macanes

Old school train of thought here. Remember when folks said ALWAYS keep your state of original licensure current? I believe keeping all of your AP licenses with your original state of licensure might be a good idea, too. Until a national license or a 50-state coop agreement is locked in, I wouldn’t be parceling out my licensure. Think about renewal — ‘you have to renew that one first, the we will renew your AP license’ and ‘no, we do not have your RN license — how can you have an AP?’ I’m just imagining the nightmares bureaucracy can wrangle. Just my $0.02 .

I agree and don't usually give a defasculating dose before my SCh, when I use it. Several points: (1) the defasc. dose needs to be on board for a few minutes, so I should give it when I get the pt on the table, (2) I use 5mg roc, if I use it at all -- still can see respiratory compromise prior to induction with this, and certainly if you let 10mg roc set up for a few minutes, (3) suggamadex is a game changer (but does have SEs at dose required to reverse a full RSI dose of roc), thus I use SCh much more rarely (usually in places that don't have Sugg), (4) I always, always mix my glyco with my neostig -- not because of onset, but because it removes the possibility of a major error (i.e., give the neostig. and forget/get distracted/whatever and not give the glyco in a timely fashion = bradycardia, SLUDE, profound problems), which I prefer to avoid. Sorry about the run-on sentence. Just my $0.02. God bless

You are sorely misinformed. I am not trying to be disparaging when I say you are clueless on this subject. But, you have clearly not done your homework. Your institution is not the standard, nor do I think things are exactly as you perceive them to be, even at the location you observe every day. please do some research, talk to some people, then come back and decide if yours was a valid question. I don't recommend using this tone if you decide to question a military CRNA on is subject. Respect would be better. Have a nice day.

I had just graduated nursing school and went to a party with a friend of mine. There was a vivacious redhead there who had obviously lost interest in her date/boyfriend/whatever. I started chatting her up and thought I was doing ok. Then, she found out I was a nurse and started telling me about her irritable bowel syndrome. Now, I wasn't grossed out -- hardly, after all of the code browns I had been elbow deep in over three years as a tech in the unit where I now worked. I was very interested in the intimate details of her life. But, seriously, it's hard to turn the conversation away from IBS to more romantic topics, especially when the talker is intent on telling you every. little. detail. about. her. medical. history. Do you get that sometimes? Thank God I'm married now. My buddy got a good laugh at the time. Joke is on him, though - he is now divorced and back in the romantic rat race. Every. detail. Some folks just need to unburden. I still get this all the time. From people I don't know, even.

