Enjoy the beautiful day!
Last week, I had the opportunity to represent as a CRNA student at a middle school. In my preparation, I found a few inspiring talks about how to choose a career. I remember when I was in 6th grade, on my way home from swim practice, I broke down crying and asked my dad, “what’s the purpose of my life?” In retrospect, that was deep.
Anyways, Ashley Stahl, a career coach, said you should ask yourself three questions to choose a fulfilling career. This, hopefully, is a key factor for happiness.
- Who am I?
- What am I good at?
- What’s holding me back?
Who am I?
This question requires you to think about the most important values in your life. Everyone is unique in that they hold varying values more closely. Family, friends, the media, etc. can all affect your perception of what is most important to you. Ultimately, choosing the ones that matter to you the most is what will help you live your life the way you want. Values will determine your behavior and attitude and guide your life.
Remember, other people’s values can pull you away from yourself. ‘Lists’ of how to be happy don’t often work. However, living out your values will make you happy. While some people value family time, others may value individualism and climb the career ladder. Others may value both. This can cause an internal struggle, or it’s possible to create or find an organization that allows you to live out both values. Others may value education, etc. It is helpful to find a career and organization that most aligns with your values. Of course, some values may change over the course of your life, depending on the stage in your life.
Personally, I value education, optimism, caring, persistence, kindness, and traveling. I’m sure several of these values were pressed into me. Taking care of my education is number one because no one can take that away from me. Always trying to beat my personal best. It’s a competition with myself to push me to do better than the last time. And to reflect, what did I do well? What can I improve on?
When I don’t feel right, it’s because I’m not living out one of my values enough. When one value is lacking, it’s time to nurture it. It may be difficult to do if a value depends on others. For example, if you value being the best, and now you’re in school again (such as anesthesia school), and you’re back at the bottom of the food chain (in the OR), it will feel very uncomfortable. Either you shift your values (which can be difficult to do but a change in perception can help significantly), or you continue to struggle until school is over and you’re practicing on your own.
What am I good at?
This was one question that was hard for me to know, especially when I was younger. I expected everyone to be just as good as me in everything. Of course, this is not true. Ashley suggested that you can find your strengths by someone TAPping you… Teach, Advice, Praise. What are others asking you to teach them? What are others asking you for advice in? What do others praise you in?
Of course, you will realize that you cannot be good at everything and that you can improve your skills through practice, through visualization, through discussions. Tune in your natural abilities.
But how do you know? Through experience. My mom has always told me that any experience is a good experience (except drugs. Thanks for the advice). Anything that may pique your interest (or a part time job that will hire you) try it out. I recommend reading www.80000hours.org. It’s called 80,000 hours because that is the time you will spend in a career.
What’s holding me back?
Other people’s values and expectations of you will hold you back. Your fear of failing. Your internal talk saying, “I’m not good enough” or “I don’t belong here” or “I’m an imposter”. Yup, I’m guilty of this too. Several times throughout school I would question my ability. Do I belong here? To get myself out of this feeling, I used my value in optimism to take me out of the funk. “Jess, you are learning. You will make mistakes. Don’t be so hard on yourself. What can you do next time so you improve?”
When you are in a new situation, visualize the scenario. I remember my first semester of school when I arrived in the OR at 5:30 am to set up my room. It was certainly exhausting. How do I check out my machine? Which syringe size do I need for each drug? Where are the drugs? How much drug should I draw up, should I use? Which colored label belongs to each drug? Why aren’t all the blue ones, orange ones, white ones bunched together??! Where is all of the equipment, and which drawer? I physically walked from the door to the head of the bed and thought through my steps. Later, I had to think, how will I prone a patient? I physically held out my hands and pretended to move the patient’s head from supine to prone. Of course, later on I realized that I also had to be aware of all of my monitors and lines too. The next time, I was considerate of my lines. The next time after that, I became more and more aware of my surroundings and different cues.
What helps is having a clinical instructor, a mentor, a boss, a friend, an acquaintance, who can listen, see, and understand what you’re going through and guide you through those difficulties. What are failures they’ve encountered that would make it easier for you?
