TheLemur

What's a CNRA?

Vegas.

Emerald, First of all, you might not want to use the term MDA. On one hand, everyone knows who you are referring to when you use it, so it is an effective abbreviation for a long title. On the other, 1) they don't like it (due to historicial and political reasons that I'm not clear on) and 2) it's not accurate, as quite a few of them are graduates of osteopathic medical schools, or DO's. Similarly, as I have found, CRNA's don't want to be called "anesthesia nurses". So I don't. To answer your question, it depends on the program. 4 years; the first is a general medical internship (?), followed by 3 clinical years, CA-1, CA-2, and CA-3. With each passing year comes increasing responsibility and independence. They cycle through rotations, such as CT, neuro, OB, etc. Didactic instruction is interspersed throughout; less structure than CRNA school, more independent reading is expected than actual classroom work. Remember, residency is a JOB, and these guys are paid a liveable but not hefty salary to train and learn all they can before their board exam to become certified anesthesiologists, which contains an interview/oral component. I am currently in clinical at a teaching facility that trains 6-10 anesthesia residents per class. The residents function more or less the same as CRNA's; they are present for the entire case with an attending "covering", whatever that means (always present for induction, usually present for extubation, and always "available"). Residents do just about all of the neuraxial and regional anesthesia for the entire hospital; this is usually during a "block" rotation. They work 6-5+, 5 days a week, with periodic night and weekend call. Plus a fair amout of research is expected/required. I'm sure it's tough, but they are rewarded accordingly when it's done. Check out a teaching hospital's website for more specific info. Maybe someone can elaborate on what I've mentioned. It would be nice if some anesthesiologists posted more frequently, but this has been known to be a hostile environment.

Euthanasia? By not intervening? Maybe negiligent, but it probably wouldn't hold up, in that situation. Certainly not euthanizing, though.

My thoughts: This lady is no longer "obese", with a BMI Maintenance fluid requirements are approximately 135cc's/hr (weight in kilo's +40), and you want to replace the deficit sooner rather than later (1/2 first hour, 1/2 second hr or whichever method you prefer). Obligatory loss for your case was probably high; I'm thinking an additional 8-10ml/kg/hr, or almost a litre an hour. Replace blood and urine loss appropriately. But I realize that the above is more guideline than reality. How much colloid vs crystalloid? For a case that long, I would want to keep what I'm giving her in the intravascular space, so hextend (up to 1.5L) or plasmanate would be prudent for at least some of the volume. I did an abdominoplasty several weeks back, and I remember being in t-berg for most of the case, so pulmonary edema is a concern. More reason to not use crsytalloid only. How much of which, and at what point do you want to check labs for electrolyte imbalances / hemodilution? And how do you manage this along with the hemodynamic status of the patient? This is the "art" stuff that I'm still getting a sense for. And I'm sure I'm not including some important details. Thanks for the learning opportunity.

Good post. Still, this thread is a real loser that barely deserved such a well-written and thought out statement. What are the OP's intentions, anyway? I have heard a veteran CRNA, former prez of the AANA, probably as "militant" as they come, say that we need the doc's, and they need us. If that's how she feels, then it's good enough for me. At no point, as far as I can tell, has it been the goal of organized nurse anesthetists to push MD's out of the practice of anesthesia. A more accurate description is that nurse anesthetists have fought to prevent THEM from pushing US out of practice. It's a real bummer to me that there is such political animosity between the two professions. Political maneuvering by the AANA to block resident training (or the reimbursement thereof, or whatever) is not going to help it either. It's too bad that the mistrust goes that deep that the AANA feels it necessary to use such tactics, but I don't know the whole story. The cycle continues. It has been a relief to see CRNA and anesthesiologists working together so well at my clinical site. If there is tension there, it's not out in the open. When it comes down to it, final decision rests with the MD. Got a problem with that? Don't work in an ACT. But I've found that the attending's judgement is overwhelmingly reasoned and informed by experience and literature that exceeds most of the CRNA's. And if not, the CRNA's are in position to question it without hesitation. One may get the impression on these forums that the professions will never get along. Maybe they won't; certainly not when financial interests trump fairness. But from what I can tell, this BS is peripheral to good patient care, which comes from doctors AND nurses, and especially when working together.

