Last Friday we were privileged to have several student nurses visit us from the California State University at Long Beach. Friday’s is our conference day with a late start in the operating rooms. This week’s presentation featured a couple of Residents presenting poster boards in preparation for their showing in a couple of weeks before a state assembly. Following the morning conference it was back to the Operating Rooms for the days cases.

The student nurses followed a couple of the CRNA’s until noon and were able to get a glimpse into what we do on a daily basis. For the students it was a good exposure to Nurse Anesthesia practice. This morning I received a note from two of them that I would like to pass along. I have slightly modified the letter to correct a couple of small things and to protect the innocent.

This first letter comes from Chi and details her experience with us at LAC-USC Medical Center:

Dear David,

I wanted to thank you for the wonderful and invaluable experience of shadowing you, your colleagues, and your SRNAs this past Friday. It was a great pleasure to be able to slip into the shoes of a SRNA for a day, an experience that only solidified my decision in pursuing the CRNA route.

From the early morning start to early afternoon, everyone in the program was warm, supportive, and provided a wealth of information. I was immediately drawn in by the warmth and comradery amongst the faculty and students all the while still upholding the impressive professionalism during morning conference. When we gathered for the morning presentations featuring resident speakers presenting their current research findings, I was impressed with how supportive the faculty was as the floor was opened to questions and comments on the presentations. I sensed a safe environment for learning which, in my opinion, can only foster growth and improvement. Even as visiting students on the campus, my fellow classmates and I were invited to participate in the open forums during discussion! As the morning progressed and we were each assigned to shadow a CRNA and his/her student, I was amazed to find how engaged, Karen, the CRNA was during my shadowing experience. I had expected to be her “shadow” instead, she was explaining and teaching me about the various equipments used, the types of drugs and their effects, and even going into “what if” scenarios with me, all the while not skipping a beat with her own SRNA and her patient. I was in absolute awe that one person can do all these multiple tasks and be so efficient in everything!

Aside from getting advice from the faculty and CRNAs about the career and field, I was extremely grateful for the SRNAs’ honest portrayal of the rigorous program. Despite hearing the students confess they sweat blood in the program and having it be the hardest thing they have ever done, every student that I spoke with also said that it was an awesome experience that is well worth the hard work. Again, I just wanted to thank you for this experience and I hope to come back and visit you soon in the very near future.

Sincerely,
Chi D. Huynh
SN, CSULB

The second letter comes from Lisa and reveals her strong desire to pursue graduate level studies. What is important for these nursing students is to have a goal. It is very difficult to reach for such a difficult level of practice such as Nurse Anesthesia so it takes a lot of motivation and time to achieve. These visits and shadow experiences hopefully will provide incentive to keep them driving on through to the next several levels.

Dear David,

It was a genuine pleasure meeting you, Kari, Jim, Karen, Stephanie, JR, Diane, and Hill yesterday. From the very get-go, the CRNAs and SRNAs were warm and welcoming – even with the many questions my classmates and I had!

You patiently and thoroughly answered my questions about USC’s CRNA program, and I greatly appreciated the valuable information and advice you gave me. From the different experiences I would get at a surgical vs. medical ICU and contacting Alice a nurse manager at UCLA; to reading Paul Marino’s “The ICU Book” for preparation as an ICU nurse, I feel more informed in setting up a strong pathway to CRNA school.

What still amazes me about my CRNA shadow experience was not just how knowledgeable and intelligent the CRNA and SRNAs were, but also how supportive and enthusiastic everyone was about our interest in the nurse anesthetist profession. Even at 0530 hours, Kari was excited about us being there and shared different CRNA books and websites to further our knowledge. JR, Stephanie, and Diane (the SRNAs who walked us over for the anesthesia residents’ presentations) were so willing to provide thorough and honest advice about getting into a rigorous CRNA program and also what made them excited to be a part of USC. Also, the morning conference presentations confirmed to us the high level of research and involvement in the anesthesia department at the University of Southern California Keck School of Medicine. We were impressed with the involvement and encouragement of the CRNAs and SRNAs in the department of anesthesia.

Later on in the OR both Jim and Karen were simultaneously focused on teaching their respective SRNAs as well as us observers; I am still excited about seeing my first carina via the fiber optic! How awesome is that!

Thank you again for an experience that has further solidified my decision to pursue the CRNA profession. And if it is OK with you, I hope to keep in touch for advice on my journey to “CRNA-dom.”

Sincerely,

Lisa Chong
CSULB SN

In the future I am hoping that there will be more opportunity for others to come and visit us. If there are those that would like this experience I encourage you to call the LAC-USC anesthesia department office at (323) 226-4597. Ask for Kari is the best bet and tell here I sent you. I’m sure she will appreciate that!

Till next time keep focused on your goals and pay attention to all of the messages you receive. There may be a key somewhere in there that will open the next door.

David

The longer I am exposed to the great anesthesia practitioners the more respect I have for what we do in the OR. I feel so privileged to be where I am today with the opportunity to do anesthesia and to teach – I am really blown away every day. One of my former clinical instructors and true mentors has confided in me concerns about what it takes to do well as an incoming anesthesia student and I wanted to share their concerns with you. If you want to know the truth it may hurt but it will set you free. Thank you so much “There, I Said It”. You rock TISI! For those of you that want to be CRNA’s take heed and follow the advice of a pro and you will be well prepared for clinical residency.

Why I think year ICU experience isn’t enough by “There, I Said It”.

I am a Nurse Anesthetist and a Clinical Instructor of Anesthesiology at a large metropolitan teaching institution.

I have been a clinical instructor for some years, and have seen many students come and go. We have so many applicants to our program, and each time the interviewing process becomes more and more difficult, as each applicant appears to be cream of the crop. The difficult decisions as to who will be accepted into the program come from a comprehensive process that involves input from many individuals of varying levels of practice; from student nurse anesthetists to department chairs.

According to the AANA, requirements for admission to an accredited program of nurse anesthesia include a minimum of 1 year of acute care experience, such as in ICU or ER. Herein lies my beef. Applicants or students who think 1 year of acute care experience is enough to perform at an acceptable level, in my view, are sorely mistaken. I feel this requirement should be changed. Can one truly master the art of ICU or ER nursing in 1 year?? Is a year enough time to glean an adequate level of skills or experience in adult critical care or ER nursing? After one year, can you throw up epi, levophed, dobutamine, dopamine, nitro, etc. and truly be comfortable with what you are doing?? Do you think you’ll be able to insert a swan and know what in the hell you’re doing? How much code experience occurs over 1 year? Is a year time enough to mature the development of interpersonal relationships with other members of the health care team much less the patient? Ask yourself these questions and I bet your answer will be no, no and no!

The students who have slithered through the interview process with what looks good on paper but have never been realized in practice have a hell of a time in residency. The clinical instructor has to work overtime to protect the patient from the student. I daresay there are those individuals that just have met the minimal requirements and are truly stellar students. However, these are few and far between.

I suggest the minimal requirement in an acute care setting be increased to at least 3 years. Applicants, if you barely have the minimal requirements for admission, ask yourself if you truly have enough experience to entertain delivering anesthesia care to an elderly individual with an aortic aneurysm, a child with epiglottitis, or an individual with multiple gunshot wounds to the chest and abdomen.

Signed,

There, I Said It