TU RN

personal time 100%. my best friend had a copy of Duke's Anesthesia Secrets he read twice from the beginning of DCC til the start of Phase I. still has the thing - it's ***ing ruined LOL. I have a funky binder of misc. doesn't help you a lick in Phase I, which starts off with hard sciences like biochem and A&P (none of which are meaningfully discussed in Duke's). enjoy your life while you have it. USAGPAN will occupy your existence for 3 years until you emerge a furious, deathless anesthesia machine

I did phase 2 at Womack on Fort Bragg, NC. every clinical site has its pros and cons which you'll be able to tease out a bit more as you progress through phase 1 and socialize with classmates. they're all gonna challenge and frustrate you, so do your best to stay humble and lovable. we all suck when we first start out, just try to suck less and less every day. as far as the timeline - the classes after me and HPSP people I've interacted with have shared that COVID has screwed it up. I applied in June 2018, received my commission in December 2018 (lots of waiting on recruiting/admin/scroll ***), traveled to Fort Sam Houston, TX in January 2019, DCC at Fort Sill, OK from February to March 2019, BOLC at Fort Sam Houston, TX from mid-March to May 2019, Phase I mid-June 2019 to mid-June 2020, Phase II mid-June 2020 to mid-June 2022.

haven't posted on this site in ages. I directly commissioned into the Army in 2018 and graduated USAGPAN last year. currently work at BAMC as a CRNA. AMA

Speaking for most of the FY19 direct commission cohort, we didn't receive our orders until December. I didn't actually swear in until late December only a few days after my orders were cut. I was in the same boat you are now. There's a lot of back and forth that HRC has to deal with and recruiters seem to be relegated to the role of messenger at this point. Recruiter not getting back to you is frustrating though and I get that - just believe that the big Army and USAGPAN do genuinely want you and are making strides to get you here!

Good advice from angelsigns. You state you wanted to be in critical care so bad. Why? What are your goals?

