Gottago

You don't have to become a RN to circulate or first assist. You could become a scrub, or surgical technician, and have the option of scrubbing, circulating, or even becoming a surgical first assist. If you are in a RN program, then you may want to complete the program. There are options. Surgical technicians are not strictly limited to scrubbing.

Worked OR and PACU. Understand your bad image as glorified go-fear, and sometimes it is that, but there is often much more needing to be done, particularly in terms of setup that is not seen nor known by nurses who have not worked in the OR. I sometimes compare it to being a stage manager trying to gather all participants on the stage, and ensuring they have what is needed to be successful in their roles, along with the equipment, drugs, prep, drains (such as Foley,chest tube,etc.), and, if your facility still has one foot in the Stone Age, tons of paperwork, the OR nurse needs to fulfill their own duties. It's a team effort, but as an OR nurse, your focus is not strictly on performing your own duties to provide care for your patient, but also being aware of what your other team members need to provide care in terms of their role. It can be a huge juggling act with many needs needing to be met at once (then you feel like a short order cook being bombarded with several orders at one time from several different people). When giving report to the PACU nurse, particularly in terms of vitals and meds given to maintain blood pressure,etc., the OR nurse is not the person to ask. I've had many PACU or ICU nurses ask why I did not know this information; or, what was the patient's heart rhythm, etc. Then have to explain, why those questions are best answered by anesthesia, and only have the eye roll, exasperated sigh, or more contemptuous response as a result. Working PACU, for me, often is less stressful, UNLESS, as in any department, the patient starts crapping out. When I make the point of less stressful, I am meaning, my focus as a PACU nurse can be more concentrated, and I can give more undivided attention to my patient. We all have our role to play, and every job can have its good and bad.

CRNA programs not requiring ICU/Critical Care...??? List them.

Started the investigation, but welcome others to do the same. Here is a copy of my request which I just submitted to NPR: I am looking for a copy of an interview Terry Gross did with a female scientist who was in charge of making the flu vaccine. This interview occurred in the 1990's. I think 1994, but could be earlier or later, but definitely 1990's. I know it was after 1992. I believe it would have been in the fall, perhaps October, since that's when the topic of the upcoming flu season discussions often start. Thank you for your time and attention regarding this matter. P. S. Your questionnaire below asks the time of day I heard the interview. I recall it being heard in the afternoon. I think between 3pm-4pm, since I believe that was the time slot for the Fresh Air radio show with Terry Gross.

I have looked also on their website, but it doesn't seem to have shows from that far back, which is not surprising since the Internet was not as developed then as today. I have often thought of writing NPR to see if they have copies of past shows. I know I received a copy (transcript) from the NPR radio show, Marketplace, back in the 1990's regarding the future of nursing, but that request was made shortly after hearing that segment. Anyway, don't just take my word, if you are interested, it may be possible to get a copy of the Terry Gross interview via emailing NPR.

Heard an interview back in 1990's, probably 1994, on the NPR radio show, Fresh Air with Terry Gross. She was interviewing the scientist from the CDC who was in charge of making the flu vaccine. Interview was insightful. CDC explained how the flu vaccine is manufactured, statistical data, etc. But, before concluding the interview, Terry Gross said, I just have one more question...will you (CDC scientist-wish I remembered her name) be taking the flu shot this year? CDC scientist replied, "No, I will not." Then Terry Gross (who seemed as surprised as I) said, Well I wish we had more time, but we don't. Then the show concluded with Terry Gross thanking her guest scientist from the CDC for coming on the show. Now, if the scientist in charge of making the flu vaccine said she would not take the flu vaccine, then why should I? Please provide a reasonable answer to that question.

Yep, Rose Queen is correct. Lots of good points.

"Whenever propofol is used for sedation/anesthesia, it should be administered only by persons trained in the administration of general anesthesia, who are NOT SIMULTANEOUSLY INVOLVED in these surgical or diagnostic procedures...failure to follow these recommendations could put patients at increased risk of significant injury or death." This was a joint statement released by AANA and ASA, and is consistent with the drug package insert. My question comes down to this: who administers propofol, when it is given, during endoscopic procedures at your facility? Is it the doctor, who is simultaneously involved in the endoscopic procedure, or another healthcare provider?

