No Interview

Do you think all SRNAs are lazy? In my class all of us work our asses off in the OR, at home, and at other times. I admit, I sometimes don't know the answers asked of me in the OR, I DO go home and look them up, usually reporting to the questioner the following day (if I see them). As for the complaining, I'll admit I do that, most of the time its to blow off the steam that accumulates through stress. Wel aren't all lazy...most of us are just in the middle of it all.

Well here is a typical day in the OR with a Senior Student. We are doing a carotid endarterectomy. This student was doing a vascular/neuro rotaition at our hospital and has about 8 months to go. I had a meeting between 7 and 8 just to set the stage. I was in the OR just after 6 and the student showed up about the same time. We set the room up and I told him what gtts to prepare. No problems here as some CRNAs are minimalists while I like to be ready for bear. We went to interview the patient and as we were finishing up it was time to leave for my meeting. I told the student he should hang at the bedside with things set up so he could place the A-line when our MDA showed up. Well, I got back at 8 and the SRNA had left for coffee and missed placing the A-line. He also didn't volinteer that info. nor did he seem to take responsibility for that, just complained. So, he did a great job intubating the obese patient and we were off. I suggested that if he had to give more than a couple of tweaks of pressors/vasodialators he start the appropriate drip. Well after far too long (IMHO) and with a couple of repeated hints, he started the neo gtt. We struggled for a few min. with a poorly running IV but eventually got that sorted. I said that part of his responsibility at this point was to watch the carrier IV to insure it didn't stop/slow and reduce delivery of our gtt. Well repeatedly, I had to remind him to flush, reposition the IV. He also missed catching clamp, shunt, openig times etc. The surgeon forgot to ask for protamine and he didn't catch that either. Urine wasn't being monitored until I repeatedly reminded him. Now, as far as knowledge goes, I was less than impressed also. Blood flow to the brain? Anterior spinal artery and carotids. Amount of blood flow thru the respective arteries? Nope. Blood flow amount? Not even close. Oxygen consumption, glucose utilization, ATP consumption, nada. STP causes cereberal vasodilation. Huh, vasodialtion? No concept of "coupling". He did know which nerves were at risk in the neck. But didn't know the branches of the external carotid or if there were branches off the internal carotid a. No concept of the neuroprotective effects of isoflurane (not applicable in this case I know). Remember, he is doing a vascular and neuro rotation that is about 1/2 over. This is the type of students we are putting out to stand at the head of the table. No apology for being unprepared, just defensiveness at the end of the day when I tried to discuss with him his performance. I asked him how he thought he did and I recieved a diatribe as to how I WAS IN HIS WAY. So demonstrate to me you can handle what comes up, show me a working knowledge and I'll leave you alone. Show me behavior like he did and I'll be over you like white on rice and claim that some SRNAs are lazy, and full of excuses and worse, don't know they need to work harder. The patient deserves better.

Well here is a typical day in the OR with a Senior Student. We are doing a carotid endarterectomy. This student was doing a vascular/neuro rotaition at our hospital and has about 8 months to go. I had a meeting between 7 and 8 just to set the stage. I was in the OR just after 6 and the student showed up about the same time. We set the room up and I told him what gtts to prepare. No problems here as some CRNAs are minimalists while I like to be ready for bear. We went to interview the patient and as we were finishing up it was time to leave for my meeting. I told the student he should hang at the bedside with things set up so he could place the A-line when our MDA showed up. Well, I got back at 8 and the SRNA had left for coffee and missed placing the A-line. He also didn't volinteer that info. nor did he seem to take responsibility for that, just complained. So, he did a great job intubating the obese patient and we were off. I suggested that if he had to give more than a couple of tweaks of pressors/vasodialators he start the appropriate drip. Well after far too long (IMHO) and with a couple of repeated hints, he started the neo gtt. We struggled for a few min. with a poorly running IV but eventually got that sorted. I said that part of his responsibility at this point was to watch the carrier IV to insure it didn't stop/slow and reduce delivery of our gtt. Well repeatedly, I had to remind him to flush, reposition the IV. He also missed catching clamp, shunt, openig times etc. The surgeon forgot to ask for protamine and he didn't catch that either. Urine wasn't being monitored until I repeatedly reminded him. Now, as far as knowledge goes, I was less than impressed also. Blood flow to the brain? Anterior spinal artery and carotids. Amount of blood flow thru the respective arteries? Nope. Blood flow amount? Not even close. Oxygen consumption, glucose utilization, ATP consumption, nada. STP causes cereberal vasodilation. Huh, vasodialtion? No concept of "coupling". He did know which nerves were at risk in the neck. But didn't know the branches of the external carotid or if there were branches off the internal carotid a. No concept of the neuroprotective effects of isoflurane (not applicable in this case I know). Remember, he is doing a vascular and neuro rotation that is about 1/2 over. This is the type of students we are putting out to stand at the head of the table. No apology for being unprepared, just defensiveness at the end of the day when I tried to discuss with him his performance. I asked him how he thought he did and I recieved a diatribe as to how I WAS IN HIS WAY. So demonstrate to me you can handle what comes up, show me a working knowledge and I'll leave you alone. Show me behavior like he did and I'll be over you like white on rice and claim that some SRNAs are lazy, and full of excuses and worse, don't know they need to work harder. The patient deserves better.

