Pete495

Hi, I took my AANP in early January and passed! I am stoked and wanted to share with others what I did to pass. I took 2 review courses over the Fall semester from September to December I did the Hollier Live Course and the Fitzgerald Live course with Sally Miller. I highly recommend both Instructors. Sally Miller was a wiz when it came to physiology, so you are able to understand the reasoning behind a lot of the guidelines and decisions we make with patients. I took two weeks off prior to the exam to study. I used Hollier's syllabus as an outline for studying, and supplemented each category with the Fitzgerald review. Over the two weeks, I covered all the topics. I felt Hollier's review was more specific to the exam, and her exams, quizzes, and questions were spot on for the exam. I also had the Leik book and although the questions for valuable, there is some misinformation in some of them. I can recall a couple of questions right from Hollier and right from Leik however, so studying them definitely helped me in the end. The one thing that I did over the two weeks before was a ton of questions. Get used to thinking about each question, and eliminating answers. On the exam, I was generally able to eliminate at least two answers. I suggest if you are not a good test taker, do as many questions as you can, and review material through multiple avenues, and you will do well. Don't study the day before the exam. It won't help very much, and will probably just make you tired. Eat a healthy meal the night before with brain food, high protein like a big steak. most people's brains are best in the morning, but do what is best for you. Do your typical routine. I did my routine. I got up, ate a light breakfast and went to Starbucks for my coffee. Then I went to the exam and they got me in 30 minutes early. All in all, the exam was easier than I thought it would be. It is more straightforward than a lot of the questions I did. Hope this Helps, Pete495

My experience with online programs is that the coursework and content is quite rigorous. However, there is no research comparing online programs with traditional classroom programs, so we are all speaking strictly from our own experiences. Hopefully, somebody will start a study someday. The school I am currently studying at is an NP program that is 75% online (cept for clinicals of course). My wife is attending a different University as an NP student full time. I am part time. My course work is so much more rigorous than hers. She even says it seems that I have double the work. I would guess that every program is different, but I don't think all online programs are weak. In fact, some are highly respectable programs. Look at the Frontier School of Family practice and Midwifery. This is a very respectable online program. You have to be somewhat intelligent and independent to participate in such programs. When it comes to hiring, there is no difference. It's more about who you know, and how smart you are. What else is the medical profession going to say about our online programs? I would expect a lot of them to talk cheap from the bleachers. Do I believe it's hurting our credibility? No, I don't. Sooner or later medical schools will realize they too can charge people a bunch of money by offering classes online and being more flexible to the individual pursuing a medical degree. Technology is here to stay, and I think you will see an increase not a decrease in these types of programs, and it will become an accepted practice if it isn't already.

Med Surg doesn't matter. They don't care if you've had medsurg experience. You should look for a critical care fellowship if there are any available in your area. They train nurses out of graduate school in critical care. Not all hospitals offer them, but it is a good opportunity. I would only enter med surg if I absolutely couldn't get a critical care job. If they are willing to train you, then put forth the effort while you are there. Get your ACLS, CCRN, etc. Learning hemodynamics will be key for crna school, so do your best to get exposure to swans, vents, IABP's, etc.

We get patients all the time that come in for stupid ^&$$. We send them straight to Triage if possible. They figure if they call the ambulance they will get seen quicker, but in my hospital, we try to send their asses straight to triage, esp. if it is a hangnail or crap like that. We get people who want prescriptions all the time. We get people who want to check in to get band aids. We get people who want pregnancy tests, or the results of their STD panels. We get regulars who come in all the time for the same damn thing repeatedly. We get patients who were sent over from their doctors office, but they don't know what for. We get homeless people who want a meal and a cot. All this crap monopolizes and clogs the system, and we are required to treat these people. If we turn them away, we are just being mean.

