aquaphone

Oh, believe me, I'm willing to move, and I'm willing to drop more money. I would move ANYWHERE in the states tomorrow if it meant getting another shot. I'm even considering going outside the U.S. if I have to. As for the money, it's an investment in the future. Besides, doing what you love to do is priceless. I'd take a pay cut to practice anesthesia again. I dream of the day I'll step back into the OR. I can't go into the details of why I chose to withdraw; the most I can offer is my original post. I appreciate your vote of confidence that I will be accepted into another program. If you have any suggestions as to where I should apply or how I can make myself more competitive, I welcome them. Thank you very much.

Thank you, I appreciate the support. I will make it happen. It's just a matter of where and when.

Thank you for responding. I had heard that Akron has taken students from other programs... never a first hand account. How did you hear about that? I see you are from Ohio....

It's a complicated situation, so to simplify I'll say I withdrew because there were interpersonal problems between my program director and myself, as well as some others. It was not an academic, clinical performance, or patient safety issue. My clinical evaluations from my preceptors were overwhelmingly positive, and I was in good academic standing. Believe it or not, many people liked me and enjoyed working with me; at least they made me feel that way. I really was "value added" to the team. I loved coming to clinical every day. I certainly share responsibility for what happened. Had I handled things differently and stayed under the radar, I would have graduated. However, I made mistakes, and I paid the price. It took a while, but I've come to the point where I'm okay with that, and now I am moving forward. As per your advice, I will start calling schools this week. I've logged hundreds of hours in the OR, so I don't know if shadowing would be necessary. I have already obtained letters of recommendation from the preceptors who supervised my cases as an SRNA, so I feel positive about that. Thank you for your feedback and advice. Are you a CRNA yourself? You seem to know a lot about the programs and how they work.

Hello everyone, I attended an anesthesia program and a significant amount of clinical before withdrawing in good academic standing. To put it mildly, things did not end amicably between myself and my program director, so a recommendation is out of the question. I am now reapplying to CRNA programs. I'm wondering if anyone knows of a program that has a track record of accepting and graduating students who were in the same predicament as myself. I have a colleague who graduated from a fully accredited program in Puerto Rico. In his class there were several students who had been forced to leave other programs for various reasons. Besides Puerto Rico, does anyone know of CRNA programs that have accepted applicants like me? Thank you in advance for your constructive feedback.

Sorry, I don't believe a word of this story.

Yeah, the 10mL of air was from a test question. Guess it was a trick question, lol.

The AHA changed the guidelines. It is no longer recommended to give Atropine for asystole or slow PEA. Atropine is now only given for bradycardia.

Dr. Najeeb has an excellent series of cardiac lectures. And lectures on just about everything else, for that matter. http://drnajeeblectures.com/

Wow. Thanks for sharing, I had no idea!

That's interesting about the PICC line placement. I've seen plenty of central lines placed, but I've never personally seen a PICC line placed. In my unit (MICU/SICU) the patients would always go off the unit for PICC placement. So I'm amazed at what you're saying; you really do use ECG as the only confirmation for PICC line? Have you actually been able to observe the procedure? How does it work?

What specialty are you interested in? What are your long term goals?

Thanks, all very good points.

Yeah, I think you're right... the 10mL of air sounds like it could be extremely detrimental to the patient's health, to put it mildly. And I like your analysis of the ECG method. I've seen CVP catheters go all over the place as well. Good point about the pneumothorax. Thanks for the input.

As far as ECG confirmation of a CVP catheter? I've certainly never seen the catheter confirmed that way, and I wouldn't want to rely on such a method. But apparently they were doing it at one time. As for air bubbles, well, we still do that. But not 10mL of air, that seems dangerous. I think I've injected maybe 1mL of air mixed/agitated with 10mL NS to create bubbles used in ultrasound. That was to look for abnormalities in cardiac function though. Never heard of that being used to confirm a central line though.

