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The last I heard Yokota had a two bed ICU. Nellis and Elmendorf are DOD/VA joint venture hospitals. It makes for interesting dynamics working with both systems under one hospital.

Is this really a bad thing? A hospital like this probably has no respect for CRNAs and would more than likely go out of it's way to limit CRNA practice. Teaching nurse anesthesia students how to perform all aspects of anesthesia independently should be the top priority of all nurse anesthesia schools. It doesn't matter if a CRNA will never work out of an ACT environment. Our patients deserve nothing less than a CRNA that can provide full service anesthesia (blocks, CVLs, advanced airway techniques, and be able to effectively run a code without a physician) with or without an anesthesiologist. This decision will increase costs for the students/program and be inconvenient with the increased travel. It will also increase the cost to the hospital since all their free labor will have left. Anesthesia departments are one of the most hospital subsidized departments. This decision maybe popular this quarter, but when the hospital has to shell out more money to an already expense laden department this decision will come back to haunt them right where it counts right in pocketbook.

Fair enough I will quit antagonizing, but there are two sides to every story. Maybe next time you can find a provider who will communicate better. There are many ways that sedation for colonoscopies can and are done. The overall method that has shown to have the best outcomes is propofol sedation with or without small amounts of versed and fentanyl or Demerol. One of the biggest areas of research right now in anesthesia is POCD (postoperative cognitive dysfunction). Propofol has shown to offer fastest return to baseline cognitive function. The reason I say all this is because I would bet most providers don't take the time to explain these things to patients or take the time to build rapport with their patients.

A psychiatrist that has trouble communicating with other health professionals and controlling the conversation without becoming emotional.........

This thread is about NAPS (nurse administered propofol sedation) not patients bad experiences with having a colonoscopy. You should find another thread on that topic or start your own thread if that is what you want to discuss. Yes, your education/profession is relevant to all discussions if you are claiming to be a health professional. Your posts leave me to believe that you are not a health professional, and more like a lay person that gets most of their health information from the internet. Also, the fact that your not willing to share your educational level/profession in anonymous internet forum gives reasonable doubt that you are health professional.

Care to answer the question about educational level and what you did in psychiatry?

You don't just familiarize yourself with a medication and hope to become proficient in its use for sedation. Do you think the endoscopist became proficient in doing colonoscopies by just doing one or two? There is a reason people in anesthesia spend thousands of hours getting experience doing sedations. I don't think I am mischaracterizing your concerns at all. I am giving you a provider's perspective and you can do with it what you want. It is also interesting to note that many countries do not routinely do sedation/analgesia at all for colonoscopies, because it isn't considered that painful. A lot of what we perceive is based on cultural perception. I have to ask what is/was your profession in psychiatry and level of education? I am a CRNA with a MSN. I don't see where the endoscopist was deceitful. You asked for a pediatric scope to be used, and you got a pediatric scope. You asked for only fentanyl. You got only fentanyl even though you got 3x the starting dose of fentanyl you quoted in the study it was still painful for you. The endoscopist and the nurse tried to convince to use propofol for your sedation you refused and got exactly the sedation done the way you wanted.... I also don't see how the GI clinic violated any patient rights that you quoted also. They could have provided better customer service and been nicer, but again this maybe just a perception issue or they could just be jerks...

I did my Masters research looking at sedation practices for GI procedures. I am sorry your outcome was less than satisfactory, but I see this all the time where patients come in wanting all these things that are out of the normal for that particular place and expect excellent outcomes. These patients set themselves up for failure before the procedure even starts.

i am not sure what kind of health professional (not professinal) you were, but you have some misunderstandings about certain medications and dosages. 1. fentanyl in general is somewhere between 75-100x more potent than morphine, but it isn't given in mg (milligrams) it is given in mcg (micrograms) if they had given you 75mg of fentanyl you would have coded immediately from respiratory depression. 2. there is more than 1 reason to give other medications with the fentanyl. the meds we usually use in combination for sedation work synergistically, and allow us to use each one in lower doses while providing more consistent sedation/analgesia. 3. using a pediatric scope degrades the quality of your colonoscopy by decreasing the view. i don't really understand why someone would want to put themselves through colonoscopy to have poorer than standard imaging that could miss the findings you are getting the colonoscopy for in the first place. 4. demanding that a procedure to be done a certain way that is unfamiliar to the provider and nursing staff is a certain way to expect poor outcomes. a gi doc that isn't familiar with giving only narcotics for gi procedures is going to have a hard time ordering an effective dosing to cover procedure. 5. there isn't a conspiracy among healthcare providers to try to just make more money and move patients through. the recommendation to use propofol with or without versed/fentanyl for gi sedations has been shown in well over 300k cases to be the most beneficial to patients undergoing sedation in the gi suite. propofol sedation provides quicker recovery, quicker return to baseline cognitive function, hemodynamic stability in asa 1-4 patients, better patient satisfaction, and better provider satisfaction. here are some good references (see the bottom of the page): http://www.gastroenterologistnewyork.com/md-cohen-lawrence-physicians-staff-new-york-gastroenterology.php

You need to be careful about going to a civilian CRNA school and then joining the military. There are a lot of civilian schools that won't teach you how to be independent provider or have you become proficient with regional anesthesia (ultrasound and nerve stim guidance techniques). The military nurse anesthesia programs make sure that you are able to function as an independent provider and are proficient in regional anesthesia. Going from new grad CRNA to staff CRNA I had two days orientation in the OR and then within two weeks I was on call as the only CRNA in house covering OB, OR cases, ER etc. not many CRNA schools will teach to do this. The other thing is once you go AD all your time will go towards retirement including your time at AFIT.

