Athlein

I think it would help if you clarified your long-term medical education/research goals. I completed a medical research internship as a post-baccaleaureate, and I came away with a completely different understanding of what it takes to succeed in this realm. Ask yourself what it is that you really want to do. Provide direct patient care or work in a research setting or teach? Do you want to head the research and conduct science-based investigations, or do you want to explore clinical phenomenon as a part of a team? And if it's teach, then teach what? Medicine/science or nurse anesthesia? It will be difficult to choose a path until you answer these questions. Remember that the CRNA role is a clinical specialty, and while there are many opportunities for educators in CRNA programs, direct patient care is an integral part of nurse anesthesia practice, which is why the vast majority of CRNAs can be found at the head of the bed, not at a desk.

Where the heck do you go to school where you can get to the gym before and after school? The only thing I can figure is that you are still in your didactic phase, because now that clinicals have begun, I am up by 5 to get to the hospital on time, and when I get home, I have anesthesia plans to write, studying for classes to accomplish, and, oh, sleep in there somewhere. You may be in clinical for only 8 to 10 hours, but I swear, when you come home, you are just exhausted. Seriously, at least in my case - and the case of classmates and the other SRNAs I know, once clinicals started, all bets were off regarding any semblance of schedule and routine. Exercise and fitness are crucial to maintaining your health and sanity during anesthesia school, but understand that you can't get something for nothing. I'm getting up at 0400 a few times per week to stick to my fitness goals. The tradeoff? Caffeine is now a physiologic necessity for cerebral function!

MJB, I think college is going to teach you a great deal. Do you have a roof over your head, food on the table, and clothes on your back? If so, then you are not as poor as you think. As you grow up, you will realize that affluence and wealth do not necessarily guarantee any sort of life security. And you will also realize that the lack of options you bemoan may in fact be attributed to flawed perception on your part. There are plenty of opportunities out there for students who do not have life's every advantage. I can attest to that personally.

Ditto about Kaplan. I can't speak to other review courses, like Princeton, but I can tell you that the methods and review that you receive from the Kaplan study materials are outstanding - if you are a dedicated and self-directed student. I scored in the 80th and 90th percentile my first time on the GRE. It was not luck. The materials work if you put the time into studying them.

The anticholinergics - atropine and glycopyrrolate specifically in this discussion - are competitive antagonists of acetylcholine at all the muscarinic receptors. However, there is compelling evidence that these drugs are not PURE anti-muscarinics. It is theorized that the bradycardia seen at low doses is attributed to the drug's peripheral muscarinic agonist effect. Theories that bradycardia could be due to central vagal MOA were refuted by the facts that: 1. low-dose brady could be demonstrated with glycopyrrolate, as well, which does not readily cross the CNS. 2. bradycardia occured with low-dose administration of atropine, scopolamine, and glycopyrrolate even with the interruption of the vagus nerve impulses (AKA vagotomy).

Consider this: It's a short trip from driven to desperate. Admission to a CRNA program is more than just admission to a school - it is an admission to the profession. When I say that it takes more than GRE and GPA to gain admission, I am also referring to the intangibles of personality, ability to achieve and reflect positively on the nurse anesthesia profession, and professional demeanor. CRNA programs look carefully for "personality pathology", whether you realize it or not. The best way to stand out in the admission process is to interview well. Understand, too, that wait-listing or denial is not necessarily a statement against your personality, attributes, or character. In this time of very competitive applicant pools, there just may be nurses that are a better fit for the particular program. Schools have a general idea of who will be a successful student in their program. That is a part of the admission process that simply cannot be changed. I know the waiting and stress is tough. Here's a quote from Alexander Graham Bell to ponder: "We so often look so long and so regretfully upon the closed door, that we do not see the ones which open for us".

