Happy Nurses’ Week 2019

Happy Nurses’ Week.

We are there for patients during their most vulnerable times and we advocate for them when we see something that isn’t quite right.

One of the things that I learned in nursing school is to keep asking questions. After conducting a head to toe assessment, we should ask ourselves: Is there a reason for a certain lab value or condition? Can we correct that? If yes, how (which drug, route, fast or slow; is there evidence-based practice to support it)? When should we re-evaluate our efforts to ensure that it’s improving the patient?

Anyways, a lot has happened since my last post. I’m moving back to Michigan. After practicing out in Northern California as an independent CRNA, I feel that I’ve learned so much in the last year and gained much confidence as well. There are some things that I feel has improved.

  1. The communication among the surgeon and the OR staff. Letting the nurses and the support staff aware of my presence, discussing with the surgeon my anesthetic plan.
  2. Regional anesthesia. While I did perform them in school, the experience I gained while performing them with and without other anesthesia staff has been tremendous. Attending a Maverick regional anesthesia course improved my hand-eye coordination with the needle. Interscalene blocks, TAP blocks, adductor canal blocks…
  3. Ultrasound guided arterial lines. It is the preference for the cardiac anesthesiologists to perform ultrasound guided central lines and arterial lines. So why not make it a standard of care for ultrasound guided arterial lines? Sometimes the ‘feel’ of the pulse is not accurate and a visual of the artery improves the first time success rate even for beginners.
  4. When there’s a sick(er) patient or a patient with a potentially difficult airway, I ask for another CRNA or an anesthesiologist to standby to help me start the case. As a professional, I’m aware of when I need additional help and when I will be able to manage the case on my own.
  5. While the first couple of cases I was a little apprehensive of starting and ending the case of my own (considering that in my training I always had a CRNA and anesthesiologist in the room during those times), I feel much more comfortable with induction and emergences on my own. The positive aspect is that cases tend to start shortly after entering the room so that there is no delay (unlike in a medically directed setting where it may take more time for the anesthesiologist to arrive if s/he is not readily available for whatever reason).
  6. Reducing the amount of opioids used in surgery by utilizing a multimodal analgesia. As you know, the opioid crisis is exactly that – a crisis. There are simply too many people who continue to have post-op pain and require opioids. That is one of the ways that is contributing to the crisis. If we can improve our processes to reduce the amount of opioids during surgery, postoperatively, and utilize other evidence based pain management strategies, then we should all move towards that.

That’s it for now. Until next time.

Posted in Nursing.