Every year in January, we celebrate CRNA week. Most people don’t even know we exist, what we do, or what we are capable of. Let me illustrate a story of how we make a difference everyday and the importance of the previous anesthetic record.
Last week, I encounter a patient that I’ve taken care of twice before (how likely is it amongst 30 CRNAs at the hospital that I get to take care of him 3 times in a row?). I was able to connect with this person and spouse quickly and go over the previous anesthetic record. Since I remembered how it took much longer from him to recover from anesthesia, I adjusted my anesthetic and he recovered much more quickly.
Another patient had a history of postoperative nausea and vomiting so I performed a Total IV Anesthesia (TIVA) and the patient wasn’t nauseous postoperatively.
Another patient had a true history of a difficult airway so we were able to perform a spinal for this particular case.
Another patient had a history of requiring a lot of vasopressors so a drip was used throughout the case and led to a smooth and stable anesthetic (otherwise known as railroad tracks, one of our favorites).
Another patient required extra TLC, explanations and a calming presence prior to the induction of anesthesia. Frequently how you feel going to sleep is how you wake up.
Another patient had a history of emergence delirium and that allowed me to provide additional medication to reduce its occurrence.
Many patients state that their previous anesthetic went well so you can repeat a similar anesthetic and expect it to go well, especially if it is a similar type of surgery or procedure.
As they say, you’re only as good as your last anesthetic. Every case, you find ways to improve your anesthetic technique and tailor the anesthetic based on the individual.
It’s 2022 and we are entering our third year of the pandemic. Omicron is ravaging the country. In Michigan, it’s currently plateaued at 1600 new cases a day. At my hospital, we haven’t completely stopped surgical cases. We are canceling cases due to the nursing shortage. There aren’t enough nurses to watch the patients after surgery overnight. There aren’t enough nurses to monitor patients in the ER, med-surg, ICU and PACU. There are overtime mandatory hours. Nurses are asked to work 20 out of 24 hours. How can that possibly be safe? Is it simply getting out of hand.
What we need to have is an appropriate nurse to patient ratio. The frontline nurses who have too many patients are bound to miss something in the patients’ care and that could be your mom, brother, child. In California, it is mandated at every hospital to have a certain nurse to patient ratio depending on the type of care rendered. The result of this is having more nurses hired who can provide the care necessary for the patients. Why can’t that be in every state?
Some may argue that would close down more hospitals because there aren’t enough nurses. However, that is furthest from the truth. There are more registered nurses now in the USA than ever before and yet we still have this nursing shortage.
This nursing shortage exists because nurses are burnt out and the hospital doesn’t want to pay for more nurses. The hospital administration knows that nurses cannot take care of too many patients and yet they ask them to. They keep hoping new nurses come to replace the retiring nurses. There are more people applying for nursing school now than ever before. When you are chronically overtaxed with patients, you know you aren’t providing the best care that you can. You start to perform sub-optimally, and that eats away at your soul. It gets to you emotionally and physically. It happens to the nurses who want to provide great care but they aren’t able to because there is just too much to be done in a safe manner. If you’re constantly being asked to provide care that isn’t up to standard, you will become demoralized and burned out.
If there is less burnout amongst nurses, more nurses would stay in their career and continue to care for patients. It is satisfying work to care for patients but when it starts to negatively affect nurses, they will make a jump to retire early or go into another career.
Just remember, when you enter a hospital, you are depending on the care of the watchful nurse to ensure your treatments and monitoring for changes. Without appropriate ratios, the nurses can no longer do their duties to the best of their abilities and things will get missed. And that can be the difference between life and death. Is that really fair if it was your loved one?
I think this is the year to ask our state legislators to make a change to get safe staffing ratios. This will make a life and death difference. Thanks for reading.
This last 8 months of 2021 has been difficult, polarizing, and changing. At the beginning of this year, I got the Pfizer COVID-19 vaccine and thought everyone would eventually get on board with getting the vaccine and ready to cull the pandemic to its end.
People were going across state lines where less people were getting the vaccine. The rush to vaccinate began in the USA.
Then I heard chatter amongst my colleagues. People were scared to get the vaccine. A lot of misinformation was and is still out there. They hear about the cases where people got bad side effects. They weren’t going to chance getting the vaccine. They would rather get the virus and brave the disease process and treatment. While many survive, many also maintain “long covid” symptoms such as the loss or reduced smell or taste.
Finally, the rush to vaccinate had subsided and those hesitant to get vaccinated began to say “how could you want an experimental drug, I’m not a guinea pig.” The institutions were not to be trusted— only their “sources” would reveal the “actual truth”.
