alterego33

Being IV competent is critical to being a CRNA. Many times we are the most qualified and experienced person in a facility to start IVs and we are called to start others and our own. You will learn and do great, it is like any technique, learn the tricks and get the experience. Another difference you will find in anesthesia, the size and location of the catheters are judgment calls in the surgical setting. Those of us experienced in anesthesia will tell you that a good working IV is often life saving.

I have taught graduate level pharmacology to nurse anesthesia students and was appalled at the lack of basic knowledge of the students. Because they knew very little about pharmacokinetics, basic metabolism of medications and even math, I found it necessary to have the students take a remedial course before starting anesthesia school. My point here, if you are teaching at the undergraduate nursing level, please try to develop a course that is really pharmacology and not just what classes of drugs are given for various diseases. I personally think basic pharmacology should not be "dumbed down" in any program. The genetics and mechanisms of action are changing every day and our graduating RNs MUST understand more than the basics.

Many are as rude as you let them be. Respect should be mutual and earned. I usually ignore them in tense situations, but don't allow it as an ego thing.

When someone asks me the difference between a nurse anesthetist and an MD anesthesiologist, my answer is that we (CRNAs) bring our nursing experience into the anesthesia care. We listen to the patients, reassure them, watch them closely, are methodical with our techniques and are caring. When you consider that the anesthesia part of our education is practically the same, and our continuing education required, and our outcome data show extremely safe practice, CRNAs are the way to go.

It sounds like you have a good science background and certainly, the interest to become a CRNA and I would encourage you to consider it. However, you also need to develop some good patient care skills and people skills. If you love taking care of people, relieving pain and seeing pharmacology at work, you will have a good future. I would suggest that you find some CRNAs who have gone your route or some who like to do mentoring. Having realistic expectations will help you in many ways. Note there are lots of nurse-anesthesia related boards on the net. Some of them are devoted only to the profession and are excellent resources for you. AE Edited by traumarus - tos

Cerebral, you and I must be joined at the hip. This thread is ridiculous and should be closed. The OP is offering an opinion that has no factual basis and is totally irrelevant as well as being insulting to the entire CRNA profession. I would be happy to answer a reasonable question, this is simply not one. AE

It is really in the answer of how you define independent practice. Many CRNAs are independent business people, have their own practices, do their own billing, and everything else involved in being in a business. Also, many choose to work for someone else, hospital, MD Group, ASC, All CRNA Group, etc. Those people are employees and, as such receive a salary and benefits. Another important distinction, independent CRNAs purchase their own malpractice insurance, if you are employed, your employer pays. CRNAs are the pioneers in independent practice by nurses. One way is not necessarily better than the other, but the option of going independent is important.

Check with your board of nursing, unless you are a nurse practitioner. They are really clamping down on non-advance practice nurses practicing outside their scope. Nurse anesthetists are setting up pain clinics and are doing very well, but it is necessary to be a CRNA to do this and there are restrictions against it in a couple states.

Anyone who cuts off the pilot tube of any airway device is a sloppy practitioner, in my opinion. Deflate it with a syringe. Cowboys belong on the range, not taking care of patients. Finesse is an art and is what separates the good from the marginal practitioners. I have been intubating and extubating patients for years and have never cut off the pilot tube. AE

