our OR staff is always willing to jump in and help clean the room so we can turnover more quickly. In our ASC, our turnover is 5 minutes, with very few exceptions. We do not have cleaning staff or anesthesia techs over there so it is just team work that gets it done.
At my current position, we do not do kidney transplants. However, when I was in anesthesia school, we did quite a few. We always gave the donors 2 liters of fluid before going to the OR and then made sure they had received 4-5 liters total before the kidney was out. We also gave mannitol/lasix and occasionally renal dose dopamine before harvest, depending on surgeon preference. We did have a kidney harvest protocol that had been developed by anesthesia and the transplant service, but would deviate from that if the situation called for it.
In the spontaneously breathing patient, opiates cause a decrease in respiratory rate with an increase in tidal volume. Unless your patients that are intubated are on SIMV or PSV and breathing on their own, opiates shouldn't alter their respiratory pattern. Now, if they are breathing on their own with just ventilatory support, yes, they will take larger volumes at a slower rate.
There are no CRNA schools in Indiana b/c it has traditionally been a fairly CRNA "unfriendly" state. However, you can practice in Indiana as a CRNA and there are quite a few jobs available (go look at gaswork.com sometime). I think there are something like 200 CRNAs working in Indiana right now, but who knows what the future will hold. With reimbursement decreasing and healthcare costs increasing, I would imagine that more and more hospitals will look into CRNAs as opposed to the all MD model that many of them use now. The incoming AANA president is a CRNA from Indianapolis who does pain management for a neurosurgery group, as well as works OB in one of the smaller hospitals in Indianapolis.
I keep trying to reply to you but for some reason, there is no button that says reply (wierd, huh). Can you just pm me your e-mail address and I will answer your questions that way....I'm so sorry it has taken so long to get back to you...I read your first message a long time ago and completely forgot about it! Anyway, just send me another pm b/c either I am stupid or my pm box is acting wierd.
P.S....sorry to hijack the thread guys.
I pretty much get all of my patients back breathing as soon as it is feasible (after relaxation no longer required, etc...). I like to use SIMV or PS at first, then let them breathe spontaneously. While they are breathing, I titrate my narcotic of choice to achieve a respiratory rate of about 6-10. I have found that if the patient is comfortable and has enough narcotic on board, they tend to wake up much more smoothly.
I understand that it might have been scary for you that the patient had to be converted to a general, but I would not call "no pre-oxygenation" a lapse in safety. The anesthesia provider was likely trying to get the patient to sleep ASAP and didn't have time to pre-oxygenate. Yes, pre-oxygenation buys you more time for apnea if you have airway difficulty, but it isn't a lapse in safety if it doesn't occur.
you can also take this opportunity to do some travel/agency nursing. no one cares if you are going to anesthesia school when you sign a 3 month contract!
I am going to assume you are talking about CRNA results...not NCLEX. I took mine today as well and it also shut off at 100 and so did my 3 classmates who took it with me. I do know one person who got the minimum last year and failed, but I don't think it is super common. Unfortunately, there is no way to get faster results so we just have to sit at home and wait for the fed-ex truck!!! Good luck!
hello , i was wondering what the least expensive CRNA program was? if its public then i will be a non-resident, thanks!
I find it interesting that anesthesia is required for the donor body, already pronounced clinically dead, during the harvesting of organs for donation. Yes, anesthesia is not just for the living. Does the CRNA role involve actively trying to keep all of the hemodynamic parameters stable to maintain the viability of the organs prior to surgical removal? If so, I would assume that this is very challenging. Are there any CRNA's out there in "CRNA land" that would be able to provide more insight into this very fascinating topic? Thanks in advance, I would be very interested in hearing about your experiences.
The metropolitan rate applies to students who live in certain counties in Kentucky, such as Boone County. If you move to Ohio and your wife has a job, you should qualify for in-state tuition. Answers to your other questions are below in bold.
I will look into the metropolitan rate. My wife might actually do some paid work during her 3L year, so it sounds like I may get a break during the second year. The monthly stipend option brings another question to mind...
1) Do you negotiate your furure salary up front with stipend paying hospitals in that contract? Enlighten me on the pros and cons of that option...
