yoga crna

I can assure you, pain doc that my patients could care less about whether I have an advanced degree or a diploma in anesthesia. (I have both and a law degree) It is not a good idea to disparage us diploma grads, we are quite good anesthetists, because we studied anesthesia before a lot of monitors and ventilators and know how to watch a patient for subtle changes. Being an old diploma anesthesia grad, you might be interested to know that we received our anesthesia eduation with MD residents. We learned what they did and spent more clinical time administering anesthesia. When I got me degree (after being a CRNA), which was an anesthesia degree at a very prominent medical school, taught by medical school faculty, I realized how much I already knew from my diploma program. The funny thing is most CRNAs are confident in both our education and clinical skills. It is everyone else who seems to have a problem. Yoga crna

What you have to remember is that physicians have UNLIMITED LICENSES, which means, based on their medical license they can do anything. Whether or not they can get hospital privileges for anything is another issue. We have seen that a lot with office based surgery, where GP's are doing breast augmentations and liposuctions. I have reviewed lawsuits where GPs were doing general surgery. There is a whole world out there outside of the big hospitals. CRNAs and NPs are not comparable in education and scope of practice. If nursing boards wish to classify us as advance practice nurses, that is fine. I have taught both groups and can tell you the nurse practitioner curriculum is very soft on the sciences and on clinical experience. Whereas, CRNA students are educated to be self sufficient and independent practitioners when they graduate and our pharmacology and chemistry courses are not for the faint hearted. Clearly, our functions are different and, in no way am I disparaging our nurse practitioner colleagues. But anesthesia involves acute care of cradle to grave patients with all disease processes and pathophysiologic changes. That is what makes it so much fun and what keeps us constantly studying. yoga crna

Anesthesia is not for everyone, that is the plain simple truth. When I was a program director, one of the hardest things I had to do was dismiss students from the program. The reasons usually were not academic, but were related to difficulty learning clinical skills, inability or understand the politics of the operating room or rigid thinking regarding anesthesia techniques. Now that the admission requirements are more rigid, students are comfortable with many of technical aspects of one to one patient care and with ventilators and tubes. As a CRNA, I have seen some mediocre colleagues (the ones you wouldn't request for family members) and I have seen some spectacular anesthetists. This is probably no different from any profession. As a legal consultant, I have seen some really bad practice, usually by CRNAs who have become complacent, have not kept up with current practices or have substance abuse issues. As you know, I love anesthesia, but it is not a profession for anyone who doesn't like it. You have to be comfortable in the anesthesia environment, like patient care a lot and be willing to participate in life-long learning. We are an elite profession with an excellent professional organization, AANA and have an amazing history. But, if you need a lot of direction, not comfortable making your own decisions or have difficulty dealing with stressful situations, you need to reconsider anesthesia. yoga crna

I notice from your profile that you are a student nurse, so I can't help but wonder why you think you are such an expert on CRNA independent practice? You are simply mistaken and I want to take this opportunity to enlighten you. CRNAs practice independently now, have done so in the past and will continue to in the future. If you have contrary information, please post it here with references. I am an independent CRNA and the last time I saw an anesthesiologist in my operating room, he was on the table and I was giving him an anesthetic. In my state, there is no such thing as "supervision" per the nurse practice act regarding nurse anesthetists. Of course, we practice in collaboration with physicians, dentists, podiatrists, but that is because anesthesia is usually performed in conjunction with a surgical, diagnostic or therapeutic procedure. Except for pain blocks, which are done via an order, such as any procedure is, like an x-ray. I have extensive experience and education in the profession of nurse anesthesiology, the law and the business of anesthesia. We are one of the most elite professions in the country and are proud of our role in making surgery painless and safe. The AANA, our professional organization has the reputation for being the strongist in nursing and over 95% of all CRNAs are members. I apologize if you think I was too hard on you, but I am proud of my profession, love every minute of doing anesthesia and have distain for deliberate misinformation. Please prove your point or reconsider posting incorrect information. yoga crna (independent practitioner of anesthesia)

