The Anesthesia Record

Internet, meet my study group for the day:

I have a feeling there will be a lot more where this came from!

We have our first exam covering gas laws and anesthesia machines on Wednesday, followed by another exam testing our knowledge of the machine on Friday.  In addition, we each are required to give a short presentation (5 minutes) on a selected drug before Friday's exam and must prepare for yet another exam, this time covering neuro, scheduled for Tuesday of next week.

Whew.

We're definitely expected to know a lot of information, but I find it so interesting that I almost don't mind.  I wonder if my boyfriend realizes that he's dating such a huge nerd?

...only 103 weeks left to go!  Not that I'm counting or anything.

Well, I'd say we had a pretty good first week of classes.  Everyone seems to be managing and I'm already impressed with the teamwork and selfless sharing of tips/study aids/information that I've seen from my classmates.  I definitely lucked out in the peer department!

But, no amount of assistance can eliminate the need to buckle down and study.  And that's pretty much what I did this weekend.  I studied for 10 hours on Friday alone, not including the 2 hours I spent in the lab that day.  Like a bad version of the film Groundhog Day, I again hit the books for 5 hours on Saturday and another 8 on Sunday.  Which leads me to my next point:

Now I'd be lying if I told you that I didn't have any fun this weekend.  Myself and a few new friends from the program enjoyed the weather (and possibly some beer and live music. Possibly.) at the Downtown Winston-Salem Summer Music Series before hitting up the West End Cafe for dinner.  It was  really fun - just what I needed before resuming my hefty study schedule!

Background: For the first few months of anesthesia school, my fellow students and I are in class Monday through Friday.  Class begins at 8:00 every morning with the exception of Wednesday, on which we begin using our brains at 0645.  We have been warned time and time again to arrive to class early, as running late is unprofessional and frowned upon.

(You see what I did there?  That's a little something called foreshadowing...)

Early yesterday evening, I sat at home studying my anesthesia system book, when I began drifting off to sleep.  Knowing that I retain very little information while struggling to stay awake, I made the decision to take a nap and went to my room to lay down.  When I awoke, it was dark outside my window and my clock read 8:37.  I know this because I muttered that time under my breath, along with more than a few obscenities, as I ran around my house trying to throw an outfit together and collect my thoughts.

One of those thoughts?  How, just hours earlier, I had sent an email to our assistant director containing my personal mission statement, which included arriving prepared.  This, I'm pretty sure, requires that I arrive in the first place.

After roughly 30 seconds of meyhem, I finally thought to look at another clock and realized that it was actually 8: 37 PM.  I'm not lying when I say that it took me another 2 full minutes for my heart rate to return to baseline, after which I immediately called my classmate, Dave, to laugh about the mishap.

His response?

"Wow, A. Young, stressed-out much?"

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One of the requirements that Baptist SRNAs must fulfill prior to graduation is the completion of a Service Learning Project.  UNC Greensboro describes Academic Service Learning as "a teaching method that links community action and academic study so that each strengthens the other."  According to our student handbook, the project must support those outside the patient realm; provide the student with opportunities for relationship-building, social change, and public relations within the community; and elevate the profession of nurse anesthesia.


"Surviving the Bubble", an introduction to Baptist's Nurse Anesthesia Program led by a former camp counselor and Baptist NAP alumna, was originally created to fulfill the service learning requirement.  This year's program was held this afternoon at Piney Lake Recreation Area, where we spent the day participating in team building activities, mentally preparing for the rigors of school, and getting to know one another.

One of the highlights was meeting Ken Leonard, a High Point police officer who lost both of his feet to an IED while in Baghdad to train members of the Iraqi police.  His personal goal following the incident was to requalify for a position on his local police force and, with time, determination, and a whole lot of work, that's exactly what he did.  Mr. Leonard's story was both inspiring and motivating, and exactly what I needed to hear before embarking on the challenging journey ahead.


Before wrapping up, we were asked to compose a mission statement for the class.  After a lengthy discussion and editing session, we ended up with the following:


It reads:
"We the Class of 2011 will embrace the challenges of becoming excellent Nurse Anesthetists.  We pledge to rely on each other, providing support to one another as needed.  We will encourage each other to persevere in this endeavor as we grow both personally and professionally.  We are thankful for the opportunity to be here and are resolved to remain optimistic, finding joy in our chosen adventure."

Can I get a "hear, hear"?

