starae

I am very conservative and do not think this is a good practice. According to some references, NDNMBs can actually decrease LES pressure which combined with the chance of inflating the stomach is not a good combination. LMAs are not a substitute for an ETT. Rather, I think of them as a substitute for a mask. The airway may be secure, but it is not protected. Like I said, I'm on the conservative side and have seen many people use LMAs in situations where I would not even consider it.

I don't think the intention of anyone is to be negative, but rather to express frustrations. I do think it is important for people who may be considering this training to understand what they may be in for. I have never witnessed or experienced any physical abuse or attacks on personal character that I have seen reported so I do not think that is the norm. What I can speak to is my own experience and that of some of my classmates. It is a humbling experience to go back to anesthesia school. Most people in these programs were very good critical care nurses and prided themselves on their knowledge level. Once you get to school you go back to the bottom of the ladder and know NOTHING again. Being back in a clinical setting as a student is not comfortable for most of us. We went from being preceptors to being the slow, awkward student who is often in the way. The transition is not easy. Also, the program is so long that you are in this setting where you feel like you don't know enough and are not good at anything for at least 2 years. On top of that add that anesthesia school consumes your entire life. You lose touch with friends and family and activities you once enjoyed. I go days at a time without seeing my own husband. Then let us not forget the academic demands with learning and retaining an enormous amount of information, writing papers, taking tests, doing research projects, etc. All of theses things combined with the multiple types of personalities you face in clinical setting could lead anyone to frustration. Honestly there are times when I don't know how I'm going to get through the next week or month. Then somehow I do, am fine for a few days, then get overwhelmed again. Anesthesia school is difficult and exhausting. I know many people will at some point or another reach a breaking point and question their intentions. For me is has been reassuring to read some of these posts because I feel like I am not the only one feeling this way and somehow I muster up the strength to keep going. Good luck to anyone now in school and those about to start!

I am over halfway through my program and the mix of emotions has truly been a roller coaster. The first quarter I was wide-eyed and excited, ready to learn, and full of energy. After the first quarter ended, the newness wore off, and I then truly knew what I was in for over the next 2 years. I got really depressed at this time. Throughout the next several months there have been many ups and downs. One day I will leave clinical on top of the world, and the next I will have a bad day and feel like I'm back at square one, a complete idiot. At this point looking at one more year it's hard to describe the feelings. No matter what you read or hear, you are not really prepared for the level of sacrifice that goes into an anesthesia program. I feel like I have not seen my husband for the last year. He is a great support for me, but it is hard to continuously have to miss out on time with him to study/go to class/clinical. I feel like I no longer have friends outside of the program because they don't understand why I can't get together even for a few hours on the weekend. Well, honestly I need to sleep, study, clean, grocery shop, etc. and those few hours I can not spare. My family lives 3 hours away and I have only been there to see them once in the last year. So for me the excitement did wear off and the reality of how intense the program is set in. The good things are I love the clinical aspect of anesthesia, so I'm pretty sure if school ever ends I will love the job. My classmates are great and are always there when I need to vent, cry, or celebrate. They are the only ones who truly understand what you are going through. Hope this gives a little perspective. :wink2:

I'm sure this is an agonizing decision, and one I can certainly empathize with. When I was in my mid-twenties I left the military and was on the pre-med route. I did very well in the classes and maintained a 4.0 GPA, but found that I had to work extremely hard to keep that level. At that point in my life I decided that I didn't want to sacrifice everything for 6+ more years in order to go to med school. Things like buying a home and possibly building a family were just too important. So I switched my major to nursing and made a promise to myself that I would at least obtain a Master's degree. In nursing school I enjoyed learning the science, but often felt it stopped short of what I craved to learn. The physiology didn't go as deep and I had hoped and I was somewhat dissatisfied, but continued and became a RN. I often wondered if I had made the right decision, but after working in the hospital and seeing the hours the residents and even the attendings put in I was more convinced I had. In just a few years I was working normal hours and had an income that allowed me to have a life. If I had continued the medicine route that would have all been put off much longer. Then my story continues since I had made that promise to myself to go to grad school. I started work as a RN in a CICU then after a while transfered to PACU. It was there that my curiosity and intrigue with anesthesia began. The more I looked into the field and spent time working with anesthetists, the more I wanted to go that route. Long story short, I am now in anesthesia school and feel that I am on the correct path. Finally I feel like I am learning the depth of physiology and science that I had craved in nursing school. Also, I'm able to apply what I learned as a critical care nurse to my current practice. For me, giving up the med school dream was the right one. I love what I am doing now and do not feel that I sold myself short. It is hard enough to keep me challenged and interested, but not so overwhelming that I feel I can't finish. This is just my story, and every situation is different. You have to consider your short term and long term goals, and also your priorities. The route to becoming a CRNA is not short or necessarily easy, but you can take some breaks along the way and catch your breath. However, you don't want to live the rest of your life wondering "what if?". If you have the time, commitment, and drive then you may not feel satisfied unless you pursue medicine.

