QuestForWa

So I have an idea investigation starting with the BON. There was an issue at work, which work and the medical provider considered practicing outside of my scope, for writing a medication order that the provider did not agree with or sign later when reviewing her orders for the night. At any rate, as part of my BON investigation they need to do a 14 panel hair/nail test with recovery trek. Where would I be able to find what's on there? I have taken Kratom in the past but no other drugs or alcohol. Thanks!

People, for the love of God, why is it so hard to face facts? Don't you think there are reasons for the requirements for each, CRNA and MDA? CRNA's and MDA's are competent and capable clinicians, but there is no denying that the Med school component and it's inherent instillation of a certain method of thinking is to be so easily dismissed. Disclaimer: I am a 24 yr old ICU RN w/ 2yrs exp. with the hope of entering CRNA school soon. I enjoy working with RNs and Dr's and other specialties(RT,PT, etc), providing they aren't arrogant or insensible, and I've seen a fair share that were from each class. In this time I have kept my eyes, ears, and mind open to absorb EVERYTHING I could about nursing, medicine, critical care, patient interaction, and of course anesthesia. In turn I have learned much due to my own studying, but also due to my interaction with nurses AND DOCTORS of all levels. The ones that are patient and interested enough have gone into depth on issues (clotting cascade pathologies, TRUE 12 lead interpretation, sepsis markers and outcomes) have a thorough understanding and quite honestly get a little over my head by the end. My friend since 1st grade is now done with his 2nd yr of med school. He has shown me what he is tasked with learning and knowing. It is insanely in depth! True, some of the residents will forget this stuff by the time the ICU comes around, but how many nurses can accurately recall pharmacodynamics after school? For the most part they have their knowledge bank correct and I learn something from them every day. I also just completed an advanced physiology class (using medical student text) for CRNA school and it was damn hard. The demand placed on the BSN student to learn their physio and pharm however, pales in comparison the their doctor counterparts. Point being, yes we will learn the same theories and principles, but I believe the doctors will have more depth and reinforcement on all aspects REGARDING THE PERIOPERATIVE ANESTHESIA PROCESS. ICU work/training is invaluable. It gets an RN comfortable with necessary topics prior to CRNA school, drugs, hemodynamics, vigilance, technical interpretation. But beyond that, it's what the RN puts into it that determines what they come out with TRULY KNOWING. Seriously, my boss is concerned with the stupidest stuff ever; careplan completeness, error-free lab specimen labeling, etc. vs knowledge and "critical thinking" (i hate that phrase...) Unless I push myself I won't advance. I once caught an MI in progress on a pt. due to a subtle EKG change and behavioral change, pt went to cath lab that night and was scheduled for open heart the next day. Even the jerk Cardiologist (he really is) was impressed. However, my NURSE boss/manager the next day commented on how my tubings weren't properly dated, with no mention of what I did last night (granted, I was only doing my job). Point here is that just saying you have have "2 yrs ICU exp" means nothing if you didn't bust your butt EVERYDAY to earn it, because not many others will take you to task and make you into the quality CRNA applicant you should be. Beyond that, I can't comment. I haven't been through CRNA school and don't know enough about MDA residency to spout off about either. But if both are rendering anesthesia in the OR when the dust settles, there has to be a good deal of consistency between the two. The main reason for this fight to opt out and do away with the MDA is crazy. I have a feeling some of it is due to the ACT model and CRNA 's getting frustrated with that type of smothering. But for the most part, it would be good to have an MDA around. Sure, there are scenarios where the CRNA can and does do everything. But what about the ones where the pt. is deteriorating and the surgeon can't offer help, and your elder CRNA cohort(if there is one there) can't work it out either, and there is no MDA in house or on call. Then who suffers? Most of the CRNA's i've talked with and shadowed are happy with thier collaboration with the MDA's and are given a good amount of latitude, and consistently comment on how much they enjoy their job. The exception is the CRNA essentially feeling like a tech and strictly following orders. If there are any CRNA's still posting here, feel free to correct me on the above if I'm way off. Doc Holliday: I don't believe that a CRNA is practicing under your license. Your liability from anesthesia is dependent on the extent that you choose to direct the anesthetics' delivery, whether by CRNA or MDA. On that note, it wouldn't be in your favor to order the anesthetist just to reaffirm your order on the totem pole, as that is what the tone of your comment suggested. https://www.aanafoundation.com/uploadedFiles/Resources/Legal_Briefs/2007/legalbriefsp89-93.pdf That comment aside, Doc has been completely reasonable in his recounts and narration of his thoughts, yet people here are blatantly missing the point and looking silly, or poking their heads in to throw a jab at a doctor that "dared to come here" and give his 2 cents on the subject. His replies may be direct and unabashed, but it is the other posts that are laden with barbs. And Dr.Nurse2b, if you are going to make a case for us, take the time to get the facts right. CRNA: 4 yrs BSN, 1 yr ICU, 27-36 months CRNA school = 7.5-8yrs. MDA : 4 yrs undergrad, 4 yrs med school 4 yrs Anes. residency= 12yrs. And considering everything builds on the past, that summation factor ultimately favors the MDA. I think only 1 CRNA school offers the DOCTORATE DNAP at this time, the others award a MASTER'S. A CRNA is still the most fascinating and exciting role I could imagine working as. But I will know, or at least seek to know, my limitations. I don't mind having someone else around smarter than me, who may tell me I'm wrong because of something that I simply didn't have knowledge of. Think of it this way, the pt doesn't get hurt or die, and you learn something new that you will likely remember, move on... Perhaps my views will change after 10 yrs of being a CRNA, but hopefully this crap won't still be going back and forth and we can all just clam it and realize WE ALL have the opportunity to do some of the best, and most important work on the planet.

