I don't know if I've posted this topic before, but I'll ask again.
Are there any D.C. CRNAS on this board? Does D.C. use CRNAs heavily or do they rely on other anesthesia providers?
I'm asking these questions because gaswork.com, and other CRNA job sites, really don't have any openings in D.C.
After graduation, I would like to move out of Wisconsin (maybe to Texas, or Tennessee, but D.C. also seems to be like an interesting place).
If there are any nurse anesthetists on this board practicing in D.C. could you just describe your work experience: do you feel like you are supported and well respected? how does your salary compare to CRNAs in other states/regions? is there a large market for CRNAs in D.C.? etc.
Nurses bashing nurses is NOT BY ANY MEANS what this forum should foster. Regardless what the arrogant docs and AAs post here, nurse-bashing by anyone has NO place on this CRNA BB.
Get over your own self, CNM.
deepz
Not every doc or AA is arrogant. You should re-read some of your own posts.
As you might imagine, I absolutely LOVE CNM's comments.
Not every doc or AA is arrogant. You should re-read some of your own posts.
As you might imagine, I absolutely LOVE CNM's comments.
That you would LOVE nurse-bashing comments, jrk, fails to surprise me. Judging by the cohort you and GAGAA have recruited to pervert this CRNA BB, nurse-bashing seems to be an Olympic sport down there in that anomalous A$Ahole bastion called Atlanta.
Did I say every doc or AA was arrogant? No, I did not. You counter a point never advanced. Previously, as you may recall, I pledged not to deal harshly with you, and I stand by that. You're a plenty smart fella, you just have these blind spots. You obviously cain't hepp it. So I will address the balance of these remarks to the larger group.
Kiddos, the Sunday sermon for this evening is on Boredom, Arrogance, and Subtlety: how that trio impact Clinical Anesthesia in America and, in this man's view, open a broad Philosophical Divide between physician anesthesiologists and Certified Registered Nurse Anesthetists, to the detriment of quality patient care.
Here we have a fictional young anesthesiologist -- let's call him Dr Ouija. Dr Ouija has a problem. Dr Ouija is bored. Bored to death. He finds clinical anesthesia utterly stultifying, maddingly dull, hour after hour after boring hour, sitting on that stool at the head of the table. He often wishes he had made the match for a pathology residency; then he wouldn't be so bored. But someone, alas, graduates at the bottom of every class in medical school, and we still call them all Doctor. Dr Ouija has really never liked people all that much, and he would have preferred working with dead bodies. But he didn't make the cut. So sleeping bodies instead, that's close enough. Dr Ouija has a Crackberry PDA which keeps him entertained during cases. And a laptop computer with games and WIFI. And an iPod. He also has a hairpiece that looks as if a possum chose his head as its final resting place. Paid a small fortune for it. He'd like to pay someone to do the clinical anesthesia for him, it's so boring. He skips out of the room now and then, while his patient is on the ventilator, to use the phone down the hall.
First day of his residency, Dr Ouija spent an inordinate amount of time fixing his hairpiece under the surgical cap they gave him. When he stepped out into the O.R. hallway, his chief resident handed him a surgical mask to put on, a syringe of 20cc of propofol, and abruptly pushed him into a room where a woman waited already on the table to be put to sleep for her D&C. The Chief then disappeared, and so began Dr Ouija's career in anesthesiology. That day he was not bored. But every day since that first one, he has been.
For generations certain residency programs have trained MDAs as if clinical anesthesia were a mechanistic simplicity: give them a suit of scrubs, a mask and cap, a stick of Pentothal and then push them into a room -- i.e., the craft of clinical anesthesiology for physicians as *O.J.T.*, On the Job Training. Many if not most of those residents were grossly unprepared to accept that reponsibility. But they did get by. ....Good enough.
Residents rapidly begin to confuse luck with skill.
Fortunately, in those first few weeks following July rotations, very few people die from anesthesia mismanagement overall (there is some modicum of stupervision to ride herd on greenhorn newbies); therefore, often, as the doctors continue to 'get by,' a cavalier attitude arises: an overweening arrogance which says anesthesia actually requires surprisingly little effort, minimal preparation, and poses virtually no intellectual challenge.
After all, historically speaking, anesthesia *is* nurses' work. How hard can it be? Why should I check my gas machine, ascertain that my vaporizers are topped up before a case, etc, etc? I'm a physician, not a technician. I refuse to do demeaning nursey detail crap. Boring! How about now we go spend a year of our residency in the rat lab? Is that the latest PDA?
So, Kiddos, among residents Science -- science and technology -- becomes vastly more important in the Art-and-Science balance of clinical anesthesia, and the Art aspect, the subtle hands-on fine points of safe AND CARING anesthesia care are devalued as manual labor, discounted, and often even disregarded altogether. Including the most critical aspect of all: monitoring.