These are the AFIT graduate application requirements: B. INFORMATION 1. Academic/Course Completion Requirements: Selects who have not completed specified prerequisite courses must do so and submit proof of completion to HQ AFPC/DPAMN before school assignment orders can be processed. Candidates who are in locations where the required courses are offered may submit their applications and state in the application cover letter their plans, including the name(s) of the college/university they will attend and a specific timetable for completing these courses. Selects that cannot successfully complete the identified prerequisites prior to school start date will be removed from selection lists. 2. GPA Computation: AFPC/DPAMN uses the traditional cumulative undergraduate GPA and computes failing grades and passing make-up grades. Except where indicated in a specialty attachment, candidates must achieve a 3.0 GPA. Master's or doctoral credits will be computed and submitted for board consideration separately from the undergraduate GPA. 3. GRE: Completion of two sections (verbal and quantitative) on the GRE is required for all programs except nurse anesthesia. See the breakdown below Program Minimum Required Score Nursing Practice Specialties 950 Leadership Specialties 1000 for MBA/MSN; 1050 for MHA/Army Baylor 1000 for Master of Public Health (USUHS) Doctorate 1000 for DNP or PhD Completion of all three sections of the GRE with a minimum combined verbal and quantitative score of 1000 and a minimum analytical score of 3.5 is required for nurse anesthesia. Scores must be no older than 5 years (not waiverable) at the time of projected school start date for both, USUHS and AFIT candidates. The Master of Public Health degree at USUHS must be current within 2 years of school start date. Contact your local Base Education Services or Sylvan Learning Center regarding local testing dates and application procedures. Computerized versions of the GRE will provide scores at the conclusion of the test and provide written confirmation within two weeks. Request the GRE testing agency send scores to HQ AFPC/DPAMN, Institution Code Symbol: 6900 (U.S. Air Force Base Health Science). 4. Program Length: Maximum time allowable for master's programs is 24 months with the exception of the Nurse Anesthesia program which is 30 months. Doctoral program may not exceed 36 months. In all cases, selects must complete their degrees in the least amount of time possible. Selects will attend summer sessions, in accordance with current AFIT guidance. If a school does not offer full-time summer sessions, it will not be approved. 5. School Selection: The AFIT program manager will propose to the selects several schools that offer the desired major, ensure they can complete the degree requirements within the funding allotted, as well as meet several other criteria. AFIT will attempt to place students in a school within their state of legal residence or base of assignment in order to receive in-state tuition rates, or in a school that grants in-state tuition rates to military members. Placement is based on numerous factors, and candidates must realize AFIT will make the final decision regarding school placement. 6. Waivers: Waivers for this DESB will not be considered for medical qualifications. Waivers for undergraduate GPA & GRE scores will be considered on an individual basis for all programs except the doctoral programs. However, generally dual waivers will not be granted, exceptions will be considered on a case by case basis 7. State License Requirements: Some schools may require nurses to obtain a registered nurse license in that state prior to school start date in order to participate in the program's clinical requirements. This is a non-reimbursable expense. 8. Degree-Completion Requirements: The Nurse Corps expects selects to complete all requirements for award of the degree prior to leaving their residence program. 9. Prior Air Force-Sponsored Educational Assignments: In accordance with student eligibility criteria outlined in ECTA, applicants with a previous PCS educational assignment, to include residence PME, must have completed at least 36 months of intervening service by the date of anticipated class entry. 10. Candidates currently on orders cannot apply to the developmental education selection board. 11. Life Support Course Requirement: All candidates must be current in BLS. See specific degree program for other advanced life support requirements. Include dates in the education summary. All selects must report to their university with current BLS registration issued within six months of projected school start date. 12. National Certification: National certification in the candidate's current or related nursing specialty is highly desirable. The member's AFSC must reflect the 'M' prefix to qualify as national certification.

?????? I am talking about AFIT, and having the AF send you to graduate nursing school. What are you talking about?

GRE is required for all AFIT graduate nursing applications.

You can get out of OB, but it usually requires a lot of initiative on the OB nurses part. Don't expect your supervisor or even the Chief Nurse to go out of their way to help you. To get out of OB you will most likely have to cross train through the yearly AFIT call into one of the short AFIT nursing speciality programs (critical care or OR), go into advanced practice nursing, and/or pick up your 46N on your own time by either working part-time downtown or off-days on Med-surg/Clinics at your hospital. We have two OB nurses that are or have transfered out of OB recently. One went to Med-Surg and the other is going to OR training.