Vince, Congrats on passing your boards and welcome to a wonderful profession. Back to the original question. I agree with VInce, think a lot about what your real goals are and if the sacrifices are are worth obtaining those goals. Do you have any idea what a CRNA does and why the education is so extensive? If you are simply looking at money, this is probably not the profession for you. We make good money, because of the value attached to administering anesthesia, and not because it is easy. It is very difficult, involves life-long education and is for only the highly dedicated. You may well fit that mold and if so, go for it. Who knows what will happen with health care reimbursement in this country, so the money may not be there in the future. Medicare has just reduced anesthesia reimbursement by 40%, so it is already started. Yoga CRNA

It is clearly the best profession there is--if you don't mind working hard, being very alert, using your brain and your knowledge, your hands and your intuition. I can bring the best of nursing--calming the fearful patient, relieving pain and making the sugical experience great--with the science of anesthesia. Also, the money, the respect, being a member of probably the best professional organization (AANA), a wonderful peer group, the most professional of all nurses and the independence and incredible number of practice options. Today I got a lovely gift from a patient thanking me for the great anesthetic and telling me it was the only time she woke up from anesthesia without nausea and vomiting. What a great feeling. There is a lot more I could say; I am in my own practice, run my own business and have fun every single day. yoga crna

You guys will not like my answer, but you need to have a very good chemistry background to make it through anesthesia school. Inorganic, organic and biochemistry are necessary to understanding anesthetic agents, physiology and pharmacology. If you are looking for shortcuts, please do not choose the nurse anesthesiology profession. We are looking for the best and the brightest, not those who are looking for the easy way. Anesthesia is a very specialized clinical profession and involves a lot of knowledge. Also, you will be competing against others who have high GPAs in the sciences. I have been doing anesthesia for a long time and have never been sorry for taking the hard science courses. Nursing is generally considered a "soft" science. Yoga crna

Ok Mac I am guilty of posting that I NEVER use droperidol. First, please be careful how you state your posts, I have been doing anesthesia for over 46 years and am very current im my techniques and use of agents. You may VIOLENTLY disagree with me and I have the right to VIOLENTLY disagree with your accusation. I was hoping that CRNAs would be more professional than to be so opinionated and not get all of the facts. I stopped posting on here for awhile and am actively involved in the OTHER and BETTER forum, because of that type of attitude from our nursing (non-anesthetists) colleagues. Second. Why I NEVER give droperidol 1. It causes dysphoria, even in small doses (check the literature, if you don't believe me). I am in private practice and my patients having a good anesthesia experience is very important. 2. EKG changes with drop (read black box in package insert) 3. Very few of my patients need anything for PONV, because they don't have it. 4. We don't have it in our surgical facility. I promise to keep an open mind if you also keep one.

I agree with Vince. It needs to be related to anesthesia practice, such as pain management. I wan't sure if this was what you were asking, or if you want to do cosmetic botox. Why do that if you are an anesthetist? yoga

PONV- Post operative nausea vomiting I usually don't like acronyms, but this one is easier than typing out the entire thing. y

Yes, stevie I indeed do use ephedrine in certain cases. If you observe post-op patients, you will find that most of them start vomiting when they are moved. I think this is a combination of middle ear issues and postural hypotension. We sit up our patients slowly, watch their BP, give more fluids, If they get nauseated with the sit up and fluids don't take care of the isssue, I lay them down, give ephedrine 25 mg IM, wait for about 15 min and try again. It works like a charm. My approach to prevention of PONV is a combination of techniques, including getting a good history of prior problems, identifying those in the high risk groups, tailoring my anesthesia for prevention like keeping air out of the stomach, using more local anesthetic in the surgical site than narcotic for post-op pain. I can't remember the last patient who vomited or the last time I gave decadron, zofran or anzemet. Droperidol - NEVER. I do like phenergan in recovery. Prevention and treatment of PONV is a nursing care issue and all nursing techniques like slow movements, IV fluids, prevention of postural hypotension should be used. I rarely need to use any meds. I noticed the other day zofran had been ordered in January and has never been opened. I know most of you love to pick up a syringe, but not me. And I have a stack of letters from happy patients who said the anesthetic I gave them was the first one where they didn't get sick. Sorry for the long answer. Yoga crna