Thanks so much for your constructive, informed input. No, this thread is not a joke. It's supposed to be a serious scientific discussion and a request for help. Small quantities of air bubbles are routinely injected into central lines during cardiac ultrasound to assess flow. From Wikipedia: "An echocardiogram is an study of the heart using ultrasound. A bubble echocardiogram is an extension of this that uses simple air bubbles as a contrast medium during this study and often has to be requested specifically. Although colour Doppler can be used to detect abnormal flows between the chambers of the heart (e.g. patent foramen ovale) it has a limited sensitivity. When specifically looking for a defect such as this small air bubbles can be used as a contrast medium and injected intravenously, where they travel to the right side of the heart. The test would be positive for an abnormal communication if the bubbles are seen passing into the left side of the heart. (Normally they would exit the heart through the pulmonary artery and be stopped by the lungs.) This form of bubble contrast medium is generated on an ad-hoc basis by the testing clinician by agitating normal saline (e.g. by rapidly and repeatedly transferring the saline between two connected syringes) immediately prior to injection." Also, ECG can be used to detect CVP catheter position, although this is probably not a desirable method. From the Annals of Surgery, 1986: "In an attempt to improve the accuracy of central venous pressure (CVP) catheter tip location, 84 consecutive cardiac surgery patients in sinus rhythm were studied prospectively with respect to subclavian insertion of a CVP catheter using a guidewire technique. The presence of cardiac arrhythmia was used as an index of right atrial (RA) location of the guidewire tip, before threading the catheter over the guidewire. Correct catheter tip location (superior vena cava [sVC] or RA) was achieved in 100% of patients (N = 78) with premature atrial contractions (PACs) related to guidewire insertion. This fell to 50% (N = 4) if no arrhythmias were noted from the guidewire. Ventricular arrhythmias were noted in two of 84 patients (2.4%). Other problems related to the use of this technique are discussed."

We all know the gold standard for confirmation of a CVP catheter is a chest x-ray. However, if that is not immediately available, has anyone heard of: Confirmation via ECG? or Confirmation via doppler while injecting 10mL air? I found some info discussing the use of premature beats on the ECG monitor to confirm CVP catheter placement. Didn't read too much about it but it seems study results varied, and the sensitivity of such a method would be low. It is however, possible it seems. I could not find ANYTHING about confirmation via doppler while injecting air. Anyone know about this? Thanks!

Laborer, I don't know what you're trying to say. Are you trying to be funny? Are you making light of the situation and laughing with me? Are you trying to imply something else? Since this is a text based forum, not a face-to-face conversation, a lot of the intended meaning behind your message is lost. However, I think you're trying to be insulting. Am I wrong?

Here is an email I sent to NYSNA: Dear NYSNA Leadership, A highly unprofessional flyer was posted on the walls of my hospital with photographs of NYSNA executives attacking them on a personal level. This is equivalent to something an adolescent might do. It explained nothing about the actual grievance, and only served to convince me that these are not people I would want representing me. Then I received two emails from NYSNA's CEO. These were more sophisticated than the flyers posted by the USW. The first email painted a portrait of a fair and equitable management offering a wonderful contract to a bullying staff. Management seemed to have no idea why the USW would want to strike. It seemed to claim that since the contract being offered was so fantastic, the only logical reason for a strike was to get rid of the NYSNA management. However, the second email admitted that there were in fact some changes to the contract. Since neither side has helpful, I've had to get information from other sources. Most of my co-workers had no idea any of this was going on, even yesterday, the day before the strike. It just goes to show you how little involvement there is in union matters on the part of the staff. Perhaps if NYSNA management and employees spent more time organizing and less time fighting amongst themselves, my co-workers would have some idea of what is going on. The general consensus among my co-workers is that they 1) really don't care about the whole situation, 2) think you all are wasting our money 3) would like to fire all of you. (That is, they would like to fire BOTH the NYSNA employees and the NYSNA management.) You are now supposed to be negotiating a contract for us, the nurses who pay your salary. Instead you are fighting with each other. Oh, how Continuum management must be laughing at us. You have made us into a joke. Sincerely, (name withheld for privacy)

i'm a member of nysna. all the information i've received form nysna and the usw has been, in my opinion, dishonest propaganda. i did manage to find some outside information about the strike: nurses and negotiators that represent unionized nurses plan to strike at midnight friday because of changes to their work conditions. the irony, they say, is that their employer is a union that advocates for worker rights."it's surreal," said kathleen korman, a nurse representative from guilderland who is part of the united steelworkers union within the new york state nurses association. about 65 nurses, lawyers and professional staff at the association are represented by the unit. "we fight all the time against employers who make unilateral changes to working conditions," korman said. "nysna directs us to fight them and we do it, but i guess (nysna) can do it." latham-based nysna represents about 37,000 nurses and health professionals in new york. a nysna spokeswoman said the association has offered a fair and fiscally responsible contract and hopes to have a resolution soon. "we really believe that we can arrive at a mutually acceptable contract and avoid this strike entirely," said robin wood, director of communications for nysna. the union that represented the professional unit was dissolved in march 2010, but days before the union's end, leaders of the professional staff went to nysna and asked the administration to voluntarily recognize the staff's new union. nysna administration refused the request, saying several unions were trying to organize the staff, and advised them to choose a union by vote. two months later, the staff voted 64 to 1 to join the united steelworkers union. in the meantime, nysna imposed new working conditions that required the staff to carry blackberry mobile devices, changed rules for compensatory time and restricted vacation time accrual. wood said the changes brought the professional staff in line with nonunion professional employees at nysna and other professionals within the united steelworkers union. previously, the professional staff had a 35-hour work week and received compensatory time if they worked excessive hours, but nysna's new conditions removed the definition of a work week and proposed "when one has worked excessive hours with justification to the associate director and with his or her approval, an occasional (comp) day would be granted." victoria longo, co-chair of the professional staff's union, said nysna would never let nurses agree to such a contract. "the very things we are asking for are the very things we get for our members," longo said. a mediator has called for the parties to negotiate saturday. read more: http://www.timesunion.com/default/article/union-threatens-to-strike-new-york-state-nurses-1366323.php#ixzz1lzt3fqsd

