TXCRNA

I dont know Austin, although I have a couple of friends there that work for Capital Anesthesia group and seem happy. The climate in Houston is good, just depends what facility/group you work for. Lots of places have CRNAs that do regionals, lines, pedi, ect... And others dont. When you interview those are the questions you need to ask. I can tell you if you work for GHA they do not let their CRNAs do any lines or regionals. So if that is important to you then you may want to apply elsewhere. They do have the CRNAs do pedi and big cases though with alot of autonomy. So..it just depends on whats important to you. But, I think overall Houston is very CRNA friendly, but thats my opinion working in Houston for the past 2 years.

GHA is a large group. Better pay and benefits at non GHA facilties. Their pay maxes out pretty low as well. I know CRNAs who do hearts. Just depends on where you work. But there are many places in Houston where you will do big cases. You can do as big or little as you want depending on where you decide to work. Look at some of the state facilities like LBJ and MD Anderson--excelllent benefits and pay. Go on gaswork.com to check out jobs

In Texas propofol may only be administered by CRNA or anesthesiologist to a nonintubated pt. If pt intubated & ventilated an RN may administer. If the RN is acting as the CRNAs or MDs "hands" and administering propofol while the anesthesia professional mans the airway this is also allowed by RN practice act in Texas. Although some RNs dont know their own scope of practice and simply do as theyre told by MDs (esp the newbies). I recently responded to a code where an RN was giving propofol to a nonintubated patient for MRI because she had an order from the physician to do so. Pt had a respiratory arrest in MRI and when we responded to code the propofol was STILL infusing. Beware....MDs have no clue what is and what is not in the scope of practice for a RN. Look out for yourself and know your own states nurse practice act.

Most programs require a BSN, very few just BS/BA. Do an accelerated BSN. You can do in one year if you bust your hump. While getting BSN get your ICU exp...then apply. I would recommend CRNA vs AA. More job opportunity as CRNA. Just look on gaswork.com and compare the opening for CRNA vs AA-huge difference. I started out as a LVN. Went through a couple accelerated programs (LVN to RN & then ADN to BSN). Im now a happy CRNA. You wont be sorry.

Sounds like your surgery was stressful to say the least. Im sure you're glad it is behind you. Im glad your faith in CRNAs has been restored as well, although sounds like her job was easy since you didnt want any meds. As I told you, I recently had c-section. I had a spinal & not a drop of any sedation...it was stressful beyond words(although my spinal worked great). So...I understand your experience. Whenever I do a block I make sure the pt understands that it could fail or wear of prematurely thus making a general anesthetic neccassary. I explain that I cant guarantee no general anesthesia if this were to occur mid-procedure. There are also complications from the local anesthetic that rarely occur, which Im sure you're aware of, that require possible intubation, medication, etc.. So I would hesitate to write on the consent no sedation/general, but barring that, I would abide by your wishes if I was doing your case (although I would've prob tried to talk you out of it. LOL).

I was a neuro ICU nurse and did per diem on the side.I put all on my CV. Had 4 years ICU exp w/ no certifications. I was asked in my interview why no CCRN. Explained too busy trying to get prereqs for CRNA. Got in & am now a very happy CRNA. I really think alot of getting in relies on your interview. Be yourself. Confident & look 'em in the eye.

All depends on the facility. If thats the MDs role where you are having your surgery then you'd be better off to keep the status quo. Changing the way things are usually done is usually not the best. Im sure you are going to do great. If a bier block w/o sedation is poss Im sure they would be happy to provide that for you. Please let us know how everthing goes. good luck.

Im very sorry to hear about your experience and Im glad everything worked out ok (im assuming since you are posting here). Unfortunately, CRNAs dont have a monopoly on med errors. Ive seen med errors by both CRNAs & MD anesthesiologits over my years of experience. I myself have made a drug error--benign results. Anyone who tells you've they've never made an error is either lying or hasnt been practicing very long. Again--Vigilance is key. Its not that the CRNA wasnt educated enough. A person on the street knows dont give a med to a person if they are allergic to that med. It was lack of vigilance on his/her part. Obviously, human error occurs...look @ wrong site surgeries...those are docs. i just want to make the point that no matter what letters are after your name, MD or CRNA, you are human. I think you should discuss your concerns w/ your next anesthesia provider prior to the procedure. I myself just had a c-section 4 weeks ago and I was scared to death because I know all the poss problems that could occur. I wanted my anesthesia provider to be whoever did c-sections and spinals the most. If that was the doc thats who I wanted and vice versa for CRNAs. I didnt want someone who hadnt done OB in 10 years. So...just ask " Do the docs do their own anesthetics @ this facility?" if the answer is "no. we sit in a lounge and havnt done an anesthetic in years" then I wouldnt want that MD, Id rather have the provider who usually dose the anesthesia. I work @ a facility where our MDs do there own anesthetics all the time & are excellent, along w/ excellent CRNAs doing their own cases.