I need help. I am developing a research hypothesis for my doctoral program. Many states, including Alabama and my nursing home state, Georgia, ask nurses as part of the licensure/renewal process whether they have been treated for mental illness (excluding substance abuse) within the past X number of years (varies from state to state). Speaking with an Alabama nurse with PTSD brought this issue to my attention. He said he would not ever answer in the affirmative on that question when renewing his license. He felt it would be punitive, were he to admit to treatment. A member of the Alabama Board of Nursing told me that nurses answering "Yes" were required to submit further information detailing their illness and treatment, and their fitness to practice. She said that "something less than 5 percent" of Alabama nurses answer in the affirmative. The 5-percent figure roughly corresponds with the NIMH statistic of 4.1% of adults having "serious mental illness" -- perhaps something a nurse would not be able to hide, and therefore self reports. It does not correspond with the National Institute of Mental Health statistic that 18.6% of American adults have "any mental illness" (again, excluding substance abuse on both figures). In my estimation, this brings up several ethical issues and -- questions about stigma associated with mental illness, not only toward patients, but particularly toward coworkers in nursing and other licensed professions. The ethics, I believe, include the fact that one must maintain integrity by self-reporting. Conversely, it is unethical to stigmatize someone who is receiving effective treatment. Practically, it seems the state boards' questions are ineffective, if few are self-reporting (despite the possibility of punitive action if they are caught) their illness and treatment. Practically, also, I believe a professional might deny -- even to themselves -- that they are ill and need treatment, especially if theirs is not a serious mental condition (and thus feel no ethical remorse about not reporting). The NIMH of the National Institute of health says about 4% with _serious_ mental illness, about 18% for lesser types, not counting any substance abuse; still seeking more numbers, but it appears 'less than 5%' would apply if only SMI sufferers self-reported (they might not have option with SMI because more obvious, objectively?) - if only SMI sufferers don't have option not to self-report because of obvious symptoms, then non-SMI nurses with lesser mental illness will either (1) self report (which apparently they are not, at least in Alabama), (2) violate their integrity by not reporting, or (3) not seek treatment so that they don't have to report treatment (would still violate spirit of self-reporting, although I think many licensed people would deny problem, therefore not ethical problem not to seek treatment) - think will have to be a survey with comparison to numbers reported to state board(s); would require state boards' cooperation in more ways than one - think I should stick to a couple states (AL & and GA); might do more states if I can accomplish surveys there and if I get cooperation from state boards to get numbers (I am assuming possibility of cooperation in GA and AL b/c I can get "connections" through y'all and GA network - I think I will have to find a way to deliver surveys or link nurses to an online survey; depending on questions and targeting, Survey Monkey could be $300 to $3,000; I can do $300; can't do $3,000 - Questions, then, may be: (1) do you suffer from mental illness, (2) pull-down menu for type/seriousness, (3) have you/are you receiving treatment, (4) do you self-report to state board? employer?, (5) pull-down menu why/why not (e.g., afraid lose license, lose insurance, job; report b/c right thing to do, because is law, because had public breakdown(?) at work/no choice, (4) ... still working on it. So, any thoughts? Feedback? Ideas? I know there is a research hypothesis in here somewhere. Is the statistical analysis a comparison between the self-reported state board numbers and the self-reported survey numbers? I think it is. Now I'm considering where to go next. Thanks, Macanes BTW, I'm a CRNA. I have no idea how I got interested in a mental health issue.

I need help. I am developing a research hypothesis for my doctoral program. Many states, including Alabama and my nursing home state, Georgia, ask nurses as part of the licensure/renewal process whether they have been treated for mental illness (excluding substance abuse) within the past X number of years (varies from state to state). Speaking with an Alabama nurse with PTSD brought this issue to my attention. He said he would not ever answer in the affirmative on that question when renewing his license. He felt it would be punitive, were he to admit to treatment. A member of the Alabama Board of Nursing told me that nurses answering "Yes" were required to submit further information detailing their illness and treatment, and their fitness to practice. She said that "something less than 5 percent" of Alabama nurses answer in the affirmative. The 5-percent figure roughly corresponds with the NIMH statistic of 4.1% of adults having "serious mental illness" -- perhaps something a nurse would not be able to hide, and therefore self reports. It does not correspond with the National Institute of Mental Health statistic that 18.6% of American adults have "any mental illness" (again, excluding substance abuse on both figures). In my estimation, this brings up several ethical issues and -- questions about stigma associated with mental illness, not only toward patients, but particularly toward coworkers in nursing and other licensed professions. The ethics, I believe, include the fact that one must maintain integrity by self-reporting. Conversely, it is unethical to stigmatize someone who is receiving effective treatment. Practically, it seems the state boards' questions are ineffective, if few are self-reporting (despite the possibility of punitive action if they are caught) their illness and treatment. Practically, also, I believe a professional might deny -- even to themselves -- that they are ill and need treatment, especially if theirs is not a serious mental condition (and thus feel no ethical remorse about not reporting). The NIMH of the National Institute of health says about 4% with _serious_ mental illness, about 18% for lesser types, not counting any substance abuse; still seeking more numbers, but it appears 'less than 5%' would apply if only SMI sufferers self-reported (they might not have option with SMI because more obvious, objectively?) - if only SMI sufferers don't have option not to self-report because of obvious symptoms, then non-SMI nurses with lesser mental illness will either (1) self report (which apparently they are not, at least in Alabama), (2) violate their integrity by not reporting, or (3) not seek treatment so that they don't have to report treatment (would still violate spirit of self-reporting, although I think many licensed people would deny problem, therefore not ethical problem not to seek treatment) - think will have to be a survey with comparison to numbers reported to state board(s); would require state boards' cooperation in more ways than one - think I should stick to a couple states (AL & and GA); might do more states if I can accomplish surveys there and if I get cooperation from state boards to get numbers (I am assuming possibility of cooperation in GA and AL b/c I can get "connections" through y'all and GA network - I think I will have to find a way to deliver surveys or link nurses to an online survey; depending on questions and targeting, Survey Monkey could be $300 to $3,000; I can do $300; can't do $3,000 - Questions, then, may be: (1) do you suffer from mental illness, (2) pull-down menu for type/seriousness, (3) have you/are you receiving treatment, (4) do you self-report to state board? employer?, (5) pull-down menu why/why not (e.g., afraid lose license, lose insurance, job; report b/c right thing to do, because is law, because had public breakdown(?) at work/no choice, (4) ... still working on it. So, any thoughts? Feedback? Ideas? I know there is a research hypothesis in here somewhere. Is the statistical analysis a comparison between the self-reported state board numbers and the self-reported survey numbers? I think it is. Now I'm considering where to go next. Thanks, Macanes BTW, I'm a CRNA. I have no idea how I got interested in a mental health issue.

