Getting Started as a CRNA Student
As you begin the clinical phase of the CRNA program you will faced with a whole new set of stressors. Your initial goal will be to become more comfortable in the OR. Make sure you have the right attitude, and remember your main focus is the patient. Most CRNA students come from a critical care setting where they worked their way to the top of the food chain. Clinical is a whole new game, and you must once again work your way back up. The most important thing to remember is that pride has no place at the head of the table.
Quality Anesthesia Care
This can best be achieved by coordinating your efforts with all the others in the OR. Quality anesthesia is a team effort. Don’t make the same mistake that most CRNA students make and gravitate to the chart. This is your time to learn new skills, sharpen old ones, and learn how to give a good anesthetic. In order to do this you must watch the patient and not just the monitors. After awhile your tunnel vision widens, and awareness of others in the OR becomes more apparent. This will help to make your coordination efforts with others in the room much easier and second nature.
The main desk is for delivering supplies from other areas of the hospitals. You are allowed to wear street cloths in this area. You will also find a receptionist there, and I would recommend that you become their friend. The receptionist can make a CRNA student’s life a lot easier.
The dressing room is usually located off of the outer corridor. The dressing rooms may also communicate with the outer and inner corridor. This is a great place for CRNA school students to lock up valuables and store street clothes.
The inner corridor requires you to wear scrubs at all times. The lay out is usually either arranged in a circle or square. You will also need to find the hat and mask rack which is usually located at the entrance of the inner corridor, and don’t forget your shoe covers.
This is where CRNA students will spend a lot of their time, and is usually adjacent or close to the ORs. This is where patients from the outside or floor can be placed in a gown, assessed, get an IV, and start to get “pre-oped” by the CRNA , CRNA student, or MDA.
PACU is usually located pretty close to the OR rooms, and this is to maintain safety. If distance is far it is a good idea to keep O2 on the patient. ICU is another place that you will frequently be taking patients after surgery. Pre-op assessments for ICU patients will be done in ICU. Many patients are intubated with a lot of pumps and drips. This can make picking up and delivering patients to the ICU difficult.
This is a place where all the IV start kits, arterial line supplies, airway supplies, ETT’s, and anything needed for backup will be located. Most of supplies for a standard case should be in the room on the cart or machine.
The anesthesia lounge is where a CRNA school student can eat, study, or just relax in-between cases. If it is too loud and you are trying to prepare for your next case just find a place that is a little more quite.
People in The OR
This is the individual responsible for assigning cases and personnel (RNs and Techs) to the different rooms. They assigns rooms to the OR staff, and also write where the anesthesia providers and surgeons will be in which room. They make sure the OR runs smoothly, and that the cases get done in an efficient manner.
The pre-op nurse is the person who gets the patient ready to go to surgery. Pre-op nurses mainly work within hospital settings, administering care to patients prior to surgery. Pre-op nurses administer pre-surgery medicine if necessary, evaluate and access admission documents, identify emergency procedures, and adhere to necessary pre-operation policies and procedures.They will admit the patient, take initial vitals and prepare the patient for surgery. They will make sure the chart, lab work, X-rays, etc, are all up to date.
The circulating nurse is a CRNA student’s BEST friend! They can be an incredible help or make your life difficult. Having a good working relationship with the circulator is very important. It is also very important to not sedate the patient until they have spoken with the patient. Throughout the procedure, circulating nurses monitor the condition of the patient and the needs of the surgical team. Other tasks that the circulating nurse is assigned with include: surgical prep of site, completing OR record, handling communication in the room, answering phone and pagers, retrieving any needed instruments to room, retrieving any more extra medications that are needed, and applies the wound dressings.
Operating Room Technician:
Operating room technicians are the scrub techs and scrub nurses. They will assist the circulator in gathering equipment for a particular case. They also open items to create the sterile field. This is your cue to put your mask on. They also help the surgeon to glove. You might have to help them put their gown on (strap around neck, tie inside, tie outside).
Surgeon & First Assistant:
The surgeon is the primary operator while the first assistant is their second pair of hands. The surgeon may want to see the patient one last time to check and make sure it is the right patient and right procedure. Once surgeon is there it is ok to put the patient to sleep and start the anesthetic.
Anesthesiologist can be a tremendous asset. It is nice to have MDA that enjoys to teach. Listen to what they have to say. Most of the sites have MDA’s working with CRNA’s, and are usually present for induction. They also may want to be present for emergence and extubation.
CRNA & RRNA:
CRNAs are there to guide and protect. Working with CRNA school students keeps the knowledge base fresh. Each CRNA has a different way of performing everything, and expansion of different ideas should come after basics are understood. CRNA school students are practicing on CRNA and MDA license so they must protect their license and patient, and some will be more brusque than others. The stress level is high and being courteous to one another is important.
Anesthesia techs help keep carts stocked and will provide extra supplies during the case. Sometimes equipment will not be anticipated and techs will retrieve the equipment. They will also clean machine between cases.
Most ORs have own housekeeping staff. These people will clean the OR between cases, and make sure that the room is ready to go for the next case.
Patient transport helps move patients from floor to pre-op and help take patients from recovery room back to floor.
PACU nurses will admit post-op patient. These nurses have great knowledge of surgical procedures, techniques, and are able to recognize emergency situations and assist in corrective action. PACU nurses are typically trained to use a variety of medical equipment and supplies that may be necessary to deal with issues that are peculiar to recovery rooms. You need to be sure and provide a clear idea of patient’s history, type of procedure done and current condition. Report should be as clear and concise as possible.
This can be a stressful time during CRNA school, however it is important to take it one day at a time. Try not to get overwhelmed, and just remember you will have plenty of time to learn the ropes. The OR requires everyone to work as a team. There isn’t one person that can do everything, so try and be respectful and work as a team.
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“Shoot for the moon. Even if you miss, you will land amongst the stars.” (Jill McLemore)