What was the "mistake"? Surgeons tend to blame everything on the anesthesia provider. There are very good/competent CRNAs & MDs. Then there are some not so good CRNAs & MDs. In multiple studies it has been shown that anesthesia mishaps are related to vigilance of the anesthesia provider & not if the provider is CRNA vs. MD. CRNAs would not be allowed to practice independently otherwise. I would not hesitate to have a CRNA or MD anesthesiologist do my anesthesia. I would speak to whomever does your anesthesia in the future & explain what the anesthsia "mistake" consisted of. I am interested in what problem you had.

Its not a problem if the pt wants a MD. As long as the facility has anesthesiologists and if staffing permits. If its at a facility w/ anesthesia care team ( an MD supervising 2-4 CRNAs) staffing may be too limited to permit an MD being in one room. That would leave several rooms/cases now w/o a MD to supervise & the facility may not have another MD to staff the now unstaffed rooms. When this occurs @ my facilty the case is usually delayed until staff is available (Which could be hours. Work @ a busy private practice) or case may be cancelled til another day. Or staffing could permit--then case goes forward w/ no delays.

You defenitely should know what you are talking about before replying to a question. This statement is untrue. Obviously not written by an anesthesia provider. Sorry, but it frustrates me when I see these kind of posts. You can work independently in many states, mine (Texas) included. And no states have the requirement of working under an anesthesiologist. There are some medicare billing requirements that apply when an anesthesiologist wants to bill mediacare for supervision of a CRNA on a particular case, but they are not required to supervise the case. They do supervise in alot of facilities, but this is so they can bill for the service & make more $$ for the dep't. Although, you may work for a hospital that writes into their bylaws that CRNAs must be supervised, but this is decided by a facility. Alot of rural areas have independent CRNAs practicing w/o any supervision. CRNAs can provide the same anesthesia- regional and general anesthesia. Also invasive lines, etc...

The problem with the bovie is when a pt has an ICD (defibrlilator). With a defib (all ICDs can also pace, but not all pacemakers are ICDs) you should turn off by placing a magnet due to ICD can read bovie interference as tachycardic activity & shock the pt when not needed. You only do this with bovi use & CVC placement, If you disable w/ a magnet you must put an external defib on pt in case they actually do have an event where shock is needed. Also, must have device interrogated after surg to make sure ICD wasnt perm disabled by magnet. You dont have to put a magnet on if just a pacemaker. Have it in room if pacemaker has failure to capture, etc.. Then u can place & hopefully get asynch pacing. You have to be careful putting a magnet on a pacemaker willy nilly, some older pacemakers can be perm disabled. And you send your pt home w/ nonfunctioning pacemaker. If your pt has a pacemaker card you should call the company to see what a magnent will do if anything. Read the chapter in Miller over pacemakers & ICDs.

I am a CRNA & I never leave my pt. The nurse gets something if I need it. I may step out for 2 sec for an xray, but thats it. There are very small places where there is only one anesthesia provider and it is not unusual for them to run out to quickly use the bathroom, but it is super quick and is unavoidable. Also, if a pt is on bypass sometimes anesthesia can step out, but it still isnt very common. Ive worked @ 2 hospitals and in school had 9 diff clinical sites & never saw anyone leave their pt. Im 9 months preg & sometimes am about to potty on myself & I still never leave unless I have relief from another CRNA or MDA.

Lesson to learn now. Dont listen to non-CRNAs about anything to do with your practice. They usually have no clue what they are talking about. There will be plenty of jobs when you graduate. Attending CRNA school will be one of the best decisions of your life.