Hey tridel! Good look researching USAGPAN - best kept secret in anesthesia education in the US! I applied to several civilian programs along with USAGPAN. With USAGPAN you're applying to both the accrediting university (Baylor University) as well as the US Army. The Army runs the show here, though - it's the Phase II interview, which is one of the first things you do once you contact a healthcare recruiter that really determines whether you get into the program or not. I'd make good with your manager/professional references and let them know that you might need some extra documentation for this program (letters for Army and Baylor each, certification of ICU experience). DCC and BOLC are easy. You report to Fort Sam Houston, TX early-mid January and in-process there. That is, house hunt, get your finance/insurance/military admin stuff in order, get your bills in order, buy your uniforms, etc. Act quick on your apartment/house. I got bored waiting for DCC. DCC doesn't start until early February and only lasts a month. BOLC takes place at MEDCOE in FSH, TX and usually picks up within a week upon your return from DCC and lasts until about mid-May. You commute from the home that you (should have) set up from between your report date and start of DCC. Also easy, it requires a bit more time and focus compared to DCC. The program starts in mid-June, so whatever you couldn't get set-up before DCC and during BOLC you can finish up in this time frame. If your USAGPAN cohort has other direct commissions, you'll be doing these programs with them. I have been fortunate to have 16 others with me (I was a direct commission) and we made the most of it. Many of the other direct commissions have families, but pretty much mostly waited until after DCC to have them come to San Antonio. You will not see your family when you are at Fort Sill for DCC. Some even waited until after BOLC to bring their families, since you're at AMEDDCS (now called MEDCOE) for class most of the days. My wife was here and I saw her plenty. USAGPAN will assuredly remove you from your family and that is something you must prepare for. It's a strain to be sure. To put it into context, I spend from 0650 til about 1730 every weekday away from my wife. There are guys who have children who spend even more time away. If you're serious about USAGPAN, know that your family's understanding and support are essential to your success. I picture my attendance in this program as a lifetime achievement and my wife supports it as such. What's up pizzabox! Nice to meet another direct commission! Congratulations on your acceptance to USAGPAN and on embarking on the most incredible and rewarding experience of your life. Phase I is pretty heated right now but we're getting it done (FY19 is gonna be a tough act to follow ?) As far as living recommendations are concerned, I recommend finding a spot as close to base as possible. The commute becomes a bit of an issue during the program where your first hit time is usually 0745 (peak rush hour). I live in Selma, TX which is 17 miles North of base. I commute 20 minutes down I-35 Find a spot that charges you less than your O-1/2 BAH ? There are about 2 weeks between your report date and DCC, where you're expected to establish yourself in San Antonio. As I said above, in-process with the Army, get your uniforms, figure out the lay of the base, find a house/apartment, set up your bills, get a car or whatever you gotta do to get to and from base, get in shape, etc. There are another 2 weeks between BOLC and USAGPAN, but you should be pretty much squared away by then besides settling up your ORB and DA photo which you'll learn more about later (really no big deal). I moved from Philly and flew, as a civilian. My other buds flew from CT and NY and drove. This part is really your choice (i.e. drive or fly) - you'll be compensated more for travel days driven than flown, but weigh that convenience VS compensation yourself. The Army moves your goods regardless, without additional charge (I'd say free of charge, but here you are serving your country). If you're single, it would behoove you to set this up so that the loading takes place before your departure. They movers need a receiver. Otherwise a parent or spouse is usually sufficient. If you drove, or if your wife drove, you'll be compensated for your travel and lodging by mile. There's a weird alchemy that exists in Army finance that I am not qualified to answer, but you end up getting paid either way. I expected the school would be the hardest I ever saw. I expected I would spend all my time away from my wife. I expected that it would be hot as hell in Texas. I guess that the most unexpected thing for me would be how motivated I am by my classmates, faculty, and the US Army. I didn't anticipate in my wildest dreams how functional and driven everybody is both in my program and on the base as a whole. It truly is a unique and extremely motivational experience to be in a place where every. single. person. is moving towards some productive end. As far as financials go, you'll probably find an all-around better deal in some civilian program if that's your main concern. Obviously you specifically have already decided, but it's worthy of mentioning that the math doesn't work out to support USAGPAN from a financial perspective. My (really, our) motivation in USAGPAN consists of a greater desire for service in the US Army. I don't think I could have lived with myself in the long term in a civilian program realizing that I refused to do my part for this people which has selflessly given me so much. We nurses convince the public that we exist for them - to give care. If my consciousness is obliterated, and my vital signs are reduced to barely sustainable metrics, I would want a vigilant, elite individual watching over me. Laziness and incompetence have no place here. In the Army, state-of-the-art machinery and pristine environments may not necessarily be available either. However, the anesthesia provider is the ultimate embodiment of guardianship over that individual. In my opinion, no greater compassion exists than in the ANC. If you need any more motivation than this, I suggest you listen to the Gettysburg Address. Effective, modern anesthesia began in the military and is most excellently carried on here. Besides not having to shell out the $75-150K for nurse anesthesia education, the financials are available online. I came in with enough experience and the CCRN to commission O-2, so I make $3673 (grade) + $1710 (BAH w/ dependents) per month (google it yourself). If your BAH is greater than your rent, you are not required to return the allowance, just saying... this combined with my own subjective motives serve as more than adequate compensation. In fact, I feel as though I owe them more still. Got 7 more years to do that though haha. I can't say enough about the faculty. These folks are dedicated to your success. You're entering a program where the anesthesia students are the only thing on the faculty's radar (besides one, their only focus is USAGPAN). Our class consists of 24 students and there are about 15 faculty. Advice coming in: get in shape for the ACFT. The APFT is going to be pretty much phased out by the time you guys have to take a real physical fitness test. The event that people are failing is the leg tuck. You only have to do 1 for our MOS, but many people are struggling. Fortunately, if you're horrible at running even a short distance, you are permitted to run (or power walk) 2 miles in 21 minutes. The requirements are available online. That's all I got for now - hit me up closer to your PCS date and I'll walk you through the base and such. Great choice, btw.

