Monday, April 28, 2008

So, it's been awhile. I'm still working hard to reach my goals sometime between January 2009 and January 2010 (getting into anesthetist school). I came across a blog of a nurse anesthetist and found it extremely resourceful to read. I contacted the author and he was very generous, and indicated me a valuable tool and resource that he utilized before getting into anesthesia school and which according to him made a world of a difference in his studies.So being all nerdy as I am, I ran out the door to the first Barnes and Noble and bought the book. It's called simply "The ICU Book" by some doc called Marino. As it was suggested to me, it reads like stereo instructions but I must admit its very resourceful and rich in information. I'll be walking around with this one for awhile. Maybe i'll read when I have a breather during my shift. I'll update you guys on the book as soon as I cover a couple hundred pages (It's 1064 pages long).

Monday, April 14, 2008

Just a comic strip I found amusing.

New developments in my quest to CRNA school.

My journey to become a nurse anesthetist has been long, 4 years worth to date. Much has happened and many things changed in my life during that time; got divorced, graduated nursing, passed boards (N-CLEX), passed my open heart recovery internship program and got hired on the unit. All of which were carefully planned from day one with Nurse Anesthesia in mind. Every exam I took, every hour studying, was with the anesthesia program in my mind.
I am currently attending classes for my BSN program and have only 5 classes left to graduate. This week I was ecstatic to find out that the college in which I intend to apply to anesthesia although states we must take the GRE, notified me that with a GPA of 3.75 or above I need not take it in order to apply. Not only that, but since I only intend to apply to the program in June of 2009 for the January 2010 program, they also offer 5 classes from within the program to be taken while waiting. In essence, I can knock off 5 classes (over 12 credits) without being in the program. This news was phenomenal and hopefully potentiates my chances of being accepted into the program. The fact that I completed all my credits (ADN and BSN) at this college will also help in my pursue of this graduate program (hopefully).

Sunday, April 13, 2008

So.. u want to become a CRNA...

It seems everywhere I look I see people talking about CRNA school. I don't know if its because Im more attuned to it, as I myself want in. Its like when one of my previous girlfriends told me she thought she was pregnant, I noticed every expecting mother and babies in the streets for days and it seemed as if everyone was pregnant. Fortunately, it was a false alarm. 

So... you have decided CRNA school is the way to go. Here are a few tips you might want to consider while preparing: (complements of

What are the prerequisites for CRNA? 

First, you must be a Registered Nurse, and you must have a bachelor’s degree. Not all programs require a BSN. In many cases, being an RN with an unrelated bachelor’s degree is sufficient for admission. Check with programs where you intend to apply for this information. 

Next, most schools require an undergraduate degree GPA of 3.0 or higher. If your GPA is below this, check with the school that granted your degree about the possibility of taking more classes, or retaking classes to raise your GPA. 

Most programs will look at applicants’ GPA from a few different angles. The first consideration is the overall GPA, which must be at least greater than 3.0. Next, the applications committee will consider grades applicants received in the science courses, such as chemistry, microbiology, etc. Finally, the committee will look at grades received in nursing school. There is a lesson in this. If you have a 3.5 GPA, but your science and/or nursing school grades are lower grades, this may hurt you. 

Many schools will require you to take the Graduate Record Examination (GRE), and will have a requirement for a minimum score on this test. The test is administered at most Sylvan Learning Centers. There are a number of books and computer programs available to prepare you to take this test. Taking the test “cold” is probably not a good idea. You can retake it if you do poorly, but both scores will be reported to schools where you are applying. Also, the test is fairly expensive, so if you can avoid taking it twice, you should. 

Nearly all schools require one year of experience in an ICU before an applicant will be admitted to the program. Most will not accept ER, OR, or other experience (though a few programs are a bit more lenient). There is a good reason for this requirement. You will need experience with vasoactive drips, ventilators, and other things that you can only get in an ICU. Larger hospital ICU’s are generally preferable to smaller ones. 

