Life as a CRNA

Fall Semester (Aug-Dec)

My first semester was primarily spent in the classroom where I was introduced to the basic principles of anesthesia, physiology, pathophysiology and pharmacology. It was an exciting time, but also, a period in which I was trying to figure out where I stood amongst my peers. In retrospect, it sounds trite and trivial, but what can I say? I was an insecure person. 😉 I often tell new students to approach their 2 year education as one big game, whether they’re in the classroom or clinical setting.

There are two approaches to getting through the program. The first is to be the student who excels at everything, scores through the roof on their tests, and become actively engaged in classroom discussions. However, that’s just exhausting. I know because I was that person. Well, kind of. The other approach is to keep a low profile. Just do what you’re told. Don’t complain. Take the tests and participate only when called upon. This is the approach I encourage every student to pursue because the experience of going through nurse anesthesia school is a marathon, not a sprint.  I thought I had the stamina to handle the first approach, but man, did I burn out by the end of the first year…for reasons, I’ll explain in my subsequent posts.

In any case, my first semester was full of excitement, anxiety, and wonder! Excitement and wonder because it had been a 2 year journey for me to get to this point and I was looking forward to developing a new professional identity as a nurse anesthetist. However, the first semester was also anxiety-provoking because I was used to being the smartest (or at least one of the smartest) person in my class. However, that wasn’t the case. If anything, I felt like the dumbest person in my class and felt like I had to work hard to keep pace with my classmates. There were individuals who gave the appearance that they barely studied and were scoring high on our bi-weekly tests.

I’m not going to lie that my first semester was more of an exercise in learning humility and not letting my vanity consume me. And yes, that’s how insecure I was and I’ll be the first to admit it, but the best lesson I learned from my first semester was to let go of the idea that I had to be the smartest person in class. The moment I let go of that idea, the easier school became for me.

Also, there will be individuals there who will attempt to establish themselves as the alpha students. That’s okay too. To me, I just see it as posturing. Don’t let someone’s professional background nor their proclamations that they barely studied for tests deter you. Like I said, it’s all one big game where everyone is trying to jockey for a position in class. If you keep a low profile and don’t attract any attention to you and just get through class, you’ll do just fine.

Spring Semester (Jan-May)

It was during this time I began my clinical rotations. I was learning how to perform preoperative evaluations on my patients and learning how to provide anesthesia. I felt like a baby born into the world. My synapses were on full blast. My senses overwhelmed. It was both exciting and exhausting. Clinicals were exciting and exhausting and I had to balance that with learning advanced principles in anesthesia and pharmacology. Additionally, I had a huge research paper to write during that semester. I ultimately front loaded writing my paper, meaning I spent the first 3 weekends getting it written and completed, so that I could coast through the remaining semester without having to think about writing anything else. Though it was a huge time commitment in the beginning and I felt like I was going crazy because I spent nearly every minute during those three weekends to complete my research project, I’m glad I did it though because it just meant one last thing to think about for the semester. The rest of the semester was easy because all I had to do was go to class, learn anesthesia, go to clinical and practice anesthesia.

It was during this semester that I started to realize that getting through this program is all about time management. I had 2 days of class and 3 days of clinical and 2 days off to study the following week’s lesson plan. On top of that, I needed to make sure I exercised and ate healthy to keep myself sane. Unfortunately, I was only able to exercise. My nutritional intake was horrendous during this time and I would say for the remaining portion of school. A lot of fast food was consumed because I just felt like I had no time. Whatever free time I had, I used it on working out to alleviate my stress from the program or I was studying to keep up with the curriculum.

Overall, though, because I finished my research practicum at the beginning of the semester, it made my life so much easier. I felt like I was coasting to some extent (minus my awful diet). As the semester wore on, though, I did start to notice myself feeling more and more fatigued and more and more stressed. Going to class itself was easy, but clinical was a little more challenging because I was just getting myself accustomed to the OR environment. Learning how to synthesize all of that information and applying it, well, it took some time…

From January to April, I was at a clinical site that introduced me to the foundations of anesthesia. I did a lot of bread and butter cases (e.g., GYN, breast, laparoscopic surgeries, ortho). Obviously, most of my time was spent learning how to provide monitored anesthesia care and general anesthesia. I learned how to intubate with different instruments, how to induce patients using a variety of different medications, and how to place arterial lines and spinals in patients. It was a good experience. It seemed like the majority of the focus was spent in the intraoperative period (duh, but I’ll elaborate more on why it was different with my next rotation). Oddly enough, because I wasn’t expecting this at all, but I found myself really enjoying the site I was at. Before starting at this place, I had already made up my mind as to where I was going to go once I graduated and this place wasn’t on that list. However, over the course of 3 months, I found myself developing a strong liking to the kinds of cases that were being done there and more importantly, I really liked working with the staff at that hospital. It’s hard to explain, but there are some places, some rotations where you develop a vibe at and this was one of three places where I developed that vibe. I was sad to move onto my next rotation, but knew that this place would be a potential place to work upon graduation.

From April to May, I rotated to an academic medical center, which provided a completely different kind of experience. In my previous rotation, I felt like I was only relegated in the OR. However, at this institution, it seemed as though I had to a “holistic” approach to anesthesia. And by holistic, I just mean being more involved in my patient’s perioperative experience. I had to learn how to do a thorough preoperative evaluation and I had to write postoperative orders for them. In retrospect, it really doesn’t mean much, but when you’re starting out as a new nurse anesthesia student, obviously, understanding and actively managing a patient’s care throughout his/her perioperative process is essential in developing an appropriate plan of care for them as well as knowing what kinds of problems to anticipate when taking the patient into the OR. While I had to think about those things in my previous rotation, I think having to actually fill out a preoperative form and perform a preoperative interview helped me hone my that skill set of thinking about my patient’s care from a global perspective.

Summer Semester (June-Aug)

Basically a continuation of my spring semester except now I’m going to clinical 4 days out of the week. Class was only once a week and it was the summer where I learned pediatrics and obstetrics. I was also part of the first cohort to do my pediatric rotation, which was very stressful for me. I had never taken care of a pediatric patient during my nursing career, let alone provide anesthesia to one. I’ll never forget my first day at Children’s Hospital. I intubated a patient and and after securing the tube, my attending immediately left me. We didn’t have a discussion  about what our plan of care was for the patient, which I mean, was fine because I could figure it out, but for someone’s first case with a pediatric patient? It just seemed a little strange to me that my attending didn’t want to have a discussion. In any case, I survived my rotation, but I won’t deny that it was stressful because I was trying to learn pediatric anesthesia while providing anesthesia to kids. Kind of hard to do when you don’t have a foundation on the principles of providing anesthesia to a particular population, but tons of people have done it before me, so I guess it’s not uncommon. I survived. That’s all that matters.