You might also seek help on the CRNA and SRNA forum on Facebook. But, job searches on gaswork is probably your best indicator. If you are a fully qualified CRNA, do the rest of us a favor and don't jump on the first ACT job that offers you $120k/year to be their *****. Search around. You might not be able to get a job in the place you really want to live, but home is where you hang your hat. Do your homework. Find a good prospect. Research it. Go visit them. Talk to CRNAs (offline - buy them a beer after work and shoot the ****). Find a good spot, because you're going to be doing this day in and day out - make sure it's a good one. Don't settle for some super-supervised, salaried work-til-you-drop kind of crap that people settle for first thing. Be willing to move. Pump up your skills. Go for the gold, baby! Thanks Z

It sounds like you haven't considered or have already ruled out training in the military. I think Army training (my experience) was the best — and Navy grads wills ave a similar point. You'll get your DNP, and the $100,000 other folks mentioned is more than made up for by graduating debt free. I know some folks will say the pay is crappy compared to civilian practice, and at the lower officer ranks (captain and below) that's easily true. On the plus side, you'll get great training in a great practice environment. I'm a UAB DNP student myself, but online. I have nothing to say plus or minus — I do like the DNP and am thinking about switching to the PhD program, don't ask me why. I do know that pay in tge Birmingham area is crap because UAB has turned out so many graduates in the past few years. You have to be prepared to move. I would not work the job I do for the pay they receive — forget it. I don't know anything about Tennessee practice or the school. Don't be squeamish about the military. I still work in the Army system 10 years after I got out and there's a good reason — the practice environment. It sucks when the politicians screw around with our lives, such as with that sequester crap. But, don't think your life is going to be perfect in the civilian world. My now Arny colleague from civilian practice originally has the equivalent of another mortgage to pay off for his schooling had the practice where he used to with sold out to the hospital — great for the partners, ****** for the CRNAs who were not partners. They had their previously fabulous pay cut in half. My two cents. I'll be happy to talk more, or put you in touch with more recent grads, if you like. Message me if so.

I agree with the other comments here. I have worked primarily in military settings -- as active duty, then contractor, and now GS. I generally enjoy working in the military environment, if only for independence. However, I'm at a small MEDDAC, and things might be different at the large medical centers. Also, I'm a fan of the Army program in anesthesia nursing (bias alert -- still one of the best, with Navy ). Don't shy away from the military without checking that route. I can put you in touch with an active duty guy who went to school on his civilian dime. Or, more like 1.5 million dimes. The military is a GREAT way to go to graduate school for that reason. If you can get accepted directly into the anesthesia program from your civilian nursing practice (that is, get some critical care experience in the civilian world), you are golden.