One advantage to soft bite blocks is that they sponge up oral secretions. And I agree that it has never made much sense to me to be told to insert a bite block of either variety at the beginning of the case; if your patient is biting during surgery, you have a problem with your anesthetic as opposed to a lack of things stuffed in the oral cavity. I've been putting mine in at the end of the case, usually when I d/c the OG tube and/or eso thermometer.

A glut is an excess, not a shortage. :angryfire

https://allnurses.com/forums/f227/first-job-crna-144047.html

I would respond to this by saying that coffee the temperature of the sun would exist in gas or plasma form and would not be tolerated by anyone .....not for long anyway.

Where did that come from? jwk is a consistent and positive contributor. Other types of anesthesia providers posting makes this place less insular. By the way, you didn't refute what Tenesma said. Or was "jerk" your best response.

MmacFN, you're not getting anywhere NEAR my dog.

So what is the fair monetary price for incapacitating injury or death? Is there an actual dollar value to these things? I've merely scanned this thread as I have little interest in legalese, but I believe that it has already been stated that most of these B.S. lawsuits are settled, meaning, unless I am totally mistaken: NO JURY. Just a slightly richer plaintiff, a much poorer and embarassed defendent, and a lawyer laughing all the way to the bank.

Golf boy, I was once pre-dent as well. BS biology, 2.9 gpa, DAT score 18. (and the DAT, folks, is essentially the SAME as the MCAT, minus physics, plus "perceptual ability" portion). I did not get in dental school (see above gpa). Nursing was my backup plan; sorry people, that's just what it was. So, after choosing to get a second degree in nursing, nurse anesthesia entered the picture, and I haven't looked back since. I did significantly better in nursing school, thanks to a renewed dedication to hit the books, slaughtered the GRE, and worked as an RN in a high-volume CTICU for 1.5 years after a year in the step-down to the same. I think this last part is what differentiates CRNA school from most any other professional program: the requirement that you work/learn in one of the toughest environments imaginable, and do so well enough to get highly favorable recommendations from managers/phsyicians/co-workers etc. You know what? Not getting into dental school was the best thing that could have happened, b/c diagnosing and treating disorders of the teeth just isn't that interesting to me anymore, compared to what I'm learning in anesthesia school. You should shadow a CRNA, obviously. You might discover that you've just got to be an orthopedic surgeon while you're at it, and if so, great. Don't let others influence this decision you've got to make, cause, let's be honest, it gets harder and harder to change directions the older you get. One thing I will say is that if you don't get into dental school first try, it's probably easier to give it another go or two b/c the road to CRNA would still be >5years at that point.

Wow. Thanks a lot. I know I will be fine, but I can't help having some anxiety before the real learning begins. Hopefully my instructors will share your attitude.... One thing I will be sure to do is to thank the CRNAs and anesthesiologists who participate in my education repeatedly. They don't have to do it. My biggest concerns at this point are: 1)all of the outside time requirement that care plans will consume 2)easing patients' anxiety when I'm so nervous myself and 3)the dreaded morning that I oversleep (please please don't let this happen, I keep telling myself). Thanks again.