What is your point again?

What is your point again?

A portion of potential CRNAs are lacking in motivation. As illustrated by the repeated questions regarding retaking GREs, science classes, CCRN, interview avoidance and poor performance in the OR.

A portion of potential CRNAs are lacking in motivation. As illustrated by the repeated questions regarding retaking GREs, science classes, CCRN, interview avoidance and poor performance in the OR.

Are you implying this is a new phenomenon? Be careful with sweeping generalizations Dave. Your basing these accusations on anecdotes and posts on an internet message board.

Don't forget that a large majority of the posters here are prospective SRNAs (which both of us were not too long ago) and they are trying to determine how to make themselves competitive for anesthesia school. This is a place where people can vent and share personal experiences.

Your posts come dangerously close to sounding like self-righteous indignation.

Are you implying this is a new phenomenon? Be careful with sweeping generalizations Dave. Your basing these accusations on anecdotes and posts on an internet message board.

Don't forget that a large majority of the posters here are prospective SRNAs (which both of us were not too long ago) and they are trying to determine how to make themselves competitive for anesthesia school. This is a place where people can vent and share personal experiences.

Your posts come dangerously close to sounding like self-righteous indignation.

Nicely said gotosleep.

Dave, if you are starting to generalize SRNA's, maybe you should take a break from precepting. (i know that can be very stressful also)

Yes, i like it when my preceptors are tough, i learn the best that way. But, if im walking into a situation where he/she already has me labeled as lazy and ungrateful....no thanks, ill take the tough, pimp-me-all-day preceptor over the the self-righteous preceptor any day.

"Are you implying this is a new phenomenon?" No

"Your basing these accusations on anecdotes and posts on an internet message board."

Yes, that is the forum we are using. The questions of GRE, class taking, interview avoidance come from the very people that want to get into school and use this forum. I never claimed I was using scientific method to determine my opinion, I am basing my opinion on what I see in the OR and what I read here.

"they are trying to determine how to make themselves competitive for anesthesia school."

Yes, many are, but the troubling posts are from people that are distressed at the inconvinences presented before them.

"This is a place where people can vent and share personal experiences."

True, and I am using this board for that purpose. This is a CRNA forum also, not just a SRNA or SRNA to be forum.

"Your posts come dangerously close to sounding like self-righteous indignation."

Very true, I am indignant and a bit self rightous when a student 2/3rds the way through his program walks into my room on a specialty rotation unprepared and nonvigilant and acts like I shouldn't hold him to a high standard.

Nicely said gotosleep.

Dave, if you are starting to generalize SRNA's, maybe you should take a break from precepting. (i know that can be very stressful also)

Yes, i like it when my preceptors are tough, i learn the best that way. But, if im walking into a situation where he/she already has me labeled as lazy and ungrateful....no thanks, ill take the tough, pimp-me-all-day preceptor over the the self-righteous preceptor any day.

Actuall, I had no preconcieved thoughts about the case example I presented. I have walked to meetings with him, chatted in the locker room with him, had lunch with him, sat around in the halls and goofed off with him. This was the first time I was working with him and I was pleased to see him assigned to my room. He was not "labled" as lazy or ungrateful by me. He earned that. Later, in asking what kind of student he was with the clinical coordinator, she said he was "inconsistant." BTW, I didn't tell her what kind of day we had, just that I was wondering how she found him in clinicals. You'll notice I have consistently used terms such as "a portion" and "some" certainly not "all" or "most". I truly don't believed that I'm being unreasonable when I expect preparation and vigilance from those that have had time to prepare and just hard work form those that have not. Consider that the tough time I might give one that is poorly prepared or performing is nothing like the one the CV surgeon or cranky MDA will dish out, or worse the plaintiff's lawyer.

"Are you implying this is a new phenomenon?" No

"Your basing these accusations on anecdotes and posts on an internet message board."

