air

I am not sure about the exact number. I have been in my program for about 20 months. This is the third person to be let go.

yes, getting into another program has proven a challenge. some programs have indicated that his application would not stand out well. some would want to call his previous program for a reference or recommendation to admit. both of those options would not be favorable if i venture to guess.

Well, if by the game you mean "getting along" maybe you are right. Remember that once you are isolated and shunned, no matter how good you are progressing clinical, you will end up being marked to be let go.

I think ultane is a very benign drug. That kidney issue raised by CAMP SUPRANE is way overblown. In the clinical setting,I have learned to use what my preceptor wants. Some clinical sites have agent preferences mostly related to cost issues

I had experiemented in changing my agents. For long cases, I use Iso if it suits the patient. Towards the end, I turn on DES or Ultane. My interest in nitrous is minimal. Some pros use 70% nitrous in the end and keep their patients vented, blow off your agent, then turn off your nitrous keep your oxygen at 6-7 liter flow, 100%. Within two minutes you call the patient's name, the open their eyes and follow commands. Well this applies if they are adequately reversed.

In CRNA programs you get issued a number by AANA. Other programs will interested in why you left your former program. You would have to explain yourself in a neutral way.

we all sat in class with him. We saw what was happening. I particularly was not brave enough to speak up on his behalf. I just thought they would toy around with him and let him complete the program. He did excel in class work. Showed up on time for clinicals, helped the nurses out in pre-op holding. But when the in-house faculty settled on him finally, everything just headed one-way.

Actually the looked at the whole situation from the clinical aspect, stayed on his case and accumulated documentation for him to leave the program. Those clinical mistakes were mistakes we all make but when he made them it became a news and a point of correction to the rest of us in class. Usually he would have been written up by that time.

Well, it happened in the USA

A friend of mine was forced to leave a program mostly because of personality issues with the assistant program director after 1yr in the program. What are his chances of getting into another program. Are there folks out there that had moved from one program to another for whatever reason? Was the new program receptive during the application and interview process? This guy did very well in all his didactic work

Roland when I was applying, I let things like this determine schools I wanted to apply to. I applied to schools that I thought I met all their requirements. I factored in cost program and living, requirements for application, (did not take the MAT and I was not going to take it.), a school that asked for graduate level statistics which I did not have at that time, I slowly placed their application near the waste paper basket. I am not sure what I would have done if a school would have asked for a state licensure prior to application( My primary license is from a compact state, I would not have had a problem). I have also been a travel nurse for sometime, so I have held licenses to most states.

I am a student I am currently rotating at a site were lot's of locums work I spoke to this guys at length when i work with them. The usually pay for their own malpractice insurance, they are responsible for their own healthcare and pensions. Some of them work in other areas where they do their own billing, while others allow the institution/group to do the billing for them. If and when they do not work they do not get paid, simple. You are working for yourself. Unlike an employee, if you do not work you get PTO. Malpractice unfortunately if a state by state thing. So, some of them have a malpractice premium for NJ and PA. Some just for PA. They pay a ryder(sp) to work in endoscopic only settings, even though some locums would negotiate for the ryder to be paid by the facility. You get paid what you negotiate. It needs a strong work ethic. Unfortunately most of the guys i met as locums none of them has less than 15 years experience under their belt. Then the agency CRNA, usually this an agency negotiates the contract with the facility/group. That agency sends you a paycheck, weekly or biweekly. The may take out 8-12dollars from your hourly rate and call it malpractice premiums, some may provide healthcare, 401K, STD, LTD. They may also provide housing and transport. Most of the CRNA's I saw under this group have 5years or less of experience. I can tell you that these guys initially worked at one facility after they graduated, that facility usually was big, tertiary teaching facility before they moved into this practice arrangment. I hope there are some of them on this forum who would add some insight to this discussion

Howard review. Howard is/was a PD in one of the schools around the Pittsburgh area. he offers a review course. It is thought his review is not as popular or far reaching as Valley review. If you meet proffessionals that graduated in the later 80's or 90's in the PA area the mostly took the Howard review. I met a recent Drexel graduate this Summer, he spent his last dime on the howard and valley review. He took his board exam within a week of graduation. He told me, those reviews were invaluable to him, but refused to rank or rate them in terms of which was a better review.