To clarify, wtbcrna, you _can_ go directly into the USAGPAN if you are already qualified and have it WRITTEN INTO YOUR COMMISSIONING CONTRACT [emphasis added for obvious reasons], such as the critical care experience, GRE, and prior acceptance into the program. This is how I did it in 1997. I know the active-duty commitment changed (I owed 4yrs, now 4 1/2 I think), but it should still be a viable option. And, like you, I recommend this route. Waiting for years for your nursing chiefs to ok your packet for school is fine, if you don't mind waiting, potentially, for years. But, no better way to go to school, and no better program, IMHO.

It's not that the PR dose is necessarily more. In anesthesia, we often given kids a LOADING DOSE ONLY of 40mg/kg of PR Tylenol intraoperatively after induction of anesthesia., then let the parents revert to the 10-15mg/kg regimen.

So, you've got this great job. But now, a new fly-by-night company has won the bid on the Department of Defense (DoD) contract at your facility. They come to you and say, "Hey, we're the new contract holders - want to come work for us (at a 22-percent less than before)? Sorry, we can't pay you what you were making before - that's a lower rate (per hour) than we bid for the contract (So we rolled the dice and bet we could win with a low-ball bid, hire the people in place at no recruiting and moving cost to us, and force you to accept lower paytoincreasr our profit margin). If this sounds familiar, let's talk. Federal contractor CRNA

You're family is probably going to have to endure several career changes throughout, whether you go for CRNA or not. For my part, it was a question of us being able to endure without me being a CRNA. Honestly, trying to pay our bills now, I don't know how we would do it if I didn't make the money I do. Not to say we're stretched. We maintain our lifestyle (which is to say: we pay our bills and mortgageS on time and no frills) without huge amounts of stress over money. The kids will go to college - on scholarship. The car will be paid off. The house has another 26 years of payments. In other words, your question might me rephrased as 'How can I NOT give my family this security' bevause it's something you want to do anyway? Yes, you'll spend a couple of years studying and at work like a dog. To support them, you're going to have to work like a dog anyway. Why not increase your earning potential anyway? This is all assuming the anesthesia is something you want to do. If it is not, none of this applies.

Well, since the Army trains a lot of y'all, you'd have to say you've got "Arrrrrmy traaaiiinning, sir!" Specifically, though, since I'm not aware of the AF having it's own CRNA program, and the Army and Navy are top-rated, I was not slighting my brothers in blue (at least not in that posting 8) ). Hey, some of my best friends are . . . well, no. 8) Z

I cannot emphasize enough how critical -- and superfantabulistic personally -- it is to have the Army pay you and pay for your school while you slave away in graduate school (and a tough one at that), nay, REQUIRE you NOT to work whilst learning. A thing of beauty, surely. Best in the world . . . oh, chill out, Navy. You, too, are excellent. Just . . . chill. Don't know where they got that 90 days in 2 years. Active duty deploys six months at a time every 18 months or so . . . needs of the Army and all that. Unless you're assigned to a FORCOM unit (field unit, part of the cadre, not PROFIS -- on loan -- from a hospital assignment, which most medical personnel are -- many fewer FORCOM slots in the Medical Command). FORCOM people deploy with their units for a year (or more) at a time. Reserve rules are probably different. Still, we get a lot of reservists rotating through our hospital for 90 days at a time. That two years thing might be stretching it, but it sounds semi-close to correct. My gut feeling is 90 days once a year or 18 months seems more like it. Have to ask a reservist. Deployment-wise, depends on your point of view, I suppose. It sucks, I hear. I don't know how I was not deployed my whole time on active duty -- worked in a busy hospital with tough bosses who were chronically short, or just lucky (or unlucky), I guess. On the other hand . . . I also hear it is an experience like no other. You decide. Good luck.