Damn I haven't posted in a while. I remember joining this forum as a venting strategy after accepting my first Stepdown RN position out of nursing school (2013) and absolutely hating it. Here I am in USAGPAN living the effin dream. As Joe Walsh says: life's been good to me so far. And certain fingers up to the doubters, btw, cuz we're out here doing it anyway. Another direct commission, current Phase I student here (FY 19 represent). I like to think of myself as an underdog (who was refused by 9 civilian programs and accepted only by USAGPAN / I say hooah). Don't let my man Bhebe55 spook ya, yes it is a lot of work, but we have had a lot of fun, struggled together, and learned a lot in the process. I will gladly answer your questions, tridel, and if anyone else has anything please don't hesitate to ask here or PM me. I'm extremely grateful to the help I received from my predecessors and am glad to hand down any help that I can. How has your experience been thus far? My experience is relative only to my desires. My goal is to be a CRNA and to serve my country - I'm accomplishing both of those goals satisfactorily and I couldn't be happier. At this point you would be in 2nd semester correct? Correct, but "semester" might not have the same meaning as you expect. There aren't typical "breaks" between "semesters," as the next classes are just gradually worked into the curriculum. USAGPAN Phase I is designed to be an onslaught of academia to prepare you for Phase II, an onslaught of practicum. Are your classes solely GPAN students or are there other specialties mixed in? The program is taught entirely as one entity, in one classroom: USAGPAN. No other specialty. I spend every day with my 23 Army SRNA colleagues. What I love most about my class is this: 17 of us started talking to each other about this time last year (direct commissions), commiserated about the application and "scrolling" process, and then continued to bond after we met up at our report date in January. I can confidently say now that I love these folks (although they often drive me crazy) and truly appreciate the value of selfless service. How much homework and how much class time do you average? Yeah we have about 2-3, 2-hour classes daily paired with 5-6 hours of study time after class. Like Bhebe said, 9-12 hours total daily x5. Actual physical homework isn't quite as prevalent as in undergrad, but you're expect to have a conversational understanding of the concepts for class as you will be grilled. More importantly, you will be expected to function independently as an anesthesia provider in a deployed setting to save our soldiers and allies. Do you wear uniforms on campus or dress as other students do? Uniform is the ACU. Are there civilians in your classes? We're all soldiers and officers in the United States Army. Do you have to do daily reporting? When there is class, you are required to report. It's nothing crazy like some formation then you fall out to classroom, but you're expected to be in your seat at 0745 for class every day. If you're not well, you have to go to sick call and be evaluated. My people would refer to this type of practice as "no ***" - being a student in USAGPAN is your military occupational specialty. How about daily PT? PT is not conducted daily as a group in USAGPAN, but you are expected to physically prepared to participate in group PT sessions once weekly, a diagnostic PT test monthly, and a record PT test every 6 months. Do not neglect exercise. In this program, you are a soldier. Absolutely research the APFT (push-ups, pull-ups, and two-mile run) and the ACFT (more intense, functional physical fitness test that will be officially replacing the APFT in 2021). As a general rule, I'd say be able to do 40 pushups and 40 situps or more in 2 minutes, and be able to run 2 miles in 17 minutes or less. If you can't perform in PT for the program you won't be kicked out immediately, but you will be ridden (not comfortable) until you succeed. How often are y'all meeting for (Military) administration duties? For USAGPAN, outside of DCC and BOLC, nothing. I'll have to get back to you once I finish Phase II, though.

During my interview day, the director told us we should hear from them before Christmas. She explained that it's later this year than years prior due to their application and revision for DNP accreditation. I'm curious to hear what others have been told about when we'll be informed of acceptance, waitlist, or denial. I'd also be interested if anybody has heard anything about their accreditation reapplication. According to the COA website, the program is still listed as MSN expiring in 2022. Looking forward to sharing with you all when I receive further updates to my application - hope you'll do the same!