You do not negotiate a starting salary when you sign the contract. When you graduate and accept a position, you will get the starting salary they are offering other CRNAs. In Cincy, most hospitals are paying about the same (within $3000-5000 of each other). The pros are that you get $1000 a month and you don't really have to worry about finding a job when graduation approaches. The cons are that if sign it up front, you may decide you want to work elsewhere. If you sign a contract and do not accept a position, you have to pay back the amount given to you plus a 50% penalty. However, if you decide to work somewhere else, many places will buy out your contract and pay the penalty for you. For example, I had a contract with one hospital here but upon rotating at another facility, I decided I really wanted to work there. The other facility bought out my contract and payed the penalty for me. If you do sign a contract, you need to read it carefully or have a lawyer look at it for you...with your wife being in law school, I would imagine she could cover that for you.
2)Are there hospitals in other Ohio metro areas offering the same types of stipends to UC students in exchange for the same types of work obligations? (eg. Columbus, Cleveland, Dayton, etc.)
I'm pretty sure there are. I think a couple classmates have contracts at Miami Valley in Dayton and I'm sure if you contacted other hospitals, they do the same thing. It's pretty common in a lot of areas around the country. Some places will also offer a better deal than $1000/month, depending on how badly they need CRNAs.
3) Are the scholarship offers based entirely on GRE scores or might I have at least a small chance with my grades? (again, no candy-coating lol) Any classmates getting needs-based scholarships (i.e. both spouses in grad school, guys with stay-at-home wives, girls with stay-at-home hubbies)?
Yes, the scholarships are based completely on GRE. They take all incoming graduate nursing students and simply rank them by GRE. When the money runs out, those below the cutoff get nothing. The College of Nursing does also have other scholarships, some of which are based on need. I got $1000/quarter my first year and then $1500 per quarter my second year. I don't know of any other scholarships my classmates are receiving, but I do know that you can sometimes qualify for grants and stuff if you have low income. The problem for you will be that the year before you enter school, you will work as an RN and that is the tax return you will have to use to fill out your FAFSA for the first year. My second year, we did qualify for more subsidized loans b/c we had less income.
4) Are you using an I-phone/Treo type PDA/phone or separate phone and PDA? Any companies offering amazing deals to UC students?
I have a TREO and I really like it. In the program, you need to have a Verizon phone b/c that is how we communicate with our CRNAs and MDs in the OR. So, when school started a bought a phone/PDA combo so I wouldn't have to carry around 2 devices. A PDA is not mandatory but I find it really helpful to look things up in the OR. Verizon does offer a small discount to UC students but it's not a super deal.
5) Does UC offer any good deals on laptops for grad students?
Not sure about that one.
6) Many options for online or online components to any anesthesia and/or school of nursing classes?
If you are accepted to the program, you can take some of the college of nursing classes ahead of time and I don't think UC necessarily offers them online but other colleges of nursing do. You could take them anywhere that will transfer.
7) I am aware that there are some hot issues involving reimbursement and supervisory agreements for CRNA's--any others that might be worth doing some research into for the interview?
You could maybe look into the AA issue and it might be helpful to know that our program director is the current President of the AANA. Not sure if they will ask about political/current issues but I would think it would be nice to know about.
It sounds like you have had great experience and really well prepared for anesthesia school. Although working in the OR won't help with the actual clinical skills, I think being familiar with the whole OR dynamic is a great advantage. As far as the GRE, over 1000 should be enough to get you in if you do well on the interview. I can tell you that I have one classmate who got around 1000 at first and then after she was accepted to the program, she studied and retook the GRE to try to qualify for scholarships (which she did). I think that is always an option b/c that money really helps out. As far as childcare near campus is concerned, I haven't really looked into it but surely there is something. I know Cincinnati Children's has a daycare but I think?? it is only for employees. The Hyde Park area is a nice area near campus (maybe 10 minutes) that I'm sure has childcare but might be a little more expensive than other areas. As far as your other questions, I answered them below in bold. Hope this info is helpful! Let me know if you have other questions.
Thanks once again. You have allayed some of my initial apprehensions. I did not really stop to consider the potential difficulty associated with locating child care closer to campus. However, it might just have to be a challenge we choose to take on anyway b/c my wife will be in her third year of law school during my first year of anesthesia school (if i survive the interview cut). If this pans out, she will be done in 1 or 2 semesters at UC as a "visiting student", but graduate from U. of Utah. Unfortunately, proximity to campus might be one of the only keys to survival we have control over.