There have been some questions about study groups and I thought I would throw in my two cents. Haven't been around lately because school is kicking my butt! Study groups can either be a big help or hold you back. I have a unique and solo way of learning, but have found groups to be essential for my success in this program. It took some trial and error in the first few weeks to get a group of people that work well together, but once that core group of people came together it has been a big help. We usually only get together before tests or quizzes because we definitely need focus and direction or we don't get much accomplished. It seems to work best for everyone if the people in the group have already studied the material on their own. I personally do not get much out of the group if I have not put solid effort into the material before going. Then we go over the material, trade memory techniques, clear up confusing material, and share that extra information that someone else heard while you were taking a mental snooze in class. Study groups seem to be great for reinforcing material or clearing up confusing concepts. They are not a good substitute for individual study. If I don't have time to study the stuff on my own before a group, then I stay home. This may seem elementary, but hope it helps.

Average clinical day 0415 - wake up cranky, hit snooze a couple times and stare at the TV news people because it's nice to know I'm not the only one up this early 0500 - head to hospital (and I'm one of the later ones, many classmates already there) 0520 - have changed and head up to OR to set up room and pray I don't have any major issues or to hunt for everything I will need. Mentally prepare for first induction 0600 - please let my first patient be in pre-op so I can start interview & IV (but they are probably running late) tap my foot and pace if they are not there yet while BP rises and nerves are firing up 0630 - hopefully have finished with the patient so I can have an intelligent discussion with CRNA. If so day starts off well, if not feel like a slacker 0715 - off to OR to start the fun. Boy I hope I remembered everything I needed in that room. Why do I always forget to check for the PNS? 1300 or 1500 - off to class depending on the day and lasts until 1600 or 1830. Go to gym if class ended at 1600 to work off all that nervous energy Evenings: 1. Prepare care plans for next day -1-3 hours depending on the cases. May have to go back to hospital if the patients are inpatients or to see patients from the previous day 2. Eat something not too unhealthy but most likely cereal because I have no time to go to the store. And friends milk is often expired or empty 3. Study because I probably have 2 tests or quizzes that week 4. Read up again on any special techniques or procedures for the next day 5. Shower and get to bed - always plan on 10pm, but usually around 11 + 6. Stare at the ceiling and wake several time a night from nerves. Check the alarm clocks 2-3 times to make sure they are set for 4:15am Oh what a fun life! Wouldn't trade it right now!

I can not say that I have had the thoughts of quitting.......yet. I'm too stubborn for that! However these thoughts cross my mind several times a week: Why am I doing this to myself? Am I really going to be able to pass all these tests I have in the same week? Can I really take this for another X months/years? I don't think you are alone because this is not easy or very much fun. It puts me at ease to see people from all over the country with similar thoughts and situations. Hang in there because you would probably regret it for the rest of your life if you didn't.

Are you able to take any of your non-anesthesia classes in advance? I wish I would have had the time to take some of the core grad. nursing classes before starting. It is difficult to divide my time and give the other classes the attention and prioity they deserve. I also worked in PACU before school. It was helpful to be exposed to all the different procedures and get an idea of how long they take, usual blood loss, pain, etc. Not to mention seeing many of the complications of surgery and anesthesia first-hand. I spent a lot of time reading the intra-op record to try to familarize myself with some of the medications and terminology. My unit was very busy with many ICU patients, but I would not recommend working in a slow, lower acuity PACU before going to school because you don't want to lose you skills with hemodynamics and drips. Most important, relax, sleep, and spend lots of time with your family and prepare them for not seeing you much! Good luck.