Thanks for the input. That puts things into better perspective from a SRNA/CRNA viewpoint. Sounded like a good idea at first. But I was even a little hesitant to plan on this after thinking about it. So if you're only going to class/clinical and then studying would you recommend to take out loans just to cover expenses(with some buffer) or give yourself a normal yearly salary like others have recommended? It never really sounded right to me take a higher loan to have extra money when you have no time to spend it on anything.

What about maybe picking up one wkend shift a month? The idea would be to have earned income to contribute to a Roth IRA as the salary bracket of most CRNA's preclude you from being able to contribute. At~27.00/hr. and one 12hr shift per month, that's roughly 4,000 in one yr and the taxes on that EARNED income would likely be negligible, allowing you to contribute the max amount. Then live off the loans for everything else...does that sound logical? Please tell me there is room for 12 free hours a month as an SRNA!:uhoh21: Keep in mind I'm approaching this as a 23yr old, so the time advantage of compounding interest in this idea is huge compared to someone starting at 35 or so.

Beauty, I am applying for CRNA school next summer. It has been almost 4 yrs in the making now, starting from the time I entered nursing school. In that time I've learned a lot and became even more motivated to pursue this as a career. As you'll read here and hear from anyone in anesthesia, it is something you have to really want and strive for, not something you can be pressured into, or a "plan B". The path to get "there" likely isn't what you imagine it as now; some of what I learned would be enough to deter some people from pursuing it further. When I first decided I myself thought "Oh cool, finish undergrad(which I will ace), work a year(which will be a piece of cake), then start school(i'll get in no problem)....sounds easy enough." It didn't quite work like that for me, but I want it bad enough and I know it will come. I was a very bright and upper acheivinig student in high school as well, but as I said the path isn't as it seems and can make you question your committment at times. HOWEVER, it is fantastic that you are looking into this at such an early age! I hope I didn't discourage you! The previous poster had it right: work your butt off for good grades, get into a good university/BSN program, and work your butt off there for good grades too. Just do a thorough search so you have a good idea of what to expect. Hopefully your parents are understanding and will give you some latitude in your career decisions. I changed my major 3 times before graduating, many of my friends did the same. Search this site in depth; it has great info on the CRNA profession. If you find that it truly draws you in, then go for it! As for the job outlook, you can again use this site to find that info, or go to gaswork.com to do a search of specific listings. The short of it is that you will find work easily, so long as you don't refuse to leave the city you're in (you mentioned that hospital doesn't employ many CRNA's). There are plenty of options. There is a school in Washington at Gonzaga I believe. Again, if you really want it you'll have to be flexible, as most applicants sacrafice A LOT, including having to move great distances for a program. Use this link to find all programs in the USA: http://webapps.aana.com/AccreditedPrograms/accreditedprograms.asp?ucNavMenu_TSMenuTargetID=222&ucNavMenu_TSMenuTargetType=5&ucNavMenu_TSMenuID=6&ucNavMenu_TSMenuTargetID=223&ucNavMenu_TSMenuTargetType=5&ucNavMenu_TSMenuID=6 Or the home site: www.aana.com and search from there. PM me if you have any other questions! Good luck.