Well, there is labor and delivery, radiology, psychiatry (ECT) and various places in the hospital where deep sedation and anesthesia are used. But, anesthesia is primarily administered in the operating room. I am puzzled by your question. If you are not interested in working in an operating room, anesthesia is not a specialty for you. That is where the jobs are, that is where you get your education and the experience necessary to give anesthesia outside the OR. Most of us in anesthesia love the OR environment, as crazy as it can be sometimes. It is a world to itself. Hope this helps and let us know if we answered the question. yoga

At this point in my profession, I am interested in mentoring students and young CRNAs. Having given so much and received so much from anesthesia, I want to make sure the legacy continues. Nurses have a tendency to "eat their young", nurse anesthetists do not. This is a wonderful profession and I want to welcome all who have an interest in it. yoga crna

Vinny, Congrats for a great achievement. Now your education will really begin--anesthesia is lifelong learning. Welcome to the best profession in the country. Hope you will have time to participate in our professional activities. yoga

I agree with the above posts about market forces and a VERY stong professional organization. I would like to add to those by saying that we are the only area of medicine where a doctor and nurse can do the same thing and get paid the same money. The reason for that is, our understanding of the VALUE of administering anesthesia and how that value translates into income and reimbusement. The value of administering anesthesia is a calculated monetary number based on the difficulty of performing anesthesia for a particular procedure, plus time and multiplied by a predetermined figure. That is a round about way of saying that we get paid what we are worth, as determined by the difficulty of the procedure. I believe our education is much longer and much more intense with emphasis on hard sciences. The good news, we are very self-sufficient, hard workers and work in difficult surroundings. Earnings are rarely fair. It is hard for me to see how a marginally talented , not very bright professional football player can command so much money for the little they do. yoga Nurse anesthetists education and practice is more of the medical model rather than the nursing model.

From your description of the reaction, I think you had either an overdose or an intravascular injection of the local anesthetic. The ringing in the ears in one of the most common signs of overdose. It is VERY rare to be allergic (true allergy) to amide type of local anesthetics. But, it is rather common for oral surgeons to use high concentrations and have the symptoms you described. Also, commonly seen in dental settings are reactions to the epinephrine in the local. Hypertension and tachycardia are common signs of this. It is my sense that you can safely have local anesthetics in the future, but you should always disclose your reaction and ask them to titrate to effect, so not to overdose. It would be useful for you to look up the pharmacology of lidocaine. Hope this helps. Yoga

I give you credit for asking the question. My opinion. 1. Circulating nurses be more concerned about the patient and less concerned about the surgeon and "things" --equipment and supplies/ 2. OR warm and QUIET during induction and wake-up. 3. Learn basics of anesthesia machine 4. Be at patient's side and QUIET for induction 5. Don't tell anesthetist that patient is moving. Trust me, we know 6. Understand your role and WHY with rapid sequence inductions and difficult intubations. 7. it is your job to circulate for the PATIENT, which includes the surgeon, the scrub tech and the anesthetist. 8. PLEASE don't bring your personal issues into the OR. When I am giving anesthesia, I can only deal with the patient and am not interested in your menstrual cramps, headache, boyfriend, husband, children or financial problems. It is not that I don't care, it is just not right now. 9. NEVER talk about legal issues (ex. putting you license on the line) unless you know what you are talking about and can give me documentation. 10. READ, READ, READ and keep current with OR practices, surgery and anesthesia. 11. Be cross trained to scrub, circulate, admit and recover patients. You will be more marketable and a better circulator if you know the other jobs. 12. REMEMBER gossip spreads fast in the OR and everyone loves to hear about bad news. Stay professional. 13. Last thing. We make administering anesthesia look very easy. It is NOT. Behind every med we give, every liter flow, every piece of equipment, every parameter being monitored, every induction, maintainece, emergence and technique is years of education, constant studying and keeping current and information in our head that has to be utilized on a moment to moment basis. REMEMBER RESPECT IS MUTUAL yoga crna

etomidate is a general anesthetic, midazolam is a sedative, fentanyl is a narcotic, combine them together and you have a general anesthetic. You are not going to like this--but if you have to ask the question, you shouldn't be giving the drugs under any circumatances. Read the preceding answer about the definition of conscious sedation. He is right on.