I asked several programs if I could apply before BSN fininshed (RN-BSN), and all of them told me it would not be a problem. At the time of my interview I had 8 months left of the BSN program and did get accepted. Ask the schools you are interested in so you don't waste any application fees. Also, make sure you have all the other requirements met before you apply.

I used Kaplan and Princeton Review. Found that they presented things a little differently and that helped me really absorb the information. Also used number2.com (less helpful, but free) and the ETS program (great information and hard questions). Good luck!

I learned this skill in the assessment class of both my programs (ADN and BSN) and was actually tested on it in both. Didn't really understand what good it was since the person making a diagnosis would also have to look, but I guess we could at least report symptoms.

Hello. I work in a large PACU and I think we have a pretty good system. When people come in to work in the morning, their spots are added to a running list. Usually they will put one spot at the top and the other at the bottom to help eliminate getting doubled up with patients. As patients come out they go to whatever spot is top on the list. When there is a big case or ICU case due to come out they try to give it to someone without patients or will look around for whoever can handle it. Our secretaries are very good at their job and management is closely involved. Also, they are pretty good about skipping our turn or holding an open spot if we let them know we need time to settle things down with another patient. For lunches we have people who come in at 11am, and it is their designated job to give lunch breaks. This means that nobody has to cover multiple patient assignments at once, and that patient flow is not interrupte. By 3pm everyone has gone to lunch and those lunch break people will start taking over for people who get off. It is a very fair system and I actually enjoy getting a lunch break off the unit! Our system is not perfect, but works well for us. Unfortunately there are some who will try to manipulate the system to avoid taking certain patients. I think you have "those" people in any unit.

I like this answer, but I would be worried that the student would be so nervous by the end of the "quiz" that their hands would be shaking and they would fumble with the procedure! :roll I have been really good about students (nursing and MD) learning with me, but the last few years my gyn visits have all had students. There is nothing like a crowd for that exam, and even better when the student performs the exam and the teacher has to also do one when they are done. Two for the price of one, yippie!

You sound so much like me that I could have written this exact post a couple of years ago. It started in nursing school when I also worked as a tech, and the feeling did not go away as a new nurse. I jumped straight into critical care out of school and weekends off were torture for me often times because I would be so obsessive about what I did or did not do on my last shift. It was almost like I would replay the day in my mind looking for something to worry about. Now I'm not talking about mistakes I made that I was failing to report, please don't assume that. I'm talking mostly about doubting myself and my actions. Like, did I restart that tube feed (when I know I did but would convince myself that possibly I hadn't) or did I chart all the VAP care I did? I'm a type A personality and a perfectionist. Also, I was scared to death when I first started working on my own. I can tell you, however, that those reactions started to decrease as months went by and I felt more comfortable with what I was doing. Hopefully you will experience the same. Just hang in there and don't let your fear or caution paralize you. Start each day as a new day and give the best patient care you can. Be a careful nurse/tech, don't become complacent, and trust yourself because you know that you follow safe nursing standards. As far as the clamped IV, was it on a pump? If it was the pump should have alarmed letting someone know there was a problem. Also, since it was the change of shift the expectation that the oncoming nurse would assess the IV and hopefully quickly catch any problems. Good luck! :nuke:

There are so many things wrong with the clinical situation you described that I would have been very angry with the nurse. There was a combination of things going on here that the nurse did not recognize. This sound like one of those "What's wrong with this situation puzzles." BP and lab work both dropping, suction on NG hooked up wrong, vented patient in T-berg, ABG results way out of range without concern or appropriate action. Yikes, sounds like this nurse either doesn't understand her job or doen't know any better. Either way I don't think I would want her taking care of critical patients. Don't beat yourself up. You are looking our for her and the patients.