I started my BSN program at 27 (previous degree, took three years to do prereqs and Jr & Sr year), started the Army anesthesia nursing program at 32, graduated the USAGPAN as a CRNA at 35, been working as a CRNA since Jan 2000, now 43. When is it too late? I got married at 35 and (again) at 42. Start now. It only gets better as you get older, but you're sometimes too tired to enjoy it (unless you can afford as housekeeper 8)) Carpe diem, man.

I use ephedrine to treat hypotension . . . which I find is frequently the reason a pt is nauseated, especially on OB and especially during SAB for c/s. I also use decadron with zofran or anzement (study showed 40% greater efficacy with t&A in kids, as I recall from a few years ago). I also use zofran or anzement alone. I also use double dose zofran (8mg) for itching. I also use droperidol (0.625mg) for n/v as my #1 rescue med when they're already puking. I rarely use phenergan -- although it's very effective -- only because we don't keep a lot of it around and if you haven't really flushed your line, you'll be changing it. I violently disagree with those folks who like to post "I NEVER USE . . . " Please. There are 50 ways to do any anesthetic. Try to learn something new every day, yes?

To me, too. My father was a medic in Korea (Chosin, Pusan, Inchon, etc.) and went to nursing school a couple of years after getting out of the Army in 1953. He went back into the ANC in 1960 as an RN, and got his CRNA in 1964, the year I was born. Proud of dad. I don't use the term "male nurse" anymore. He's a nurse (CRNA, former ANC COL). I'm a nurse (CRNA, former ANC CPT). Mom's a nurse. My sister is a nurse. My poor brother can't stand to have dinner with us discussing the day's gross nursing stuff -- turns him green. Grew up in the Army. Feel like it's a part of my life. But, sure don't miss the BS. More power to you, hoss. John Z, CRNA Ft. Benning, GA

You will need to "make tape" throughout your Army (or any service) career in order not to be "flagged for no favorable action" -- that is no promotion or awards and bad juju with the chief nurse. It is a pain, but the truth. If you are overweight and do not "make tape," they will require you (at most places) to attend remedial PT. Every morning or evening, you and the rest of the flagged folks do physical training with the NCO of the month assigned to such duties. Great way to get in shape -- takes away the ability to decide not to work out. But, again, a pain. I know this because that's how I spent most of my Army career. Wouldn't change it. Glad I did it. But, I don't miss it now that I'm out. Talk to your recruiter. If you're a little bit over, you can work that. If you are a lot over and don't see that changing, be sure to consider carefully. John Z, CRNA Ft. Benning, GA

What you are asking about is exactly what I did in 1996. I was 18 mos. out of my BSN and had been working in a CCU/SICU for five years (3.5 as a tech during school, 1.5 as a RN after grad) when I entered "direct ascesion" into the Army. I went to the Officers Basic course in March 1997 and began phase I of the US Army Graduate Program in Anesthesia Nursing in June 1997. The commitment has changed (was four years for my class) to 4.5 years. Other than that, everything is much the same. When I entered, you had to apply to both the San Antonio program (which I wanted) accredited (sp?) through UT Houston HSC, and the USUSHS (sp?) program in D.C./Maryland. I'll dig up some of my old posts on the subject FYI, if you're interested.