Consider yourself lucky. Would you really want to attend with faculty that behaves in such an unprofessional, inconsiderate manner? Better to not get involved in the first place than to invest tens of thousands of dollars and years of your time only to realize you're made a terrible mistake. Keep in mind also that if you are forced to leave a CRNA program, you can pretty much forget about ever getting into another one. Why not apply to Buffalo, Albany, or Columbia, for example? All of those are excellent schools. I was fortunate enough to be accepted by a few other CRNA programs. However, if I were not, I would NOT reapply to UMDNJ next year. They showed their true colors the day of the interview. This demonstrates the importance of applying to multiple programs. Admission to CRNA school is extremely competitive. You greatly increase your chances of success by applying to as many programs as possible. I personally applied to nine programs this year. You don't want to find yourself in a position where you're forced into program with a "toxic" environment. Good luck in the future.

Well, I got a rejection yesterday, but I guess that's no big surprise!

I think it you will help you stand out. You already have lots of experience at the bedside, so you won't be in shock, and you also have some pretty impressive education under your belt.

Pedicurn, Of course your views and experiences are important, and sexism does still exist. But I ask you to consider that male nurses do face a great deal of verbal and physical abuse from patients, as well as disrespect from physicians. I have personally faced it many times, and don't you think my experience is important, just like yours? I had one family member come into his wife's room and start screaming and cursing so much that I had to lock myself in a supply room and call security. I had never even met this person. I just heard him screaming from outside the room. His tantrum was triggered by the physician's refusal to speak with him in a timely manner regarding his wife. My boss later criticized my decision to call security, although the man was out of control and disrupting the entire ICU. I had a male patient punch me in the face. I've been verbally abused by plenty of patients, both male and female. The verbally abusive females didn't seem intimated by me, male or not. I've had physicians shout and behave inappropriately towards me many times, and I've had to write them up or put them in their place plenty of times. Believe me, these are things male nurses ALSO have to put up with. This is not a MALE or FEMALE issue, it is a NURSING issue. Please, we should be working together on this. A hospital administration with a culture of blaming nurses is the problem, not gender. We nurses need to support each other and stick together. Let's not be divided on this.

Pedicurn, What exactly is a 30 something "loss of control" professional female? Perhaps you can clarify that one. A "particularly snobby" couple isn't going to give a civil response to anyone, because they are, as you put it "particularly snobby." Particularly snobby people are not nice. If they were, we would call them "particularly polite". You are correct, men are not usually referred to as "the girl". No, I have not had a patient ask "Can the girl get me something to drink?" in reference to me. I have been called "young man" on several occasions. Both men and women can be verbally abused by doctors. Residents learn very quickly that female nurses are NOT weaker. Anyone who believes that female nurses are "easier to unload on" is in for a rude awakening and abrupt attitude adjustment. I've seen arrogant doctors cower after getting on the wrong side of certain female nurses. I love it. I've also seen female and male nurses verbally abuse doctors, especially residents, so it goes both ways. There have been times when I've been ashamed of my fellow nurses for the way they talk to doctors and patients. Suggesting that we don't need evidence or studies to validate behavior is dubious. There is a whole movement towards evidence based practice. Your personal observation was that you worked ONE ENTIRE twelve hour shift with a male nurse and that he didn't receive bad treatment while you did. So based on that ONE shift, you have concluded that it was because he was male and you were female? Is it possible there are some other reasons why he gets along with the doctors and patients better than you? Your personal observation and opinion is not a substitute evidence. As I said, I stand behind my female co-workers 100 percent. I proudly support the female surgeons, anesthesiologists, nurse practitioners, physician's assistants, charge nurses, nurse managers and staff RN's, and CNAs I work with every day. There are many women who I am glad to say are my role models in the workplace. Of course sexism still exists. My own mother wanted to be an attorney, but was told by her high school guidance counselor that women didn't do that. She was marching for civil rights before I was born. And now you are labeling me as sexist and offensive to females, and you say that I'm doing a disservice to women? I say workplace abuse and violence is an issue that BOTH male and female nurses frequently face and that we must remain united.