Say it's not so

[yoga crna]

Calling all anesthesia students. There is currently a discussion on Old-Gas. regarding the attitude of senior students and new grads. One of the posters said that a new grad was wanting a 4-6 month orientation. Others do not want to take call, do not want the major cases, and spend a good deal of their clinical time complaining.

What is going on? Other than "senioritis" that happens to most anesthesia students, if this is a prevalent attitude, I have grave concerns about our educational process.

Only AANA members, including student members can post on Old-Gas, but I hope if you have time, you will read what is being said. I dearly want to support our students, but would have a hard time, if this is a common attitude.

Yoga CRNA

[smiling_ru]

I think that there is always someone who can tell me what I need to know. I can get the layout of a hospital in a couple of days. This floor that room is the same all over the country.

I don't think I interviewed anywhere prior to graduation that had an extended orientation. I believe the standard is between 3 days and 1 week.

In a perferct world it would be easier if the orientation were longer, but I don't neccesarily think it would be safer.

[Qwiigley, BSN, MSN, DNP, RN, CRNA]

I only plan on having a couple of days to get to know the procedures for this particular hospital. But I have accepted an offer (yes, I graduate in Aug, accepted in Dec the position) that will provide me with access to help as needed. I want to be left alone more. I learn better and faster. I will always keep the patient safe first and keep my pride on the back burner. So a fine tuned balance should encourage learning and safety.

[sweetdreams]

Yoga,

I'm in my first semester of SRNA clinicals and have read the posts on OGP, finding an strong underlying "Back in the Day" theme to it all. The idea that you take the cream of ICU RNs, put them through the academic wringer for 2-3 years and produce practitioners that are incompetent and lazy seems ludicrous. If this were actually the case I'm sure the ASA would have picked up on it by now.

I believe there is probably another side to this story. Maybe it's a lack of teamwork or support shown for recent grads by their more experienced peers that drives these new grads to look for the door at quitting time. Nothing will crush team spirit quicker than having some more equal than others.

Or perhaps in light of the current CRNA shortage, these people were promised hard and fast X number of hours per day. If not, it seems that this problem behavior could be easily remedied by administration.

I don't know what the average orientation time is or should be; 4 to six months does sound like extreme overkill. I think though, that if I were an employer I would rather have a new grad come in and ask for an extended orientation, maybe showing an honest self assessment of skills, a serious respect for the responsibility of the job, and a concern for quality patient care, rather than one who comes in wanting no orientation. It seems that it would be fairly easy for the employer on OGP to visit with one of the interviewee's clinical preceptors for hopefully, an objective assessment of skills.

[NCgirl]

So now I'm curious and really starting to wonder about all this. And I must say that I love this conversation, b/c it reminds me that I will one day be a CRNA, not just a SRNA. I thought four weeks was a good orientation. Scratch the first week, that's all hospital BS. So, you're left with three weeks. Let's just assume one is doing 12 hour shifts. That brings us to 9 total shifts for orientation to a gigantic hospital's anesthesia department. So, here's a logical breakdown of those 9 shifts. 2 days in main OR, 1 day in heart tower, 2 days in L&D, 4 days for all the places you'll be sent for out of department cases (which is probably around ten areas). To all the practicing CRNA's (especially Yoga), do you think that's too much? Is that simply babying a new grad? Or should I truly just expect to walk into a new place right out of graduation, and pick it up on my own? My program says we should be able to walk into any OR in the country and be able to give any type anesthesia. I still have 5 semesters left in school, so I'm not really clued in yet to what the practicing anesthesia community expects.

[athomas91]

right now....i look at it and say yeah, yeah, 9 days of orientation...

but once we are more comfortable in the OR and w/ our own anesthesia practice...it may be too much...

i am the type of person who just says "show me where it's at..." and i get to work....

i agree you need to know where everything is...so i guess it just depends on setting and size of the facility.

[deepz]

Originally posted by sweetdreams

....read the posts on OGP, finding an strong underlying "Back in the Day" theme to it all. The idea that you take the cream of ICU RNs, put them through the academic wringer for 2-3 years and produce practitioners that are incompetent and lazy seems ludicrous. .........

