Nuggets of Wisdom

Sorry about the double post guys -still trying to figure it out

Now, Im no a CRNA and have nowhere near their wisdom or expertise (as I am just an anesthesia tech) but I guess Ill kick us off!

This year, I learned: never be afraid to cancel a case -even when the surgeon disagrees.

I observed two cases that come to mind in particular: one was a difficult airway no one saw coming. The second was a patient who smelled like pot and was very obviously stoned. Both cases were with the same surgeon and he wished to proceed -getting quite upset at one point. Despite the CRNA repeating: "Im not comfortable with this; it's an elective case" she still got her fair share of nasty looks and snide comments. BUT she stuck to her guns and didn't budge. It actually turned out to be a marvelous teaching experience -at least for the wannabe (me). She never wavered and was confident in her ability -and knew what she was and was not comfortable with. It got very awkward for a moment in PACU (and the OR) but she didn't seem to care.

The memory stands above many others I could share so this shall be "my" nugget of wisdom that stands out from last year: be confident in your ability and don't be afraid to cancel a case (especially an elective one) that makes you feel uncomfortable.

I'm an SRNA in my second semester now, so I can't offer up much, but I did learn this one the hard way last week.

This applies to fellow SRNA's:

If your surgeon is doing something that makes you uncomfortable and your CRNA seems to be complacent about it, you can always call your MDA for another opinion. It might tick off both the surgeon and the CRNA, but if I had done this, a complication would have been avoided. I've never had to use them for this purpose before, but from here on out, I know I won't be afraid to make that call. In this situation the MDA told me afterwards she really wished I would have called her so she could tell the surgeon he was in the wrong.

What if there are no MDA at the facility? :)

What if there are no MDA at the facility? :)

In this case, I would find it interesting to challenge the CRNA by presenting your interpretation of events and contentions of why you feel the way you do and see what they say.

Maybe I've been blessed by personal circumstance but the CRNAs I work for are extraordinarily smart -and part of being smart is having a good measure of open-mindedness. In my opinion, CRNAs learn all the time and I don't think (I would hope) they would be defensive -depending on the manner in which you present your information and the manner in which you ask your question(s)- about being asked something by a student. Our CRNAs are great teachers and seem to have an incredible ability to turn most anything into a teaching/learning experience. In fact, in my opinion, perhaps this would be the very best route to take. I don't know. We don't have MDAs where I work so I would probably take this route to begin with.

Then again, to play devil's advocate a moment, I imagine the notion of challenging the CRNA would be very difficult notion for a student. Live and learn, I suppose.Either way, I don't think anyone should be complacent. If the CRNA wasn't receptive to questioning or was defensive, perhaps another tactic should be employed.

What would you have done if you were the SRNA in this case NomadCRNA?

What if there are no MDA at the facility? :)

Then the circumstances change. I have yet to work in such a facility, but I'm really looking forward to it to see how different things are run.

No difference. We do anesthesia the same exact way. :)

I forgot how anti-MDA this site is. If you don't think offering advice to fellow students that an MDA is a resource if you need them, you're a lost cause.

I guess it's better to ignore a problem to please your CRNA for the day so you can be assigned to them again. Right.

MDA=devil

Most of us have been abused by them in the past. Used like a stable of &^%$.

if you don't think the case should be done that way then you state I am sorry I cannot do this case with you because I don't think it is safe for x reasons, but I respect your decision and hope that we can still work together after this case.

Because that would go over smooth as butter, I'm sure. Threatening to walk out of the room is sure to get you a glowing review.

Aside from all the legal BS, an ACT practice is a collaborative practice and I don't think there's anything wrong bringing in the MDA in such a case. If it is a patient safety issue, the MDA should be involved if your CRNA is disagreeing with you.

This thread is about advice. Most student's clinical sites are ACT practice and I don't think anyone will go through a program where they don't run into an issue with a CRNA they are working with. But as you said, you should always discuss the issue with your CRNA first and exhaust that option, which it definitely valid advice I am not arguing against.