At the end of June, my hospital decided to implement a vaccine mandate by September 10th, based on the belief that the vaccine would pass FDA approval (and no longer under emergency use authorization). Of course there are medical and religious exemptions.
Since then, protests occurred in the name of freedom. People quitting, going into a different field away from healthcare. Others quit to become a “traveler” where in healthcare you could make 2-3x your regular wages. Nurses becoming jealous of those with big sign on bonuses and thinking of wanting some of that too.
Many religious exemptions were made. Personally, I’m not sure if it is to keep the staff or if there are truly that many religions that are against vaccines. What religion promotes transfer of diseases? When you know a way to protect yourself, adding a layer of armor against something, wouldn’t you want it to help yourself fight?
About a week ago, the FDA approved the Pfizer vaccine. The excuse to not get the vaccine changed again. Did it really encourage those people who were hesitant to get the vaccine to get the vaccine? I hear many say the government pushed them too fast to get it approved. Basically, why trust the government.
Right now in Michigan we are lucky to not have a big surge, unlike in Florida. We are lucky to be “business as usual” without delaying surgical care to patients. We don’t have a huge influx of covid patients and for that I am thankful. We are starting to get a few more covid positive cases compared to the last few months. I sincerely hope with the start of the new school year that everything stays the same. But I highly doubt that. More people will get sick. Sure there’s treatment for it but isn’t it better to take measures to prevent getting a disease?
Starting in September, we will see what will happen. Until then…
As for my little one, I feel fortunate to have pumped /breastfeed for one year. But I am also happy that he readily accepts whole milk and doesn’t mind (too much anyways) that it’s only bottles now.
I can’t believe he’s already 15 months old. He’s running around, bounces up and down to music, climbs furniture more readily, goes up and down the stairs, understands quite a bit of what I say to him (even in Chinese!), points where he wants to go or do or eat, and says a few words. He loves the water and can’t wait to jump back in the water again. It is such an amazing journey.
The storms are getting bad, with my parents losing power for 5 days. I am seriously considering getting solar with a battery backup.
Disclosure: I share some affiliate links below of products that I personally use. If you purchase I may earn a commission. I only share products that I really enjoy using and hope that it’ll help you too.
First of all, happy CRNA Week. Today I’d like to talk about how to have a happy pumping CRNA.
Before I became a first time mom, I really had no idea what breastfeeding and pumping entailed. It’s not really talked about anywhere online especially regarding those working in healthcare and how they managed to work and pump. Now that’s been more than 8 months, I’d like to share my experience to encourage new moms to continue their breastfeeding journey once they return to work.
It’s good to share than the American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Personally, I set my breastfeeding goals to the first month, then 3 months, and then every 3 months to one year.
What I’ve discovered that the breast pump represents freedom from the baby and the ability to still provide the best and complete nutrition for your baby. You don’t need to have your baby attached to your hip to be a good breastfeeding mom. The breast pump gives you freedom to express milk whenever you want and it is not dependent on when the baby is ready to eat or if the baby has trouble latching. Also in the beginning, nipples take a beating (boo… I highly recommend Motherlove Nipple Cream and Lansinoh Hot/cold pack and Ameda gel pads especially for the first week or two) from breastfeeding so pumping gives your nipples a break.
Ever since I got back to work, I’ve had the support of my colleagues and family and the opportunity to continue feeding my baby breast milk. I have to be thankful for the positive nursing culture and a built-in system in the surgical department. That really is key!
It is super helpful to have supportive CRNA leadership, especially from someone who’s done it before. It’s also helpful to have an understanding from all the other CRNAs who can give me a little extra time to pump (getting a 20 minutes break instead of the usual 15 minute breaks).
For me, I take 10 minutes to pump. 5 minutes to clean my pump parts and use the bathroom. 5 minutes for walking to and from the pump room and getting my cooler bag. However, some moms may take more time to pump, usually up to 20 minutes.
In addition, I just wear my nursing/pumping bra to reduce the time that I have to put on and take off a specific pumping bra. I love the one from Kindred Bravely.
When I get to work every morning, I write down my pumping times on the assignment board so that someone can get my pump break at those times. Breastfeeding is a matter of supply and demand and requires you to pump at least every 4 hours to maintain your supply throughout the day. It is extremely helpful to try to maintain this. It is ok to seldomly miss it but not on a regular basis. Otherwise your supply will take a hit.
Anyways, I try to pump at 5am, 9am, 1pm, 5pm, 9pm. However I do adjust my schedule and move it one hour earlier to accommodate the OR schedule. For example, at 5am (at home), 8am, 12pm, 4pm, 8pm. Many moms will try to pump around the same time she would feed her baby.
