HillaryC

No problem!

Legally it's not considered euthanasia as long as it is being given with the intention of making the patient more comfortable, even if it is recognized that giving propofol may hasten the patient's death. It's a fine line. I had this clarified for me when we had an ICU patient who was completely with it and was being taken off the vent (by his choice) because he was never going to wean. He was given a propofol infusion to make him more comfortable. Perfectly legal. I suppose there are some who would be against this (likely because of their own religious views) and would try to call it euthanasia, but legally it's not.

Don't stress about it too much. I started anesthesia clinicals with very little IV experience, for the same reason you mentioned (all my ICU patients already had tons of access). When we first started clinicals, a lot of my classmates and I would complain "I suck at IVs." You'll get plenty of opportunities to start IVs in anesthesia school, and in my experience most preceptors are understanding and are pretty cool about giving you tips. I've only encountered one CRNA who made a comment that SRNAs should be proficient in IV starts when they start clinicals, but this CRNA is a pretty nasty and judgmental person. So, get some practice if/when you can, but don't stress about it too much. An article I found very helpful when learning how to do IV starts was from the journal Nursing2005. The title of the article is On the road to successful IV starts. I tried to upload the PDF here but didn't succeed. Good luck!

I took the SEE for the first time last fall; I didn't study at all -- just wanted to get it over with and see where I stood. I take it again this fall prior to graduation. To study, I would recommend using the usual anesthesia textbooks or even Valley(their Sweatbook and Memory Master are awesome!)

So sorry to hear your instructor is tearing apart your care plans. That sucks! I agree that Jaffe's book is invaluable. I have Roizen's too -- it's great too, but pretty hard to come by. Good luck!

I discovered this site: http://www.freewebs.com/ginacareplans/ I downloaded all of the care plans from the Southern Illinois site but I'm not sure how to share them. Hope this helps!

I can't tell if the OP is kidding but I think she's serious. This is why the popularity of shows like "Grey's Anatomy" and "House" makes me nuts. People will say "it's just TV," but clearly there are a lot of people whose views of hospitals and nurses are very much influenced by what they see on TV.

Are you freakin' kidding me? That's horrifying! What is wrong with people? I had no idea how widespread these dangerous practices were! I remember when I was a nursing student, I stuck myself with a clean needle that was attached to a syringe of some med I'd just drawn up. I remember my instructor saying I should just change the needle, but even as a student, I remember thinking -- isn't that potentially risky? Not that I had any blood-borne illnesses at the time (sort of beside the point) -- I just remember thinking that maybe a drop of my blood got wicked up the bore of the needle into the syringe. I can't remember what I did; hopefully I did the safer thing and wasted the med and started over. I am simply horrified to think that this situation is more than just a few bad apples engaging in unsafe practices. Hillary

I've heard that the old cellular phones might have interfered, but that today's digital ones don't. I also recall reading something about having to be less than 3 feet from the monitor for there to be any problems. I've never heard of cell phones interfering with pacemakers. My suspicion is that our no cell phone rules in the ICU have more to do with keeping visitors from disturbing patients (and us) talking on their phones. We probably do it in part because that's how it's always been done. I've known some nurses who carried their cell phones, though I've never done it.

It's so nice to hear how people are doing. I'm especially encouraged to hear of someone losing weight during clinicals, because I (as well as several of my classmates) have gained 5 or 6 pounds this first semester; hopefully it will start to come off once I'm spending all my time in the OR Hillary

It's so nice to have our own forum! I wanted to help get this forum started. I'm in my first semester of a front-loaded program; it's really flying by! I'm loving my classes and my fellow SRNAs. I'm in a smaller program and we've become a really tight-knit group. I'm loving my classes but trying to figure out how I'm going to learn everything I need to learn! How's everyone's semester going, especially my fellow first-semester SRNAs? How do you like your classes? What are you finding most difficult? Most interesting? To those of you graduating soon, do you have any words of wisdom for those of us just starting out? HillaryC

