As readers of CRNAbiz are aware, I have been frustrated by the transition to digital anesthesia records and I’m curious as to how the next generation of nurse anesthetists are using technology. Through the online CRNA forums I have had a chance to read some of the observations of Joseph Rodriguez, a student nurse anesthetist and he has agreed to answer a few questions and offer his student perspective.
First of all, Joe, thank you for finding the time to share your insights.
Sure Dennis, my pleasure! Thanks for asking me to speak to you and your readers.
Would you give us an overview of your background and how you decided on nurse anesthesia as a profession?
My interest in nurse anesthesia started when I realized they were the most clinically advanced, most autonomous nurses that were in existence in the world. Sounds a little dramatic, but it’s true! I was an ICU nurse for 3 years when I first heard about CRNAs, and since I enjoyed topics such as physiology, pharmacology and hemodynamics, it was a natural progression for me to head into anesthesia. I was also searching for something that could create some more options for my family, and my other option was hospital administration. As you can imagine, picking between anesthesia and administration was pretty easy!
In general, how did your pre-conceptions of nurse anesthesia compare to your current reality?
Well, my pre-conceptions went through two-phases. Initially, I thought all CRNAs worked with anesthesiologists, as they did in my hospital. After doing some reading on sites like yours and nurse-anesthesia.org, as well as reading Watchful Care, a book that documents CRNA history – I realized that CRNAs practiced independently all over the country! So I started out by thinking CRNAs pretty much were working with anesthesiologists, and then entered school believing that many CRNAs were mostly independent.
With time I’ve realized that there is truth to both perspectives. Many CRNAs I work with are in an anesthesia care team environment, and I’ve worked with fantastic anesthesiologists and CRNAs. In addition, I’ve also met very impressive CRNAs – those with PhDs in pharmacology or physiology, those who run corporations or are CEOs of hospitals, and of course – independent CRNAs. Being independent is a lot of responsibility, and I am struck at how seriously these CRNAs take their work. They are dedicated to their patients and to knowing and practicing the science of anesthesia.
I have been disappointed at the failure of our field to transition to digital anesthesia record systems. How are informatics and in particular anesthesia informatics involved in your educational program, both by individual students and by the program?
Well, I’m not sure anesthesia informatics is truly incorporated into our program. We are required, as all APRN students are, to take an informatics course that encourages students to get out into the healthcare technology market and really learn about the products. We then do write-ups on them, and discuss the importance of the product.
In addition, technology is used in our courses, but mainly via blackboard and other common educational technology tools.
How prevalent are AIMS record keeping systems at you various rotations?
Only one hospital in my program uses an AIMS. This is no surprise as it is a major academic medical center here in Philadelphia, and it’s generally known for using the latest-and-greatest of technology.
What are the strengths and weaknesses of the systems you have used?
I’ll try hard not to be biased here, because it was a frustrating experience. The strengths were expected – having a legible record, being able to use pre-charted documentation for certain types of procedures – but that’s really where they ended, in my view.
The system required additional computers (monitor + keyboard) to be installed onto the anesthesia machine, and was not intuitive to the clinician. It was hard to decipher where information was, and hard to chart quickly. If vital signs were inaccurate from surgical interference (bovie or leaning up against the BP cuff), it was cumbersome to manually change each pressure. Especially when BPs are being taken every three minutes. In addition, many pages would print out for the smallest of cases, which is fine, but inefficient.
When I made the switch to paper anesthesia records, it was much easier to learn. I look forward to when clinician-driven AIMS are more prominent, similar to Cosalient EHR that you featured recently.
How important is technology in general, to your experience as a student and as a nurse anesthetist?
Technology has truly changed my experience as a student. In the OR, I use an iPod Touch to keep various handbooks in my pocket at all times: Sota’s Omoigui’s drug handbook, Handbook of Clinical Anesthesia, Handbook of Pharmacology and Physiology for Anesthetic Practice, and Oxford American Handbook of Anesthesiology. All of these resources – right in a tool that is about the size of a few note cards. Each handbook has its strengths, and I use the iPod Touch everyday in the OR! In addition, I also use iAnesthesia’s PediSafe application and Instant EKG occasionally.
In the classroom, I use a program called iFlash to review flashcards from my iPod Touch. This allows me to carry less in my bag, and have a quick study tool available to me at all times. I also use my iPod touch to record classroom lectures, and listen to the lectures while I’m making my long commutes.
Technology has allowed me to connect to the greater anesthesia community via forums such as “Nurse-Anesthesia.org”, “Old Gas Passers”, and “CRNAs and SRNAs” on Facebook. I’ve been able to learn about student experiences all over the country, as well as meet CRNAs who work in every environment. Many of the people I’ve talked to in these forums I’ve met in person at national and state meetings, so it’s been a real pleasure learning from and befriending fellow SRNAs and CRNAs.
Describe some of the devices or services you feel have been especially helpful.
Well, besides what I’ve already mentioned, there’s the many useful websites out there on anesthesia education. Sites like O2Demand, Simulations in Anesthesia, Tutorials in Anesthesia, CV Pharmacology, NYSORA, Pediatric Regional Anesthesiology, and Anesthesia MCQ have all been helpful.
As a student, what do you see as the immediate challenges facing nurse anesthetists specifically?
Students heading into the workforce see many challenges ahead of us: there are those whom, rather than working with CRNAs, seek to control and or eliminate CRNAs from practice. The potential impact for patients and ourselves (CRNAs and SRNAs) is enormous, especially for many students who have taken out mortgage-sized loans to cover the cost of education. Thus, the biggest challenge is finding ways to reduce the limits that are placed on our profession – both for students, whose education becomes limited, and for clinicians, who are unable to use their full scope.
I appreciate you taking the time from a very busy schedule to share your thoughts, thank you.