Orientation for new CRNAs

TraumaNurse · Jan 17, 2005

When you graduate CRNA school, you are expected to be able to function as an "Entry Level Practitioner". I do not know of anyone who had extensive orientation like staff RNs are used to getting. You will be lucky to get a day where you are shown around to see where the things you need are. Otherwise, you are expected to know how to provide anesthesia already.

As far as being a GRNA, this may be hospital or state dependent. Our hospital hires new grads as GRNAs and they have to take boards within 1 year. Most take it ASAP. The guys ahead of me did not get any extra time off to study for boards. They graduated on Friday and were in the OR as GRNAs on Monday. Most took boards within a month or so. This, of course, is just how it works at our main clinical site. It will be different in other places.

mwbeah · Jan 18, 2005

You better be able to "rock and roll", when you are licensed you are expected to perform.

Good Luck,

Mike

TennRN2004 · Jan 18, 2005

I was kind of thinking when we had a post a while back about being alone in the OR that is very scary. I can see now though if the expectation is to be a provider when you graduate, then those steps towards independence are very necessary. It's gonna be a hell of a 2 and 1/2 years to learn everything and be able to perform on it right of the bat.

The reason I asked the question about the certification exam is because I talked to a new FNP who took her boards last year and said it was hands down the hardest exam ever she ever had and she was very prepared. I know for my undergrad I studied my butt off hearing how horendous boards were, and I was out of there in 1 hour with only 75 questions thinking that was a bunch of work for a pretty easy test.

How do anesthesia boards compare to anyone who tested recently? I'm thinking there's a difference though in walking in after graduation ready to work and apply your stuff. Clinicals for the BSN were a joke and I knew I didn't know half of what I should when I graduated. But, if you're in the OR performing daily, you oughta know enough to pass the test. Is that naive of me?

jwk · Jan 18, 2005

I can give you a little management perspective. Although we expect all our anesthetists to be able to function well in their positions from day one, there's not a chance that we would turn them loose the first day by themselves. Unless they've rotated through our hospital during their training, this is a person we've never laid eyes on, and have no true idea of their capabilities, their strengths, or their weaknesses. We have six weeks of orientation through all of our different clinical areas and facilities, giving everyone a good get-adjusted period. New anesthetists are also on a 90-day probation period. Even newly hired experienced anesthetists get three weeks of orientation, although they'll be much more on their own after a day or two of "administrative" orientation.

That's not to say we don't want them taking care of the patient. We do. They'll be in the OR their first day. But there's a whole new set of paperwork from pre-op through to PACU. We have OUR way of doing things. For example - you like remifentanil? Sorry, it's not even on formulary at our hospital. And did you know Dr. X likes to hold his patient's hand while they're going to sleep? Oh, and of course we do OB epidurals very differently than most places. Every place has their quirks and a way of doing things that works well in their institution. It takes a little time to get used to it.

I've had anesthetists that were absolutely superb from the first day on. I've had a few that had their orientation extended because they were a little slow in putting it all together. And on occasion, there will be one who just doesn't quite seem to work out, for one reason or another.

BigDave · Jan 18, 2005

"The reason I asked the question about the certification exam is because I talked to a new FNP who took her boards last year and said it was hands down the hardest exam ever she ever had and she was very prepared."

Actually, of the 3 cert exams I took (ANP/med-surg CNS/CCRN--all within 6 months), the CCRN was the hardest. I think that they are all cake compared to the CRNA exam though. I guess I'll know in 3 years!

PTU2SLP · Jan 20, 2005

Two words for boards...Valley Review.

air · Jan 24, 2005

I cannot really help you with question 1.

2, Some States have such a thing as GRNA, one minute past mid-night after you graduate you can sign that title, work. I am not sure but if you read the AANA website, there at some supervision issues involved. I know OH and OK require certification prior to work.

I am still a student, in fact a first year, I would hardly term any case as "easy". I have been in situation were with was a MAC or IV sedation with local and things then proceeded to turn scary, it was not my propol, thiopenthal or etomidate finger at all.

I was looking at some CRNA job sites today. Several things I was looking at were group vs. hospital employee, types of cases (heart, OB, peds, trauma, etc.), and how often on call. One other thing that caught my eye was if the CRNA would be hired if in the AANA examination process. Most places said yes. I am assuming this refers to the certification test to use the title CRNA. How does this actually work when you graduate from an anesthesia program. (I realize this may be state and/or hospital related.)
1. Do you still have orientation time similar to a new RN who graduates, or are you allowed to do cases on your own with help nearby if needed?
2. Is there something similar to a graduate RN title for anesthesia graduates?
3. Does someone have to sign behind your charting after a case?
4. Are you allowed time off at most places to study for the certification exam?
5. At places where CRNAs are fully utilized, do newbies start off with the easier cases first, then progress to harder cases, or does exposure in school make you pretty comfortable with starting any type of case?
Thanks for any responses everyone!

WntrMute2 · Jan 24, 2005

I can give you a little management perspective. Although we expect all our anesthetists to be able to function well in their positions from day one, there's not a chance that we would turn them loose the first day by themselves. Unless they've rotated through our hospital during their training, this is a person we've never laid eyes on, and have no true idea of their capabilities, their strengths, or their weaknesses. We have six weeks of orientation through all of our different clinical areas and facilities, giving everyone a good get-adjusted period. New anesthetists are also on a 90-day probation period. Even newly hired experienced anesthetists get three weeks of orientation, although they'll be much more on their own after a day or two of "administrative" orientation.
That's not to say we don't want them taking care of the patient. We do. They'll be in the OR their first day. But there's a whole new set of paperwork from pre-op through to PACU. We have OUR way of doing things. For example - you like remifentanil? Sorry, it's not even on formulary at our hospital. And did you know Dr. X likes to hold his patient's hand while they're going to sleep? Oh, and of course we do OB epidurals very differently than most places. Every place has their quirks and a way of doing things that works well in their institution. It takes a little time to get used to it.
I've had anesthetists that were absolutely superb from the first day on. I've had a few that had their orientation extended because they were a little slow in putting it all together. And on occasion, there will be one who just doesn't quite seem to work out, for one reason or another.

Quite different from my hospital, The chief CRNA showed me the paperwork/Pyxis machine during a single cataract case. I then finished the day in that room by myself and that was that. No orientation, no nothing. Didn't like that much. OTOH, some of my classmates were still getting their hands held 6 months out of school at a different hospital. They didn't like that much either.