As an expert in anesthesia, I will offer a few answers. First, it depends on what goes wrong and who has control of the situation. There are times when there is massive hemorrhage at the surgical site. The surgeons try to control it surgically, the CRNA pumps in blood and fluid, monitors vital signs and makes necessary adjustments in the anesthetic agents to help stabilize the patient. Then there could be a fire in a surgical site that was prepped with alcohol and the cautery used. All of the members of the team would put out the fire, maintain oxygenation of the patient, make a decision about to proceed with the surgery. Then there is fetal distress and the need for a stat c-section where everyone in the team has a role to save the baby and the mother. All of this points to the incredible team that is present in every operating room. We all have our role and the patient depends on us to know what we are doing and then do it. What we do as CRNAs is make second to second decisions, that include a very quick assessment of the situation and being able to multitask and to keep focused and calm. That is why (1) you have to be very bright to qualify for anesthesia school--good grades, lots of critical care experience, (2) we get paid well and (3) anesthesia is not for everyone. A recent example, last week I had a leak in my anesthesia system and while I could ventilate the patient, there was clearly something wrong. within 30 seconds I had to make a quick check of the anesthesia machine, connections, gases, ventilator, and tubings. When they were all normal, I checked the nasal endotracheal tube and determined the leak was there. I had to extubate the patient and reintubate without a muscle relaxant while trying not to contaminate the surgical field. Leak solved, patient did fine and all went well. It doesn't sound like a big deal...but I had to be an biomed engineer, a respiratory physiologist, make quick observations, identify and solve the problem. I hope these examples helped answer your questions. AE

Thanks Cerebral. I totally agree with your post. There is a lot of wonderful information available regarding the clinical practice and profession of nurse anesthesia. I was hoping this forum would allow me the opportunity to learn from other CRNAs, SRNAs and to be able to mentor others interested in the profession. For some reason, the CRNA thread of all-nurses in heavily moderated and not to the advantage of the profession. I will look elsewhere on the net for places to fulfill my needs. AANA.com has a listing of other nurse anesthesia boards, one of which is excellent. I'll see you there.

Not every patient gets amnesia from versed. It should not be relied upon as an amnesic. I know, because I have had versed a number of times and remember everything. We even set up a trick question to see if I would remember, prior to my last surgery. Everyone was shocked when I remembered it. Note to moderators: I agree with another poster. If you want to get any relevant clinical information on this site, you may want to suggest that non-CRNAs be careful about posting on clinical anesthesia issues. Unless they have special knowledge or have done research on the topic, their comments are not useful to CRNAs and leads to cynical, if not hostile posts. I want to learn and share information.

Starting IVs is a technical skill and is one you can learn quickly. There are a few rules for starting IVs for anesthesia that are different than IVs for other situations. 1. Use local to make a skin wheal before inserting the bigger bore angiocath. Use your brains on this rule. If the patient is in shock, needs an IV quickly, etc, then you should skip this step. But for elective surgery, the patients love it and don't listen to anyone who says a needlestick is a needlstick. In anesthesia, we are held to a higher standard on all of these technques and our job is to take away pain. Remember that. 2. Use as large a bore cathether as is practical. 3. Tape it in well. 4. Consider the type of surgery and surgical site when selecting a vein. 5. If it is not threaded up to the hub, don't use it. Start another one. Doing an IV induction requires a GOOD IV. If it infiltrates while doing an induction, you could have a partially anesthetized patient who is paralyzed. 6. Remember with a good IV and an endotracheal tube in the airway, you can handle just about anything in anesthesia. 7. Check you IV frequently duing a case. I saw an anesthesiologist forcefully push 2 liters of fluid in an infiltrated IV leading to a severe compartment syndrome. 8. I use a heating pad, or make sure the patients' arms are under the bair hugger to distend the veins. 9. Don't go digging around for a vein unless you can see or feel it. 10. After 3 attempts, let someone else try. Usually, I am not a big rule person, but these have worked for me and other anesthetists. AE

Good luck at whatever you decide to do. The future is bright for nursing and finding one's niche is important to being happy and satisfied. I never regret having chosen to be a CRNA, but have a lot of respect for all of those who have gone different routes. However, it is hard for me to respect anyone who just likes to complain and is not interested in a solution. (general statement not related to anyone or any profession). AE

In a recent discussion with nursing educators, CRNA educators and critical care nurses, from their perspective, there appears to be a lack of clinical nursing experience going on. Nursing programs are having difficulties finding clinical sites for their students, CRNA PDs complain that people who have minimum experience are trying to apply for anesthesia and the critical care nurses tell me that new grad RNs have to be trained on basic skills. The message here---get as much clinical nursing experience as you can before applying to anesthesia school. It will give you a competitive advantage, especially if your science grades are good.