Having a dedicated private pump room that is close by to the OR is extremely helpful. When the pump room is far away, it takes so much more time to walk there and back, which cuts into the pump time (and every minute counts!). Also, when there are more than 2 pumping moms in the same unit, it is extremely helpful to have additional pump rooms available nearby. The reason is that frequently, pumping moms will have a similar pump schedule. Our unit has multiple pumping moms. We started with one room when I returned to work 5 months ago. Now we have 4 private pumping rooms near the OR. This will ensure timely pump times.
Here are “must haves” to a private pump room:
A lock to lock the room or curtains to separate the space in a large pump area
Private room with no windows or a screen if the room has indoor windows so no one can peek in
A table large enough to put all the pump bag and supplies (for example, a bedside table typically found in hospitals)
Chair where your feet touches the ground
Trash (housekeeping should empty this daily)
A whiteboard and a dry erase marker for the outside of the door when there’s more than one pumping mom to indicate the estimated “out” of the door time so the next pumping mom knows when the room will be available. It’ll help her decide to either wait for the room or try to find another room.
Here are “nice to haves” (but you can have workarounds):
Mini-fridge to keep the milk/breast pump parts cold
Workaround: get a cooler bag and place an ice pack in there. Or put the whole pump bag or just the milk bottles into your work refrigerator (but it may take more space)
Nice ambiance conducive to a relaxing environment. Stress decreases milk production so thinking or looking at pictures of videos of the baby helps
Extra pumping supplies. If the hospital already has a mother/baby unit that has a hospital grade breast pump, having this extra set is extremely helpful when something breaks (your own breast pump, parts) or is missing (you forgot to pack it!).
I always keep a manual breast pump (the hospital gave it to me after giving birth before I left for home) in my locker for those “just in case” times. I’ve used it several times and I could actually empty one breast in 5 minutes but it definitely requires using one hand to pump and the other to manually pressing the breast towards the nipple to empty the milk ducts.
Whenever possible when I’m home, I’ll directly nurse the baby. Once you get the hang of breastfeeding, I find it to be easier than exclusively pumping. However, there are definitely pros and cons to both.
In conclusion, having a happy pumping mom at work is so vital to prevent burnout and help moms do great work and feed her little one. Having a private pump room close to the OR and a respected pump break time helps immensely.
If you’re a potential or current pumping mom, what would or has made your pumping journey easier?
If you’re in management, what can do you to implement a better pumping culture to reduce burnout for new pumping moms?
It’s been one week since I received the second Pfizer COVID-19 vaccine. I didn’t feel as fatigued compared to the first shot. However, the injection site became red, swollen, hard, warm, itchy, and painful starting on the second day.
It peaked on the 4th day where you could see red streaks and it got to be about 2 inches in diameter. After work, I went to my primary care physician to have her take a look at it. She said it was unlikely to be cellulitis since they clean off the site with an alcohol pad and used a clean needle. She said it looked more like a strong local immune response to the vaccine.
That same day, I started taking Tylenol, iced it, and rubbed some hydrocortisone 1% on it. I just went to my local CVS to purchase some. I also rubbed some Nature Republic aloe on it.
By the fifth day, the injection site started to decrease in size and became less tender.
Today is now day 8 and while it is still slightly tender, it is in much better shape now.
Even though I had some side effects, it beats the unknown effects of COVID-19. While I’m unlikely to die due to my age and comorbidities, there is still a possibility of getting sick and worse– passing the virus to my loved ones.
I hope when the vaccine becomes available to you, you make the plan to get it. If you’re concerned about it, chat with your doctor about it or feel free to reach out to me. Do your part and get vaccinated!!
Working in the UK as a nurse could be an excellent career choice with the added bonus of an opportunity to travel. Hospitals within both the National Health Service (NHS) and private sector often conduct recruitment in other countries in order to attract qualified nurses.
Employment opportunities in the UK
UK recruiters have acknowledged that there is still a significant demand for full-time nurses. Besides hospitals and clinics, nursing and care homes are also looking for nurses to fill their vacancies.
So where do you start?
If you are from overseas and want to work in the UK, then naturally you will need to make an application. The process will take some time and a little bit of paperwork.
The requirements will also differ depending on whether you trained:
Within the European Economic Area (EEA)
Outside the EEA
The difference is due to the EU’s employment regulations. If you want to speed up the recruitment process, here is some sound advice.
Register with the Nursing and Midwifery Council
Registering is a requirement for all those who wish to work as a nurse in the UK as the NMC is the official organization that regulates the nursing profession.