I hate to get into this discussion again, but... If you are not a professional anesthetist (CRNA, MD, AA), you should NOT give propofol on an unintubated patient, particulary in the ER, if they have a full stomach (most ER patients), if there is a chance of cardiovascular collapse or a danger of respiratory depression. Period, Amen I understand from my legal research that there are a couple lawsuits regarding this in the pipeline. One is an RN who didn't read the package insert on propofol. See you in court. The problem is a few patients may have to aspirate or die before the point is made that propofol is an anesthetic and should be used ONLY by those educated in anesthesia. I don't care if you are ACLS certified or a non-anesthesia physician, only the very best anesthetist can intubate a trachea in a patient who is vomiting solid food. My last point, so many RNs who are now in anesthesia school or are new graduates, state that they didn't know what they didn't know when they were giving propofol as a non-anesthetist. These people feel very stongly about it. If you are going to argue with me on this, please state scientific facts and not give a history of how many times you have given it without any problem. I don't want my grandchild to be the next one!! It only takes one to aspirate or die for your record to be broken. yoga

Yes, I will be there Saturday evening through Monday evening. Then I must get back to work. I am most anxious to hear President Clinton. It was a major coup getting him to speak. As you know his mother was a CRNA. yoga PS, If you want to meet, send me a PM

The AANA is celebrating its 75th anniversay next month. Just look at its history--the first nursing specialty organization, over 90+ percent of CRNAs belong to the AANA. This is better than the ASA and AMA. The AANA is known in Washington, DC to be one of the most effective lobbying groups in the country. All attempts to limit or eliminate CRNA practice have been overturned by the courts. There has NEVER been any valid studies that show any difference in anesthesia care by nurse anesthetists and anesthesiologists. I could go on and on, but I won't waste my time or energy on things posted in the student doctor's forum. I will be happy to take them on, one by one, and I will win. The really should be careful what they post, they or a member of their family has probably already been anesthetized by a CRNA. yoga

While the student doctors are agitating, myself and tens of thousands other CRNAs are in the operating room administering safe and cost effective anesthesia. The future is strong for our profession and don't let the jealousy and arrogance of others influence your future. Their rants tell me a lot about them, and it isn't flattering. yoga crna

While I am always open to learning new techniques, I have very healthy respect for succinylcholine. Years ago, I saw a small dose (10mg) given for an ECT and the patient vomited coffee ground fluid from a gastric bleed, aspirated and died. I was a student then, but it is something you never forget. Personally, I think many anesthesia providers use muscle relaxants to cover up poor anesthesia. They paralyze and not anesthetize. The point is--why give one of the most dangerous drugs we use--without a very good reason to use it. I can put in an LMA without a muscle relaxant. If I have difficulty, I then give a paralyzing dose and intubate (love that secure airway). yoga

DFK, You may want to check out my sticky on the Pre-CRNA forum about money and reality. It has a lot of information regarding private practice. I have been in private practice for over 20 years and know many, many CRNAs who are in the same or similar types of practice. It requires a business knowledge, ability to market yourself, thorough understanding of reimbursement, contracts and negotiations. The most important element is you must be an excellent clinical anesthetist. There is frequently no backup or support and you must be able to handle the most difficult situations., If you are a student AANA member, you may want to subscribe to the several CRNA groups at yahoogroups.com. There is old-gas, CRNABiz and several others. Rignt now there is a discussion going on about reimbursement codes for post-op pain control. Also, non-CRNAs or SNRAs are not permitted to post. So we don't have to put up with those non-anesthetists with hidden agendas who tend to post on these boards. If you need specific information, send me a PM. yoga crna

Mike, I am sooo pleased for you--I didn't have any doubts. Sorry for the delay in offering you my congrats--I have been on vacation or working 14 hour days. Checking emails and the internet now while on vacation. yoga