Call your family doctor if you are having pain. don't let it get so bad that you need to come to ER. You need to be specific about your pain. If you're having pain in 3 different areas at the same time, it's hardly an acute condition unless it's related to recent trauma. You mentioned you had spinal stenosis, kidney stones, and neuropathy. These are all chronic conditions, and while I do believe they flare up at times, it is important that you be on the proper medicine to prevent the flare ups, and also do the appropriate things to make your life better, such as not drinking tea and eating all the Brewster's ice cream you can find. And for god's sake, stay away from the damn cupcakes and carboyhydrates if you are overweight or diabetic. It sounds as if you became addicted to pain killers. I probably would not give you pain medicine either to be honest. I would just be adding fuel to the fire, and you will just come back another time for the same thing.

In my ER, they are not as conspicuous with the Doritos. Usually you walk in on them eating. Then they want a turkey sandwich and some crackers not only for themselves, but for all 3 of their visitors as well.

Not true at all. Many hospitals pay their critical care floats, or "superfloats" between 37-50 dollars per hour. Look at it as leverage for Nurse Practitioners. Use the leverage to induce a higher rate of pay if possible. This is part of what is wrong with our profession which we need to fix. The disregard for higher level education and an accompanying rate of pay is partly why there is a lot of disatisfaction in the profession. What is the point of higher level education if you're going to be paid what you were before you recieved the education. It just doesn't seem worth it. Nurses need to be rewarded for their experience and background. Hospitals are just starting to see NP's as midlevels or independent practitioners, but we have more work to do to make others see it.

Don't be so discouraged! Health Care is moving in a new direction, and Advanced Practice Nurses will be a huge part of the movement. Family Nurse Practitioners are going to be some of the most utilized Practitioners. This is partly because the number of family practice doctors coming out of medical school is dying off. It is also because Nurses as professionals are pushing for more advanced practice. While there may not be many FNP's in Florida, I can tell you for sure they are needed in many other areas of the country. I am also surprised they are so brutally honest with you regarding the job market. They certainly are not doing themselves any favors by telling their prospective recruits that the job market around here sucks. Why would anyone even bother going to school there if the job market sucks. Instead of telling their recruits not to look for jobs in the area, they ought to be encouraging them to open up practices, and integrate themselves into the community. I guess that's a separate issue though. I don't think you should be discouraged by what one group is telling you. If you want to go for FNP, then I think that is what you should do, because there are jobs available in the country (if you are willing to move), and there will be more opening up in the future.

Nurses need a more independent role, report argues - Health - Health care - msnbc.com

My hospital is a Level III, and we are generally 3:1 in Williamsport, PA. The acuity level is medium. I couldn't begin to count my patients. A majority of them are not in and out though. Patient satisfaction at my hospital is terrible because of the long wait times. But I think when we see the patients, we treat them pretty well. 3:1 is pretty good, and I don't think you'll get better for a medium sized metropolitan hospital. Nurse satisfaction is variable as in any case, but I think they don't realize how good we have it. Our ED has an urgent care center, so we only see class I through III type patients in the ED. The class IV and V patients go to the urgent care center. When we get vented or 1:1 patients, we try to cover each other and help one another out. As other places, we're always short staffed, and there is never enough time to do it all. Cost cutting measures have hit our hospital as well. If someone calls in sick, we simply go short, and this can make for a long shift.

Well, I would pick a different school if at all possible. I doubt if you can argue their requirements. That sounds a little like overkill if you ask me. One has to wonder why they even offerred you an interview if you hadn't fulfilled all of their requirements on paper. Maybe apply elsewhere, or look around at different schools to see what their requirements are for students who have been out of school for a long time but have fulfilled the requirements listed. There is no doubt a better grade can make you more competitive as well as provide evidence to your motivation, but another school might differ with this view of preparation for crna education.

Spode, I sent you a pm Pete495

Bottom Line is you need a BSN and critical care experience (at least one year). I would take this seriously. It will be very difficult to get in without it. Not only do you need it for admission, but you need it for yourself to be competent as a student for CRNA.