Today was our first clinical conference.  You see, every Wednesday morning at the ungodly hour of 0645, we are required to attend a conference in which the Baptist hospital CRNAs and (often an anesthesiologist) discuss any particularly interesting cases or topics related to the field of anesthesia.  I didn't quite know what to expect, which is probably for the best considering that if I'd anticipated the number of questions us newbies would be asked after a mere 2 days of orientation, I would have gotten very little sleep last night.

Fortunately, Dr. Tobin, the Chair of the hospital's Anesthesia Department, lead the discussion and really excelled at explaining the concepts that were covered.  The case at hand involved a patient who suffered complications on the operating table following an apparent laryngospasm.  What I found most interesting was Dr. Tobin's description and explanation of flash pulmonary edema.  It caused me to realize that, though I'd cared for a number of patient's diagnosed with this affliction while an ICU nurse, I had never before grasped the mechanism of injury.

According to Dr. Tobin's lecture, flash pulmonary edema may occur after too much pressure has been exerted on the pulmonary artery by way of the alveoli.  How might this happen?  First, it's important to understand that during normal respiration, the vacuum created in the alveolar spaces (the intra-airway pressure) during inspiration ranges from -5 to -10 mmHg.  However, an obstruction or laryngospasm exacerbates these figures as an even greater inspiratory force is exerted in an attempt to overcome the airway constricture.  In such cases, the intra-airway pressure during inspiration may register at -60 to -100 mmHg.  This massive pressure swing causes the alveoli to become more porous and, because pulmonary artery pressure is only around 25/15 mmHg (systolic/diastolic), fluid from the PA intravascular space weeps into the surrounding pulmonary tissue. This flooding of alveolar spaces not only prevents oxygen exchange, but also inactivates tissue surfactant.  Although this substance is slowly replaced by the alveoli, patients often require mechanical ventilation with a corresponding ICU stay while their lungs regain function.

I don't know about you, but my brain feels bigger.

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A description of my interview at Baptist, the program in which I'm currently enrolled, can be found here.  The other school I applied to conducted their interviews in a similar fashion.  The day included an introduction, a meet-and-greet with current students, and an individual interview with members of the selection committee.

The tone of the day at this particular interview was, in my opinion, markedly different from my experience at Baptist.  Suffice to say, I felt that Baptist's administration arrived prepared and maintained a professional tone throughout the day.  They were proud of their institution - for good reason - and it showed.  Unfortunately, this isn't the same impression that I received from the other program I interviewed with.


As for the interview itself, it differed slightly as compared to Baptist's.  Seated at the head of the classroom, I faced roughly 8 members of the selection committee.  The interview was only around 5 minutes in length and consisted of a few behavioral questions as well as one "clinical" question.  Like the others interviewing that day, I feared the clinical question.

Fortunately, a CRNA forum I'd read months earlier (I don't recall which one) provided sage advice regarding clinical-related interview questions.  One of the CRNA contributors, in discussing interview questions, wrote (and I'm paraphrasing):

If you don't know the answer, say that you don't know the answer!  But follow it up with an example of what you would do in the clinical setting if faced with a similar situation (e.g. consult a reference manual, ask another anesthesia provider for assistance, etc.).

Former students at this particular school had also advised me to highlight my accomplishments in the interview but steer clear of any "one-off" experiences or areas that I was not incredibly  proficient in, as the committee generally drew the clinical question from the procedures and medications the interviewees had previously identified as being familiar with.  My clinical question involved the drug vasopressin and why I might choose to use it in lieu of epinephrine.  Fortunately, I had taken the time to review the important medications and disease processes affecting my patient population (Surgical/Trauma ICU) and was able to confidently answer the question.


I was fortunate in that I was accepted to both programs.  Ultimately, I chose Baptist because it better fit my goals and learning style.  Robin, Baptist's Program Secretary, was available, prompt, and helpful.  This is incredibly important to me as I've found that maneuvering my way through "the system" is often the most challenging aspect of higher education, and Robin makes that process as pain-free as possible.  Furthermore Baptist's Nurse Anesthesia Program Director, who teaches many of the classes, explains complex and abstract concepts in ways that resonate with my learning style.  I believed him to be an invaluable resource given the type and amount of information that I would need to understand in order to pass the board exam and provide safe and effective anesthesia care.  I also appreciated the well-rounded training offered to the Baptist students.  More than simply passing the certification exam at the end of their coursework, Baptist students are expected to develop professionally and benefit their communities, and are given the tools and freedom they require to do so.