There are days when you’re harder on yourself, and days when a ‘superior’ – be that an instructor, or a senior, or someone up the hierarchy in some way – will tear you down. One day is usually ok. But when it’s a constant uphill battle, it can be difficult to mentally withstand it. From being in school where there’s an evaluation of your work everyday, I’ve come to appreciate resilience.
I remember playing Final Fantasy and as one of the stats was resilience. I thought, WHO CARES about resiliency? I want strength! However, now I believe that the ability to pick yourself up after being knocked down is so vitally important. What is your coping mechanism? Some turn to drugs, some turn to family time, some will need to vent to classmates, some need therapy, some will dive in deeper in their studies, etc. Ideally, don’t do drugs because you’ll go down a rabbit hole that may be hard to get out (of course, rehab is an option but if at all possible, you can avoid it, why not?). How can you pass the daily evaluations?
Daily evaluations can be tough because one bad one can lead you out of the program. The fear of failing out of the program is real. Getting into anesthesia school is a big ordeal for yourself and your family and friends. It’s almost ‘everything you stand for.’ Failing out can be detrimental not just for yourself but from those closest to you. For example, there’s a story about an anesthesia student who failed out and then committed suicide on the day of her ‘supposed’ graduation. Very scary!!) However, ultimately, it is about what your choices and how you deal with each situation. For me, I have plan A, B, C. Of course, I want plan A but if that fails, plan B kicks into place. For me, having a backup plan (a backup anesthesia plan and life plan!) was a sense of calm that I needed to reassure myself that I can do it.
Hi readers of Nurse Jess,
It has been nearly a year since I posted on my blog. Some readers (aka a few junior anesthesia students) have met me and wondered if I’ve fallen off. Nope, I am right here!
Every time I considered posting, an exam, a care plan, paper, or even the limited time off to do nothing, pulled me away. But now I’m back.
I have so much to say and yet so little time to do it. I could write a lot, as I often do, to convey all of my thoughts. But I will try to keep it short to encourage me to post more.
Since the beginning, I’ve done over 700 cases and over 1800 clinical hours. And there’s still 4.5 months left of anesthesia school. It may seem like a lot, or a little, depending on who you are.
That time doesn’t include class days, the preparation for clinical, the preparation for anesthesia school (GRE, CCRN), the intensive care unit hours, the bachelor of science in nursing AND biology. In my mind, it’s been ten years of training. Wow.
I have to admit, the beginning of anesthesia school was tough. What makes the training challenging is at first, you are learning the basics of airway management (intubation, LMA, oral and nasal airway, chin-lift, jaw-thrust, etc.) and the anesthesia flow for each type of surgery and unique to each patient (preoperative, intraoperative, postoperative course). Not only that, but each anesthesia provider (CRNA and anesthesiologist) have their preferences and expectations of you. Even during the short breaks, one CRNA may be ok with your choice, but another CRNA would reprimand the choice. The only thing you can do is to understand their choice (What’s the rationale?). As they say, there are a 1000 ways to skin a cat.
Now, there’s less anxiety and more of a discussion, even as I go to different clinical sites. It’s much easier to anticipate changes and adapt to the circumstance. For example, just today there was a switch in the schedule. Last year, I felt more frantic and had to think about my each step more carefully (especially in pediatric cases when there’s a change in age and weight that require a change in equipment size and drugs). Today, it changed from a two-year-old, 15kg to a 6-year-old, 25kg for ear tubes (*real age and weight are changed). What are the appropriate emergency drug doses I would give? What equipment changes do I need to make? I switched a size 3 to a size 4 mask, and had a 5.5 ETT (endotracheal tube or breathing tube) with a MAC2 blade, and thought –
- atropine 0.02mg/kg = 0.5mg = 1.25ml,
- succinylcholine 4mg/kg IM = 100mg = 5ml,
- epinephrine (1:10,000 or 0.1mg/ml or the big stick) 0.01mg/kg = 0.25mg = 2.5ml.
Anyways, that’s it for today.
Anesthesia school is a 2-year marathon.
When you feel tired and beat up, you just have to keep going. Just keep going to clinical.
Anyways, I just wanted to announce a couple of things.