Many students wonder whether one year’s experience is sufficient. Generally, the answer is yes. However, some may feel more comfortable applying after two or three years experience in an ICU. The bottom line is one year meets the requirement. After that, it is up to the prospective student to decide when they feel comfortable. 

How do I apply for a CRNA program? 

Application requirements vary from program to program, so for specific information check with the schools where you intend to apply. You will have to do this in any event, as you will need an application packet from the school. 

Generally speaking, you will first have to send in a “paper” application that the school will send you. There will usually be a required non-refundable application fee that must be sent in with your application. Check carefully that you meet the requirements of the school before sending in your application. If you do not, you will probably have wasted your application fee. 

Some applicants consider sending out applications in “shotgun” fashion, sending out as many applications to as many schools as they can afford. This is not a good idea. Beyond being expensive, scheduling interviews at all these different schools can become a real headache. It is better to pick out two or three schools that most interest you, and apply to those schools. 

Once the application deadline has passed, the school will go over all the applications, and will select a certain number of applicants for interview. Those applicants will travel to the school at their own expense for a face to face interview with the program director and the admissions committee. These interviews can be stressful. See the next question for more information on interviews. 

How do I prepare for my interview? 

Admission to anesthesia school is highly competitive. If you have reached the interview phase, you have passed a major hurdle, but you are not at your goal yet. Most schools will interview something like two to three applicants for each available seat. You will want to avoid giving the selection committee a solid reason to choose someone else over you. 

-BE ON TIME! If you are late, even if the committee waits for you, you have given yourself a black mark that may be impossible to overcome. 
-Wear conservative business attire, such as a suit or conservative dress, to your interview. 
-Insofar as possible, be relaxed during your interview. The committee will expect nervousness, but if it makes you incoherent, that’s a pretty good sign you don’t handle stress well. 

It is impossible to predict what kinds of questions the application committee will ask, but be prepared for certain “stock” questions: 

-Why do you want to be a CRNA? 
-What do you know about what a CRNA does? 
-What have you done to ensure you really want to do anesthesia? 
-What steps have you taken to prepare to get through school (generally, though not always, a financial question)? 
-Also, most interviews include a question or two on vasoactive drips (i.e. dopamine, nitroglycerine versus nitroprusside), or some other aspect of nursing you should have learned working in an ICU. 

Be prepared for questions to which you don’t know the answer. Most interviews will try to find such questions, to discover how you handle that situation. When these questions arise, don’t waffle or try to “BS” your way through. Stay composed, and admit you do not know the answer. 

One other note: Every school has its criteria in looking for students. It cannot hurt you to contact the directors of the programs you are considering and asking them what you can do to make yourself a more attractive student. Admission to CRNA programs is very competitive. Give yourself every advantage. 

Where are schools that have a CRNA program? 

The American association of Nurse Anesthetists maintains a website with a link to all schools currently accredited by the Council on Accreditation. This site can be found at: 

What are the “best” CRNA programs? 

There is no “ranking” of schools. The term “best” has little meaning, because it means different things to different people. Rather than worrying about finding the “best” school, it is probably better to find a school that is the “best” fit for you. In your considerations, you should include geographical location (is the school close by, or in an area you are willing to relocate to), length of schooling, and program cost. If a school is accredited, it will provide you with the education needed to pass the certification exam and become a CRNA. 

What are the differences between CRNA schools? 

As mentioned above, schools offer a variety of different options. Length of school varies from 24 months to 36 months. Some schools grant Masters of Nursing (which require some core nursing classes, such as nursing theory) degrees, while many others grant Masters of Nurse Anesthesia degrees, which are not strictly speaking “nursing” degrees. While there are a certain number of core clinical experiences all students must get, clinical experiences vary as well. At some schools, clinical is slowly phased in while in didactic education, while in other schools, the didactic education is “front loaded.” Some schools have clinical education in the same area as the school location, while others offer clinical education at “satellite” locations. The point is there are a number of different options that must be considered when selecting a school. 

Can I work during school? 

