sweetdreame

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Advanced Practice Nurses often find our practices limited for political reasons, having nothing to do with our skills, training, and abilities. Currently we are facing the battle of the decade regarding nursing practice. The VA system has proposed a handbook change allowing advanced practice nurses to practice to their full scope. Contrary to some biased news reporting, this does not diminish or impair the role of physicians as part of the care team. It would simply allow APRNs to do what we are trained to do....care for patients. We nurses are often distracted by "eating our young" and other common themes of in-fighting within the profession. However we all saw our power with the "Show me your stethoscope" movement. When we join together, we can make a HUGE difference! I hope you will consider joining in to ensure access to services for our vetrans, and allowing your fellow nurses to respond to the call. If you have questions, please contact me. I am happy to discuss this issue. Go to Home - Veterans Access to Quality Healthcare Alliance and make your voice heard! It takes less than three minutes to advocate for your vetrans and fellow nurses!

I am doing DNP research on culture of safety and implications of disruptive and inappropriate behaviors in the clinical setting. We know that often, several errors lead up to a critical or sentinel event occurring. The key to prevention is for staff to feel empowered and safe enough to report "near-misses" or opportunities for improvement. The question I have for you is: in your job, do you feel safe enough to report...or do you feel you will be somehow reprimanded? Is there a "blame culture" on your unit?

Wow! Thank you all so much for your advice! It really amazes me that some people expect you to clean up after them...that's crazy! I have had a few days in the O.R. now and I have to say that the circulators have been SO nice and friendly. They definitely made my nerves slightly better. You guys rock! Thanks again!!!

All ICU experience is good for CRNA school. The MOST important thing is that you take care of very sick patients and you make yourself think through what you are doing and why in each situation. If you are caring for super sick medical (or CV, or Trauma, or Surgical) patients on a daily basis for 2-3 years and know your CCRN material there is absolutely no reason why you should have trouble. I think that we all have preferences here and there, but I really think it is more the QUALITY, not the specialty that you should be really focused on. Getting in the door is only half the battle. Don't just worry about what looks good on paper. You need to have a strong foundation on which to build your anesthesia education. You don't have time to learn how to be an ICU nurse in anesthesia school....you have to save time to procrastinate on allnurses.com.

I'm so sorry to hear that you are going through this. Unfortunately, I don't think nursing school is the problem. There is no program, graduate school, post-graduate, etc. that doesn't allow for a few hours a week of free time. It is important to maintain a "work-life" balance in every stage of life...including this one. I hate to say it, but we make time for what we want to make time for. I would encourage you to seek counseling. Sometimes educational institutions have free counseling for students and even spouses. I hope everything works out for your family...hang in there.

Hello! I am an SRNA and while I am totally comfortable in the ICU, I am very new to the culture of the O.R. I just started clinicals and am trying to learn the ins and outs. I have so much respect for O.R. nurses and what you do, but I can't help but feel that there is sometimes tension between anesthesia and the nursing staff. This confuses me because we are all nurses, with a common background and a common goal..we are in it together...for the patient. I am looking for advice and pearls of what I can do to not peeve off the circulators, and how I can create a culture of mutual respect. Please let me know what you like, dislike, and feel free to share any funny stories about silly things anesthesia has done to drive you crazy! Thanks in advance!

Get your CCRN, there is no excuse not to have it. Most programs require it, but even if they don't they will ask why you don't have it when you interview. You have a good profile, but take the final step. Also, its not like the GRE...you actually learn clinically relevant pearls when you study for the CCRN that will help you when you interview! Good luck.

Hello! I am a second year SRNA and I have experience in ER, trauma ICU and CVICU. I definitely agree that you will suffer if you don't have ICU experience, but I think sometimes people minimize ER experience. I feel that my ER experience was PRICELESS and made me the nurse I am today. I am confident with skills and procedures that I would have never seen if I only worked in ICU. No matter which you choose, you need to focus on independent thinking and learning as much as possible. If you only choose one, choose CVICU, but I think that a well-rounded experience is SO beneficial (I might be just a little biased). Good luck and don't hesitate to contact me if I can help you in any way!