Yes, that is the forum we are using. The questions of GRE, class taking, interview avoidance come from the very people that want to get into school and use this forum. I never claimed I was using scientific method to determine my opinion, I am basing my opinion on what I see in the OR and what I read here.

"they are trying to determine how to make themselves competitive for anesthesia school."

Yes, many are, but the troubling posts are from people that are distressed at the inconvinences presented before them.

"This is a place where people can vent and share personal experiences."

True, and I am using this board for that purpose. This is a CRNA forum also, not just a SRNA or SRNA to be forum.

"Your posts come dangerously close to sounding like self-righteous indignation."

Very true, I am indignant and a bit self rightous when a student 2/3rds the way through his program walks into my room on a specialty rotation unprepared and nonvigilant and acts like I shouldn't hold him to a high standard.

I agree with you that the student you describe in the way you describe it was lazy, unprepared, and in the wrong. However, I also caution you not to make generalizations about all SRNAs. my attitude is, if I don't know it, teach me, tell me where I can access that information, tell me what I need to look up, I"ll do it. I agree also with the SRNA that stated she didn't want an indignant preceptor who thought she was lazy. If someone comes across to me like that I'll behave poorly to them as well. If someone quizzes the hell out of me and then attempts to teach me what I obviously don't know, I';ll appreciate that. I love being with MDAs and CRNAs that love to teach, even if it's a hard, brain twisting day. If you don't like to teach and precept, prehaps you shouldn't be doing it. And, if SRNAlets want to ask questions about how to improve themselves for the interviews, let them. Be encouraging. Most of the SRNAlets here in on this forum aren't lazy,. they are trying to improve the way they look so they can aspire to become CRNAS someday.

Last post from me on this subject. First, I am not generalizing, I expressed mismay at those posts looking for shortcuts and I presented a case history. No generalization. I am NOT talking about all SRNAs, or SRNA wanabes. I do a lot of teaching, most students seem to like me or at least act that way. Most come up to me later and thank me for some tidbit I taught them, challenge I presented them, good eval I returned, etc. Who said I didn't do a good job teaching, that I was burned out teaching, that I was being stressed out? I said none of those things. For the last time, I am not complaining about those who are wanting to improve, I was refering to those continued questions as to retaking GREs, classes etc. Those with questions about how to improve have all gotten a fair shake from me, my quarrel is with those looking to slip by. No one said you all were lazy but I can complain about those that demonstrate it. Get over it

I recently learned of a person that was accepted into CRNA school without an interview. I've been reading this forum for a couple of years and have noticed that interviews are a very popular topic. I was under the impression that the interview was probably the hardest part towards gaining acceptance into a program, and had just assumed that this was standard for everyone. Anyone get accepted without having to interview?

"Well, I got back at 8 and the SRNA had left for coffee and missed placing the A-line."

I thought this was a key part of your post. I can definitely agree with you, that between drinking coffee and putting in an A-line, I would much rather do the latter, and I sure as hell wouldn't be on a coffee break if there was a chance to do the a line. At the expense of sounding lazy, I also think one should also have a chance to take a piss every now and then. This isn't a break, it's a basic need. There was another thread nearby somewhere that talked about the number of hours srna students were putting in. Granted, I definitely think a fair amount of overtime is needed to accomplish the program, but to the point of exhaustion and severe sleep deprivation, I'm not sure it's warranted. I only bring it up becuause it seems pertinent to the fact that CRNA school is sometimes comparable to medical school. However, with the experience of being nurses, I think that most CRNA's should realize what sleep deprivation really does to one's decision making and functioning. Now, I expect a lot of evenings to include OT, and one should be used to making quick decisions in the middle of the night, especially for sick patients who need surgery right away. But is it appropriate to sleep deprive students in school? Part of me says yes, because how else will one learn to face the critical cases competently esp. in the middle of the night when one really doesn't feel like working, but part of me says the practice is unsafe because of the possible complications that could arise, and the high rate of addiction among health care workers, particularly CRNA's. Health care requires overtime hours, but also requires time to let loose of your insanity. That said, students and preceptors alike should make the most of the time they spend in clinical and in the classroom.

Hello everyone. I have to agree 100% with the postings from Wntrmute2 and Dreamatrix. Suck it up and step up to the plate. Don't whine about how hard it is to get into a CRNA program. 27 months is a relatively short period of time to invest when you think of the scope of practice you will get to one day enjoy. Try four years of undergrad, four years of medical school and then a residency. If you ask me, we should consider ourselves blessed to have the opportunity to be on our own practicing after 27-30 months. Think about the tremendous amount of respomsibilty we will have. If we are going to be holding the lives of people in our hands, we should have to work our asses off and be grateful for what we have.