I don't see how it wouldn't help clinically, but it is not the right way to get started on a path to CRNA. You need a bachelor of science in Nursing and some critical care experience before you can apply to CRNA school. Read the stickies on the site for information on what you need to get into CRNA school.

Well, there is also the simple plan of JUST NOT USING IT. Seems pretty simple, but it works. The reasons textbooks don't tell you when and when not to use it is because clinical judgement is in the hands of the provider.

Can't argue with Barash. There's no doubt about Ketamine's bronchodilating effects. I think the question is do you use it in a rapid sequence w/ sux, and do you use it with hemodynamically unstable patients. In some instances, the ketamine could be beneficial because it does increase your heartrate and blood pressure, however as Mike said I believe, it increases your myocardial work load, which would contraindicate it in heart patients. Personally, just my opinion, but I still think it was a poor choice because 1) The patient is already altered, and Ketamine causes hallucinatory effects, and how does one evaluate the pt. while in an emergency room if the pt. is halllucinating. 2) Heart rate will already be increased with asthmaticus. why potentiate it 3) Ketamine's bronchodilatory effects do not outweigh hemodynamic instability and the use of other drugs which can counter histamine release or facilitate intubation with minimal histamine release in the asthmatic patient. just my extra 2 more cents. not trying to step on anyone's toes.

The use of ketamine is very contraversial, so I won't get into that too much. Suffice it to say if a patient is crashing, I wouldn't look to give ketamine, giving its propensity to cause so many other side effects and know what else is going on. How can you evaluate your patient if they are hallucinating from the ketamine is my point of view. except the ketamine, the meds for induction seemed appropriate. I'm not aware of literature that says propofol causes aspiration, but you can enlighten me if you find any. There's a higher risk of aspiration the longer it takes to intubate somebody, or if a patient is has a difficult airway, is morbidly obese, diabetic, pregnant, or has a full stomach. Generally pts. are difficult intubations when they are considered a 'trauma' patient also. I suspect this doc used ketamine because he didn't want to snow the patient with propofol, and the pt. had asthma, which probably a poor choice. don't know why etomidate wasn't used. probably cuz it's hard to draw up (j/k). A MAP of 60 is sufficient from my point of view, esp. if the patient is non cardiac and on diprivan, but in your situation, I would have done the exact same thing if my pressure was in the crapper. It was probably right to get the pt. off of the propofol, and fentanyl is used very commonly for sedative purposes even though the tolerance to it is reached pretty quickly, and it requires increasing doses. I don't think the SVN was making your patients heart rate high. It was probably related more to what was going on, and poss. the ketamine. that's why I wouldn't give it in an emergency. I've given a lot of SVN's, and rarely see such an increase in HR. After changing the sedation, I would have given the fluid, and brought down the PEEP(causes hypotension and decreased cardiac output), and just rode it out.

Hey Mike, Since nobody else is biting, I will take a shot. I'm just a lonely student though. My program requires a precordial stethoscope, which you must purchase yourself. I have two of them, one adult, and one pediatric. I've been through every tubing in the OR though, and Have yet to find one that works better than my regular stethoscope, so I just use my cardiology stethoscope mostly. I suspect whatever program you choose, they will make you buy one. I will probably get flogged, but in my opinion, they are not worth the money. I just met an agency crna the other day who had a whole bag of stuff, everything from blades to gauze and esmarch wrap for carpal tunnels. guess he goes to a lot of places that don't have some things. some things people carry are a nerve stimulator, though my OR has these anyway, so I didn't waste my money. PDA's are frequently common, but don't use them in the actual OR room. You'll look like an ass. I usually go through the work room in the morning, and take what I think I might need for the day, such as a MAC #4 or something. Other tidbits to take in the OR: Connectors to hook up to the common gas outlet (hard to find). list of commonly used drugs and dosages pens clipboard (I prefer my Atracurium) brain (somedays I forget this one)

Part of the point also was that if those resources are not avail. then you will have to do it by hand, which I totally believe in. I don't even take my PDA to work, cuz I think it looks bad in the OR to be looking at it. I do have a calculator with me all the time, and I constantly have to keep brushing up on my math and simple equations for figuring drips out and also locals, which are a pain in the a*s to remember.