First, I’m done with my second semester and I’m onto my third semester. I took a week off for a family vacation in between the semester. It was definitely much needed. This semester is supposedly better in some ways. For example, there are less OR jitters compared to the 1st semester. But going to a new clinical site presents its own challenges (a new anesthesia machine, new charting system, different drug dispensing, different protocols, different equipment, different labels, different drug vials and doses, new names and faces, not knowing where anything is, new surgeons, new procedures, different patient population, etc). Now we’re going strong by going to clinical 4 days a week and 1 day of class (and my, that day is 10 hours long!!). When I look back at what I knew in October versus now, it is a huge difference. It’s incredible.
This semester there’s a couple of focuses: research, emergency management, regional anesthesia. I’m pretty pumped. I’ve come far but there’s still much more to go. Resiliency has never been more important than now.
Second, as of yesterday, I’ve done 100 successful intubations. It’s a great feeling.
Third, thanks to everyone who’s been writing me positive messages about the blog, supporting me through the flashcard purchases, and anyone who’s enjoyed reading my blog. I see that each month there are more visitors and visits than the next, despite me not updating it as frequently as I used to.
Fourth, happy nurses week again.
Fifth, congrats to those who got into the UM-Flint nurse anesthesia program. It was nice meeting some of you and I’m sure we’ll meet again soon enough!
I have to go now. Until next time,
This past week was CRNA week. And since I’m training for this profession and it’s been awhile since I’ve posted, here it goes.
I believe that most of my readers know what a CRNA is: a certified registered nurse anesthetist. While there are some hospitals or surgery centers that only use anesthesiologists, the majority of hospitals in the United States also use or contract CRNAs. In some locations (especially in rural areas), the CRNA is the sole anesthesia provider. CRNAs are masters or doctorally prepared and thus go under intense full-time training typically from 24-36 months, depending on the program. They must have at least one year of critical care experience and often also take the GRE and CCRN before applying.
Currently, there are over 49,000 CRNAs in the US providing anesthesia in all settings and all kinds of surgery. Since I’m currently in Michigan, I know there are about 2,500 CRNAs practicing in Michigan alone.
I have to admit as a student registered nurse anesthetist, the program is tough and requires my full attention. Everything I learn in class is applied during clinical. Each day for clinical requires a full preparation, which requires a few hours of reading the night before, considering how each anesthetic is personalized for each patient, depending on their health history, anesthesia history, surgical history, medication/drug history, weight, height, labs, last time eaten, airway assessment, allergies, patient’s preference, and more. The expectation is that from day one that you’ll be an independent anesthesia provider and thus doing preoperative assessments (full head to toe assessment; are they optimized? What kind of anesthesia is appropriate, if any?), induction, maintenance, emergence and post op are all a part of the CRNAs role.
During the first semester, I felt this level of anxiety in my life that I had never experienced before. Even the smallest thing that goes wrong would make me question if I was able to do this program. Usually, if I did something wrong, I would tell myself that I did it wrong, and how to prevent that mistake the next time. However, some mistakes will be drilled into your head, which only furthers the anxiety (though I know the program is only hoping that it won’t ever happen again). Before each night, I could feel my ear pounding against my pillow. When I woke up, I was in sweats, waking up from a nightmare that I did something wrong. Then I’d force myself to eat at 4 am otherwise I knew I’d be hungry during the morning rush (because you never really know when you’ll be able to eat). Each day you have a plan, but you’re never sure exactly which plan you’re going with or questions you’d get asked that day. Sometimes I am prepared enough and other days I feel defeated. There’s a high level of expectation that you should know more than what you’re taught in class and that was a part of what makes it tough.
As the first semester waned and the second semester started, I compared what I knew back in August with what I knew at the beginning of January. In 4 months, I poured myself into these three 2-inches worth of notes and powerpoint. It’s impressive how much more I know now.
It’s been a month since the second semester started and I can say that I’ve reached a milestone: 50 intubations via laryngoscope today. From a year to 80-year-olds, orthopedics, dental, GI lab, plastics, burns, laparoscopic, c-section, healthy to very sick and so much more, it is incredible the range of patients that I’ve had the privilege to give anesthesia.
I’ve learned much but still have much to learn.
I have to say that I couldn’t do this program with the support of my family and friends and just as importantly, my classmates. They truly understand the turmoil that goes through the SRNA. We get each other’s backs and study together. How great is that.
