nursenary57

Everybody here has made great points. I've only been in school for 6 months (about 130 cases so far) and there are definitely extremes. One day it is cysto after cysto (some done in 20 minutes, some up to 45) and then the next day is an open belly for a bladder tumor with creation of a new bladder from small intestine plus a prostatectomy. God only knows what else they did in there! The only time I have felt bored is on those all day cases where you have got your agent dialed in just right and VS are railroad tracks. To combat that I pull out my Mass Gen anesthesia handbook or whatever I've got with me and study up on something I haven't looked at in awhile. Of course I'm still watching VS, UOP, blood loss, end tidal CO2 and listening for any wayward expressions from the surgeon such as "Oh crap." Depends on what surgeon you are with you can learn alot about the surgery itself. I just finished a rotation at a large teaching hospital so he was already talking about stuff to the med student and residents. Learned a couple of things but not as much as I wished I had. I'm actually looking forward to the point where it becomes boring. Hopefully that means I won't be scared to death everytime I walk in there! When I got out of nursing school I would look at the older RNs and think "When am I gonna feel comfortable with my knowledge/skill/experience level where I can come in to work without being scared to death?" I feel the same way now. I'm sure it will be awhile before I get there.

Hey guys! I'm not dead. Brain dead maybe. Just finished week 3. Through 6 quizzes/tests I'm still clutching onto an A. Got two weeks left on this initial orientation period and then I'll be in the OR on 8/28. Thats when the fun starts. We average 4-6 tests/quizzes per week. Keeps us on our toes. The first two weeks were rough. We were in class 12 1/2 hrs one day. Spent at least ten hours in class on a few other days. Sitting there is mind and butt numbing. Regular class begins 8/28. Class is 1pm is Mon-Thurs. Class usually ends 6-8pm. In the OR Mon and Wed 6am-noon and all day Fri. The next week class is the same but I'll be in OR 6am-noon Tues and Thurs. It alternates like that so I get a three day weekend every other week. I've got to get back to studying. My machine check, RSI, Bier block, and spinal anesthesia checkoff is coming up. I'll check in soon.

I'll update you guys on the weekend. Kind of busy right now!

Hey guys, I'm starting my anesthesia program Monday, July 24th. To say I'm nervous yet excited would be quite an understatement. The percentages on each are variable, just like Owen Wilson said in the launch scene from Armageddon "I've got that excited scared feeling. But 98% excited, 2% scared. Or maybe its more, it could be 2, it could be 98% scared 2% excited. Thats what makes it so intense, cause its so confused. I can't really figure it out." Yeah, that pretty much sums it up for me. I'm attending Middle Tennessee School of Anesthesia in Madison. It is a 28 month front loaded program. First twelve months is majority of classes along with clinical 3 days a week. Last 16 months is OR all the time. First 5 weeks is an intense pre-OR orientation that introduces us to settig up the OR and the anesthesia machine. We also recert in ACLS, PALS, and 12 lead EKGs. If anybody out there is gonna be a classmate of mine, drop me a line. I'll keep you guys updated on how it goes. Good luck to those in or trying to get in.

I understand you getting upset about the difficulty of getting IVs in the "hard sticks". I used to work in a high volume Level 1 trauma ER. The hardest thing about that job was that we were incredibly busy and it sometimes took a lot of time to get an IV started on those spider veins in these patients. We have the same 2 sticks per RN protocol but unfortunately due to how busy we were that was not always followed. Even though it was a teaching facility our docs were reluctant on going forward with central/PICC access unless they were extremely sick. We didn't have anything like midlines but we were allowed to do external jugular IVs. Usually and 18 or 20 guage and it gave a great return and flushed well. No need for xray either due to the short catheter. But keep your head up and keep sticking!

Walec, No problem. I'm glad to help. PM me anytime if you have any questions. If I can answer them I will. If I don't know I can come up with a pretty good lie!

Walec1, I understand your nervousness, especially since I just went through the process in January. I'm very fortunate that I only had to do one interview and I start school in July! The key to getting through the interview for me was to overprepare. Probably not what you wanted to here. I talked to many people who had attended/was attending my school of choice (mtsa.edu). I learned about the type of interview that the school did and what they expected. Some of these people had interviewed at several schools and talked about the vast differences in style of interview. Some were basic meet and greets while they looked over your transcripts. The school I'm going to has you present a patient you have recently taken care of and they ask questions after that. My interview was 5 questions in 7 minutes. Yeah! A nerve-shattering time! Almost all of their interviews average less than ten minutes. So after gleaning all of the info I could from former/current students of the program I made out a study plan covering the things they mentioned. I wrote out answers to possible questions and reheorificed them over and over again. Whats funny is the best practice I had was when my roommate and I would toss the football around and ask each other random questions and practice our answers. Ex: What is the difference between Epi and Primacor? Why would they be used together? What are the parameters for weaning off the vent? If you see these Swan numbers what type of shock do you think the patient has? Blah, blah, blah. I could go on and on. This constant repetition of answering aloud is what got me over the fear (well, the majority of it anyway) of interviewing. So when I got in the interview and they asked a question my answer just flowed out because I had already practiced it a thousand times. So talk to people at the program your interested in and find out what the interview comittee expects. Mine was invasive hemodynamic monitoring, vent management, and vasoactive drugs. The drugs being the big deal. Had to know them to the cellular level. And I don't mean saying "Neo acts on alpha-1 receptors." That was just the beginning. It went way deeper than that. Try www.cvphysiology.com and www.cvpharmacology.com. Physiology book by Linda Costanzo also. To sum it up (finally), get the inside scoop on what type of questions they ask and write out your anwers to different scenarios. Have a friend throw questions out there for you to practice saying those answers aloud. Then do it again. And again. And again. After all that remember this: Repetition is the key to mastery. Good luck. You can do it.