Come on, people. Anesthetist (n): one who specializes in the administration of anesthetics. So, looks like they are anesthetists. That's an emotional stab at AAs, not a reasoned one. This thread, and the larger issue, certainly carries an emotional element. It reminds me of the anesthesiologist/nurse anesthetist threads. No surprise, since we all want to defend our career choices and sacrifices. The pattern seems to be: Anesthesiologists are threatened by CRNAs. CRNAs are threatened by AAs. AAs are thwarted by CRNAs, but have increasingly strong backing by MDs. I don't know if the AANA has always played fair in its lobbying efforts against AAs ("fair" is a murky term in American politics), but it is clear that there is more to it than merely "suppressing the competition". Let's not deny that many anesthesiologists would prefer AAs merely because you pose less threat to their economic well-being. And so-on. I don't really have a problem competing with AAs for jobs in anesthesia care team settings, so long as the better anesthetist gets the job. I would like to think that my clinical experience as an ICU RN would give me an edge (it should, all other things being equal, and yes, I took all the pre-reqs mentioned). However, it appears as though politics and money might influence that hiring decision in the future, and not in my favor. That's why I will support the AANA. It's nothing personal, AAs. Excellent anesthesia care doesn't depend on titles. All the patient safety rhetoric, while of utmost importance, seems (to me) to be peripheral to all of these sad practitioner ninja swordfights.

JWK is an Anesthesiologist Assistant who is well-respected around here for his clinical knowledge and opinions on all things anesthesia-related, despite the differences the two professions may have. At least, I think so.

Thanks for the responses, guys.

Hi all, I'd like to hear (read) some opinions on what to look for in a first job fresh out of CRNA school. I just started my program, no clinicals yet, but it can't be too early to start thinking ahead. There are various stipend possiblities to complicate it, but I'm not prepared to sign anything yet, and my financial situation does not make it imperative to do so at this point. So what kind of facility should I shoot for? Big teaching hospital with a residency or not? Medium-size hospital where CRNAs do more but without the sickest patients? Rural hospital? Anesthesia care team, yes or no? I've ruled out outpatient kind of stuff; do many new grads go into this anyway? Let's assume one could get a job anywhere and location is not a factor. What's the BEST situation for a new grad? Appreciatively, An Arboreal Primate Native to Madagascar.

OK, I m no beer snob, pretty much anything will do, Guiness or Sierra Nevada Pale Ale or PBR or a good red are favored, but BUD ICE LITE, nitecap? This stuff's still around? Favorite inhaled agent: don't know, haven't tried any, but I suspect desflurane.......in the sevo vaporizer.

Oh yeah, and drink lots of beer, too. Last chance for awhile. Drink it while reading that book. I did.

I agree with the above posts, particularly the financial aid business. I'll tell you what I did, however. I got the Morgan/Mikael/Murray text, Clinical Anesthesiology, which is one of the most universally praised books around for its clarity, ease, and comprehensivenessity(?). All SRNAs, residents, etc. use it and love it (well, the ones I know). Freshen up on the drugs you use in the ICU, review basic phys such as respiratory and renal, and glance over acid/base balance chapters. Lots of stuff you probably already know, but with an anesthesia slant. Ignore the fact that it makes no mention of nurse anesthesia anywhere. It's a great book, you can get the third edition (2002) for really cheap on amazon. Not to imply that you really need to do this. But I found it to be good introductory "fun" reading. Nerd? Maybe.

Hey, that website IS kewl! Thanks Arnie, RN, RT. Does anyone have a compilation of educational websites such as this one and the virtual anesthesia machine? I would like to see more stuff like this, you know, for lirnin.

Appears as though I struck a nerve. So do you refute the statement? MDA's are NOT more extensively trained? Anyway, it was beside the point I was making, probably should have left it out. I don't mean to offend. Look, I haven't been an SRNA a day yet, and there's no guarantee until I take the last board question that I will make it to CRNA status. So let me qualify my perspective by acknowledging that. I am ignorant of much of these issues. I'd rather discuss clinincal topics, but it's a little premature for me until class/clinicals start. Just looking for CRNA input on a particular debate that I had only seen over "there". Thanks for the responses.

Thanks for your perspective, heartICU. And let me add that it is incredibly embarassing to end one's very first post by "envoking" the First Amendment.