I have 2 questions re: applying the next year after not being accepted the first time: 1) Do you need new letters of recommendation for the 2nd application if you're applying to the same schools again? 2) Will most CRNA schools accept the credit from the basic level classes that one can take pre-acceptance if the credit is from a DIFFERENT school? I'm talking like assessment, anatomy, etc... Are there any classes that would be a good idea to take that definitely DO cross over? I hear a lot of "Just go for it and apply, it can't hurt you..." But what if you have a manager who disapproves of your goals and would continue to dash you dreams year after year? Then you let the cat out of the bag that first year and you might not even get a good manager-manager recommendation should you decide to pack up and try another ICU... Thanks!

Thanks everyone for your replies...this is a tough time trying to get everything to line up right for CRNA school. Am I alone or did most of you (CRNAs/SRNAs) think and worry EVERY DAY about how to make it all come together? -Brian, did you find it hard to get in good with that one manager, given the varrying lengths of contracts? I would think it would be hard to choose the ideal one without the hindsight that comes after parting...Plus, what if the best manager to write for you happened to be one you worked with 2 or 3 yrs ago and doesn't remember you much anymore?? Thanks again everyone. Keep the advice coming; I'm all ears.

Other than trying to establish a good, solid relationship with a manager(which I realize is huge), would I be at a disadvantage for CRNA admission doing Agency or contract nursing in the big chicago hospital ICU's ?

Katy, I just graduated in May 2006 and started in CVICU at a large hospital w/ open hearts, thoracotomys, AAA's, etc... I had a 6 month orientation from June till the start of January which I felt I learned A LOT from. However, I never tech'ed or held any other RN position, so I was at a disadvantage compared to those who already knew the way around and within the system. It ultimately led to me not being able to continue in CVICU for the time being. I can't yet say exactly what it was that prevented me from pulling it all together on the consistent basis that they needed to see from me. A combination of feeling overwhelmed(daily), "I can't possibly get all this done/ transfer them that soon", and clouded judgement/crit. thinking when it hit the fan i guess. I tried with all of my power to reel it in and prove it to them for the last month that I could do it, but in the end they just weren't satisfied with my progress. So now, regretfully, i'm on my way to some other unit to regroup and address my deficiences. The point is that although my brains and heart were never in question, I just couldn't get with the flow of the unit. It was extremely busy, with multiple different Docs/services involved, QUICK pt. transfer expectations, little HCT help (simply by numbers, not quality), Family issues, etc. On top of that stuff you HAVE TO stay mindful of all the ICU stuff that you learn and be able to apply/recall it while under pressure. Take heed what the others have said above as the "ICU stuff" is enough to make your head spin on a good day. Some preceptors are better than others; I had 2 great ones and 7 in total (when interviewing i was told there'd be 2, MAYBE 3). And yes, as a student you have an idea, not fantasy, of what your job will entail. And for the most part you'll be drastically off from the reality of it, so you'll need to adapt quick. You need to be strong/confident, but also shed any cockiness/closemindedness you may have. And btw, this came to me as a big blow since I've never had something I couldn't conquer/handle. So just be ready for the fact that you might find yourself in my position should you not be ready for this type of position. On the other hand, you may take off and fly without any problem. I don't regret taking this position because I now have to leave it. Great experience. So even if you take the ICU position and decide to/have to leave, you will still learn a lot that will help you as an RN. Sorry, hope I didn't soapbox too much...PM me with any other questions.