I interviewed late October. When I arrived there were 3 other people interviewing. The day started off with a presentation from two senior students followed by a presentation from the program director. After that we had a short 10 question quiz (basic critical care knowledge). Then we had a Q+A with the two senior students as we were individually brought back to tour their sim labs (very nice btw) and interview with the program director and one of the other administrators/clinical instructors. I personally felt like I did really well in the interview, answered every one of their questions confidently and accurately, and got them to laugh a couple of times. BUT I've felt really well in these interviews before and been denied based off of my noncompetitive GPA (3.27). I believe I more than adequately responded to the challenges against my GPA by selling my hard sciences, CCRN, PCCN, precepting, ultrasound IVs, workplace committee involvement, overall experience (5 years), and little intangibles like my drive and my life story (lol). A big plus going in was I had the confidence of knowing I have already been accepted to at least one of my programs and this particular interview wasn't "do or die," so to speak. All that being said, I've still been turned down simply because it's a big numbers game for these admissions committees, they get a ton of super competitive applicants, and they can afford to have very high standards. Time will tell. Sorry to those who didn't get interviews or didn't get in. Take it in stride and keep applying. I've applied to about 10 places this year (pretty sure my nurse manager hates me lul). Got interviews at 4. Accepted by one, rejected by one, one is coming up this week, and this one (which I'd prefer to my first one) is still pending a decision. *shrug* I'm going to succeed in anesthesia either because of or in spite of these programs - the ball is in their court.

If my information is correct, I believe today is the last day of the Army boards. Hopefully soon we'll get another update on the status of our application/scroll. I can't see how Baylor would issue acceptance letters if they didn't receive assurances from the Army that the recipients would successfully board and scroll in. I suppose an offer of admission can as easily be taken back as it is accepted, too, though. Does anybody know how pay scale/rank would work for civilian applicants who are commissioning? I've read on the USAGPAN 2018 post that BSN + certification + years worker factor into "constructive credits" i.e. a system to determine whether you commission as O1, O2 etc. based on professional experience outside the military, but I was unable to find that information anywhere on my own search of available government policies. I could bounce the question off my recruiter as well. In the meantime I'm gonna keep working on my run, push-ups, and sit-ups. I downloaded the Army physical fitness manual which gives a sort of fitness plan for what goes down at basic. I don't imagine the physical component of BOLC will be too far off for us. I'm also taking a biochem class as recommended by the phase II director who interviewed me. Challenging stuff so far. What's everyone doing to keep busy?

I've made the cut as well. Congratulations everyone!

Add one small click box that says "Ultrasound-guided" or "USG," if you absolutely must. If you are a registered nurse who places ultrasound-guided peripheral IVs, then you already know how time-consuming they can be. This skill is usually practiced in combination with a standard, level-of-care appropriate patient assignment. The nurse is doing enough already just walking away from those patients to do the thing in the first place.

@Bhebe55 - LTHET (Long Term Health Education and Training) is a US Army program that takes current active duty officers and approves them to go get additional training in a job-related specialty. LTHET approval is a necessary precursor to USAGPAN acceptance for the active duty guys. From what I can surmise ArmySRNA2B is probably an active duty critical care nurse (66S) who applied to USAGPAN. He's already been approved to attend USAGPAN through LTHET, but since the jury is still out on USAGPAN and Baylor admissions he's in the same boat as the rest of us (civilian and reserve) waiting to hear.

I was reading through the comments up until this point about less slots VS less applicants, so I looked back on the USAGPAN guidelines document on Baylor's website, under the "application deadlines" section on page 6 I found this: "a. 15 August 2018 is the deadline for the primary selection board. If all seats are filled then this will be the only selection board. i. If vacancies remain after the primary selection then a rolling selection board may convene until 1 September 2018." This plus yesterday evening's email sort of suggest to me that there are lingering applicants that could still be fit into the 2019 cohort and USAGPAN is still trying to work that out. I was also given a pretty confident date of 08/20 for the official USAGPAN notification of acceptance by the phase II director I interviewed with. Baylor's probably waiting on the go-ahead from USAGPAN, hence the "admission decision still pending" message. Then again I could be overly optimistic and dead wrong, but hopefully not For me, putting everything up to this point into perspective is both nerve-wracking and exciting: Assuming I'm admitted... there's only realistically ~5.5 months left of preparation/civilian-hood/...freedom... before DCC/BOLC/moving to JBSA/phase I. Honestly I can't wait for it all