The last thing before I end my update — considering that I’m in Flint, Michigan all the time now, I feel that I should address the water crisis. Drinking high amounts of lead, especially among kids under 6 whose brains are growing, will cause brain damage. I don’t know the effects among adults, but I’m sure drinking unsafe levels that over 1000x the acceptable level over a long period of time is not good for you.
It is true that people are drinking only bottled water. And bathing in bottled water (because it has caused rashes in many people). It is unfortunate that Flint’s emergency manager refused to acknowledge that Flint citizens’ water was affecting them negatively. The Flint City Council had voted to switch back to the Detroit River water but the emergency manager had vetoed this vote and denied this demand. It is terrible that only after scientific research done by a pediatrician at Hurley Medical Center that this problem becomes public in October 2015, before becoming an emergency in January 2016.
It is true that Flint has been devastated but now it is just so much worse. The majority of people who work in Flint travel from another town because people don’t feel safe. People don’t feel safe because there’s a high crime rate, most likely due to low income (the average person living in Flint makes $24k, which is HALF of the national average of $48k). When there is simply not enough funds to live, people will commit crimes to make ends meet. The low income is due to a lack of companies willing to be in Flint. But there’s a lack of companies because they don’t believe Flint has people capital. It is a terrible, terrible cycle. Having crazy high amounts of lead in water just adds fuel to the fire. Even fewer people will want to live in this town.
I’m disappointed that ‘saving the Michigan state funds’ or money, was more important than providing a safe source of a basic need: water. Money was more important than the wellbeing of over 100,000 people in the USA. It is hard to believe.
And one more thing — thank you to everyone who’s supported me on this website. Until next time.
All this week, there’s been so much hype about the Michigan vs MSU. With Coach Jim Harbargh at Michigan, Michigan football is doing better than ever. Usually, I don’t really follow but my fiancé is a huge fan (he listens to podcasts and even submits questions via Twitter, haha) and now I’m a student!!
Anyways, Michigan has been dominating the last 4 games although MSU has won all five games undefeated thus far.
Apparently people all over the country are driving or flying in, staying in the cheapest hotel almost 30 minutes area at $250, with the cheapest tickets going at $175 this year (unless you’re a student who got season tickets).
Guy Fiori is going to be at Meijers this morning. “Game Day” is happening at the Diag. Somehow my friend talked me into going so I woke up early to get some studying done before I take a morning break and start back up in the afternoon.
It’s gonna be a lot of fun.
Speaking of studying, there’s a lot of new material. There’s a final exam in physical assessment and a principles exam coming up on pediatrics, fluid and electrolytes, blood products, and part I of the anesthesia workstation (yes, I can draw the oxygen molecule from the hospital outside, through the entire machine, and to the patient circuit— wow!).
I definitely feel on edge at a much higher rate than ever before. I’m usually a pretty calm person but now more than ever, I can feel my heart racing and getting anxious. And that’s almost everyday. I try to calm my nerves by either studying more, or setting time aside to go for a walk or watch some funny TV. Taking care of myself is probably one of the most important things I can do to endure through the program.
I learned this week (amongst other things), that a “sugar high” isn’t really a sugar high. As a tasty candy bar, full of “simple sugars” or glucose or monosaccharides readily available for insulin to act on, glucose is too quickly shoved into cells, causing a hypoglycemic effect. The alpha cells in the pancreas senses the hypoglycemia and releases glucagon. Epinephrine is also released from nerve endings and adrenals. Both glucagon and epinephrine go to the liver, which then undergoes glycogenolysis, breaking down glucagon into glucose and releasing it back to the bloodstream.
However, image the little kid full of epinephrine, setting off the sympathetic nervous system, causing him to run around like crazy during recess or banging his head against the wall. So a “sugar high” is really caused by “hypoglycemia” that’s induced by our more primitive insulin that floods our bloodstream when sensing a huge amount of glucose. If instead the ingested glucose was complex such as a starch, then our insulin is a much better match, releasing the appropriate amount of insulin without going overboard.
I did a few spinals this week (how cool and amazing it is!!) but next week I will try to do more general cases. All right, enough updating. Until next time.
PS. I know the first round of interviews is coming up so I just want to say good luck to anyone who’s interviewing at UM.
PSS. The double rainbow outside my window on Thursday is the featured photo. Nature is beautiful.
