Nuggets of Wisdom

[WhiffOfGas]

In the spirit of the New Year, I thought it would be fitting to ask the CRNAs out there for an offering of any nuggets of wisdom they might have for the wannabes, new CRNAs or anyone interested. Maybe something you wish you could've shared this with yourself at some point along this journey? Do you have a nugget of advice about managing difficult patients, cases or staff or even a story about re-finding motivation when times get tough? Perhaps it's sharing a lesson you've learned about getting started in the field or how to juggle a demanding career with family -is there anything you learned over the past year that you would like to share with the community?

Any takers?

[detroitdano]

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.

[detroitdano]

MDA=devil

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

I am in no way saying MDA's are more qualified to do care than CRNA's.

I hate calling my MDA for anything, but if you need 'em, they are there. That's all my post was really trying to say.

[wtbcrna, MSN, DNP, CRNA]

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.

I have worked in ACT practices as an SRNA and have seen this exact thing happen where the student refused to do the case and went running to the MDA. That particular SRNA was basically black listed by every CRNA by the end of the day. It doesn't look good either way, and there is no reason to get the MDA involved. More than likely at this stage it is lack of the SRNA not being comfortable with something that is done everyday.

There is nothing written by the ASA or in TEFRA rules that would suggest there is anything collaborative in an ACT practice. ACT practices are about controlling the CRNAs practice.

[wtbcrna, MSN, DNP, CRNA]

I am in no way saying MDA's are more qualified to do care than CRNA's.

I hate calling my MDA for anything, but if you need 'em, they are there. That's all my post was really trying to say.

You will be hard pressed to find one CRNA that will agree that you handled this appropriately. It looks and sounds unprofessional to go running off and "tattle" because you disagree. What are you going to do when you disagree with the MDA as a CRNA? Are you going to go find their boss and hope he/she agrees with you too?

[detroitdano]

I have worked in ACT practices as an SRNA and have seen this exact thing happen where the student refused to do the case and went running to the MDA. That particular SRNA was basically black listed by every CRNA by the end of the day. It doesn't look good either way, and there is no reason to get the MDA involved. More than likely at this stage it is lack of the SRNA not being comfortable with something that is done everyday.

There is nothing written by the ASA or in TEFRA rules that would suggest there is anything collaborative in an ACT practice. ACT practices are about controlling the CRNAs practice.

So when we're having patient issues and my CRNA asks the RN to call the MDA to the room, they are calling them in so that their practice can be controlled? Um, no.

It's to have someone else with similar training to bounce ideas off. I've seen CRNA's use other CRNA's for the same purpose, but 90% of the time other CRNA's are in their own rooms. Meanwhile, MDA's are readily available if you're having issues.

In my situation, it was the surgeon asking for something that we could not provide without causing complications later, which did occur. As students it's our job to please everyone, and who cares what goes wrong as long as your instructor and the surgeon are happy, but that's a dangerous environment.

[detroitdano]

You will be hard pressed to find one CRNA that will agree that you handled this appropriately. It looks and sounds unprofessional to go running off and "tattle" because you disagree. What are you going to do when you disagree with the MDA as a CRNA? Are you going to go find their boss and hope he/she agrees with you too?

You've read wrong apparently, as I never "tattled." I didn't even see the MDA until my CRNA called them because of the unexpected complication. The MDA later told me they wish they'd been called earlier to help back us (well, maybe me) up and intervene with the surgeon. After the case, my CRNA told me I did nothing wrong, I was doing as the surgeon requested, so I doubt they'd have gone off on me for getting the MDA involved.

As a CRNA disagreeing with the MDA, that's a vague question. What are we in disagreement about? Pick your battles. If it's the MDA wanting to use an LMA on a case you think really needs an ETT, oh well. If it involves patient safety, then yes, you need to get someone else involved.

[wtbcrna, MSN, DNP, CRNA]

So when we're having patient issues and my CRNA asks the RN to call the MDA to the room, they are calling them in so that their practice can be controlled? Um, no.

It's to have someone else with similar training to bounce ideas off. I've seen CRNA's use other CRNA's for the same purpose, but 90% of the time other CRNA's are in their own rooms. Meanwhile, MDA's are readily available if you're having issues.

In my situation, it was the surgeon asking for something that we could not provide without causing complications later, which did occur. As students it's our job to please everyone, and who cares what goes wrong as long as your instructor and the surgeon are happy, but that's a dangerous environment.

Good luck with your clinicals. It sounds like they are going to be a blast for you.

[detroitdano]

Good luck with your clinicals. It sounds like they are going to be a blast for you.

Actually they are going quite well, thank you. Enjoy your new year.

[wtbcrna, MSN, DNP, CRNA]

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.

This is your original post....What does this sound like to you?

[nomadcrna, DNP, CRNA, NP]

What complications.