Truthfully, it wasn't any one thing that led me to my decision to attend the Baptist program.  Part of it was the intangible feeling of excitement I had when I left the interview.  All I know is that Baptist was the right decision for me.  I would encourage anyone interested in becoming a CRNA to examine each option closely and remember that, while each program is interviewing you, you should simultaneously be interviewing them.  Ask yourself, is one program more conducive to your learning style than others?  If you learn best by doing, you might consider an integrated program, in which you engage in both class and clinical  at the outset (Baptist is organized in this manner).  Otherwise, a front-loaded program, in which classes take place for the first year or so before you begin clinical rotations, may be best.  Do you prefer a larger/smaller class size?  Does the program offer students a diverse set of clinical locations and opportunities?


Ultimately, the best school is the one that is best for you.

1. Know what a CRNA does!  How does it differ from the job of an anesthesiologist or an anesthesia assistant?

2. Research the school.  Know why you want to attend anesthesia school and that program in particular.

3. Prepare yourself to answer any topic that comes your way.  Review the common medications and disease processes you see on your unit and arrive ready to discuss what you know.

4. Spend some time thinking about what you would want to know if you were a member of the selection committee and practice answering those questions.

5. Identify your shortcomings.  Can you turn them into positives?  If not, what have you done to minimize or negate their impact on your success as a CRNA?

6.  Get a good night's sleep the night before your interview.  Lord knows, you'll need it!


7. Dress professionally as well as comfortably.  You don't want to be worried about a "wardrobe malfunction" when you should be concentrating on the task at hand.

8. Arrive early.  As my Assistant Director says, "Early is on-time and on-time is late."

9. Remember: While they are interviewing you, you should also be interviewing them!  Keeping this in mind always helps to reduce my anxiety by "evening the playing field".

I'm not going to lie, anesthesia school interviews are scary.  And this is coming from a girl who actually enjoys public speaking and engaging in conversation with new people.

Before I delve into the details of my experience, I feel I should remind you that I personally interviewed at two institutions.  Currently, over 100 programs exist in this country alone, so to say that my experience will be yours would be unwise.  However, both of the interviews I attended shared a similar schedule of events and interview format so I'd imagine these features might extend to other schools as well.

My interview at Baptist Hospital, the program in which I am currently enrolled, took place within the program's classroom.   I'd guess there to be roughly 15-20 applicants in attendance (I believe there were 7 separate interview dates), all of whom dressed and carried themselves very professionally.  The program director kicked off the day by introducing himself and his colleagues, followed by an overview of the program and a schedule of the day's events.

I was immediately impressed by the planning and execution of the day's activities.  A professional and informative visual presentation accompanied the director's address and applicable handouts were made available to us.  While we waited for our individual interviews to take place, members of the junior and senior class were present to answer our questions and lead groups of applicants on tours of the hospital.  Clearly, a lot of thought went into ensuring that our time at the school was well-spent.

Once it was my turn to face the admissions committee, the director met me outside the classroom door and provided a short explanation as to what to expect, which left me feeling just a bit more comfortable than I had moments earlier.  I took a deep breath and walked through the door... only to find 20 faces staring back at me.  As I mentioned earlier: scary.  Fortunately, they were all very welcoming and, after introducing themselves, the interview began.  I was asked what I would consider to be typical behavioral interview questions over the next 15 minutes.  Examples included "What led you to want to become a CRNA?", "Tell us about a time when you disagreed with a coworker or physician and what you did to alleviate the situation.", and "What do you do for fun?"

I left feeling positive about my performance, but unsure of the selection committee's decision.  Because, although my interview went well, I was also very impressed with the caliber of the other applicants and, from what I could tell, I wasn't any more qualified for a slot than those sitting to my left and right.  So, while the stress of the interview was over, the uncertainty and anticipation of waiting for the school's decision had only just begun.

1. Familiarize yourself with each institution's requirements and deadlines.  Some schools require certain prerequisite courses while others may not.  My school, for example, requires that students submit applications to both UNC Greensboro as well as the anesthesia program itself.  A small detail can render your application inadmissible.

2. Shadow a CRNA.  I can't emphasize this enough!  My shadowing experiences were immensely helpful.  They strengthened my desire to one day practice as a CRNA and provided me with numerous examples to draw upon during the interview process.  In addition, committing a small portion of your free time to observe a nurse anesthesia provider demonstrates to the admission committee that you're truly interested in and dedicated to the profession.