Generally, the safe answer is no. Nearly all CRNA programs are full time programs that require an enormous amount of study time to be successful. Some students manage to work on a PRN basis, but are very limited in the actual number of hours they work. Working full time while attending a CRNA program is nearly impossible. Not to worry; see “How do I finance CRNA school?” 

How do I finance CRNA schooling? 

Many of the same government no interest and low interest loans for undergraduates are available to graduate students. Additionally, there are a number of companies that offer loans to students in medically related fields. These loans may all be used to pay for tuition, books, and other school related expenses. These loans may also be used for day-to-day living expenses. Most CRNA’s graduate programs with what seems like a pretty heavy debt load, but remember, a CRNA will earn two to three times the annual salary of a staff nurse. Provided you don’t go overboard, the debts are easily managed. 

How much does a CRNA earn? 

This varies based on location and time. CRNA salaries are constantly changing, so exact figures are difficult to give. It is safe to say that at the time this was written, salaries for new graduate CRNA’s ranged from $90,000 to $140,000, plus benefits. Many anesthesia groups and hospitals, in addition to this salary, offer overtime pay for any hours worked over 40 hours per week. 

A word about benefits: For CRNA’s, benefits may be quite substantial compared to what a staff nurse receives. They may include education loan repayment options, full health and dental care for the CRNA and his/her family, retirement packages, malpractice insurance, life insurance, and others. In considering contracts, benefits should play a major role in your decision. When they are included into the salary package, they can increase your actual income substantially. 

When should I sign a contract? 

You may be presented with some different options after being accepted to a CRNA program. Some hospitals and anesthesia groups may offer you a contract as soon as your are accepted to a program. These contracts usually will include some benefit to the student while s/he is in school, such as a stipend or help with loans. There are rare groups that even offer contracts that pay for tuition and books while you are in school. None of these contracts are without strings, of course. These contracts will include a clause that requires you to work for the contracting hospital or anesthesia group for a set period of time, usually at least two years. Therefore, it would be to your benefit to know as much as possible about the hospital or group before signing the contract. Ask questions about hours required, call time, pay, etc. See the next question for more information. 

What should I consider if I am considering signing a contract before finishing school? 

There are a number of factors that you must factor in when considering a contract, especially if you have not finished a CRNA program. 

-Salary: Check out other anesthesia groups in the area. Is the salary competitive? Some places may offer contracts that are competitive at the time you sign the contract, but by the time you begin to work, the agreed upon salary may be well below what the local market has risen to. Some contracts will have a clause that covers this eventuality. 

-Benefits: These could include, but may not be limited to, health and dental insurance coverage for you and your family; retirement packages; student loan repayment options; malpractice insurance; overtime pay for overtime work, etc. Carefully consider these benefits, as they make a substantial contribution to your annual income. It might not hurt to compare what you are offered with what is offered elsewhere in the community. 

-Hours: Check with people already working with the group or hospital you are considering. How many hours per week are they averaging? How many hours per week do you want to work? 

-Call: Many groups and hospitals require CRNA’s to be on various levels of call. How often will you be on call? Are you required to stay in house when on call? Is the day after call a normal work day, or are you off on post-call days? 

-Location: It may seem stupid, but is the group or hospital offering the contract in an area where you want to live? Rest assured, if there are no CRNA jobs exactly where you want to live, there are probably jobs within about a 30 minute drive of where you want to live. 

-What type of anesthesia does your prospective employer do? There are a number of different ways and places that anesthesia may be done. If peri-partum anesthesia is something you want to do, make sure that the place you are considering does anesthesia in labor and delivery. If you enjoy doing anesthesia for open heart surgery, make sure the group you work for does open heart anesthesia, and allows CRNA’s to do these anesthetics. 

Many prosepctive CRNA’s do not find out what they really enjoy doing in anesthesia until they have the opportunity to try out different things in school. So, if you sign a contract prior to finishing school, you may find that you enjoy something totally different than what is done where you are going to work. For this reason, many student anesthetists avoid signing contracts until they have been exposed to a number of different environments. 

What are the employment prospects for CRNA’s? 