New email from Jana @ Baylor. BREAKING: more waiting. ;D

pkstien: Again, thank you for your very helpful and relatable input on this thread. Congratulations on your recommendation and best of luck to you in the USAGPAN! I have indeed checked the USAGPAN 2018 thread and it has also given me a lot of insight into this interview process. I will be attending my phase II interview (ie, the moment of truth) next week. It truly does seem, according to the pertinent documents I received, that such a huge emphasis is placed on not only your own - but your family's readiness for this process. I'm sure I'm not the only person whose wife (or husband/SO) has needed some convincing I remember a PM conversation I had with some USAGPAN graduate a while back, but sadly it doesn't seem to have taken place here on allnurses.com and I can't locate the exact convo... What I do remember though is that the individual seemed to give me a very positive vibe about how his family experienced "military life," although he did feel some small regret for his small child (at the time) who had to change schools. I'd be glad to PM with others interested in the USAGPAN who have family questions, as I've had to approach this with my own wife (no children yet + I'm definitely in need of ongoing support in this department, please believe it :laugh:)

Thanks for the information pkstien and CCURNCO. Little update: got an email today from LTC Adams about setting up a Phase 2 interview. Very encouraging indeed, albeit mildly anxiety-provoking. 3 days huh? Should be interesting. What were your experiences like?

Hey everyone: This thread has been most helpful to me and I thank you all for your information and insight on the program. I have just completed my Baylor application (civilian) and am waiting on my recommendation letters to be sent. The Baylor program coordinator emailed me today saying the Army is eager to look at potential candidates for an interview as soon as possible, so I was encouraged by that. I feel confident about about my application given some of the insight on here about others who have been told their credentials are competitive (though I'm sure every cohort sees different deviations in credentials, and commensurately askew are the criteria for what is competitive). I have been a nurse for 5 years, the last 3 in a general Medical/Surgical/Trauma ICU in Philly. I'm CCRN certified, have 316 V+A GRE/3.5 AW, taken two semesters of Orgo in college, but am sadly handicapped by a 3.27 GPA (lot of **** going on for me personally in college). Regardless, I look forward to the application process and the growth I'll experience win/lose/draw. I just read the message from Crj8999 about going to MEPS and then interviewing afterwards. Quick question: if a person applies and is offered an interview, and MEPS apparently takes place before that, aren't you pledging in to the Army prior to knowing whether or not you're accepted to USAGPAN? What does the timeline look like after the August 15th deadline for competitive candidates? Thanks for all info and best of luck to all of you!

I've never been asked to precept a new nurse so my input is limited by that. What I've heard from those that have though is that it's frustrating spending the time and attention for 8-12 weeks to have a nurse, many times within that "5-year-might-change-careers-still" window, then for them to leave the job. Maybe the hospital could make teaching more worth the preceptors' time through temporarily higher pay, a bonus, or at least some sort of "clinical ladder" initiative - but who am I kidding. Since when do hospital administrations wish to dole out more money, let alone listen to or even remotely care about what the bedside nurse has to say.