This is not scientific some years ago they started using laparoscopic instruments in surgery. There was talk about it changing surgery and reducing surgical time. Well, I have seen it reduce patient hospitalization not reduce surgical time, infact the opposite could be argued. Somehow during any procedure that you are doing to a patient you may need anesthesia to watch over the patient. I remember years ago, during cardioversion, it was me, the cardiologist, and the patient. Now, i see that anesthesia is all over it. Anesthesia is even pushing resp. therapist from shock (electroconvulsive (sp).)therapy for psych patients. you need anesthesia in lithotripsy rooms. Even now that new machines are out that you do not need the patient to be prone. In some hospitals in PA, even when an MDA does spinal on a C-section, you still need a CRNA to be there right up the time mom gets back to her room. In cath and EP laps, I remember, it used to be the patient, the cardiologist, a tech(respiratory therapist/nuclear med/x-ray) and circulating nurse. Now, I have noticed that it is becoming the norm in some hospitals to have Anesthesia present. I do not see technology drying up the jobs anytime soon Same day surgery centers are needing more anesthesia people than thought possible if you are going to get a procedure done in your physician's office better make sure that a board certified anesthesia personnel will be watching over you. I have seen dentist bring in patients for anesthesia for wisdom tooth extraction. they have quoted various reasons, from asthma, cardiovascular, previous MI, patient request,etc. That expection of MR therefore will not comply is not the only indication for them anymore Most locums i run into, take pains to explain the increase number of new grads would dry up jobs faster than anything else. QUOTE=bryanboling5]So far, there's been several folks post that the future looks good. Maybe I didn't explain myslef well in the OP. I don't doubt that future looks good for CRNAs, I'm not at all suggesting that the job market is going to crumble due to advances in minimally invasive surgery and interventional radiology. But, as someone who would hope to practice as a CRNA but won't be doing so for another 5 years or so (still got to finish undergrad, get experience, all that), I'm wondering what might the job look like in 5 years, 10 years? Will it be the same as now? Different? How so? I realize that this is allnurses.com and not the Dion Warwick Psychic Friend's Network, but I thought it might be interesting to hear from folks who are out doing this, going to conferences, reading the literature, seeing what is around the bend, and see what you think might be in store. Don't worry, no one will hold you legally liable for your predictions, just a fun excercise in future thinking. With that said, let the ideas flow. bryan

The economics you talk about makes sense Remember I am a student, economics usually does not come into play for me. Most hospitals here in PA, require and MDA to be present for inductions, usually they want in and out in seconds, therefore you need a drug with rapid onset, then once after induction you can do what you please. Anyway, during the TAH, that is what happened.

sometimes, surgeons change their minds and require muscle relaxation. Efven though they may have previously said they would not require it throughout the case

just like gaspassah said, if they are awake, take your time, to turn to pop-off valve completely shut, then give them a "sigh" while you extubate. I have done deep extubations only for kids. We had Egar "daddy of inhalation" take to us about deep extubations but most CRNA's/MDA's are not too willing to try it out.

My school sends us to multiple clinical sites I have been to some sites where open hostility to SRNA's is not uncommon. Right now, I am doing my regional rotation, I was twice been a procedure room and the RN mentions to the MDA that she thinks this patient would not be appropraite for a student. Fortunately, the MDA told her (thank you, I will handle it). The MDA then proceeded to stand in alongside me and observed/admonish me do the procedure. I had felt like saying something to RN, but twice i had bitten my tongue. Well, one of my classmates could not hold their tongue and had to say something to her about her attitude. We have not had a problem with her since then. There are some sites where a case would be tagged as "not a student case" for the mere fact that it percieved as challenging. I figure that is just the sort of experience i require. At the end of each site rotation, we are to evaluate the clinical site and CRNAs/MDAs. Sometimes, some of my mates let the school faculty know about situations that undermine our education way before the end of rotations. I am not sure exactly if the faculty has addressed those issues raised by my mates.