Applied to 3 schools, interviewed at 2, and accepted a position from my second interview, which I liked a lot better than the first school. So, getting the interview experience actually helps, and even if you have a good first interview, you might like the 2nd or 3rd school a little better. On the second interview, I was less anxious and, I ended up liking their program better anyway, so I accepted the position for the second interview. Then, after all that, I transferred out of that program, because I would have had to move, and my home city became a clinical site for another program, so it's all relative, as someone else mentioned. I would say, go with whatever feels good, don't over do it, but don't limit your choices either. GOOD LUCK!

Also, during MAC cases, there's always that nagging feeling, "boy I hope I don't have to go to a general, cuz this surgeon is gonna be pissed off." If it has to be done, it has to be done, but who wants to tell the surgeon the patient needs intubated when the case is gonna end in 15 more minutes.

Hi Melissa, There are pros and cons to both approaches, but I will tell you what I would do. First, if you go the bigger hosptial route, you will be involved in a lot of big cases, and will see a lot of different approaches to anesthesia, but you may find it aggravating that the resident steals your cases, and you will come in contact with specific residents who won't care that you are there, and then others will be more than willing to show you how to do things. this is something you need to question the school about, wherever it is you are going. ask them about the relationship b/w the crna's and the residents and the srna's. If you decide to go to the smaller hospital with the same routine surgeries, and you get more exposure to actually doing things, what can this hurt? I am the type of person who learns by doing. I remember things because I've had clinical experiences doing them, and I will be more confident coming out if I have actually intubated more patients with difficult airways rather than watched other people intubate. Believe me, watching and doing these skills are two different things. I believe this is how you learn the most, and I think this is what makes people the best clinical providers. I just think you will find a lot less aggravation, and less stress if you are not competing with others for the cases you are doing. As a student, if you can concentrate on the actual case and not the herd of people around you, then you will do all the better for that patient. One other thing to think about is where you will be when it is all over. Are you going to work at the bigger hospital institution, or are you going to work in a smaller institution. if you are going to be a crna in the bigger institution, then maybe you should go to school there. I am a rural person though, so my opinion is somewhat biased and slighted. Good Luck.

I am also wondering why they didn't to a mitral valve repair also w/ 3+ MR? Ablation therapy also seems appropriate while you were in the OR with the history of chronic AFIB. Did the AFIB happen after you pushed the drugs or was it while you were intubating? In any case, if it was chronic, I would treat the heart rate, not the AFIB. Quite honestly, I've given amiodarone A LOT, and I haven't seen as much hypotension as I have with the Beta Blockers. Afterall, one of the primary effects of beta blockade is to bring down the blood pressure. In my opinion and clinical experience, you will get less hypotension w/ the amiodarone. Would anybody else use dig in this case? good post.

No offense, but You're really going to spark fires with comments like that on a CRNA board. So expect a little flaming My .02 cents is that we have patients that come in all the time that are allergic to the earth, and they need 2 or 3 arm bands just to describe the allergies, which was really an unpleasant side effect to a medication he or she was given. That is why we ask specifically what the reaction was, so that we may determine whether it was a true allergy. In any case, if you didn't want the lido, and she was going to give it to you anyway, I can see why you were upest, and she had no right to force it on you. However, my .02 cents is that Lidocaine is a drug I would not want to be allergic to, because I know as an RN it has the potential to save my life. That's like me saying I'm allergic to epinephrine or norepi. Let the bantering continue....it gave me a good laugh this morning