Welp, things didn't work out so well. I took other posters' advice and really tried to fix the things they cited. In the end the concensus was that I was unable to get up to speed and safely/independently manage 2 ill/unstable CVICU patients on my unit. Nothing I could say or do to change their opinion, so I thanked them and respectfully bowed out rather than whinning or making a scene. Good news is that I'm not fired from the hospital, I just need to find another unit, one with a better "fit" as they put it. And they are going to help me get placed there. And I still haven't revealed my CRNA aspirations to them yet. So the question now is, what is the best route or the best unit to go to now? Should I try the OR, interventional radiology/cath lab, one day surgery/special procedures? What/where is going to give me the most room to grow and improve my critical thinking and time management skills? That way in a year or so I can reapply to the same or diffent ICU. Keep in mind they recommended that I not try to go to a floor unit and take the 4-6 patient loads commonly found there, and I myself would rather stay away from that. Btw, my focus and organization had markedly improved so I think it was a matter of doing some self-talk and prioritizing and I no longer think there is an ADD issue as I'd previously wondered.

Thanks for the replies and ideas. For an attempt at brevity I omitted some details in the 1st post... I have NOT mentioned to these people my intentions, and I'm fairly certain that they are not focusing on that as a means to get rid of me. At this time our unit is getting slim with staff, so I don't think they'll be canning people willy nilly. There is another new grad in my orientation and he mentioned outright at his interview that he will most likely be going back after 3yrs to CRNA, so seems like they just don't want those who will "use" the unit for that one yr. req. I know deep down that I have what it takes to become a profecient ICU nurse, and I know that that must come first. I am not just focused on the end CRNA goal here; I truly do enjoy ICU work and desire to know as much as I can so I can provide the best/safest care. I have also heard much positive reinforcement from other preceptors and have had days where I've felt really good about my progress. So let me paint over the picture of me as a cocky/whiny new grad with grad-school tunnel vision. Sidenote: Has anyone found the use of ADD medication to be NOTICEABLY useful in focusing at work? I am not entirely opposed to trying that if it actually helps.

Hi all, I've been lurking in the shadows and this is my first post after much observation and effort at getting establishment in the profession. Thanks to all those who are more experienced that have shed light and helped others here with things that only experienced CRNAs/SRNAs could... Anyway, I'm a new grad from a BSN program nearing the end of my 6 month orientation on a 12 bed CVIVU. My goal since prior to entering RN school has been to become a CRNA. I've done the shadowing, I've thought long and hard about what I want out of life and what I could see myself doing for 40+ yrs, and I've tried to gain as much knowledge about the CRNA profession as possible. I will be a CRNA, and I'm willing to let very few things derail my future. Up until a month ago I've felt as if everything had been progressing as it should(especially in regards to my orientation), despite being challenged to a greater degree than I had anticipated. I have had my setbacks and sticking points with things(charting, order verificaiton, admit/discharge) here and there, but nothing r/t safety or capability to do "ICU" work. Well aparently some on my unit(manager, unit APN in charge of orientation/education, and 2 unnamed preceptors) felt I'm in no shape to be off orientation and practicing safely on my own. "The brains and heart are there, no doubt, but you're not able to focus yourself suffeciently for safe, autonomous ICU work." Issues were lack of focus/distractability, a lack of developed Crit. Thinking skills, and a general uneasiness with my degree of safety in managing 2 "ICU" level pt's. This was brought to my attention with only 2.5 weeks left for the scheduled orientation!! Needless to stay my holidays were quite overshadowed with a sick/helpless feeling.:icon_mad: Today I had a 2.5 week follow up appointment with good progress noted, but not at the level it needs to be. I have till the 31st of Jan. to reign it in. I've never had problems/discipline like this in any of my schooling/externship, so I've taken this as quite a blow. Providing I DO stay on: 1) How do you imagine something like this so early in my CRNA prep. will effect me getting accepted? In terms of LOR, peer review... 2) What to do if I don't stay hired on? I'd still be a hospital employee qualified for RN work, just not the ICU. Try a different unit for a bit then reapply, apply ICU at another hospital? 3) It was hinted and all but suggested during these meetings that I follow thru with chemical management (ADD meds). This of course was only after I openly suggested that subject in response to the distractibility issue. "Providing you do stay, these issues and unit stimulii aren't going to just disappear you know..." Any help/advice on this subject would be appreciated. Trying to stay positive here but I can't help but have an awful apprehension for the outcome. Despite all my strengths and zeal I can't seem to show them what they need, even though the rest of orientation has gone well. And as it is, nearly the entire unit disapproves of newbies trying to go to CRNA school. Including the NM who is vehemently opposed. I'm not looking for pity/understanding, I'd just like some solid insight as the best route to go from here. Sorry for the length!! -QuestForWa