Go-GetterRN I appreciate your questions and it seems that you are certainly on the right track. Baylor does not offer clinical sites outside the medical center of Houston. This is an advantage because all of your clinical sites are in a 2 mile radius (if that) and you will never have to commute or move. However, the CRNAs in the medical center have a lot of autonomy, but there are no all-CRNA groups. I do think that would be a nice addition to Baylor's clinical rotations. I do not think that it stunts the graduates whatsoever. I know several graduates that have gone on to work in independent settings after gradation. From what I understand, regional blocks, central lines, and other skills are pretty much readily available at each clinical site. At Ben Taub there might be a little more competition with residents, but that is only 9 months of the 18 months of clinical rotation, and its not like you don't get to do them at all. I asked this same question on interview and the answer was pretty much that in order to get such amazing clinical experiences (Level I, CV, etc.) that we might have a little more competition for overall lines and blocks, but in the end we far exceed the minimums and have ample opportunities to become proficient. Classroom education involves a robust sim-lab experience that definitely puts you on the spot and makes you think independently. We take classes that focus on the legal scope of practice of CRNAs (prescriptive authority, opt-out, supervision, etc). We take classes that focus on the business aspect of running your own practice or functioning as the chief CRNA (budgets, staffing, cost-effectiveness-analysis, etc). I was happy to learn that Baylor focuses on really molding you into a fully-functioning provider, including medicolegal, and business aspects of the job. I have never, never been told in class, to consult, ask or otherwise depend on an anesthesiologist for help. There are programs grooming grads for ACT. Baylor is not one of them. No program is perfect, but I am so happy that I chose to come to Baylor. I hope you feel the same! Good luck with the application process, it is such a task that I felt like I deserved some type of certificate just for getting in!

I'm not sure you realize the extreme amount of work you would be in for. CRNA school is pressing pause on your LIFE for 3 years. That includes family activities, TV shows, hobbies, special events and pretty much everything. It seems pretty ridiculous to do all of the hard work with the goal of part time employment. If it is about the money, there are WAY easier ways to make 6 figures and you won't be in debt up to your eyeballs.

This book has very simple explanations for many ECG conundrums! I bought it as a new CV nurse and it was a required text for one of my courses in CRNA school. Taking physiology really helps, but this book breaks it down for you, even if you don't have a physiology background. It would be my gift to any new cardiac nurse. :) Oops, the picture was supposed to be of the bright orange "Rapid Interpretation of EKG's" By: Dale Dubin. Good luck!