If we're going to start the pro- versus anti-Clinton arguements again, let's at least get our facts straight. Pres. Clinton's mother was, yes, a CRNA. However, he only signed that indy-practice option in the last month before he was set to leave office -- right about the same time he was pardoning Mark Rich and some other folks who might otherwise have been indicted for something. Prior to all of that, say, 1993 . . . he and his wife had organized their push to socialize medicine in this country under a national healthcare system. I think Hillary's quote was something like, 'nurses make too much money, anyway' or some such nonsense. The Clintons' attempt at one of America's third-rails of politics -- much like Bush's attempt at social security last year -- flamed out before it really got started. Otherwise, you and I, fellow CRNAs, might be working for peanuts instead of the macadamias (sp?) we're enjoying at the moment. So, do we really need to hash out whether or not Slick Willie is pro-CRNA. Moot point. Is he a viable speaker for the convention? I've resigned myself to the fact that it will happen, no matter the opposition (like mine). I will examine the transcript to see if he actually had anything of value to contribute, beyond some 'fight the good fight' stuff. I will certainly call upon my association to open the books on his fee -- they should not be allowed to close those off to the membership, "non-disclosure clause" or not -- and call for an accounting if it is out of the ordinary. In the meantime, the student asked a valid question about convention dress. I say, "go with your instincts -- you're not being graded." Enjoy Ohio. See y'all next year. Z CRNA in Georgia

To put myself on your _initial_ side of this debate, I'll quote myself: "Hey, Corvette Guy, doesn't the Navy deploy medical up front with the Marines . . . Plenty of field work there, eh?" Or something like that. As for the rest: Dude, I can't believe you went there. Calling Army sloppy? Geez, Louise. Can we be a little bit less reactionary, put erroneous posts in their place in a professional manner, and not react like drunken soccer hooligans? C'mon! Sincerely and with all respect due the Navy (because we all know it's those Air Force weenies who don't deploy without satellite TV and leather furniture . . . JUST KIDDDINNNNGG!!!!!) Luv' ya, former Army CRNA in GA

Aren't the Navy guys deployed up front with the Marines? Corvette Guy, eh? Plenty of field work there. Z

Ok, I've got to get this off my chest and I want to hear some thoughts from y'all. BLUF: Hospital commander comes to preop and/or PACU for field-grades before or after surgery -- I say HIPAA violation certainly, but invasion of privacy at very least. Background: My hospital commander (I'm now a civilian contract CRNA) comes to the preop are or the PACU to see so-called command interest patients. She's not the only one. I have seen others (i.e., section/head nurse types, senior NCOs) visit their troops before or after surgery. I've also seen civilian sector executive types do the same when their management types have surgery. I've also seen folks go up the the L&D floor when a staffer is on the labor deck. My premise is that in none of these cases is it anyone's business to be seeing these patients. * These folks are in a potentially high-stress state of mind (awaiting the knife, in labor, etc.). * Perhaps they don't want anyone to know they're having their hemorrhoids or uterus removed -- or even a ditzlectomy -- they shouldn't have to tell beyond "My doctor says I need to have surgery." * They are in a flimsy hospital gown which might or might not fufill their sense of modesty. * Some of them are a little quiver-lipped when we start their IVs (who wants their boss to see that?). * I'm pretty sure that NO female wants non-family/non-staff walking into her labor room (correct me here, ladies, if you think I'm wrong). * Finally, their _families_ are not allowed the same visiting priviliges. * . . . ETC . . . etc . . . . What really burned my tail about this morning's visit was that while the commander -- a non-clincal MSC type -- was chatting with the patient, she also felt the need to criticize the fact that the PACU nurse had had to stick the patient twice, unsuccessfully. Heck, I've had days when I couldn't hit the broadside of a barn with a 20g (OK, not lately, but I've had them). That REALLY chapped my hide on top of the main issue (so I started the IV). Trust me, I am NOT some touchy feely type who wants to cuddle my patients to make the pain go away. I AM a total professional who believes that the rules (HIPAA training, the so-called patients' bill of rights, but mostly the common sense of privacy in our society) must apply to everyone. I am totally down with commanders keeping track of their troops (I would be more impressed if more commanders knew the names of their troops) for unit purposes. I submit that they should go through the surgeon -- that is, the surgeon recommends XX days convalescent leave, and the commander is free to take it or leave it and ask why, and to ask about the fighting effectiveness of Troop Smith or Jones in relation to their recovery for the job. Period. Ok, any thoughts. I might add to this later -- pretty steamed right now. CRNA in Georgia

Straight to trach, IMHO. Z