3. Talk to SRNAs or CRNAs that you know.  Ask them what aspects of career they like the best/least.  Find out what they wished they'd known before they entered anesthesia school.

4. Complete any and all prerequisite or core courses prior to the interview date if possible.  Earning favorable marks in relevant graduate level classes indicates that you have what it takes to master the anesthesia school coursework.  In addition, if your program allows you to complete any of its courses before entry, that's one less hurdle you'll have to jump through during the incredibly challenging years ahead of you.

5. Apply early.  A number of schools use the rolling admissions process, providing early applicants with an increased likelihood of admission.  Even if your school of interest reviews all submissions following the application deadline, it's a good idea to submit your packet well beforehand so you'll have the chance to correct any missing or erroneous information before it's too late.

While a second-degree nursing student at UNC Chapel Hill, I was afforded the opportunity to observe an OR procedure.  I was assigned to an open heart surgery and was fortunate enough to work with a number of helpful and knowledgeable individuals that day.  The PA provided a general overview of the case and what to expect before the patient arrived, the surgeon took the time to describe his actions throughout the procedure, and the CRNA and SRNA present discussed the drugs they administered, why each was necessary, and those that they anticipated using as the case unfolded.  I was intrigued, and from that moment on, I knew that anesthesia was my calling.

Over the next 2 years, I researched the profession: I scoured the American Association of Nurse Anesthetist website and frequented online forums, spoke with and shadowed numerous CRNAs at a variety of institutions, and took the time to reflect on what I wanted from my career, both personally and professionally.

The time and effort I put forth prior to applying for and entering anesthesia school was invaluable.  It solidified my decision to become a CRNA and provided me with a clear understanding of the reasons behind this choice.  Over the next two-years I will no doubt encounter numerous low points that leave me to wonder if it's all worth it.  Fortunately, I'll already have my answer.

My name is Amy and I'm a first-year anesthesia student at Winston-Salem's Baptist Hospital, which is 1 of the 2 nurse anesthesia programs associated with UNC Greensboro.  Baptist, also known as Wake Forest University Baptist Medical Center or WFUBMC, offers qualified nurses the opportunity to complete 2-year integrated Nurse Anesthesia Program (NAP).  This means that, instead of spending a year or more in the classroom prior to applying that knowledge in the operating room, I will be learning a large amount of general anesthesia concepts at the outset to prepare me for the OR, which I will enter after 2 months of didactic learning.  This also means that the first 2 months as an SRNA will be a whirlwind, to put it mildly.

As for me personally, I'm a 29 year-old who, before my return to the classroom, worked as a nurse in UNC Hospital's Surgical/Trauma ICU, located in Chapel Hill.  But I wasn't always a nurse.  After graduating from the University of Virginia's McIntire School of Commerce in 2003, I worked as an assistant buyer for Hecht's, a department store chain operating along the east coast (though it was later purchased and absorbed by Macy's).  In the summer of 2006 I left Hecht's and relocated to North Carolina to attend UNC's 14-month accelerated BSN program, which I completed the following year.

I have never been married (though I am in a long-term, long-distance relationship) and I do not yet have any kids of my own.  I'm very close with my parents and siblings, all of whom are incredibly supportive of my career and academic goals.  These points, I feel, are important to mention because not everyone enters anesthesia school with the same responsibilities (or lack thereof) and support system that I do.  As a result, my perceptions and experiences may significantly differ from those with families, commutes, or the like.  In fact, my perspective will almost certainly differ.

Regardless of your personal situation, I hope that my experience sheds some light onto the process of becoming a CRNA and aids your career decision or transition into anesthesia school.  If I can be of any assistance, please don't hesitate to email me at the following address: srnalife@gmail.com.

The purpose of this site is three-fold:

First, as a way for me to record my experiences and growth as an nurse anesthesia student.

Secondly, to keep my friends and family, all of whom continue to serve as my sources of of encouragement and support, informed of the highs and lows of my journey.

Finally, this site is for those considering the professional path I've chosen. I value the opinions of others and, were it possible, would have jumped at the opportunity to read an SRNA's thoughts while I navigated my way through the graduate school decision and application processes.

That being said, the content on this site is, unless otherwise noted, based on my personal feelings, opinions, and perspective. My goal is to document my personal adventures as a Nursing Anesthesia student and, in the process, provide future CRNAs with an honest, light-hearted portrait of the road that lies ahead.  I welcome any questions or comments, but ask for your patience while waiting on my response... I am in the midst of a rigorous academic program, after all!