EmeraldNYL

Scope of practice can vary widely depending on the culture of the institution you are at. This is definitely something to consider when you are applying for jobs. I work at a teaching hospital (however we do not have anesthesia residents) so the CRNAs do a large number of cases involving very sick patients. We do cardiac (if desired) and neuro. However, our scope of practice states that we are not allowed to perform peripheral blocks or epidurals, while we do perform spinals and arterial and central line placements. Some hospitals are definitely more "CRNA friendly" then others.

Yes, that is a correct assumption. Very exciting, but very high stress as well. Don't plan on seeing the call room at all during the night if you work at a very busy trauma center.

Lots of CRNAs take call in trauma centers. I work in a very busy Level II trauma center and a CRNA always has the trauma beeper. We respond to all trauma activations and manage the airway in the trauma bay. If the patient needs to come up to the OR, we will travel with the pt. and then continue to resucitate the patient in the OR. Once in the OR, we will place additional lines if necessary, hang blood, send labs, whatever is necessary.

I do cardiac anesthesia at my facillity under the supervision of an anesthesiologist. Even our anesthesioligists aren't really subspeciality trained to read TEEs-- when we do use one for a valve case we utilize a cardiologist in the OR to read it.

With my group, all of the CRNAs get paid the same, so someone with 20 years of experience makes the same as me with 6 months of experience.

Congrats and welcome to the CRNA club!!

It all depends on the setting you work in. I know many CRNAs who work 60 hours a week between their full-time and per diem jobs. My schedule varies somewhat, but I usually work 7-3:30 mon-fri. I also pick up a call shift about one weekend a month. This year I have to work Christmas Eve but that is my only holiday.

I think the key is to try not to get yourself in difficult situations in the first place. The more people that muck around in the airway, the more edema the pt. will have. Did you and the PA anticipate her being a difficult airway? If she was intubated 2 weeks ago, did they have trouble intubating her at that time as well? Why were you having so much difficulty ventilating? Was it just her anatomy (was she fat?) or was she in bronchospasm? You could have tried to place an LMA to see if you could ventilate her better that way, or if your facility has FastTrac LMAs, you could have tried to intubate her that way. Dexamethasone is useful for airway edema, although this certainly would not have helped immediately. Did the anesthesiologist wind up doing a fiberoptic? The can't intubate/can't ventilate scenario is every anesthesia provider's worst nightmare, especially when you don't have a surgeon in the hospital who can do an emergency trach!!

What kind of nursing skills exactly?? I don't have to clean up poop anymore, thank god!! I see the patient pre-op and go over the anesthesia plan and the patient's history, start the IV, and then manage the patient during the course of the anesthetic, whether it be general anesthesia, or spinal, or sedation. I also see inpatients after their surgery to follow up. Really the best way to understand what a CRNA does is to shadow one!!

The "captain of the ship" doctrine, where the surgeon is responsible for the actions of the OR staff members, no longer holds up in a court of law. Therefore, a CRNA is legally fully liable for his or her own actions, just as an anesthesiologist would be. So no, this will not effect CRNAs practicing independently. Being a CRNA is an enormous responsiblity, and this case further drives home that point.

It is a ridiculously huge settlement but Philly juries are notorious for that. The news media doesn't really depict a complete picture of what happened. I know several people who went to watch the trial who knew the CRNA. Apparently Dr. Glunk was scrubbed in the next case and calls for him to go eval the patient fell on deaf ears. The CRNA couldn't leave because he was the only one there and the surgeon refused to go see the pt. I also heard that the surgeon demanded that the ambulance go in through the back door so that no one in the waiting area would see. I certainly don't think a fat embolus is preventable, however I think the real issue here was the response time and slow recognition of what was happening.

CRNAs at my place of employment do varying shifts. I usually work Mon-Fri 7-3:30 with minimal weekend call. I have to work Christmas Eve this year but this is the only holiday that I must work this year. I usually pick up one Sunday 10 hr. shift a month for extra money. Some people where I work do a 24 hr. shift and 2 8's, and others do 4 10 hr. shifts. We have people who do the same overnight call shifts every week so the rest of us just need to fill in when they go on vacation.

I work in a 400 bed level II trauma center in the suburbs of Philly. We practice in the care team model but for the most part the environment between the docs and CRNAs is pretty congenial. No, I do not practice completely independently, but I do get to do big cases, like hearts, cranis, and trauma. It is very busy so if I finish my room early I am expected to do pre-ops and post-ops or make sure my coworkers have had breaks as well.