If you are from overseas, you will also need to secure a UK work permit and find an employer who will sponsor you. Once you have registered with the NMC, you will receive a PIN number which will allow you to practice as a nurse in the UK. You can visit the NMC website to find out more information about registering as a nurse. To secure a placement, you should contact the hospitals directly.
Once you have submitted your application, you will either be accepted, rejected, or asked to fulfill further requirements, perhaps by undergoing a supervised practice period.
If you have been trained as a nurse outside the EEA, you may have to take a nursing course so you can adapt your existing knowledge and skills to a UK setting. You can then register with the NMC once you have completed this course. Non-EEA trained nurses will also need to pass a competence test (CBT) and a practical skills examination (OSCE).
The particular type of work permit or visa required will depend on your country of origin. If you are from the EEA region, you can visit the Home Office website for information on how to secure a UK work permit. If you are from outside the EEA and Switzerland, you need to apply for the General Visa – Tier 2.
UK nursing vacancies during the COVID-19 pandemic
The COVID-19 crisis has meant that some of the usual hiring practices have been modified, especially for nursing home jobs. For instance, candidates can expect to be interviewed by their prospective employers via a video call. In addition, candidates may only be able to visit the employer’s facility when it is necessary or after they have been hired.
Even before the pandemic, there was a high demand for nurses in the care home sector. UK recruiters anticipate that this demand will only increase once the current crisis has abated.
Apply for a nursing position in advance
As mentioned earlier, the UK nursing application process may take some time. It can also be rather complicated. As a result, it is vital that you make your application as early as possible, well before you arrive in the UK.
To expedite the hiring process, make sure you bring all your essential documents, such as:
Nurses who are interested in working in the UK can expect a warm welcome from recruiters and employers alike. The demand for qualified and skilled nurses is still very high. Although it may require some effort and time to apply, it will be well worth it in the end. If you want to evaluate your career options, go to the NMC and UK Home Office websites to find out more information.
One of the most memorable photos from the COVID-19 pandemic is an image of two healthcare workers in full PPE embracing, face shield to face shield. It’s an even prouder moment for the nursing community as the two are a certified registered nurse anesthetist (CRNA) couple from Tampa General Hospital.
These two CRNAs, Mindy Brock and Ben Cayer, are on the hospital’s airway team. When a COVID patient is in respiratory distress and requires intubation, they are there to sedate and intubate the patient. This is a high-stress situation where time is of the essence, as a COVID-19 patient’s oxygen saturation is known to drop rapidly.
Mindy and Ben are just one example of the roles that CRNAs have played in helping fight COVID-19 across the country. Keep reading to find out more about how CRNAs are contributing to this health crisis.
How CRNA Qualifications Help
CRNAs are advanced practice nurses who are trained in skills such as intubation, arterial line insertion, central line insertion, and pain management techniques, such as regional blocks. Prior to earning their degree and certification, CRNAs are required to have intensive care unit (ICU) experience so they are well-versed in managing critically ill patients.
This education and training takes a CRNA to the head of the bed in an operating room, surgery center, or doctor’s office, but the COVID-19 pandemic has CRNAs finding new opportunities to pitch in.
Continuing the Fight in Medically Underserved Areas
CRNAs have full practice authority in 29 states. This means they can practice without a physician’s supervision. As a result, CRNAs often provide care and airway expertise in traditionally underserved areas. An example would be in a community access hospital where hiring a CRNA can be a cost-effective practice.
According to the American Association of Nurse Anesthetists, on March 30, 2020, the Centers for Medicare & Medicaid Services issued a temporary suspension of supervision requirements for CRNAs. This suspension meant hospitals and health systems could utilize CRNAs to the fullest extent of their practice. In a press release about the suspension, Kate Jansky, the AANA President, said this decision allows CRNAs to manage and staff intensive care units as well as staff operating rooms without a physician’s supervision.
Traveling to the Front Lines
Lots of facilities canceled their elective surgeries to slow the spread and preserve their PPE, and many furloughed CRNAs took the opportunity to travel to some of the hardest-hit areas to provide their services. One example of this was when 30 CRNAs from the North American Partners in Anesthesia (NAPA) group traveled to New Jersey to join in the fight against COVID-19.
CRNAs traveling to states that were hit hard would work on intubation teams as well as resuscitation teams. When a COVID-19 patient coded in the hospital, the CRNAs would provide assistance in airway management, medication administration, and other potentially life-saving tasks.
Even with the right PPE, the work is dangerous. CRNAs are working with the airway, which means they are especially at risk for getting contaminated droplets on their clothing or breathing them in. An estimated 20 percent of the anesthesiology department at Mount Sinai Health System in New York City had contracted the virus as of April 2020, according to the Associated Press. Even with the increased risk many have voluntarily given their time and knowledge.