A couple of corrections: 1. SMC is not truly front-loaded. There is a single didactic-only semester in the Fall of your first year. Clinicals start in the Winter semester of your first year. 2. Commuting is an integral part of the program. It's not a question of if, but when. In short - excellent program, significant clinical time with great experiences, dedicated faculty that really want to see you suceed. But, you can't get something for nothing. It is very tough. And no one coasts through their program.

One of the CRNAs affiliated with the COA told us that about 80% of the programs in this country are quality programs. The other 20%? Well.... I think there is some merit to the rankings process. I thought of several programs that would make my top-ten list, and sure enough, they were all right up there on the USNews list. It shouldn't be the determining factor in your decision-making process, however! PS The USC program in LA is alive and well. It just moved to the med school when the USC nursing program was eliminated.

Dustin, Hats off to you for realizing that money does not necessarily equal career happiness. Finding a good fit for you in nursing is more important than chasing a paycheck! Flight nursing and anesthesia share autonomy and independent decision-making, as well as generally happy nurses in that specialty. And dang it, it is just cool to fly around in a helo or fixed-wing and get paid for it! Coming from high-acuity ER and ICU, I will tell you that that the routine nature of the CRNA role can be, well, mundane at times when compared to the fast-paced nature of those units. I am not bored by any means, but the very definition of good anesthesia is calm, controlled, and preemptive action. Sometimes I miss those blowout MIs and traumas with all the drama and action that go along with them. At the end of one of those days, I really felt like I helped save a life! There are several CRNAs I know that worked in flight nursing in their younger days that returned to the unit for a year or so before attending anesthesia school. One of the coolest CRNAs I know was an trauma flight nurse for many, many years and well-known in flight nursing circles. Now he works in our big level I public hospital trauma center as a CRNA. Why not do both?!

Hey Gooser, I think your concerns are valid. It is stressful and anxiety-producing to play the admissions game - that is unavoidable. When you consider that your first interview did not result in admission, that outcome contributed to the tension you already carry. Sometimes, the focus on our goals and plans becomes too narrow. We worry, we stew, we "what if?"...we try too hard! My advice? Take a mental break from the admissions process. Put it on the shelf for awhile and come back to it when your next interview draws near. Limit your CRNA-related internet surfing and school literature reading. Do some things you enjoy with your family and friends. And, remind yourself that you will get in, somewhere, when the time is right!

There are only four schools West of the Rockies (Gonzaga in Spokane, Washington; Samuel Merritt in Oakland; Kaiser/CSUF in LA, and USC in LA). Competition for the limited number of slots is very tough. All the schools are excellent, but they are distinctly different from one another, so taking the time to research these programs is time well spent. Only Gonzaga, in Spokane, Washington, fits your priorities if you do not want to travel to clinical sites and/or live in an urban setting in California. If you don't want to spend time behind the wheel of your car, the California programs are not for you. Going to different clinical sites has a number of drawbacks, but the distinct advantage it offers is learning the myriad ways to accomplish anesthesia. There are many, many ways to "skin the cat" in anesthesia. Getting exposed to a variety of techniques and methods while you are a student will serve you well in practice; admittedly, it can be time-consuming and difficult. FYI - Directors and admissions offices are usually inundated with requests for information and questions from applicants in the current cycle during this time of the year. Research schools on the web and receive the informational packet from the program first.

WntrMute2 has it spot-on. I have also heard that Florida, Colorado metro areas, and California can be tough in terms of scope of practice (not from a legislative point-of-view, but from one of limited scope by hospitals and MDAs [excluding the managed care setting of Kaiser Permanente]). Desirable areas attract more physicians, generally speaking. Also, there is a funny rule about CRNAs + ambulatory surgical centers + pediatrics in Florida, but I do not know the specifics. Maybe one of the Barry SRNAs can give us the scoop.

Woo-hoo! Congratulations!