As a new CRNA, I still have scut work, but it mostly involves doing pre-op assessments and post-op rounds. My days are still crazy busy, but there is much less secretarial work, waitressing, and appeasing people (except for the surgeons!!). Some days can be quite long and boring, when I am stuck in a long case like a lap gastric bypass where the lights are off and I am getting sleepy and just dying to get up and walk around or talk to someone. Other days I am in the ENT room and I barely have time to finish my paperwork before we are on to the next case. On those days I run to drop my patient off in PACU, see the next patient and start the IV so the surgeon isn't kept waiting. Yes, there is still paperwork, and if it isn't right, some administrative person will come after me to fill in a surgical end time or procedure on the anesthesia record, but I am not filling out a million braden assessments or restraint documentations! If I feel the patient needs some metoprolol I give it-- no hunting down an intern for an order. I feel that being a CRNA is a lot less emotionally draining as well-- I no longer have to deal with family members who have a loved one dying on a vent and 3 pressors making the tough decision to withdrawl care. That being said, some surgeons can be very difficult to work with, and there are a lot of very different strong personalities in the OR, so it takes a certain assertiveness and skill to deal with this.

As other posters have stated, it is extremely common for adolescent boys to wake up from anesthesia "wild". There are different stages of anesthesia-- Stage III (deep surgical plane anesthesia) which progresses to Stage II as the patient wakes up. Stage II is characterized by dyspohoria, breath-holding, disconjugate gaze, etc. and while the patient may appear to be awake during this time, they are NOT fully recovered from anesthesia. Pulling the endotracheal tube at this time may potentially cause laryngospasm, especially in younger children. We must wait until the patient is fully awake and has reached Stage I before we extubate. The patient should be spontaneously breathing with adequate tidal volumes, have adequate strength, and hopefully be able to follow simple commands. Often younger patients may wake up thrashing before they are breathing adequately or following commands, which is why we are somtimes forced to leave the tube in a few minutes longer and request the help of OR staff to hold the patient down. Hope this was helpful! EmeraldNYL, CRNA

The CEO of Pennsylvania Hospital in Philly (affiliated with the University Of Pennsylvania health system) is a CRNA!!

Check gaswork.com. I am a new grad working in a metro area, average starting salary here is around $130,000. I work 5 eight hr. shifts a week but some people work 4 10's and others work a 24 and 2 8's. I also do the occasional weekend call shift for extra money but I am certainly not required to do a ton of call. I work in a very busy trauma center in an underserved area and we do lots of good cases on very sick patients. However, we do not do a lot of regional-- ours practice involves mainly general anesthesia. I am employed by an anesthesia group, I have 5 weeks vacation and a CME allowance and a generous 401K/profit sharing plan. No job is perfect, but overall I do really enjoy my job and I am glad that I am getting such great experience.

I am a new CRNA in a moderate size (400+ beds) hospital in a metro area. I work 5 8hr. shifts mon.-fri. and the occasional weekend call shift (which is OT pay). I have a good deal of autonomy and do a wide range of challenging cases on sick, sick patients. The pay is decent but certainly not as much as I could make working in a rural area taking more call. But in a rural area I would probably not get to do all the hearts and heads that I am doing now.

I passed! My second day of work was today. I can't wait to get my paycheck because I am so sick of being a poor student! Yea!!!

Thanks guys!! I am going away for Christmas so hopefully I will have a nice letter waiting in the mail for me upon my return. I am staying in the Philly area-- I just had an offer accepted on a house!! Whew! It does just seem like yesterday that I was in the BSN program-- how time flies when you look back on it! I am so honored to be entering such a fantastic profession; it was a lot of work but I am certain that it will be worth it in the end.

Well, I took the big test today and it shut off at 100 questions. It was HARD, I swear some of those questions I have never seen before! I feel like I could have studied Valley a million more times and I still would not have been completely prepared. Hopefully I'll have the "C" in CRNA very soon!

People, this is the CRNA forum!! Anyway, I am a new grad, work at a very busy Level II trauma center in the Philly burbs, make $125K base. We do a wide mix of cases including OB, neuro, hearts, vascular, ortho, general including gastric bypass surg., and of course lots of trauma. I went to Villanova, I love what I do, and yes I would do it all over again!

Yes, CRNAs do participate in anesthesia for organ donation. Obviously you don't need to give them any gas, but they usually come to the OR on a ton of drips to maintain proper hemodynamic parameters, and you must manage the BP, send lots of labs, etc. After they clamp the pulmonary artery you turn off the vent and leave the room.....

Where you attend school does not matter with regards to salary or job opportunities when you graduate. All future employers care about is whether or not you pass your boards. However, some schools offer master's degrees in a field other than nursing, which may impact you if you decide you want to teach one day or obtain your doctorate in nursing.

Well, you probably wouldn't have gotten into school if you didn't already have a firm grasp of pressors, vents, and ABGs. We were required to do summer reading before school started which included info. mainly on pharmacology and the autonomic nervous system.