My cummulative GPA is 3.87, but I was forced to take the GRE on very short notice (6hrs study time maybe) and limped through with a 1034 on about 4hrs sleep and after a 2.5 hr drive to the testing site I could get a date for on such short notice--so it sounds like a scholarship is most likely a longshot in my case. My buddy from work got some amazing GRE score (1300's-1400's)--so I will surely let him know about the opportunity. I am excited that your clinical component sounds like one of the best one could ask for. I agree that most "school of nursing" classes anywhere are likely to be utterly painful (If you put Orem's chocolate in Roy's peanut butter, is god revealed in brushing your teeth independently? Painful Florence Nightengale crap.). I was an OR nurse for 3.5yrs prior to my jump to the ICU and I developed some pretty pretty darn thick skin along the way(along with a severe allergy to nurse Florence and Co.)--the very environment of the OR lends itself to those who are a bit OCD anyway lol--I am pre-conditioned to take it with a grain of salt. I am sure I will come up with some more questions and I SO appreciate your replies.
Thought of a couple more already:
1) Do any clinical sites pay a stipend?
Most hospitals in Cincinnati (University, the Christ, Bethesda North, Children's, and Good Samaritan) will pay you $1,000/month throughout the program in exchange for a contract to work for them for 3 years after graduation. The actual clinical sites do not pay you a stipend for being there (university used to pay us a very small amount each quarter but that went away my first quarter in the OR), but you can get money in exchange for promising to work for them.
2) Did you qualify for in-state tuition from the get-go and/or does pretty much everybody qualify at some point in the program?
The problem with in-state tuition is you have to show them you have a reason for being in Ohio other than school. If your spouse has a job in Ohio as of the first day of school, you automatically qualify for in-state tuition (which we would have except we live in Kentucky so after one year we got the "Metropolitan" rate, which is basically in-state. I still have classmates paying out of state b/c their spouses live out of state or don't have a job here and they are considered to be here just for school. If you wife graduates and then gets a job in Ohio, you would qualify but you would probably have to pay out of state until then. You can always call the graduate student advisor and ask but I'm pretty sure that's accurate info.
3) Did most of the guys wear suit/tie or just nice business casual on interview day (sports coat/tie/khakis)?
Definitely wear a suit and tie, no question about it.
4) I wonder if UC has an in-state tuition policy friendly to members of the Army Reserve--I can actually retire prior to the beginning of the program (April/May '08), but I am currently weighing the value of available educational incentives vs. closing that chapter of my life altogether...
My answers are below in bold. Hope this helps....I don't mind to answer any others you may have.
Thanks so much for answering my previous questions.:roll
I have a couple of student contacts in the CRNA program @ Westminster (here in Salt Lake) that I know personally. Maybe some of the bad stuff they are telling me about their experiences there is attributable to the growing pains of a newer program (they just got accredited in Jan '07 and have yet to graduate a first class). They say that it has been chaotic, disorganized, callous, malignant, and that they have been pretty much treated like crap. One even said that if he had it to do over again that he would have waited another year and gone elsewhere. So alot of my next round of questions for you have to do with the climate/environment of the program @ UC.
I do not have visions of Care Bears sliding down rainbows singing "cum-by-ahh". I know any CRNA program is going to be demanding and stressful. So don't candy coat it please, lol.
1)How do you feel you have been treated?
I feel we are treated pretty well. Most of the CRNAs and MDs we work with are happy to teach. Of course, there are always a couple who you might not "click" with, but that would happen anywhere. I would definitely never say we are treated like crap. At first, it can be really hard in the OR b/c everyone you work with wants you to things their way and that can be frustrating. I think some people perceive this as being treated badly, but it's not...it's the nature of anesthesia. UC is one of the oldest programs in the country and definitely is well-organized.
2)Would you have gone somewhere else if given a choice to go back and do it all over again or do you think UC is the "the bomb."