The Price of Pastries Christina and Milton both love pastries. They both have dreams of one day becoming pastry chefs and making excellent pastries. Let's follow their respective journeys after high school graduation. Christina Christina decides to start taking cooking classes after high school graduation. She takes three years of cooking classes before becoming an apprentice cook for one year. After her apprenticeship, Christina passes a state board exam to become a Registered Cook. Christina gets a job working at a café where she cooks daily and becomes very familiar with different ingredients and how they interact. She spends four years working as a Registered Cook where she learns about and becomes comfortable working with the ingredients. Unfortunately, at the café, Christina works on a team and does not get to cook or bake independently. Christina loves baking, especially with really difficult recipes, so she decides to go back to school to become a baked-goods and pastry chef. Christina applies to the Pastry Chef Bakery Academy, where doughnuts were first created. The Academy is very selective, and only takes cooks with excellent experience in the kitchen. Each candidate must be very familiar with the ingredients and be comfortable in the kitchen. Christina is accepted at the Pastry Chef Academy where she will spend 3 years becoming an expert in preparing any type of pastry or baked treat. For 1.5 years, The Pastry Chef Bakery Academy teaches Christina everything she could possibly need to know about baking and pastries. She is tested on this specific knowledge many times before she is allowed to become a pastry sous chef. Christina spends the remaining 1.5 years as a baker and pastry sous chef where she learns to function as an independent pastry chef and baker. She graduates from the Pastry Chef Bakery Academy, passes the National Baker's & Pastry Chef Board Exam, and applies for a job at The Doughnut Shop & Bakery. Milton Milton decides to get a general education in the science of cooking. He spends two years learning about basic topics, and two years learning about cooking sciences. Milton decides to apply to Cordon Bleu to become a chef. Cordon Bleu is one of the most selective programs for chefs. It is very difficult to gain acceptance. Milton has made good grades in cooking sciences. But Milton is relieved that he doesn't need any cooking experience to get into Cordon Bleu because he has never stepped foot in the kitchen. At Cordon Bleu, Milton learns about many cuisines from all over the world. He gains understanding about many topics: Chinese food, steaks, salad, hot dogs, cookies, and more. When Milton graduates he is very familiar with many different styles of cooking, and even some ingredients. But, alas he has still never been allowed to cook. Milton is relieved when he is accepted to be a baker and pastry sous chef. However, the first year he is a sous chef, he is made to follow around many different chefs, not just the baker. He learns about various types of cuisine. Some of the chefs even let him cook as they watch. In the final 3 years of his training, Milton finally gets to start baking. He works exclusively as a Pastry sous chef and learns everything he could possibly need to know about baking and pastries. He is tested many times on this specific knowledge before he graduates. Unlike Christina, Milton does not have to pass board certification to bake or make pastries. He is allowed to work independently just because he graduated from Cordon Bleu. Milton also applies for a job at The Doughnut Shop & Bakery. After Graduation... Milton and Christina both get a job working at The Doughnut Shop & Bakery. Because Milton went to Cordon Bleu, he gets a job as a supervisor. He watches over Christina and three other Pastry Chef Academy graduates while they make doughnuts and other pastries. Christina is dissatisfied with this situation because she knows how to make doughnuts very well (without supervision). In fact, many of Christina's fellow graduates are the only pastry chef at their bakeries and work without supervision. Despite her qualms, Christina embraces her new position and enjoys making doughnuts, cupcakes, and other pastries all day every day. She can make different varieties and flavors and becomes an expert at her job. Christina and the three other Pastry Chef and Bakery Academy graduates make $2.00 for each doughnut. Since Milton is supervising them, he also is paid $2.00 for each doughnut. They make 1 doughnut each hour, so Milton makes $8.00 per hour. Milton will occasionally make doughnuts, but he mostly runs the cash register and talks to customers. One day a loyal customer comes in. She is recently engaged. She loves doughnuts and wants The Doughnut Shop & Bakery to make her wedding cake. Milton immediately assumes that he is more qualified to make the wedding cake because of his advanced knowledge of international cuisine and Cordon Bleu education. Christina feels more qualified because she bakes and makes pastries every day. Both Christina and Milton are pastry chefs and they use the exact same cookbook. Ask yourself: 1. Who do you think is more qualified to make the wedding cake? 2. Do you think the doughnuts would be less tasty without Milton's supervision? 3. Who do you think makes better doughnuts? 4. Do you think doughnuts would be cheaper if Christina and her fellow Pastry Chef Academy graduates were not being supervised? Would you be willing to pay Milton's price for his services? 5. Does this system make sense? Here is the Bottom Line: What if you were told that this scenario exists every day in the American healthcare system? Certified Registered Nurse Anesthetists (represented by Christina) provide safe and effective anesthesia that has been proven to be of the same safety and quality of their anesthesiologist colleagues (represented by Milton). Did you know that an anesthesiologist can "supervise" four CRNAs at one time and bill for 50% of each case (doughnut) that the CRNA performs? This means that the supervising anesthesiologist can make 2 times more money if he or she supervises a CRNA rather than providing anesthesia--even if he or she never steps into the room. The anesthesiologist does not even have to see or talk to the patient to bill for services. To continue with the analogy, the anesthesiologist's role in this setting (Anesthesia Care Team) is to be "available" in case someone wants to order a wedding cake (anesthesia emergency). If any party is more qualified (which may not be the case), wouldn't it stand to reason that the pastry chefs who bake every day would be better able to make a wedding cake? That is for you to decide. There is no state in the United States that requires anesthesiologist supervision over CRNAs. The interest of many anesthesiologists is not the patient's outcome but their own income$$. Inform Yourself. I wrote this analogy to help friends and family understand the role of CRNAs and other advanced practice nurses. I hope it helps you to understand as well. As you do your own research, I encourage you to stay away from opinion and focus on facts. There are many campaigns and opinion-pieces that are designed to elicit an emotional response and scare the public without producing facts based on patient outcomes and cost-effectiveness. Focus on the EVIDENCE.

I am very proud of the fact that I am a nurse, and if I give an awesome anesthetic, I don't want the MDA to get credit for it. If they don't want a CRNA, so be it... they can take their chances with the guys who spend the majority of their time looking at a board and drinking coffee.

Thank you very much for the reply. I sincerely respect your opinion and have followed several of your postings. Have a good day!