Dr Ouija can't possibly be closely monitoring his patient -- and all of us in private practice are VERY WELL compensated to PAY CLOSE ATTENTION TO patients -- if he is routinely reading Golf Digest during the case. Or Barron's or WSJ. Or surfing the Net. He's not earning his money. It's fraud. It is physically impossible to adequately monitor your patient from any point down the hallway. Yet these are behaviors that I continue to observe among MDAs year after year. It's well-known across America.
These are NOT typical CRNA behaviors, mind you, emphatically not. (.... I will ruefully confess that the worst provider I've ever witnessed was, unfortunately, a CRNA. That was a sad individual, however, a poor lost soul, and I am drawing here broad generalizations, based on personal observation of many hundred providers in a cross-section of settings around the world.) CRNAs in general are at the patient's side, and on the patient's side, having been taught deep respect for our obligations to patients.
Where does it lead then, this contrasting MDA cavalier disrespect and disregard for hands-on patient care? Judging by the actions of the radical leadership of the A$A over the recent decades, this cavalier attitude has resulted in a 'dumbing-down' of clinical anesthesia in certain locales, a belief that any idiot can squeeze the bag.
For some docs, anesthesia is just too damned easy: Half the big syringe, all the little syringe. Some docs enter the specialty because they lack 'people skills' entirely. These are not typical CRNA characteristics. Fact is, my friends, the esoteric minutiae of beta adrenergic sub-set gobbledeegook don't kill people; what kills people is the tube in the wrong hole, compounded by blockhead arrogance that blinds a person to the possibility that their skills might not be perfect. Some talk the talk, some walk the walk.
Once again, here we find ourselves swimming with sharks, treading water in the infamous Curdle Zone: the big wide, wonderful world of anesthesia, where the cream of nursing rises -- as the cream of the crop always will rise -- rises and struggles to become CRNAs, full-fledged independent anesthetists, entitled to mingle and work with ... the dregs of medicine.
That's the Curdle Zone. They ain't brainiacs, those arrogant lazy SOBs who (when they actually come out of the lounge to DO anesthesia) often won't so much as draw up their own drugs, won't apply their own BP cuff to the patient's arm (I don't do nursey stuff), who can't be bothered to STAY AWAKE thoughout the course of their patient's anesthetic, even. "That's what those alarms are for, dammit -- they're supposed to be loud enough to wake me up when there's a problem. It's the lousy alarm's fault!"
The contrasts could not be more extreme. As Woody Allen said, half the key to success is just showing up on the job. Being there. But also being there fully wide awake. Is anesthesia rocket surgery? Hell no. It's mostly paying close attention, maintaining alertness, constant vigilance. Is that easy? Hell no. Because anesthesia is mostly nursing care, moment to moment vigilance throughout. After six or eight hours, that's hard. But it's essential.
Boredom creeps in only if I fail to value the life in my hands. Respect your patient!
However, Dr Ouija doesn't care; he knows how to get out of his boring situation: he'll train some Assistants. Clueless MDAs like our fictional Dr Ouija train their AA lackeys to meet their own sadly deficient standards of care. I don't mean the standards of care they claim to follow, the standards they brag about to Congress; I mean the actual way these hypocrites behave when they *think* no one's looking. They literally have no idea what they miss.
Subtlety in patient care would be the last thing MDAs might pick up in residency. The average SRNA already knows -- first day -- many, many fine points of patient care when they enter clinical, points learned during the hours and hours of bedside nursing care experience in the ICUs. Like what things, what subtle points, you might ask? Like a sixth sense of impending change in a patient's physiologic status. (You can only learn some things with experience; it cannot be taught, perhaps not even explained clearly. Sorry.) Like the critical decision-making skills, juggling hands-on life and death priorities, hours and hours on end. Like communication skills, running codes. Like the seamless multi-tasking, as when titrating multiple vasoactive drips simultaneously, all in concert, while at the same time wiping brows and soothing family members, performing the many other functions of a nurse. Like a full and complete in-depth familiarity with the full spectrum of subtle details of monitoring, central lines, ECMO, you name it. For example now, that slight change in the rate and tone of the oximeter beep ... that'll perk up your ears, if you're in tune to the subtleties.
That extra ineffable little bit more, beyond the science of it all.
The Art.
What does this here signify now, this odd little notch in the capnograph exhalation curve? The usual train of elephants, crossing the display screen holding tails with trunks, is newly marked by notches every so often. It might signify a return from paralysis as the muscle relaxant wears off, the patient's diaphragm just ever so slightly kicking back in, even though the peripheral nerve stimulator doesn't yet show any detectable return of neuromuscular conduction. It might only indicate that the surgeon pressed on the chest during exhalation. Does the ventilator bellows also begin to show at little hiccup? That'd show the diaphragm coming back. OK then, time to top up the muscle relaxant with a small maintenance dose(or deepen the inhalation agent briefly, if you're near enough to closing). Don't wait for the patient to buck on the tube and then blast them with a big bolus of relaxant -- that may last far longer than required. Ounce of prevention saves a pound of cure. Anticipation.