Holy crap! I just figured out Artemis2 identity! I used to work with her! When I was waiting for shift change and I would see her walk through the door inside I would say "Thank God, someone who knows what they are doing and I can count on!" I learned a bunch from her and miss having her around. Thats why I tote around that bag full of books, because nursing school didn't teach me anything but Artemis2 did! Guys, you can ask her anything. I did get your email so check it when you get the chance. Great to hear from you!

Artemis, That was a great post. Wish you had been my preceptor when I got out of school. You took a complex process and made it simple. Or as I like to say "You rednecked it down for us commoners." You titrate by drops? Sounds like you've been in this game for awhile! I do have to disagree with one thing though: Levophed actually does have cardiac/inotropic effects. At lower infusion rates it has effects on beta-1 receptors, therefore causing increased cardiac contractility. I found this passage about Levophed on p.321-322 from Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application by Gloria Oblouk Darovic: "Norepinephrine is a catecholamine with predominant alpha-1 and some beta-1 adrenergic stimulation. Norepinephrine causes constriction of all systemic arterioles except those of the coronary and cerebral circulations and produces direct inotropic and chronotropic cardiac stimulation. Uses- Norepinephrine may be given in the treatment of cardiogenic shock. Although the drug increases myocardial contractility, this effect is often offset by the systemic vasoconstrictor effects (afterload increase) that limit any rise in stroke volume. Increases in afterload may increase myocardial oxygen requirements, which may be a significant problem in ischemic heart disease." I learned about this when I was studying for my anesthesia interview. The unit I currently work at doesn't use Levo often so I studied up on it for my interview in case they asked. Before then I had no clue that it had beta-1 effects. Its amazing what one can find in textbooks!

I interviewed Tuesday morning around ten and they notified me Wednesday afternoon. That made my night at work go alot better! Most of the class (total 70) were accepted at early interviews last fall. There were 90 people for the last 23 slots. I agree with being sick of nursing theory but I'll jump the hoops if I have to.

Hey guys. I just found out that I got accepted to the 2006 class of Middle Tennessee School of Anesthesia. Just wondering if any of my future classmates are out there wandering in cyberspace. Good luck to all.

Browndog, You are right about Nashville pay ranges. I work at Vandy and Baptist. If you want to chat more about it you can get me at [email protected] I've got to work tonight but if you send me your email I will try to answer any questions you have got when I get home in the AM. Pyke

I did a 2 month travel contract in their ER last summer. Nice ER, good equipment and clean too. The staff I worked with was great. Out of all of the staff there were only two for whom I didn't care to work with (Sondra can probably name them). The charge nurses were on the ball but damn that place was unorganized! It is a level 1 trauma center and I have worked at another level 1 for two years prior to going there. To say there is a difference would be the understatement of the century. Let me put it this way, if I get injured in East TN, screw the golden hour and take the extra time to fly me to Erhlanger in Chattanooga. I want to make clear that I'm not downgrading or disrespecting the staff. There are a bunch of good docs, nurses, RTs, radiology etc. Most of these folks were knowledgeable and good at their job. But good God a mighty it was unorganized. I'm only gonna give one example (otherwise my BP will skyrocket and I'll be in the hospital on my only night off). At the level 1 trauma center I came from when we learned there was a level1 patient coming in (very unstable patient) this is the staffing we had to deal with situation. Primary RN, Secondary RN/EMT-P, RN to chart, Respiratory therapist, 2 rad techs, 1 ER attending, 1 ER resident, 3 trauma residents, 1 trauma attending, 1 trauma NP, 1 patient care tech, 1 social worker for family issues and CT cleared for the patient with OR notified to have a room ready. So probably 15 people within ten feet of the trauma bay ready to go. At UTMC the first level 1 I was involved with it was just me and a surgical resident. I could have bitten an oak tree in half with my orifice! That was the worst one. They had the ER set up better than Vandy but the trauma response was, once again, disorganized. In the ER they do team nursing which I grew to hate within about ten minutes of working there. If you don't know about team nursing, well, it isn't quite the same as teamwork. IMHO, it leads to screwups because continuity of care is compromised. I think they only had been doing team nursing for 6 months at that time. I only worked the ER so I can't tell you about the rest of the hospital. Once again, the people were great at their job and nice to boot, but disorganization hampered them. I won't pretend to know why they were disorganized. And if any of you guys from Knoxville are reading this, I had a good time and enjoyed working with you. Good luck with your move and decisions. Pyke

I work ER at Vandy and ICU at Baptist in Nashville. I would go to Vandy's med/surg floors. IMHO based on my experience you get better overall support at Vandy with patient's who take a bad turn on the floor and have to be sent to the unit. I have no experience with HCA hospitals except for a prn job in their psyche unit because I just couldn't get enough of the crazy stuff in the ER or my marriage! You might want to check out Metro General or St. Thomas. Did a clinical at MG and was a tech at St. Thomas for 2 years. I really liked St. Thomas, seemed like a nice place to work. Good luck with your decision. Pyke