Gooser, Hang in there! If you went to the interview prepared, answered the questions to the best of your ability, and kept your anxiety in check, then shrug your shoulders and move on to the next interview. You were smart to contact the director of the program and ask why you were not selected. Understand, too, that some program admissions committees have a very narrow idea of what constitutes a suitable student for their programs. What is "interested and enthusiastic" for one school may be "gushing and suck-up" to another. Here is something that might make you feel better: I know a CRNA who went to a smaller school that took "interested and enthusiastic" to mean "doormat and kiss-a$%" once admitted. That environment makes for a long two and a half years. Beware of programs that make you feel like you are lucky to be in their presence. If that's the attitude they extend when they are interviewing you, what would student life be like?!

Yep, it's paper and pen for me. I have a Handspring Visor, but it is going to be used for Epocrates and storing contact information.

That is hilarious. I am attributing my mediocre performance on exams this week to the excellent FoxSportsWorld Rugby World Cup coverage. You are a dedicated student indeed to put studies over sports when the Game-They-Play-In-Heaven is being broadcast nearly every night. Here's the good news. When the 2007 World Cup comes around, we will be full-fledged CRNAs and can watch the action in person. Four more weeks of Fall semester to go. It's going by so quickly! Chompers - many congratulations. It was kind of you to post this note of encouragement!

The issue I fear most is the litigiousness of patients in this current era of healthcare. With malpractice insurers discontinuing or modifying coverage to CRNAs, how will we be adequately covered in (God forbid) a patient injury or frivolous lawsuit? How can we defend claims of anesthetic awareness and/or nerve injury?

Believe me, I do sympathize with you! I had the good fortune of geographic flexibility and a competitive profile when I chose to pursue anesthesia, so I researched programs all over the country for the best fit for me. I was astounded by how difficult it could be to get straightforward, accurate information about a program. What struck me at the time - and still confounds me today - is the VAST DIFFERENCES among anesthesia programs. Sure, the COA (Council on Accreditation for the AANA) makes certain that programs will meet core guidelines, but in truth, the structure, content, and quality of programs varies wildly. Programs can be front-loaded with curriculum (all classes, no clinicals for a year or so), integrated (classes + clinicals all the way), or hybrid. Some programs send you all over the place for clinical, others have a few hospitals. Some programs have human simulators, most do not have that technology. Some are based in hospitals or medical centers, others are university/college-based. Some programs have strong regionals and lines experience, others will only provide minimal exposure to CVL and PA line placement, nerve blocks, etc. It is crucial that you, the applicant, take the time to do the research into finding a program that fits your priorities. This is why I repeatedly post that the best thing a prospective applicant can do in the admissions process is meet directly with program directors or their representatives. There is no "best" candidate for every anesthesia school in the country. What is important to some programs is completely irelevant to others. Believe me or believe me not, but it is true. This is especially pertinent in terms of clinical experience (length, quality, and type of unit), GRE/GPA, and even whether you are willing to move to accomodate a distant clinical assignment. I know current SRNAs with GRE scores under 1000 (math + verbal). I also know a couple of applicants with GRE scores in the 80th-90th percentile who have not been admitted. I know a few applicants with arrogance oozing out of every pore that were shown the door almost as fast as they entered. I also know one person who was so anxious that she shook the table as she answered questions. With that kind of stress during an interview, do you think the admissions committee will believe that she can perform with confidence in a clinical area when the crisis-moment occurs? Admission takes more than high GRE and GPA. Really. There are brilliant students in my class, just as there are those with average intellect. Some have to work harder than others, in reality, but we are all making it. Let me be frank - in most instances, fair or unfair, the interview will be the deciding factor in whether you are accepted. What shows in an interview? You do: your attitude, determination, knowledge about the profession, financial/emotional/professional preparation for graduate study. You have already hurdled the first bar on your way to acceptance when you are selected for interview. Yet, far too many applicants spend too little time preparing for it. That lack of preparation (mentally, knowledge-wise, etc) is often painfully evident. Read some of my posts on the interview to get some more information about this topic. Conversely, because it can be difficult to get detailed information about a program before you apply, the interview often becomes a fact-finding meeting from your perspective by necessity. What looks like a good fit for you on paper may turn out to be unworkable when you meet the faculty in person. In my case of "anesthesia applicant denial", I was so dismayed by my introduction to the program (location, buildings, staff, and the requirement for travel to clinical sites - and no, I won't disclose the program, because it doesn't matter. What didn't work at all for me might be fantastic for you) that I blew the interview. I couldn't imagine attending that program - and it showed. Folks, there are over 80 programs of nurse anesthesia. I have never (and this is the honest truth) met anyone who truly wanted to be a CRNA - and that was willing to go to any lengths to accomplish that goal - that has not eventually secured a slot in an anesthesia program. l have met several nurses that have unsuccessfully applied to programs, and for reasons of family, finances, geographic restriction, etc, cannot continue to pursue their goals. I have also met several people who have taken extreme measures to secure a slot, including: taking a Kaplan GRE course (twice), moving across the country to attend school (this is not at all unusual), literally selling everything they could in order to afford tuition, spending two years taking prerequisites while working nights at a county hospital. I really hope this helps. It is unfortunate that there is so much angst and anxiety surrounding the admissions process. But here is the take-home message: Commitment to your goal, with the preparation, determination, and work ethic to make that goal come to fruition, is the surest path to success. And one more thing. Once you get into school, remember that your attitude is key. You chose this path, and you can alter your plans any time. When you are tired of studying and burnt crispy by clinicals, do not let your attitude sour. Those with poor attitudes just make it miserable for the rest of us who are slogging through, too.