Subtleties such as these can ONLY be gleaned from CLOSE OBSERVATION of the anesthetized patient in your care. You'll never see it if you're engrossed in a novel, or PDA, or laptop. Unfortunately such subtleties seem not to breach the threshhold of notice by many MDAs. They'll think nothing of taking the patient to PACU with the ET still in place, still engrossed in their Crackberry. They got by. Any landing you walk away from is a good landing. Some docs just cannot or will not learn to act like nurses. They simply don't get it. Therefore many MDAs come to believe anybody can sit on that stool -- any body -- and do so safely. They 'got by' in residency. They simply missed noticing the difference. That is NOT clinical excellence.
Subtleties count, my friends. Small things make all the difference between 'good enough,' between getting by, and superior anesthesia care. Subtle observations can make the difference between a patient bucking on the tube, and a patient enjoying a quiet emergence. Small details make all the difference, like the difference between lightning and a lightning bug, between a drone bag-squeezer and a true anesthetist.
Subtlety counts.
Amen.
Deacons, please pass the collection plates now, if you would.
deepzzzzz.... what a pompously annoying post... but since this is a CRNA board, i guess posts like these are allowed.... if i can presume to paraphrase your long tedious post: MDAs are balding, bottom of the med school class people who have no understanding of anesthesia other than to push drug A and then push drug B, and who would rather check their "crack"berry than pay attention to their patient.... whereas CRNAs are dedicated to titrating drips, wiping brows, running codes and holding hands.... I guess it is just a matter of time before CRNAs actually develop new drugs, develop new monitoring devices and publish major anesthesia textbooks.
Did I say every doc or AA was arrogant? No, I did not. You counter a point never advanced.
No, actually what you said was
Regardless what the arrogant docs and AAs post here
That you would LOVE nurse-bashing comments, jrk, fails to surprise me.
I didn't say anything about loving the nurse-bashing comments. The comments, contained in the same message, were the ones supporting AA's, made by someone who is NOT an AA, and who has ACTUALLY WORKED WITH AA's, which is more than most of the nurses on this board can say.
As for the rest of your diatribe - you make amazingly broad generalizations which simply undermine any credibility you think you have. In your mind, all CRNA's, except one, are the most caring, conscientious, mistake-free, cream-of-the-crop, and vigilant healthcare providers in the known universe, and all anesthesiologists are surfing-the-net-while-doing-a-case pathology wannabees who graduated at the bottom of their class and are lower than a snakes belly on the bottom of the ocean (but still above AA's).
As so many have pointed out, there are excellent CRNA's and lousy ones. There are excellent and lousy anesthesiologists and AA's as well. For you to think that there is not a single CRNA out there who likes to surf the net or read or pursue other bad habits while doing a case is to ignore reality. My group refers to those anesthetists as ex-employees.
......amazingly broad generalizations which simply undermine any credibility you think you have. In your mind, all CRNA's, except one, are the most caring, ......
What would you -- an AA, a presumptuous poser (since when are you privy to my thoughts?), an interloper here on the allnurses CRNA board, needily grasping for legitimacy -- what would you know of credibility?
What would you -- an AA, a presumptuous poser (since when are you privy to my thoughts?), an interloper here on the allnurses CRNA board, needily grasping for legitimacy -- what would you know of credibility?
?
So now only nurses are credible?:rotfl:
And I'm not grasping for legitimacy - I've only been doing this a few years less than you have.
.......... I've only been doing this a few years ........
My point exactly. And getting away with it, as if you belonged legitimately at the head of the table. But still here all the same, aren't you, displaying a need for validation from nurses. Newbies you may impress; they can be right gullible. Good luck. CRNAs see through your insecurity from the git-go.
When the number of AAs practicing reaches a thousand -- even 500! -- then perhaps, after thirty MORE years, you folk might become significant, might be more than posers, clamoring for attention. Till then, you'll remain the red-headed step-child, patted on the head by your paternalistic masters, then kicked in the butt and told to go do your room.
I've only been doing this a few years less than you have.
I've been doing this for more than 25 years - I was referring to you supposedly doing this for almost 40 years.
You're so hell-bent on bashing AA's that you don't bother actually reading the posts or miss the point if you do read them.
Yes I know - CRNA's have been practicing for over 100 years. So when AA's have been practicing for 100 years all we'll hear is that CRNA's have been doing this for over 170 years.
When the number of AAs practicing reaches a thousand -- even 500! -- then perhaps, after thirty MORE years, you folk might become significant, might be more than posers, clamoring for attention.
My observation from the amount of bickering and hate throwing on this board, is that AAs are very significant. At least to you DeepZ. If the AA issue is so insignificant then why do so many people have such deep rooted feelings about a handful of professionals that have a different background prior to entering Anesthesia school? It looks like the actual anesthesia training is almost identical on a whole.
pnurseuwm
161 Posts
Wow, this really hit a nerve, huh?
I have another question. Can the states that have decided to "opt-out," in the future can they ever reverse their decision and "opt-in"?