Returning to the Bedside
Because CRNAs have worked in different ICU settings before going to graduate school, some have opted to return to the bedside during the pandemic. For example, many have stepped into roles helping manage ventilators and airways in ICUs as well as taking patient assignments.
With elective surgeries on hold in many parts of the country, working in the ICUs or in emergency triage settings allows CRNAs to utilize their hard-earned skills.
While 2020 has looked very different for the healthcare community than anyone had anticipated, there are countless stories of nurses, including CRNAs, who have answered the personal call to help. The pandemic has also shined a light on CRNAs’ services and engaged politicians and communities to lobby for expanded practice rights.
Where there is a health need, nurses — including CRNAs — will answer the call.
Michiganders are now required by Executive Order from Governor Whitmer to wear a mask indoors and in crowded outdoor settings except in certain situations. All workers in indoor businesses should also wear masks and businesses must turn away customers who don’t wear masks.
Our state leader is setting the right example by wearing a mask and is attempting to change the “American culture” of individual freedoms fast. She has to set this executive order to tell everyone the seriousness of this pandemic and what we all must do to combat COVID-19.
Unfortunately our national leader, the president of the United States, does not want to set a good example and has made masks a political movement. It should not be a political movement! Instead, this is truly a public health crisis.
Wearing a mask is a symbol of caring for thy neighbor, anyone you come in contact with. The mask protects the other person from you, just in case you are amongst the 40% of asymptomatic coronavirus carriers.
Being an asymptomatic carrier means that you have no symptoms whatsoever and you still have the virus and can easily spread the virus to others. Currently, the WHO and scientists worldwide tell us the primary way of getting this severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the name of this coronavirus, is by being close to others in less than 6 feet and breathing in their air.
This coronavirus is not going away until a viable vaccine is ready, which is unlikely to happen until next year. We must remain vigilant and always think what we must do to protect our loved ones and those on the front line. Just when Florida and Texas think they are in the clear and open up the country prematurely, now they are paying for it with American lives and wrecking havoc on thousands of families. If Florida was a country, they would be number 4 in the highest number of cases right now.
This is especially important as a nurse. You must always protect yourself in order to protect and serve others. Encourage those around you to follow good practices.
I have to admit it’s been difficult. I wished for my sister to drive from New York and visit me and my newborn. Unfortunately I had to decline and tell her to visit me next year when we have a vaccine. My newborn is completely vulnerable and I would feel horrible if something happened to him. She had also visited several groups of people in the week leading up to the planned visit and planned to stay in a hotel for a night. It doesn’t help that videos come up that show hotel rooms still not being adequately cleaned even during the pandemic.
What have you done to encourage others to wear a mask? How have you struggled during this pandemic? Let me know in the comments below.
2020 is also the year of the nurse and midwife as designated by the World Health Organization (WHO) in honor of Florence Nightingale’s 200 year anniversary of her birth.
Florence Nightingale is the pioneer of modern nursing.
It is almost very fitting that this is the year of the nurse and midwife. They are on the frontlines of taking care of patients with COVID-19 and must advocate for not only the patient but also themselves. The protection and safety for themselves is vital for taking care of others.
Unfortunately there are already too many stories of nurses who were not equipped with the appropriate amount of personal protective equipment (PPE) and died because of it. Every hospital system should do everything to support the nurses and anyone on the frontline to get the right PPE. No system should deny the nurses safety and their own judgement on what is required to keep them safe.
As for the midwives, I am proud to say that I choose a midwife to be my primary care provider. Thankfully midwives and the hospital system have a good working relationship and thus many best evidenced based practices are utilized. I’ll go over it in more detail tomorrow. Goodnight for now.
I moved back to Michigan about a month ago and since then I’ve done a couple of things:
I got a new job
I bought my first home and I’m moved in last week
I attended the AANA (American Association of Nurse Anesthetists) Annual Congress
A lot of big and exciting changes are happening in my life.
Probably one of the hardest things for me to acclimate to a new institution is getting used to new
flow (from pre-op, intra-op, to post-op for all different surgeries and procedures),
equipment and location of materials,
staff (are they seasoned nurses and techs or are they unfamiliar with the preferences of the surgeon),
physician anesthesiologists (do they communicate well with you, give pre-medication, follow protocols well, etc) and
surgeons (knowing their preferences, speed of surgery, etc).
Sometimes when things don’t flow as well as I’d like, I have to think about the big picture: “did the patient safely go through surgery?” If yes, “what else could I do next time to improve? What did I do well?” I continuously reassess my day. Sometimes I’ll reach out to my colleagues to ask them of their opinion as well.