If you mean the corporate arena when you mention "industry", then yes, some CRNAs are employed there. Companies that manufacture and sell anesthesia equipment and drugs often have CRNAs working for them in some business-related capacity, like education or sales. However, these positions represent a tiny fraction of anesthesia provider employment. Like yogacrna said, being a nurse anesthetist is a clinical specialty.

Overall GPA 3.5 BSN GPA 3.8 GRE just shy of 2000 (Math + Verbal 1340) Several years in pediatric and adult ICUs and ERs (I was a traveler for a few years and took whatever day or evening shift area I could get!) ACLS, PALS, TNCC, IABP FYI - Contrary to popular belief, being a traveler does not necessarily hurt your chances in the admission game if you have strong prior experience and/or you go to "brand-name" assignments. I get asked that one quite a bit... FYI II - Please note that above-average numbers do not guarantee admission. I know a number of nurses with very favorable profiles that did not successfully negotiate the admissions game at one school or another- myself included!:wink2:

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DeepZ - Thanks for the reply. Very interesting link! This is the first I have heard of PK anesthesia. Any PONV with this reduced dose? Tenesma - Also thanks for the reply. I've used ketamine in the exact population you describe while a bedside nurse in pediatrics. I just spoke with an MDA who chose ketamine for his own GA during outpatient surgery. He is a proponent of guided imagery with induction, and he said that he had a blissful time with no PONV or emergence reaction. Interesting. To all - how about more clinical chat like this? Any interesting cases you could share/tricky questions/random factoids?

Hey y'all, Can anyone support or refute the anecdotal evidence that Ketamine is finding its way into fashion? Has anyone run across any recent publication regarding ketamine? Is anyone using ketamine in sub-therapeutic doses in outpatientsurgery settings? TIA!

After my exams this week, I feel compelled to add another lesson: When instructors tell you that exams are going to be "straightforward", what they mean is that the material is straightforward for THEM. You, meanwhile, will look at the questions and realize that you haven't the slightest idea what you are doing or how to answer!

As a group of professionals, CRNAs do not tend to "air their dirty laundry". Even so, the number of satisfied CRNAs far outweighs those that are unhappy in the profession from my own anecdotal observation. It is interesting to note that the few CRNAs I have spoken with that dislike their role also admit that they pursued the profession for a paycheck. Note the lesson here: if chasing money is the only reason why you want to be a CRNA, think long and hard about your plans.