Clinical Day as a student nurse anesthetist

I wake up at about 4:30. Clinical is only 25 minutes away if I leave by 5 am but if I leave much later it can take up to 45 minutes to get there. Typical traffic issues! After I get ready and make sure my “anesthesia bag” is good to go I head out the door and drive to clinical!

What is an anesthesia bag you ask? I have a small book bag which I take to clinical with me and often take into the OR where its allowed. This bag carries a number of references such as the Omoigui’s drug guide, the Mass General and the nurse anesthesia pocket guide. I also keep the careplans I did the night before as well as my bible, M&M (Morgan & Mikhail). Lastly I keep my palm pilot on which I am able to log all of my cases for school.

On the drive to the clinical site I usually listen to an anesthesia audio digest. These are mp3 files I pop on my iPod and hook up to my car stereo. They cover a variety of anesthesia topics and I usually get a few good pearls on the way to and from clinical.

I arrive at the clinical site usually at 5:45. First thing I do is head to the board and make sure my assignment has not changed. I actually cannot think of a day where something was not different! Either a case cancelled, the room changed or cases added! Flexibility is important in an anesthesia department. Once I have confirmed the room I am in I go and set it up.

Setting up a room initially, sounds like a simple process; check the machine, load up some dry syringes and pre-fill a few for the first case and get any equipment you need. However, as a student you are setting up the room based on the preference of the attending and CRNA you are paired with. Trying to keep this straight when you are at a department with 20 MDAs and 40 CRNAs is near impossible! So the room setup is sometimes much more complicated than it would be if I were not a student!

The next step is to review the cases I have for the day. Even though I did careplans the night before the schedule often changes and so I have to review the new cases which I have been assigned. I head to the break room, pop open M&M and go over it all. I usually work out my morning so I have about an hour to review before my first case at 7:30. If I didn’t stay up to late the night before doing careplans for cases which have been cancelled, I usually don’t nod off while reading M&M!

 7:15 and its time to go to the holding area and see if my first patient is there. Once I find my patient I do a review of the chart and go say hello. I have learned not to say the word “student” to patients and I now say that I am ‘part of the anesthesia team’. When patients hear the word ‘student’ they think of a rank amateur and often get very nervous right away. This ends in me spending 5 minutes explaining how I have been an RN for a very long time and this isn’t my first IV! Anyway, then in goes the IV and 1-2 mg of versed. Good times!

Now besides the interaction with the patient there is the interaction with the CRNA and MDA. This is certainly an important part of the morning dynamics as it can set the tone. After 6 months in the clinical area I am asked every day if I’m a senior or a junior. With such a big department and so many students it would be near impossible for the staff to keep track of who we all are. If I’m lucky I have been with these people before and they know something about where I am at. Unfortunately even if they have been with me before and remember it, in their mind I’m at the same place as I was the last time we were together, which may well have been a month ago! If I am REALLY unlucky I am with someone who has never been with me before. Well, this is what I have come to call the ‘ground-hog day’ experience. Just like the movie, you relive the very first day of clinical all over again! What does this mean? Well, someone is ‘teaching’ you how to put in an iv and how to place the leads on the patient all over again and basically all over you. It can be a frustrating experience but this leads me to the next mantra I have developed ‘cooperate to graduate’!

 Then the cases begin and once the patient is in the maintenance phase that is when rapid fire questions start! The CRNA or the MDA start asking you random questions about the case or anesthesia in general. This is the time to swallow your pride and say ‘I don’t know’ as opposed to guessing and looking like a fool. If I could give any advice to a new SRNA it would be to get used to saying that phrase and never to guess. The best and most respected clinician is one who can admit they do not know the answer and ask for help when needed. Inspire this confidence in your preceptors and you will get a much better clinical experience, act like a cowboy or someone who will guess and you will find you are watched like a hawk.

 Cases turn over quickly and you have to learn the ‘rhythm’ of the OR in a hurry. There really isn’t much time between cases to be slow. Once the case is over its off to the PACU to give report to the RNs there. This can be a right of passage in itself! Sometimes these RNs treat the SRNAs like they are idiots. Unfortunately, even if you have been an RN longer than the PACU nurse your talking to, you are now in the student role and therefore, at the bottom of the rank list! Again remember the mantra, cooperate to graduate! From the PACU it’s a dash to the holding area to do it all over again!

While there is a ‘theoretical’ clinical day of 8 hours I am usually there from 6 am to about  4 pm. There is an unwritten rule that if you are in a case then you finish your case. This may sound unrealistic with everything else you need to do once you get home, but you are certainly judged by this expectation.

 Then it is a 45 min drive home in traffic and I log in all my cases by syncing my palm with the PC. This really shortened the time it took when I first started and we would have to log them in on a website by hand while trying to remember it clearly! Then I have to do all my careplans and look up my cases I have for the next day. *•*