Hi Melissa, Someone once said something to me that I thought was quite valuable. This was several years ago when I was trying to decide if I wanted to go to nursing school or to med school. She said you have to figure out what you want to do, not just what you want to be. I think too many of us nurses are influenced by the ubiquitous message that going to med school is what smart nurses do. If you really want to do what an ICU intensivist does, then you need to go on to med school. Alternatively, have you thought about getting a post-master's certificate as an ACNP? Maybe you could find a part-time job as an ACNP, satisfying your need to be in the ICU. I once heard a talk at AACN's NTI by a nurse practitioner intensivist, but I can't imagine that role is very common. Maybe you could find a hospital open to creating a blended role for you. Like others have replied, I also have to say that I have met two anesthesiologists who said if they were to do it all again they would go the CRNA route. If you decide to do med school, you should be sure that the end result is worth the extra time, money, and energy spent getting there. It seems a waste to me, since there is going to be such a shortage of anesthesia providers and someone else that really wants to be a CRNA could have taken your spot in your NAP. But ultimately, you have to do what's best for you. You mentioned that your program has left you with a lot of questions and you mentioned the possibility of getting your PhD. To me, that seems like a more logical next step. You could get your doctorate in physiology or pharmacology and learn a whole lot more. In my experience, a professor with a PhD in physiology knows as much about physiology as someone with an MD, if not more. Good luck in whatever you decide!

Some patients will refuse their own blood even if it's given via a cell saver. The way it's been explained to me is that once the blood is not in continuous contact with the body it can't be returned. For example, if you are drawing labs and disconnect the waste syringe for even just a second, you can't reconnect and return the waste. My understanding is that at least one way of returning the patient's blood involves blood from the surgical site going through the cell saver and put in a bag, which is then spiked and infused like any other product. In this example, the blood does not stay in continuous contact with the body, so many JW patients would not consent to this.

That was my first thought when I read the biblical passage quoted in one of the news articles. Of course, seventh day adventists are supposed to be vegetarian, but I've met more than a few who don't worry about that. Religion is an interesting thing; it seems there's always room for interpretation, even between different churches of the same denomination. That fringe baptist church whose members protest soldiers' funerals is a disturbing example. Anyway, this is the passage that was quoted: And any man from the house of Israel, or from the aliens who sojourn among them, who eats any blood, I will set My face against that person who eats blood, and will cut him off from among his people Leviticus 17:10 http://news.bbc.co.uk/2/hi/health/7078673.stm To me that passage sounds more pro-vegetarian than anti-modern day blood transfusion, but then maybe that's my bias. Really, I don't care -- I think that respecting the autonomy of our patients should come before all else. Of course it's sad that this girl's children will grow up motherless, but the blame for that falls on their mother and not on any healthcare provider. As a nurse I imagine I'd be frustrated if that were my patient but it's not my place to judge. All we can do is make sure our patients are making informed decisions. -- A jaded vegan agnostic

I would be absolutely furious. Vaccines are not benign, especially in cats. There is a type of cancer in cats that's linked to vaccinations, and although it's rare, it's still a big deal when it's your cat that gets it. My friend's cat died a very sad and untimely death from this tumor. I would be so angry if I were you. It's good you won't go back to that vet; is there a board you can report this vet hospital to? If the tech has no legal accountability, wouldn't the vet then be accountable for what others working under him do? What scares me most of all is taking my dogs to get their teeth cleaned, knowing that the anesthesia is usually left to the support staff, regardless of whether they have any kind of formal education. That absolutely terrifies me. I stopped going to my old vet in large part because I was so disturbed by the high rate of turnover in his support staff, most of whom seemed to have on the job training only. I chose to start taking them to a really good teaching hospital that delineates the roles of the front desk staff, assistants, and veterinary technicians. I feel a lot better about taking my animals there.

