putmetosleep

Just wanted to update my original post--the CCRN materials have already been sold, but I do still have the CMC DVDs available. $50 plus shipping takes them. Let me know if you're interested.

Hey everyone-- I'm cleaning house right now and rather than just throw these out I thought I would see if there are any takers out there. I have the Laura Gasparis Vonfrolio CCRN Review Cram DVDs, as well as the CMC Review Course DVDs (by the American Association of Critical Care Nurses). If you're interested in buying either of these, PM me. PMTS

Hi everyone, I'm an SRNA with just under a year left in my program. While I think right now may be a bit too soon to begin the job hunt, I'd like to get a general idea on how to proceed and I'll likely start the process in the spring. I'm wondering how to start the process of job searching as a student? I check gaswork.com frequently, but I also am aware that not all employers post to that site. Many of the CRNAs in my area belong to anesthesia groups (vs. being employed by the hospital) so it seems CRNA positions are not listed on the hospital websites. I'm afraid I'm going to miss out on job opportunities in my area because I don't know how to find out about the openings. Is working with a recruiter a good idea? What are the pros/cons of this? Any advice or words of wisdom are appreciated, I just want to know where to start! Thanks!

Anyone have any tips for arterial sticks/a-line insertion? I have attempted a few now and let's just say...well I have not been very successful! Don't know what the issue is, even when I'm palpating a great radial pulse I can't seem to get the needle in the right place. Obviously I'm doing something wrong but even the CRNAs who've watched me do this haven't had much feedback/advice for me. Any feedback is welcomed! Thanks!

As a current SRNA, I can personally tell you that while it can be frustrating sometimes to be corrected on things that seem miniscule (i.e. EKG lead placement, IV taping, etc), it's important to take a step back and realize that your grad is not doing it to belittle you (I've never met one who was hostile or did things just to make it difficult for me). They are doing it because they want you to know how they do things and why. And it is impossible to develop your own practice without having the advantage of seeing mutliple ways of administering anesthesia. So try not to be offended when you're corrected, instead look at is as a learning opportunity (no matter how small the detail is). When you're on your own you can pick and choose from all that advice and create the perfect practice for you. Most CRNAs are at least a little bit Type A...but this is what makes them so diligent. Until then, try to keep the attitude that you are a guest in the OR, and be thankful there are people willling to teach you. Be open to suggestions..this is key to being a good student. Take it all in. When you're on your own you won't have the opportunity to see how other CRNAs practice...now is the time to find out all the different approaches to anesthesia and then decide what works for you (when the time is right!). Of course I am counting the months until I graduate, but I feel lucky to be where I'm at and can't believe how MUCH I've learned in such a short time. It's amazing. Anesthesia school has been one of the best decisions of my life.

A supine healthy patient, I should say!

Thanks for the responses so far. Just to be clear, I don't lie on one side or the other on this topic. In my limited experience as a student, I haven't even used all that many LMAs yet (mostly ETT), so my question was more or less for future reference, and so that this makes sense to me. Of course not for every patient or every case would it be appropriate or safe to give relaxants with an LMA(and not just succs, what I had in mind was a non-depolarizing relaxant) for all of the reasons stated above...but then again for an obese pt or a pt who you suspect would need high inspiratory pressures to ventilate, an LMA would not really be the ideal airway choice for them in the first place. And I do also have to say...that the idea of using an LMA in a prone or lateral case (or even for a laparascopic case due to the increased probability of needing higher PIP) makes me shudder!! NO way! :) So.. my hypothetical question was geared towards a healthy pt (no obesity, airway disease, etc).

But why is what I want to know? Why do you feel it is unsafe/not the best practice? I agree that you shouldn't need relaxants to place an LMA, but what if you already have one in, and then the surgeon decides he wants the pt relaxed? I have perused my anesthesia texts and can't find any reason why it would be unsafe to use NMBAs with an LMA in place.

What are your thoughts/feelings on using neuromuscular blockers during a case with an LMA in place? I know relaxants are not necessary for insertion, but are they contraindicated? I've heard yes and no...personally, I can't think of a reason why it wouldn't be okay to use a NMBA if the surgeon needed relaxation during the case. Others have said it's a big no-no. I've heard that this is done routinely in Europe, as well as mech. ventilation via LMAs (with low PIP)---another topic where there are opposing views in my current rotation. Thoughts please:)

Hi, The final exam is not too bad. It's open book/ open notes and you are allowed 4 hours to complete the exam. It took me the whole 4 hours b/c I had to look up every answer;) I got a B in the class. Let me know if you have other questions.

Duh. Haha sometimes the most obvious answers are the hardest ones to come up with. I didn't even think about smooth vs skeletal muscle. Thanks for clearing that up for me! Can you tell that my brain is in a state of overload or what?!

How does administering pitocin immediately after the baby is removed during a C-section really prevent uterine atony if there is neuromuscular blockade on board? Doesn't the NMBA in itself produce uterine atony? Thanks so much.

Can somebody please explain to me what oscillating ventilation is and when it would be indicated? I've never seen it used or used it before. Thanks

Thank you so much for the Advice. Just to clarify, I have all the support I could ask for; my family & friends are behind me 100%. This is completely my own internal struggle...I'm beginning to feel a little better about starting school. We all know that it's not as simple as just waiting a year-- just because I was accepted this year does not mean I'd be accepted next year.