Thank you.

What's the most propofol you have seen administered during an endoscopic procedure? Not wanting to discuss who administered the dose: doctor, CRNA, nurse, etc. Discussion of average dose for various endoscopic procedures are certainly welcome, but more interested in maximum dosage you have seen administered? I realize this is a frequently discussed topic, and have researched on this site and others, so please no redirect comments regarding another search, thank you. Just sincerely exploring this question amongst other professionals and their experiences. I will add, based on information I have read, and discussions I have had, the dosing of propofol within the endoscopic setting is very controversial, and there seems to be a need for more clearly written standards. Thank you for your responses.

Thank you for your response. I should have not termed the sedation as moderate sedation, but rather MAC, since I do forget CRNAs don't provide moderate sedation (think I read due to insurance reimbursement). I did read an article in Gastrointestinal Endoscopy by L.B.Cohen wherein the cited dose range was 30-250mg for colonoscopy and 10-190mg for EGD. My concern is not NAPS, since regarding this matter, it is not NAPS. While CRNAs may not be limited by exact dosages, I suppose my question should focus more so on when, as a CRNA, do you believe the dosing of propofol goes from MAC to general anesthesia? For example, if you administered 200mg propofol IVP bolus, would you prepare for intubation? Or, perhaps a more exaggerated value of 600mg IVP bolus of propofol? If 600mg of propofol IVP bolus were administered, what would be your thoughts as an anesthesia provider? Again, thank you for your thoughts.

I have never read a standard regarding maximum dosage of propofol for moderate sedation. I've read mean dosages, and policies regarding such average dosages, specifically for endoscopic procedures, but I have never read anything regarding a max dose of propofol for endoscopic procedures requiring moderate sedation. What would you consider to be too much propofol for an endoscopic procedure calling for moderate sedation only? Not deep sedation nor general anesthesia. Or, posing the question another way, what's the most propofol you have given for a moderate sedation procedure such as endoscopy?

While a patient is in the OR, and the patient becomes a code blue, who pushes IV meds in your facility, CRNA or Circulator?

When a suture or instrument has been lost (cannot be accounted for after the final count), who is responsible, scrub or circulator (the focus of this question is solely based upon a lost item, not an incorrect count when someone forgot to add an item to the count sheet)? Assuming the circulator is the nurse in the OR, I've read and heard the argument that the circulator is to blame since the circulator/nurse is ultimately in charge of the OR room. I've always made the argument if a suture (vessel loop,etc.) or instrument is lost during the case, then the blame should be upon the person who physically controlled the item. Common sense: you touch it...you control it..., then it's your responsibility to maintain control of the item. I've never accepted the argument that the circulator is ultimately responsible for the item simply because the circulator is the nurse in the OR (this argument excludes CRNA's, of course since they do not account for surgical instruments, sutures, etc.). I often get the impression that scrubs believe lost items are not their responsibility, which I believe defies common sense. There have been times when a circulator drops sutures onto the sterile field; the sutures are properly counted by both scrub and circulator ("I dropped 8 sutures"..."Yes, there are 8 sutures dropped on the sterile field"; circulator then must leave the OR (for example to get another instrument); circulator returns to the OR to hear the scrub say, "I dropped a needle, and I can't find it"; then, circulator is faulted for not maintaining the OR. I have never agreed with this "logic" and never will. I realize this thread is subject to disagreement, but I think it is worthy of serious discussion. I will also add, I have heard scrubs say, "It's not my license that's on the line." This attitude, I believe, is counter to patient safety, which is the ultimate guiding factor. The intent of this thread is not to cause dissension, but to further discussion for a better OR.

Thanks for the clarification. I've done some more reading, and it looks like you were interested in some of the same questions awhile back...such as OR opportunities, first assist, etc., if you don't mind me asking...did you join the service as an OR nurse? If so, then how has your experience been? Anything you came across that you either didn't expect, never thought you'd encounter, or perhaps, didn't realize would turn out the way it did? I know these are broad questions, but I'm just trying to get an understanding of life in the military as an OR nurse. Also, if you have worked as an OR nurse in the military, then how is the working relationship with doctors and scrubs?