Regionals after graduation

TraumaNurse · Jan 9, 2005

I think that is what you will find anywhere there is an Anesthesia Care Team (ACT) set-up. Unless you are willing to move to a more rural area, that is what you will be faced with in a lot of places. I will get a lot of regional experience while in school, but in reality, the CRNAs do very few (except OB epidurals at night and on weekends! You know CRNAs are smarter and more skilled after 3pm and on weekends!! :chuckle ) At our hospital, the Ologists will place the peripheral blocks, spinals and thoracic epidurals. In the heart rooms, the Ologist will place the central line and swan (most times). The CRNAs do little or no peripheral blocks or neuraxial blocks outside of OB. They do place a lot of the A-lines. That said, our CRNAs are given plenty or room to practice as they see fit. The Ologists do not try to control their practice, they show up for their billing requirements and if they are needed, otherwise the CRNAs are autonomous.

For me, since I do not want to move my family any more, I will just have to accept the fact that the experiences I get doing a lot of the regional techniques while in school, will be about all I will likely see. I have two choices, accept it, or move to a place where I have a broader scope of practice. NJ is a very pro-MD state and CRNA practice tends to be fairly limited. As I said, in any ACT environment, I think you will find that CRNAs do very few regional anesthetics.

deepz · Jan 10, 2005

...... in any ACT environment, I think you will find that CRNAs do very few regional anesthetics.

Whoa! A bit of an over-generalization there. Out in the big wide world, who does what is entirely a local matter, determined by local politics and local interpersonal dynamics. Many ACT setups give wide latitude to all providers.

deepz

TraumaNurse · Jan 10, 2005

Yes, I'm sorry, that was a bit of an over-generalization. Just speaking from my limited experience and what I have heard from others.

BigDave · Jan 10, 2005

gaasgurl,

If the hospital that you are referring to is the one we discussed recently, that makes sense. I am told that I will have to go to Ashville/Boone/elsewhere to get my regional experience once I get to it--reason local (Charlotte) political environment. I don't mind the traveling, so it is no big deal while in school. But I'm not sure how much stuff CRNAs get to perform in the Queen City. There sure is a lot of CRNA job openings at CHS though. They are the ones that had a stipend deal in my acceptance letter.

pinayrn95 · Jan 10, 2005

I just found out that at the hospital that offered me a stipend, the CRNA's really never do regionals or lines other than a-lines and peripheral nerve blocks for outpatient cases. Upon a few more calls, CRNA's (or so I was told) in North Carolina rarely do lines and regionals at any of the larger institutions. The MD's apparantly prefer to do these. It seems a shame that after I learn these skills, I will not be able to hone them and perfect them. Is it related to liability or politics? I really do not want to move to the boonies just to do them. In which southeastern states do CRNA's routinely do these? Should I make it a professional goal to try and change practice/minds? Or, is this ill adviseable. It seems backward that North Carolina has 5 CRNA schools, all of which teach regionals and line placement, and yet the physicians do not promote the usage of these skills. If anyone has experience or insight to the above issues, please respond. I might be putting the cart before the horse because I haven't started school yet (I may not even like to do them). But being that I am looking into stipends, I am interviewing potential employers after graduation. I want the best experience.
Thanks, Gaasgurl

not quite sure. but be prepared to put chest tube for complications

jwk · Jan 10, 2005

Whoa! A bit of an over-generalization there. Out in the big wide world, who does what is entirely a local matter, determined by local politics and local interpersonal dynamics. Many ACT setups give wide latitude to all providers.
deepz

OMG, deepz, we agree again.

It doesn't depend on the state, or even rural vs urban. It's entirely up to the individual practice/hospital as to what privileges and clinical practices they will allow their anesthetists to do. While my particular practice in Atlanta does not allow anesthetists to perform regionals or central lines, the practice right across the street allows them to place CVP's and swans, and the practice at which I do some PRN work as well as other practices in Atlanta allow their anesthetists to do both. All of them are ACT practices.

I just found out that at the hospital that offered me a stipend, the CRNA's really never do regionals or lines other than a-lines and peripheral nerve blocks for outpatient cases.

This is something both new grads and experienced anesthetists who are changing practices need to consider when job-hunting. In addition to the usual salary and benefits discussions, get a very clear idea of the clinical situation at a practice. Almost every job involves a trade-off of some sort - there are very few perfect jobs out there. And if you're going the stipend-during-school, early tuition reimbursement, or signing bonus, particularly if it involves a contractual time obligation, it's especially important to determine all these things before signing on the dotted line.

jwk · Jan 10, 2005

not quite sure. but be prepared to put chest tube for complications

You must see a WHOLE lot of complications from central lines, since this is not your first post about the potential for chest tubes and pneumothoraces.

Let's remember that WHERE you place a central line is a large factor in the complication rate. I have placed close to 1000 central lines, including single, multi-lumen, and PA catheters. 99% of those have been through an IJ. I have had exactly zero pneumos, only a handful of patients where I put anything larger than a finder needle in the carotid, and no incidents of a placing a dilator or sheath in a carotid.

And of course never say never, right? Because I have had one pneumo - it happened with one of the perhaps 10-12 subclavians I've had occasion to put in. The line was placed successfully, used it for the whole case (big trauma) and only found out about the pneumo from the post-op chest film.

Trauma Tom · Jan 10, 2005

JWK,

I am presently in CRNA school in Alabama. I have plans on practicing in Atlanta when I finish school. I am from Atlanta and I am curious if you would mind sharing which hospitals that you are familiar with that allow their anesthetists, whether AA or CRNA, to place central lines as well as do their own regionals. Feel free to PM me. Thanks

Trauma Tom

OMG, deepz, we agree again.
It doesn't depend on the state, or even rural vs urban. It's entirely up to the individual practice/hospital as to what privileges and clinical practices they will allow their anesthetists to do. While my particular practice in Atlanta does not allow anesthetists to perform regionals or central lines, the practice right across the street allows them to place CVP's and swans, and the practice at which I do some PRN work as well as other practices in Atlanta allow their anesthetists to do both. All of them are ACT practices.
This is something both new grads and experienced anesthetists who are changing practices need to consider when job-hunting. In addition to the usual salary and benefits discussions, get a very clear idea of the clinical situation at a practice. Almost every job involves a trade-off of some sort - there are very few perfect jobs out there. And if you're going the stipend-during-school, early tuition reimbursement, or signing bonus, particularly if it involves a contractual time obligation, it's especially important to determine all these things before signing on the dotted line.