I agree that the standards need to be addressed for those of you who work one nurse in PACU. Our rules are if there is a patient in the unit, there must be 2 RNs. We are expected to discharge patients if our admission/discharge area is closed. Sometimes we run into problems where they are "full" and cannot accept anymore patient before their closing cutoff. That means we have to do it in addition to recovering the endless flow of patients out of the OR. None of us like to do it, but fortunately it doesn't happen on a regular basis.

With some schools is does matter where the degree came from. There are some schools that want a BSN from a NLN accredited program. Look into the CRNA programs you think you might want to apply to and go by their requirements. There are online BSN programs that are NLN accredited. Make sure you do your research because it would be awful to think of spending up to 2 years worth of time and money, and still not be eligible to apply. Good luck in your journey!

It's exciting and terrifying to hear about those of you who are moving from out of state. I live in the area, and fortunately do not have that added stress. Just curious, where are you coming from? What made you choose UC? For me it was the location and the fact that I work with many UC grads who speak highly of their training. Can't wait to meet you all next fall.

Sometimes laying on the left side with the feet slightly higher than the head will help. This gas can be very painful for post-op people and it just needs time to reabsorb.

I too got that wonderful e-mail message. I did not think the interview went well, so I'm a little shocked. I agree, the information gained here is very helpful.

As a PACU nurse I must first say I'm sorry that sometimes this happens to you. Unfortunately, there are times when it can not be avoided. Our PACU usually gets slammed throughout the afternoon and it seems the patients are often ready to go around 6:30-7. Sometimes we can not hold them because there are several times a day we are holding up patients coming from the OR when we are full. Management does not take to kindly to hearing the patients are not moving because it is near change of shift. Also, the amount of time our patients spend in PACU is tracked and averaged. If they are staying there longer without a genuine need we have to answer for that. In our unit, we do start all the IVFs, PCAs, treatments, and IV meds that are due. I think this helps the floor quite a bit. I can say personally I have recently been on the floor and understand how hard it is to take a new patient while starting or ending the shift, and I empathize with you. It is usually not intentional and most of the nurses don't even notice that it is shift change. Just wanted to present the other side of the story. It sounds like there also may be a problem to be addressed with safe staffing for night shift on your floor.

Hospitals vary a great deal in what they will offer so look around. My hospital gives up to 7500 a year in tuition payment plus books. The tuition is paid directly to the school so I do not wait for a check. I purchase the books then turn in the paperwork for a refund. Out commitment is only 6 months beyond the last quarter/semester paid for. I know they offer more to the people who are going for their first time RN program. There is a huge difference between the hospital I work for and the other big competitors in the area. Some of them do not even come close. So, there are great deals and offers out there. I think you are safest if you work through a place that has the rules in writing and they apply to everyone rather than taking what someone says they will offer. Good luck!

Oprah doing a show on the nursing shortage and the relationship to mortality and morbidity does have potential. I don't regularly watch her show, but have seen many shows over the years where she exposes some major problem. However, my concern is she would invoke fear in the public without any good solutions. Also, I don't think her audience are the ones who need to be targeted with this information because her show is on during working daytime hours. A couple years ago Oprah did a "My favorite things" Christmas special (where the audience gets gobs of free stuff) to an audience of school teachers. I do think this would be excellent for an audience of nurses!

YIKES!!!!! I agree with the other posters who believe you did not do anything wrong. You took a horrible assignment and did the best you could. It's sad that your charge nurse was not there for you. When I realized all that was wrong, I would have pulled my charge nurse in there to see all the mistakes and problems as well as help me stabilize this patient. This could have been much, much worse as I'm sure you know. Also, assigning a fresh heart to an agency nurse is unacceptable let alone that he was transfered while unstable. At my hospital only a "heart trained" nurse can take the patients throughout their entire stay. No floats, no agency, and no untrained heart nurses....period. If all else fails, management comes in to take an assignment. Also, how can you be faulted for responding to the asystole patient first? I think in the order of priority, no heartbeat takes priority over someone you are told is stable. Hopefully you documented well, and I would also write everything down and keep it for yourself (excuding confidential info, of course) just in case sometime down the road you need to have a clear recollection of what happened. I think if it were me, I would be looking for another place to work.