The last day of simulation was on Friday (can you believe that it’s been a month since I started?) and clinical starts this week! I’m excited and nervous.
First week of exams are over. Now we just have 1 exam each week until the end of December.
The things we learned this week:
- Pediatric overview
- Second gas effects
What I learned in clinical:
- Propofol can burn, especially when the IV is in the hand or forearm. Unless contraindicated, give the lidocaine!
- Don’t tell them that it won’t burn. Because it just might.
- Make sure the IV is working pre-op.
- Always be ready to change location on the fly and be prepared for general anesthesia when doing a monitored anesthesia care (MAC) case.
- Have all the drugs looked up, patient history, and be able to discuss the plan with the CRNA.
- Follow through with what you say.
- Be confident with your preoperative assessment. Hit all the major points. Make sure you know their anesthetic history.
Ok, here it goes.
Also, the super moon lunar eclipse was cool. Though I may only feel this way because I’m not working today. Usually on a full moon, it gets just a little crazier in the hospital. I’m not sure if it’s just a coincidence.
Here’s the supermoon with the eclipse starting.
At 10:15pm EST, the moon turns blood orange. So cool! What a beautiful night.
This week was interesting. I remember first seeing this video 6 days ago with all this positivity about a Miss America contestant, Kelley Johnson, talking about her experience as a nurse. I thought that was such a different take on what it means to have a talent. It’s not the typical talent showcased on Miss America so I was actually glad that nursing was explained as a talent.
On Friday, the segment focused where nurses are and have made a difference. The NYU Stimulation instructors explained more broadly about what nurses do and described the educational background required for a nurse but I wished it was a bit more personal where they describe a more complex story that involved a nurse who played various roles and how they lead care. This would open people’s eyes into what nurses do.
Flexibility. Even in the first week, not everything went according to plan. But it’s about the willingness to adapt and go with the flow.
The things I learned this week:
- The Larynx — the cartilages, ligaments, muscles, and how all of those things work together and affected by anesthesia. And what are likely problems that can occur and how to respond.
- OR — checking the anesthesia machine and table top set up.
This coming week is the first full week of class so here it goes!
The second and final week of orientation is finished. The most important aspect that I got out of it was the wellness talk. I believe that in our lives, we continually try to find wellness in all aspects of our lives without even really realizing it.
There are six pillars of wellness.
- Social – this is how well you get along with others and your environment.
- Physical – this is how physically fit you are by exercising and eating well.
- Emotional – this is how well you’re able to express your feelings.
- Spiritual – this is understanding the purpose of life, being self aware and open.
- Intellectual – this is the desire for lifelong learning.
- Occupational – this is applying yourself to something that’s meaningful and rewarding.
We all try to obtain this delicate balance. When one aspect suffers, we either go all overindulge in one way or hide in our shell. One way to gauge vulnerability to stress is through this short test. What I learned was that these are ways to help me relieve stress for the upcoming years.
Score 1 for Always True
Score 5 for Never True
- I eat at least one hot, balanced meal a day
- I get 7 to 8 hours of sleep at least 4 nights a week
- I have at least 1 person who lives nearby from whom I can ask a favour
- I exercise to the point of perspiration at least twice a week
- I do not smoke
- I drink fewer than five alcoholic drinks a week
- I am the appropriate weight for my height
- I drink fewer than two cups of coffee (or tea or cola) a day
- I have a network of friends, family and acquaintances on whom I can rely
- I confide with at least one person in my network about personal matters
- I am generally in good health
- I am able to speak openly about my feelings when angry, stressed or worried
- I do something for fun at least once a week
- I recognise stress symptoms
- I take quiet time for myself during the day
- I have an income adequate to meet my basic expenses
- I spend less than an hour each day traveling to and from work
- I am calm when I am kept waiting/stuck in traffic/late for an appointment?
- I have regular calm conversations with the people I live with about domestic problems, e.g., chores, money and daily living issues
- I never try to do everything myself
- I never race through a day
- I never complain about time wasted and the past
- I feel organized and in control
- I am able to organize my time effectively
- I recognise when I am not coping well under pressure
Anyways, I picked the quote about courage this week because we’re told over and over again about the difficulty of this program. But I feel that no matter how many times it has been emphasized, you won’t be completely ready for it. The only way is to do it. So here it goes.