London88

Why should a circulator be alarmed because an SRNA gave fentanyl to a pt. That same SRNA was giving dilaudid and morphine to pts in the unit. What has changed because she is now giving a narcotic to a pt in the OR? I can understand the concern if the SRNA is pushing propofol or a muscle relaxant. Also as per the AANA, and for medicare billing purposes, a senior SRNA is allowed to to be in a room by his or her self doing a case without a preceptor being in the room. To the original poster I am sorry that your preceptor did not stick up for you because I would have sharply reminded the circulator of the RN in your title and would have told her to go take a hike. I have no problem addressing a circulator's concerns when it is done in a diplomatic manner, but when the sole purpose is to humiliate my student I will not tolerate it.

Platon20 When did you come to the conclusion that CRNAs do not manage vents in the OR? When CRNAs start critical care drips on a pt in the OR this is not considered CC? When we give drugs to maintain a pt's hemodynamic status I guess this is not CC. And those of us who do cardiac anesthesia and institute many life saving drips that the pt is maintained on in SICU as an extension from the OR are not doing CC right? You need to become more informed about what it is that CRNAs do before making uninformed statements.

Suzanne4; It is everybody's responsibility for positioning and not just anesthesia's responsibility. I do not position any pt without the surgeon in the room especially for positions other than supine. Granted I will make a final check to make sure the pt is in good alignment , however my notes always state that pt postioned by OR team and surgeon, and as stated to you above during positioning the CRNA's role is to manage the airway and the others in the room manage everything else.

Micugirl; keep up the good work. You might have been over prepared for your case but I am sure you scored extra points. I much rather a student who is over prepared than one who is under prepared! Keep reviewing your cases the night before and make notes on a piece of paper for your set up and the battle will be half won.

I do not read magazines in the OR period. Like gazzpasser said I do not want to miss anything. When I speak to my pts in holding I promise them my undivided attention and that is what they get. However, i am not trying to tell any other CRNA how to practice . If a student brings a magazine to read during a case with me it will be the last day that they do a case in my room, and if I have a say they will be booted out of the facility!

micugirl; ACNP has given you excellent advise as well as good reference material. I also utilized Jaffe as a student and even as CRNA if i am going to do a case that i have never done before i still browse through Jaffe so that I know what to expect. It is a lifetime learning process.

micugirl; I urge you to hang in there. I was in a similar situation at a clinical site when I was a student. I had no problem setting up for cases, but I was not treated fairly by the clinical director of anesthesia and I spoke to my director who contacted chief of anesthesia and there were major improvements. I was in tears on a regular basis over the way i was treated at that site. However, as a CRNA I love my job. Nobody has the right to grab you. The advise I will give you is you should know how to do a basic setup for any type of case if this is your third rotation not including big cases such as hearts etc. For a pediatric case you should know how to calculate the correct size ETT, have the correct blade, the correct drug doses based on weight. Your life in the OR will improve greatly if the CRNA comes in and find you have the correct setup, which you should be reviewing the night before. By your first post I am getting the impression that you do not know how to set up for your cases and that will cause a lot of problems for you no matter where you go if this is your third rotation. What refernces are you using to set up for your cases?

StikTie and paindoc very well said. I simply could not be bothered to take the time to write what you guys explained to neveragain. The anesthetic plan can change rapidly depending on what is going on especially after incision. Here you have a person who is in pharmacy school, who is now applying to nursing school as stated in his/her post above who is trying to dictate the anesthetic plan. What gives? One cannot be a jack of all trades! If I have to do a MAC on a pt and the pt refuses to acknowledge that should the need arise i may have to convert to a general then simply put they can do their own anesthesia since they know better me what is needed.

neveragain, without knowing your situation if you want to be awake and alert for your surgery just ask for anesthesia not to be present. Now if you are saying that you did not want a general anesthetic and you agreed to local MAC then that is another issue. Be mindful of the fact that a local MAC can be heavy sedation with the same drugs used to give a general anesthetic. Also many people awake from anesthesia fighting be it local MAC or general. this is not considered an adverse effect.

Online BSN is good if you have an ADN and you are practicing as an RN. I did my BSN online and only had to do one clinical as I was already an RN in ICU, and I had to show my RN license before being accepted into the online program. The school is a reputable university and I had no problem getting into anesthesia school.

SWtooth key word in your post is the pt is intubated already. As for the hypotension ask yourself what causes the hypotension? I personally have no problem in a situation where the physician can intubate such as in an ER, but I have not come across many GI docs who can intubate a pt. Last week a colleague of mine gave propofol during a TEE, the pt became apneic and my colleague ended up intubating the pt and the procedure was completed w/out any problems. Bottom line is that she is an experienced CRNA and even in trained hands propofol can be unpredictable.

It never ceases to amaze me when I walk in on a code or a resp distress situation and find the RN or the RT standing at the side of the bed with the AMBU and mask on the pt's face. This is what we are talking about when we say most non anesthesia providers do not bag correctly. I fail to see how you can open the airway from the side of the bed. The RT hate it when we come and take over the bagging from them but our reason for doing it is that we can tell from a mile off that the pt is not being ventilated. It is one thing to place a mask on the pt, but another thing to see the chest going up and down.

sc17 Now that you have looked up an-es-the-si-ol-o-gy Why don't you look up nu-r-se an-es-the-sia.

In response to your last post paindoc, I am assuming these same legislators are trying to protect all patients from a rogue CRNA, or from a midwife from treating a pt typically seen by a NP, or from a NP from doing a procedure that is typically done by a CRNA, or protection from a cardioligist who is trying to practice psychiatry when he is not qualified to do so. As for the issue of APN in your state, please clarify what it is that CRNAs do not "bring to the table." My colleague who graduated from the same school as me is practicing in Texas and is recognized as an APN so she "brings to the table" what other APNs bring to the table but if I chose to work in your state I do not "bring to the table" what other APNs bring the table. To make a long story short the concept of what APNs "bring to the table" is illogical BS.

I was under the impression that an MD can only cover two rooms with SRNAs and can only bill 50% for each room. However if he or she is cover CRNAs then he or she can cover up to four rooms. Somebody correct me if I am wrong.