This quote from OGP seems more to the point:

"[to Xxxx] I do not wrap all new grads into the same category, and I don't feel

that [xxx] or the others do as well. What we are talking about seems to be a

general attitude that the younger generation possesses. This is the same

attitude I see with the younger MDAs I work with as well. [xxx] said it best,

these

people come into the profession with a sense of entitlement! Obviously, you

came into the profession with a sense of professionalism, which is apparent by

your post, involvement, and work ethic. As one of my collegues states, a lot of this younger generation is suffering from poor parenting!

Sorry if I offended."

'Nuff said?

deepz

[yoga crna]

Hi guys,

First let me give the address for Old-Gas.

. I think Brenna asked for it.

I have been very busy these last two days and haven't had a chance to get on the computer.

What I want to see of new grads is someone who has had enough experience in anesthesia that they are confident enough to handle routine clinical situations. They should be able to do pediatric cases, OB, c-sections and epidurals, trauma, as well as manage sedation cases. Also, they must know how to set-up, clean-up and trouble-shoot equipment. I haven't seen an anesthesia aid for 20 years. Also, I want those who can work long days and cases without a break, without complaining and without going to sleep or getting bored.

You also need to understand that administering anesthesia is a daily learning experience that involves researching medications, changes in surgery and updates on pathophysiology.

To give you an example, yesteday I had a very difficult nasal intubation. I was not able to visualize anything, but got the tube in with some assistance with the surgeon and circulating nurse. Then in the middle of the case, the alarm went off on the anesthesia machine--an alarm I never heard before. I had to quickly trouble shoot and fix the problem, while grabbing the ambu bag so the patient would be ventilated. All in a day's work.

YogaCRNA

[jdpete]

I still bet that you dont get 8 weeks, I have never heard of that much no matter where you go. You know what to do, and you still are primarily in the OR, not out and about. When you do go elsewhere, you will need help no matter if you are on orientation or not. The biggest thing I felt was the nervousness of being primarily by myself, which leaves pretty quick, much quicker than I thought. Also, waking people up---It takes a while for you to do this completely by yourself, because I couldn't get a feel for it in school. Some CRNA's had you turn gas off early, some after last stitch, some had people snowed, some were wide awake, etc. You really get a good feel for it by yourself the first few weeks,,some buck, some lie there for 15 min---but you learn your style quick. You know how to do the job. Anesthesia is anesthesia, no matter how big or how small your hospital is. I worked in a large level 1 trauma hospital that was easier in ways than a couple of small rural ones I work at because you didn't do any epidurals or regionals. One month after graduation I was taking call, doing epidurals by myself, and was the only anesthesia provider in the hospital. I had little epidural experience (maybe 5) in school and my orientation was show one, do one, and teach one (if you know what I mean) We also were showed one subclavian central line, and we do all of them in the hospital---surgeons consult CRNA's-------I bought a good anatomy picture book real quick----- In RN school, they dont have you prepared at all for what the "real world" is. If they did, hell I would have probably quit before graduation. Most CRNA's can leave school one day, and work the next. (Because most have to do just that)---your hospital must be very well staffed, haha.

P.S---I just saw where you have 5 semesters left,,,no wonder you think you need 4-8 weeks-- haha-----Trust me, you will do fine--You will be prepared when you graduate----

[NCgirl]

Thanks so much for the encouragement jdpete!!! All of my instructors and CRNA's I work under say that I'll be ready for ANYTHING when I graduate. But the way things stand right now, I have my first test on inhalation agents tomorrow, and seeming competent to put anyone to sleep seems a million years away, lol. It's hard to see the big picture and imagine just how much I'll know two years from now, but the encouragement from this board helps. Maybe when I graduate (Dec 2005!!!!!), I'll come back and post on this same topic. I'll be curious to see how my opinion changes.

[yoga crna]

I am encouraged by all of your replies. It sounds like you are all working hard and are getting good preparation for your career in anesthesia. Just keep up the good work and get as much clinical experience as you can. Don't forget to get a little fun and relaxation, too. Balance is important.

Yoga CRNA