I really, really appreciate everybody's input...keep it coming. I think the biggest thing that scares me is the HUGE responsibility that I will have...which is odd because I obviously knew all about it before pursuing it. Right now, sure, of course I am responsible for my patients...but if things go REALLY bad, there are others to call for help. In a few short years, I will BE the help. That scares me. I really think that maybe I've just had too much time to sit around and think about it all since I've been accepted. Rationally, I do realize that there is a reason I spent so much time and energy to just be accepted... It's reassuring to know that there are others out there who feel/have felt this way but have pushed through and are successful in their programs. I have a lot to think about and your input really is helpful to me.

Yes, my husband is very supportive of me starting school. In fact he is one of the reasons I feel like I can't pull out; after spending years obsessing about getting accepted to a program I'll appear to be a crazy woman for not following through. Are there any CRNAs or SRNAs out there who have felt this way? Is this normal? Or is this me realizing this might not be the right career path for me? I just feel so torn up inside with uncertainty.

I really need some help. I'm not looking for anyone to tell me what to do, but I want honest feedback and need to hear what you think of this... So my situation is that I've been accepted to an anesthesia program, and I'm all set to start in August (getting close, I know). Prior to being accepted I spent several years researching the CRNA role & getting the appropriate experience (2.5 years SICU), CCRN & CMC certifications, shadowing, etc. My problem is that now that I've been accepted and the challenge of applying to programs/anticipation is over...I'm feeling wishy-washy about truly wanting to pursue it and start school. This probably seems like a really odd post to most of you, and quite frankly, I am surprised at myself for feeling this way. I had to take a chem class a pre-req before starting the program (just finished the class), and I HATED being a student again. Hated it. I'm not sure I am driven enough or want this badly enough to give up 2.5 years of my life, time with my husband, friends, and family, and having to delay starting our own family. Beyond hating the chem course (which I did do well in, if that makes any difference)...I wonder if I'm truly cut out to be a CRNA? Yes, I was very successful while working in the ICU; I consistently got positive feedback from senior nurses and felt competent caring for complex patients (mainly fresh hearts). Even though I regularly participated in them, emergency situations and codes make me feel nervous/anxious. I'm talking heart THUMPING, I feel frozen for a second anxiety (but quickly I MAKE myself get over it and get to work). I recently read a thread on here saying "if you want to run away from the crisis on the unit, anesthesia may not be for you. If you want to run toward it, you'll enjoy anesthesia" or something to that effect. I always feel like I want to run away from the crisis--and would prefer for somebody else to take care of it (although let me be clear that I never actually act this way, but this is how I feel). I am also a soft-spoken, shy person who doesn't like to be the center of attention ever and can get nervous easily. I worry about being in the OR with nasty surgeons and the like (which I know is going to happen). I shadowed CRNAs multiple times before even applying to programs, and each time, I left the OR excited and I couldn't wait to apply to school. What I love the most about ICU constantly monitoring/assessing/intervening/titrating gtts. This is also what excited me about anesthesia--all the good things about ICU without the code browns and other chaos. But now that it's a reality for me and I'm less than 2 months from starting school...I'm terrified. I don't know if I really want to the one people call when there are emergencies...it scares me that I will be "the one", that I can't just call somebody else for help, it's on me, I'm the end of the line. It will be just me in that OR...gulp. I know I would be successful as a CRNA; I alway do what has to be done, regardless of how I feel about it. But I don't want to pursue a career that is going to be anxiety provoking for me all the time? I can't tell if I just have cold feet, or if I keep feeling this way because it's the wrong thing for me...Did I pursue this just to prove to myself I could do it, or do I really want this career? Please help, any feedback is welcome.

Hi, I just finished the course last week (got a B in the class, which is about what I was expecting to get for the amount --or lack thereof--of time I put into the course). The lectures are online, there's lots of textbook reading, and all of the chapter quizzes are completed online (open book and open notes). The final is a proctored exam, and is also open book and open notes. GL!

Cardiac Medicine Certification and Cardiac Surgery Certification...both are sub-specialties of the CCRN.

Yep, you are allowed to do it faster or slower..16 weeks is what they recommend (1 week per module--14 total-- plus 2 weeks to study for the final). I'm finding that 1 week per module is pretty right on, esp with a full-time job. I'm only allowing 1 week to study for the final, so I'll finish the course in 15 weeks. Good luck, let me know if there's any other info you need

The class is going well so far, I have no complaints about the actual course. I'm about 4 weeks away from taking the final (yay!). I am a classroom learner and adjusting to the online format was a little difficult for me at first, but after the first 2 weeks or so I found what works for me and I'm doing well in the class. The instructor is very quick to respond to emails with questions (you can also call her during office hours), and all the quizzes and the final are open book/open notes. I could definitely be putting in a little more study time, but overall it's going well and my grade so far is around a B+. I'm only taking the lecture portion of the course, so it breaks down to quizzes being worth 30% and the final worth 70% of the grade...(I think if you take the lab it's 25%/25%/50%). I'll let you know how the final goes!

I don't have the numbers exactly, but the total cost of tuition for the school I'll be attending (MSA) is somewhere around $28,000, I believe. Your best bet would be to investigate the schools you think you might apply to.

Repeating my post to add my stats: 2.5 total years SICU (appx 6 months worked on a prn basis) Been out of ICU appx 18 months, working in cardiology administering conscious sedation for TEEs and facilitating cardiac stress tests. CCRN-CMC, ACLS GRE not required for the schools I applied to 3.4 GPA I think that's all...I was pleasantly surprised that my being out of the ICU for awhile didn't ruin my chances. The schools I applied to require at least 1 year ICU within the last 3 years...

Exactly...