A job well done soon you will be out there.

this is just from my experience. We learned about mivacron sometime last fall. I never saw that drug until this summer, at a clinical site in new york. I used it steady for a solid three weeks. The CRNA that introduced the drug to me in clinicals was trying to facilate rapid induction without need for reversal and to accomodate fast surgeons without subjecting patients to apparent delayed muscle pain that comes with anectine use(from my post-op reviews, i have not had a patient complaint of this pain that we sometimes hear about) Three times with LMA's for femoral hernia repairs when the surgeon working with residents all of a sudden decided that he could use some relaxation(until this time, i had never given NMB to patient with LMA's). I learned the trick is to push it slow. We gave a fraction of the STP or propi. dose then mivacron, then the remainder of the STP or propi. We allowed the patients to breath 100% pure oxygen by mask. (program rules:CRNA or MDA must be present for induction and emergence of general anesthesia) I was allowed sometimes to bag the patients once to confirm "able to ventilate" sometimes the mivacron worked faster expected. For inductions we always used 0.2-0.3mg/kg dose. I have to admit twice when i used mivacron followed by ZEM for TAH, I found it difficult to extubate, because these patients were too weak despite reversal. WE had the uneviable task of ambu-bagging the patients to PACU, then placing them on a respirator for a little while with 1-2mg of IV versed(usually less than 15-20mins). We avoided your typical COPD patients and those with questionable pulmonary status. We did not attach serious attention to their CV status. I used alot of it on kids. sweet drug.

Whatever makes you comfortable and whatever strategy gets you into the program is the best for you. CRNA programs follow the national guidelines for admission (BSc, BSN, ACLS, CC. exp). It just so happens that some schools decide what is CC and the quality of that experience i.e SICU Vs ER or cath lab. If you feel confortable with the shotgun approach then by all means go for it. I know a particular applicant with 4.0 GPA. Good command of verbal/communication skills but was accepted into my program. He had all the necessary requirements. He laid all his eggs in one basket. There is a current SRNA on this board that went to 8 interviews in 2003 and several more in the spring of 2004 and later got an admission in April 04. This case is well documented on this BB I can understand why some prefer the a standard one application approach. Maybe it makes more sense if the applications were staggered, you have your preference schools, that you apply to first and taking into consideration their deadlines then see what happens and you navigate the maze from there. I am not advocating any one method. There are pluses and minuses for both methods. Honestly evaluate your situation and determine which method would best suit your needs and goals Good luck

I have never heard that argument nicely fitted like that. It makes sense, why a patient for plastic would throw a fit if the pre-op nurse misses on that IV start. But the patient coming in for major vascular or neuro would not even flinch when you probe for that A-line site just before you numb.

This is a good topic. Those who would be graduating and looking for employment this year better pay attention to this post. I am currently running into pros and recent, who are having issues with how call is being handled by their facility/group. All this stress seems to be brought about by the shortage of providers. It would be best for new prospects to also ask questions about how call is handled before signing on that dotted line. It appears new grads/ employers expectations of call are not in Sync.

I do not know what that instructors problem is/was. Anyway, I am a first year student in my program in PA. We have two students from Oregon. In my class more than 75% started out with an ADN or diploma RN, and eventually got their BSN. Infact, some of my classmates started out as nursing assistants and moved up. I do not understand how that would create any issues. I know for a fact that in maryland, in Johns Hopkins hospital in the early 90s and mid 90s there was a pay differential between four year RNs and not Four year RNs. Some RNs with MSN's worked the unit/floors and they were also paid a differential for their extra education. Do not let things like that hold you down/back. Good luck

In all fairness to PA, the climate in PA for CRNAs for slightly mal-aligned, the atmosphere is repressive but in some facilities the CRNA's that are group employees are able to start their own cases and progress with it to completion. The MDA does not show up but is busy in another room doing another case( sitting and charting not giving breaks). It just depends on your location in PA.