I would not go anywhere else. I think we have a great mix of didactics and clinicals, with opportunities to do rotations at many sites, which gives you a different perspective on things (private hospital vs. university). We get a ton of trauma and big cases at the U, lots of peds experience (Cincinnati Children's has one of the highest surgical volumes in the country and they do over 150 cases a day), high-risk OB, and then we get to go to several private hospitals, which is great. The only negative I really have to say about the entire program is the courses at the College of Nursing are very annoying, but I think that would be true of any MSN program.
3) Are you getting more than ample clinical opportunities with particular regard to regional anesthesia? Competing with MD residents for opportunities?
Everyone in my class definitely has many more cases and hours than are required. We do have residents at the U, but I don't really feel like we compete with them. The only cases we don't do at the U are hearts (We spend 2 months at a private hospital for hearts) and liver transplants. The residents do get some of the bigger cases such as thoracic and vascular a lot of the time (although we do them too) but that is because they do not get to rotate anywhere else. We do thoracic and vascular cases at the VA, as well as the private hospitals, so I do feel I have done plenty of those. As far as regional, we do a ton of epidurals and spinals, no problem there. For peripheral nerve blocks, the pain service does them at University (although we can do them occasionally), but we get a lot of experience at the private hospitals and the VA. I think I have done about 30 peripheral nerve blocks, which I think is pretty good.
4) My friend and I are both married with kids: Have you had to find day care (mine is 2 yrs, wife due with baby #2 May '08). If so rates $?
I have a three year old who was 18 months old when we moved here so yes, we had to find daycare. We live in Florence, KY and our rates are about $650/month for one child.
5) Is commuting sucking the life out of you?
I live about 15 miles south of Cincy and it doesn't really bother me at all. Early in the morning it is no problem but traffic can be a problem at peak times. We do have 3 students who commute over an hour a day and while they sometimes complain about it, they haven't had a problem.
6) Neighborhoods within decent commute times? (I am from Dayton, Ohio and am a bit familiar with Cinci).
As I said, I live in Florence, KY. We have classmates who live right by campus (not the best neighborhood for kids), in Hyde Park (about 10 minutes away), and some who live as far north as Mason and West Chester (about 30 minutes). With kids, I would recommend looking at the suburbs, not right by campus b/c as I said, not a great neighborhood and I think you would have a hard time finding child care.
7) Has financing the whole show been really rough? (My wife is a law student, so I have a little experience, but her program is cheaper all-inclusive by far). We also have access to equity out of our houses here and can tap 401k if need be--had to do that or know anyone who has?
It hasn't been terrible. We pretty much have not altered our lifestyle from before school financially (our choice) and we took out loans to cover what we needed. See below and I will tell you your options.
8) What do you estimate your total program costs to have been when done?
In-state tuition is about $28,000 for the whole program, which is pretty cheap for grad school. Other costs would probably be about $4,000-5000 with books, Valley Review, Anesthesia meetings, and certification exam. The university does offer scholarships for the first 2 years that pay b/t 60-85% of your tuition (I think it's about 60 right now). To qualify for those, you need to do well on the GRE b/c they take all incoming graduate nursing students and rank them by GRE. Usually about an 1100 and above will make the cut. There are stafford loans that can be taken out up to $20,500. Then you get private graduate school loans from Bank One or Sallie Mae for up to $40,000/year. The money is definitely there, it just depends on how much you want to borrow vs. how much you want to save and pay on your own. We have quite a few loans but have a plan to pay them off in 5 years, which is pretty good, I think.
9) During first year about how much time do you think you spent per week in class and/or studying?
I would say that the throughout the program, I have spent between 60-70 hours a week either in class, in the OR, study for tests, or preparing for clinical.
I got the invitation from Wanda in an email today. A buddy/co-worker from my ICU got one too. We are shooting for the first day (12th) mid morning. I might end up having LOTS of questions for you, LOL.
1) Do you know how many students are interviewed for each position (isn't a class @ UC 20-24-ish)? I guess most schools are about 2:1...
2) I know about the written test--rate it on a scale of 1-10 (1 being like an ACLS test and 10 being CCRN test)?
3)Can parking be a problem on interview day? (and for the duration of the program for that matter)
4) Do you think they have a target sub-pool of applicants within the pool of interviewees that really have to step it up at the interview and a separate sub-pool who are kinda shoo-ins as long as the don't totally botch the interview?
This will be my first interview, so I guess I could be overthinkng it. Any and all advice is appreciated...
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