Hello AN it's been a while! Hope all is well with everyone here. I had an unfortunate, awkward situation with my charge nurse the other day and the way it unfolded has left a sour feeling in my stomach. Since I'm not sure direct conversation with this individual would yield a favorably air-clearing result, nor do I believe venting to my coworkers about the actions of someone in a supervisory role would do anything but backfire on me, I turn to the anonymous shroud of the Internet. A patient was transferred to our ICU for observation after a Dobhoff-tube-placement-turned-right-mainstem-bronchus-intubation resulted in a small apical pneumothorax. The patient was elderly, carried a high risk to become unstable, and had just complex enough of a story to appropriate the level of care escalation - but those details are irrelevant to this situation. The pneumo was pretty small, his vitals were stable, and the sequelae from placing a chest tube were ruled by the team to be too risky in this particular guy. Where the situation became sketchy was how we were treating the pneumo - with high percentage oxygen (ie, 100% NRB) through the night. At the time I did not understand the logic/pathophys here. NRBs in my understanding are mostly bridge therapies to actual therapeutic measures (BiPAP, high flow, or intubation), with the exception of carbon monoxide poisoning and apparently small pneumos. At 7P I got report on the patient from an experienced ICU nurse who I totally trust, who had communicated to me our goal was to leave this guy on the NRB all night long to treat the pneumo. The physician behind such an order was a 5th year ICU fellow, beloved and trusted by all the ICU staff, absolutely brilliant guy who will be leaving our hospital soon to go work in a (much, much better/bigger) hospital on the west coast. My immediate response was skepticism of such an extended time spent on such unnecessarily high oxygen percentage (I say unnecessary because the patient was previously fine on nasal cannula). I figured the patient was stable, I'd research the use of NRBs on treating pneumos, then question the resident if I didn't receive sufficient understanding in my own research. This never happened because some nightmare rolled into the open bed with a dissecting aortic aneurysm, acute MI, pericardial effusion/cardiac tamponade, intubated, A.lined, CVC'd, pericardiocentesis, coded, and died. All the while, Mr. NRB is fine. Later, the charge is asking for updates on my patients to hand off to the day charge the next morning. I hadn't researched the NRB thing yet so still didn't fully understand. When I told her he was still on the nonrebreather and was ordered to stay on it until morning she and another nurse who was sitting nearby (probably ignoring her patients who were probably sitting in feces) took interest and became concerned "your patient shouldn't be on a nonrebreather", "I would take him off", "call the doc and change the plan." So I researched the use of NRBs in treating pneumos and found some mixed responses regarding the efficacy of such a treatment, but learned it is definitely a treatment (primarily used in neonates apparently). The proposed mechanism here is to drive the intrapulmonary partial pressure of nitrogen down with pure oxygen (nitrogren washout) so that the pneumothorax (~78% nitrogen) passively re-enters the pulmonary space through diffusion. It made sense to me and I felt less guilty about complying with a treatment I did not understand. I called the doctor anyway and asked about the repeat CXR we did regarding the pneumo (who told me it was unchanged) and confirmed with him "and we're supposed to keep him on the nonrebreather through the night?" right there in front of both of these nurses so they could hear the dialogue. Anyway they both lost interest after that and left. Later as I was charting, I noticed the charge nurse go into my patient's room, on the phone, carrying a nasal cannula. I followed her in, absolutely confused and somewhat vexed that she would go to treat this patient of mine without saying a word to me. By the time I got there she was off the phone, had replaced the NRB, and left the nasal cannula sitting on the bed and I asked "what's going on?" To which she replied, "I called the doctor about this. X-ray is gonna stop in here (most patients get daily portable CXRs) first and we'll go from there." Me: "so we're leaving the nonrebreather." Her: "for now." Then she left. To be completely honest - and maybe I'm a sensitive guy - but I felt absolutely insulted, undermined, and disrespected that my charge nurse would go over my head to treat MY OWN patient without my knowledge. Like I was complicit in some sort of plot to kill the guy? Is my own judgment and quality as a nurse so far below your standards that you have to intervene to prevent people from dying by my ignorance? Later I talked to my friend / the respiratory therapist about using the NRB like that and he said it isn't common but he understood the mechanism and didn't opine that it would cause the guy any harm at all. I also mentioned what the charge nurse did and how it made me feel (he was the only one). He reassured me that nobody has ever said a bad thing about me as a nurse, and that maybe the charge nurse's intervention in that situation was less of a challenge to me but more so a challenge to the night float resident who has a bad reputation among the nurses. It helped a little bit because I do know she (and pretty much every other nurse) has openly badmouthed this doc, and I've overheard them challenge him over the phone before. TL;DR My charge nurse didn't agree with how a patient was being treated and went over my head to contact the doctor and change the plan of care. I was offended. Maybe I shouldn't be. Either way I wouldn't mind hearing what other nurses have to think about this situation. I definitely should've known my stuff, that way maybe the charge nurse would've just chilled out and accepted my reasoning for using the NRB. Maybe I am being too sensitive about what she did? It still feels weird and I don't look forward to our next interaction either way.

Bowel sounds. Definitely auscultate bowel sounds with anaphylaxis. Critical intervention

To quote Denethor, Steward of Gondor: "go now and die in what way seems best to you."

All you need is the RN license. Your facility's nursing orientation should include a brief demo of their IV catheters / insertion using their start kits. No need for certification or training unless it's some facility-specific policy.

I once had a diabetic patient refuse certain quantities of insulin because "I know my body, I've been a diabetic for 30 years." Well, sir, judging by the fact that you're here for DKA and happen to be missing a foot, I tend to disagree.

This patient needs a lot of radiation shot at her head from different angles like... yesterday. If the family wants a confident answer, then they have to accept a diagnostic workup that inspires confidence