6 tips to surviving nurse anesthesia clinical
On your first day of every rotation, you don’t know where anything is, where to park, what doors you should go in, where the locker room is, how to get scrubs…etc. The list goes on and on. Number 0 for this post is to go to your clinical site early, before you even start. Have a senior SRNA/CRNA or RN show you around so that you won’t be completely lost.
So number 1:
1. Arrive Early
When you’re early, you’re on time. When you’re on time, you’re LATE! The days I’ve been on the later side of early, I missed emergency cases I could’ve done, missed picking the cases I wanted for the day and missed being able to eat breakfast (thee worst). It will always be the day your anesthesia machine check fails and you don’t know how to fix it or you can’t get IV access on your patient. Get there early so you can get to these opportunities and not have to worry about things taking longer than usual… because when you’re late, something will ALWAYS go wrong.
2. Preparation
Care Plans suck, I know. But they’re extremely beneficial when all you know are some random gas laws and the intubating dose of propofol. When you’re starting out, knowing your doses, what medications you’re going to use with rationales, understanding the complexity of patients’ co-morbidities and adjusting your anesthetic management is key. After you’ve done a few, you get the hang of it and the information will become more useful. If you don’t need handwritten care plans, type them out. So, the next time you do that lap chole, you’ll be able to reference previous care plans that you’ve done. My mantra: ”Work smarter, not harder!”
If you don’t have to do care plans, or you’re unable to look up your patient’s information the night before, get there early so you have an idea of what’s going on with your patient. Get their weight, calculate the dose range that you need for your medications, and do a quick fluid plan (VARGO app is also great for this on the fly — full review of the app coming soon!).
Set up your room the same way every time. Your first rotation is all about airway skills and building your routine.
3. Be Flexible
I say this ALL the time. You have to be flexible in CRNA school. There’s no way around it. When I say flexible, I mean flexible with your anesthetic plan, with the surgeons preferences, with your attending’s preferences, your preceptors preferences… Flexible with the cases that you do… and with your attitude. Speaking of attitude…
4. Attitude
Don’t take it personal and don’t get too comfortable. You’re going to get your toes stepped on, you’re going to be annoyed when someone tells you to “stay off the teeth!” for the millionth time. People are going to hate your anesthetic plan and criticize how you tape your eyes.
Be a duck… let it roll off your back!
Also, don’t act like you know everything. You don’t OK?! The worst people to teach are those who don’t want to be taught.
Sit down, be humble!
It’s super important to recognize that anesthesia is an art and science. There are so many ways to do anesthesia. That being said, when you turn on nitrous oxide as your carrier gas, and your preceptor turns it off and says that it’s emetogenic, while you were just in a room with another preceptor and they showed you studies that said it wasn’t emetogenic depending on the duration of anesthesia, your first instinct is to feel bad and you’ll want to defend yourself.
You feel as if you’ve done something wrong, and it’ll take a toll on your confidence. But, PREFERENCES are PERSONAL, and they don’t mean judgment. Some preceptors are open to discussion, others are not. If you feel adamant about something, don’t say “at this facility we did it this way, or so-and-so said that…etc.” because 9 times out of 10, it’s not going to come out the right way.
You can say something like, “Thank you, that’s good to know. Can we talk more about it?” You can either leave the question open ended, or begin with talking about the studies you’ve read and what their opinion is on them. If it’s something that doesn’t need to be further discussed, my go-to is “Thank you! I never thought about it that way.”
Say whatever else you want in your head. Tongue control is essential folks!
5. Take Initiative
If there’s an emergency, offer to help. If you’re done with your preoperative assessment, and your room is set up, ask to place IV’s in the PreOp area. Don’t be afraid to ask questions that you’ve seen in practice that you’ve wondered about, and study what you’ve learned. It not only helps you make a better impression, but it’ll open the door to more opportunities.
You need to see as many people provide anesthesia as possible. These people are your influencers! We can easily get comfortable and go with the same preceptor, but once you’re on your own, it’s going to be harder to learn from others because you’ll be in a room all by yourself. Try to work with as many different people as possible, especially providers that have come from different states! Take in as much as you can so that you can begin to develop your own “style.”
6. Stay away from the blue
The worst is when someone yells at you because your scrub jacket brushes up against the sterile field and they have to tear down everything and re-drape… Watch your hands, hips & head! I purposefully grab the ends of my jacket and walk like a penguin near the sterile fields just so they know I’m being cautious.
7. Say, “Thank You”
Say thank you to the MD and CRNA, regardless of how nice or mean they may be to you. If they were rude and inappropriate, that’s an example of how NOT to act, so I still thank them for their time and putting up with me.
As far as I’m aware, if you’re working with just an MD on a case, they are not reimbursed for teaching you. So please show gratitude! I've learned an immense amount from CRNAs and physician anesthesiologists alike. I hope to continue to be able to work with both providers to perfect my craft.
So that’s my quick and dirty of “non-clinical” tips to begin your clinical rotation. I’m working on a great post (maybe video?) about tips and tricks to survive your first case that includes anesthesia set up, drug set up (which you can read about here), machine checks, preoperative assessment, and IV skills for the ICU nurse that never had to put them in!
Thanks for reading!