In a word, excellent. Currently, there is a shortage of CRNA’s. This shortage is compounded by the fact that the average age of CRNA’s is rising. CRNA’s are retiring at a higher rate than the programs that produce CRNA’s can possibly produce graduates. So, there will be job openings for the foreseeable future, with good prospects for increasing salaries and benefits. 

If you are curious, go to the following site: 

You will be surprised at how many jobs there are, and this is only one site. There are a number of sites out there that help CRNA’s find employment. 

You can also go to a “Headhunter” to find a job. These are people/companies whose sole purpose is to match people with needed skills to jobs that need to be filled. Once accepted to a program, you will begin to receive numerous mailers from these companies. One warning: These companies make their money only when a CRNA is placed in a job. Therefore, they will work hard to get you into a position. Don’t be afraid to say no, and don’t be afraid to say you want to think about the decision before you sign. Generally, these companies are pretty professional. But, remember, the job they have is to sell you on a location. 

Where do CRNA’s work? 

The short answer to this question is that CRNA’s work in hospital operating rooms, labor and delivery wards, and anywhere there is a need for anesthesia services. In the more urban areas, CRNA’s generally work for the hospital or the anesthesia groups under the supervision of the anesthesiologist. In more rural areas, there may be no anesthesiologists. In these locations, you will often find an anesthesia group that is owned by CRNA’s. As a general rule, CRNA’s at these locations are more independent, and have less back-up available for assistance. New graduate CRNA’s are often more comfortable working in locations where there is more readily available assistance. 

There are also CRNA’s who work for travel agencies. These may look attractive at first, since these type positions generally pay considerably more than other positions. The thing is that these positions are straight pay. There are no benefits connected with most of these positions, and you are responsible for your own taxes. 

How many hours does a CRNA work on average? 

Again, this varies with position and employer. In some places, CRNA’s are offered contracts that guarantee no more than 40 hours a week. Some of these places will allow you to work overtime if you want it, but will not require it. In other locations, you may be expected, depending on your position in the call schedule, to stay until cases are finished for the day. In some of these locations, it is not uncommon for CRNA’s to work 50 to 70 hours a week. These are all avenues that must be carefully explored before you sign a contract. 

What does a CRNA do? 

CRNA’s do anesthesia of all types. In school, you will learn about general anesthesia, regional anesthesia, and spinal and epidural anesthesia. You will also spend time performing obstetric anesthesia. You will learn to manage the anesthetized patient with various co-morbid diseases. You will learn skills such as intubation, arterial line placement, central line and Swan-Ganz catheter placement, spinal anesthesia, and epidural catheter placement. 

In short, you will learn the science and art of anesthesia. What you do after school will depend on your preferences and what is expected of you by your employer.

Tuesday, April 1, 2008

First Code Blue

So... I recently started on night shift at the hospital; I work in an cardiovascular surgery intensive care unit. Basically we get patients straight from the OR post CABG and valve repair or replacement. There I am 01:40, I had just gotten back from lunch "dinner" whatever.... I checked on both my patients and sat at the desk to chart on them. The alarm sound had been going off throughout the night for faulty equipment, but just then the alarm started going off again in one of my rooms. I hesitated for 5 seconds and said to myself, I'm going to get up and it's going to stop, I'm going to walk over to the room and everything will be dandy... right!!! ... WRONG.. the alarm didn't stop and when I got to the room there was my patient in a full blown V-Tack, I had never seen it except in my EKG book and ACLS exams... so I immediately pulled the code blue button and lowered the head of the bed to start compressions. 3 seconds later, I full crew of nurses were in my room, shocking the patient, pushing Epinephrine, drawing labs and recording everything that was happening. I thought.. this is freaking amazing!! I couldn't believe how everything from ACLS class came back to me and I wasn't even thinking as I was resuscitating the patient along side my nurse colleagues. Basically, after compressions, 2 shocks, 2 epis and 1 dose of 0.5 of atropine the patient was fine in a normal sinus rhythm. That was quite an experience for me.