Megan, I'm so sorry to hear what you've gone through. Just wanted to say that your BSN isn't taken away from you just because you aren't working as an RN. Did you keep your RN license? Were you not able to find any RN jobs that would accommodate you? I thought they were required to by law? Hillary

Oh my gosh -- I just read about your unit somewhere. It's certainly a revolutionary idea, having loved ones basically stay in the ICU, but I am pretty sure I couldn't do it without losing my mind. I'm one of those horrible ICU nurses that likes to just take care of my sick pt. without being alerted by family every time something beeps -- or worse, being treated like a waitress for the family. How's it working out for you?

Thank you! THAT is what I've been trying to understand! :nuke: For anyone else who's curious, I found the website for the Emory AA and PA-C to AA fast track (5 instead of 6 semesters) program: http://www.emoryaaprogram.org/General%20Track/index.htm So basically, they have two licenses -- PA-C and AA? Is there a difference in care between a 'PA anesthetist' from Emory's program and an AA from Emory's program? I'm guessing no. I guess I was just trying to figure out if there were now four types of anesthesia providers in the US, but it sounds like these people are functioning as AAs and not in some other unique role that requires the knowledge/skill set of a PA-C. Is this unique to Georgia? What about AAs in Georgia who are not PA-Cs? Do they get a PA-C license, or are they just licensed under the PA practice act? So, David -- if someone's gone through a PA program and then the PA to AA bridge program, once they choose to have a PA anesthesia license, are they not allowed to also have a primary care license? That doesn't seem fair! Granted, once someone's gone through an entire AA program they're obviously pretty set on doing anesthesia for the rest of their careers, but I always thought one of the perks of being a PA-C was being qualified to work in any setting (especially if they move to a facility that doesn't utilize AAs). By the way, does the primary care license include PA-Cs who work in acute care? This is all so fascinating -- and a bit confusing!

OP here. I was just wondering how this thread had devolved into yet another argument. All I wanted to know was if the term "PA anesthetist" is used much, as I'd never heard it before :)

I guess we're all just a little confused here. Are you an RN in Finland? Do you want to go to CRNA school and work as a CRNA in the US? If so, could you come here and work as an RN, get some experience, and take some classes (like biochem, Organic chem, etc) to show that you're a serious student now? I'm not familiar with which, if any, schools accept degrees from foreign universities. Perhaps you could look into that? You could start with the schools with CRNA programs where you would want to live in the US. If there's a way for your to get your RN license in the US without going through another nursing program, I would definitely do that. You could take a staff ICU job with good tuition benefits and gain US ICU experience while taking classes. It seems wasteful to go through an entire bachelor's in nursing program again -- that should really be your last resort. If US CRNA programs won't accept a foreign degree, you'd be better off looking into those programs which don't require a BSN, but which accept a bachelor's in a 'related field' (like chemistry). Hope this helps!

I totally agree with ready4crna. I enjoyed the program and don't regret going the ASN, then RN-BSN route even though I could have done a second degree BSN program. You can't beat the price, and the new facility is great. When I was there, there were some professors with their issues, but from what I hear, this is pretty common among nursing faculty (it has to do with the old eating the young, I think). Depending on your plans, you can complete your BSN at UMB (or anywhere else, really) while you work as an RN. Good luck, and congrats!

Are you sure? I've been searching the PA state government's sites and can't find an update on the bill (from May). Say it isn't so!!

The minimum GRE is a 400 (200 on each of two sections).

I'm confused. I thought CRNAs were already able to practice independently in all 50 states. Since we're on this topic, which other states limit CRNA practice?

Hi Jen, My impression is that most people will get the federal loan each year ($20,500 per year for Stafford). It doesn't matter if you're not working for those loans. I think most people who get private loans do try to get one loan for the entire amount they will need in excess of the federal loans. Many have said that it gets much harder to get that money once you have quit your job. I'm taking the Stafford and maybe the grad plus I was offered, but am contemplating doing a home equity loan or line of credit primarily because of the tax savings. Hope this helps. Hillary