27 Jan 2014 - To those who wait...

It's a good Monday.

I was at drill this weekend, so I was catching up on errands this morning. I woke up, checked reddit, checked my stocks and did some buying. Forced myself to go for a mile and a half run (my time is terribly embarassing, too much so to mention here. My goal is to cut off about a minute and a half by the end of February). I dropped off my laundry, went to the post office, and stopped by a sushi place for lunch.

And while I was eating, also had time to pull out my cell phone to check my email. And then I saw this:

Yeeeeeaaaa buddddddy!

Anyways, time to go to bed. I work tonight. :D

27 January 2014 - Interview Prepping 101

My interview with University of South Florida is this Friday. Have I been prepping? Yes and no.

An email sent a little while said that there would be a CCRN style test focusing on the cardiac system. If I can recall my CCRN scores, the cardiovascular system was one of my weaker subjects. I'm a tactile learner and best retain knowledge when I'm about to incorporate theory with practice. Unfortunately, I've only touched a PA catheter once in my 3 years of nursing and rarely do I deal with inotropic agents. I've played with dobutamine a handful of times and Primacor once. But these are things you can study for and apply later.

I think my weak spot is the actual inteview itself. A quick google search for "CRNA interview questions" brings up a list of questions to which I've been studying off of. Most of these questions seem to revolve around why you want to be a CRNA and why do you qualify or have what it takes to become a CRNA. More on this later.

19 Jan - An interview in review.

I meant to write this sooner while things were still fresh on my mind but I've been fairly busy with life "stuff."

On 17 Jan 2014 I had my interview at the University of South Florida's CRNA program. I flew out a day before, got a rental car, drove around downtown and walked around a little bit, looking around like a good scout. Initial impressions of the downtown area were the follow: clean, fresh, quiet. When I got the CAMLS building is right in the downtown area about a 10 minute walk from where my hotel room was. It was built recently and is very modern.

The interview can be broken down into a few parts: initial introduction, interview with faculty, interview with students, a tour of the facility, and a CCRN style exam.

So how'd it go? Introduction was fine. I suited up, walked into the building, and introduced myself. I met one of the current students and another guy that was there for the interview. We made small chit chat and the student aid spoke highly of the school.

The faculty interview I feel went well. They asked basic questions; introduce myself, why I wanted to be a CRNA, leadership and employment history. We also discussed some fairly general physiology, anatomy, and pharmacology questions. There was also a scenario given on paper that was pretty straight forward, I think I talked myself through it fairly well. Most of the questions asked covered cardiology. Needless to say, there were some things I was unsure of and I let them know it but they didn't offer much feedback. Overall, I was told I was a strong candidate and I would be hearing back in a week or two.

The interview with the students was more like a question and answer session, more so on my side. They asked me a few questions, the same personality questions asked during the faculty interview. After that I had the opportunity to ask questions, the down and dirty of the CRNA program. There was limited time to talk to the other applicants, but between the little time I did get and the feel that I got from the current students, I felt a little more comfortable with my qualifications.

The CCRN test was typical. Some of the questions were worded funny, but like the actual CCRN test, if you take your time and think through it, you'll do fine. I think I did ok; most of the questions I answered easily and I know which questions I missed. This is usually typical of how I take tests.

The way they set up there interview was a little different from the interview I had at Midwestern University last year. I actually felt ok about this interview. I didn't leave with a bad feeling.

And of course, I wander around at night randomly. Here's a couple of night shots.

As beautiful as Tampa is and despite my love/hate relationship with it, there's really no place like Los Angeles.

18 December 2013 - Congratulations, you've been selected...

I've been awake for approximately 24 whole hours as I write this. I've been awake since yesterday morning, did a full 12 hour shift, then proceeded to teach a CPR class right after work. I was driving home when I saw an email with this attachment:

Despite my lack of enthusiasm on the outside, I was pretty ecstatic to see that email. Unfortunately, the date which I am scheduled happens to fall right in the middle of my Air Force Reserve Annual Tour, meaning I'll technically be orders. So as I was figuring out exactly how'd be able to be in two places at once, I got this second email:

Needless to say, I'm kind of confused. One email that gave me a congratulations and an interview date and another that says I got rejected, try again later. I don't know how to express all these feels. Anyways, I gave them a call, hopefully I hear back soon so I can plan accordingly. 

Either way, earlier this week, I got this email from U of South Florida:

Despite Kaiser being my first choice, I believe that only fools put all their eggs in one basket. Planning for success involves making contingency plans, so I guess come January I'll be flying out to Tampa for an interview. 

26 November 2013 - KPSAN responds.

Got this from KPSAN in the self addressed envelope today; that was much quicker than anticipated. I also dropped off an additional reference letter from a CRNA I shadowed for a few hours who happens to be a KPSA alumni. Will follow up with that to make sure it's in my file this week.

I've also sent out the rest of my application packets to National University, Barry U, and the U of South Florida. Now its basically time to sit and wait until I hear back. And so my watch begins. 

The future is here: Robotic anesthesiologists/anesthetists?

Earlier this year Johnson & Johnson released what they call a Computer Assisted Personal Sedation System (CAPS) codenamed Sedasys. This automated system does real time monitoring of your vital signs and provides procedural sedation during colonoscopies by administering and titrating our favorite hypnotic/amnestic agent, propofol. But since propofol is also used for the induction and maintenance of general anesthesia, who's not to say that it might progress to that, especially for low risk procedures?

Some anesthesiologists are already concerned with anesthesia specialization going to nurses, which is all well and fine. Ultimately, the goal for anesthesiologists and anesthetists is the same; providing safe, high quality anesthesia services with an aim for the best possible patient outcome. However, with health care reform on the horizon, we're also looking more and more into cost savings. But to machines? Sure it'll take out the human error factor, but machines fail too. One thing for sure though, it'll reduce the human touch of anesthesia care.

I, for one, welcome our future robotic overlords. As long it's not the one putting the scope in my butt. Just kidding, I'm still on the fence about this one.

More information here: http://www.sedasys.com/
FDA link can be found here.

First packet away!

Application, check. Transcripts, check. Reference forms, check. Miscellaneous documents, check. 

I originally intended to turn in my packet with 4 references including one from an alumni, but I've decided to keep to 3 and turn in my packet early. KPSAN application packet all compiled and to mailed tomorrow. Wish me luck!

Eric's Notes on Nursing

Nursing now days has so many formal rules. Here's a list of thoughts and informal rules of thumbs that I've picked up in my short time as an ICU nurse:

1. A good nurse lacks shame, an ego, and a conscience but has heart, soul, and the determination to never stop smiling. Even during codes. 
2. There's nothing to be nervous about; you're not the one that's gonna die.
3. You have to laugh at inappropriate things. 
4. Be and island of calm in a sea of chaos. 
5. Primum non nocere. Do no harm. Addendum: Primum non nocere sans documentum. Do no harm without proper documentation.
6. The IV access catheter is quite possible the most important invention ever created for the medical profession. Without an IV access, I am useless. 
7. Revatio rhymes with fellatio. 
8. All the crap learned in nursing school about patient advocacy and doing "what's right" and "by the book": out the window. Patient advocacy is all good, but protect your job and license first. 
9. Work when you're sick. Call in sick when you're not. 
10. Scrubs: Pockets are your friend. The more the better. ADDENDUM: As my experience in ICU progresses, I find that I have a need for fewer and fewer pockets, because I carry fewer things. And probably because I'm tired of finding crumpled up alcohol wipes in the dryer. 
11. Invest in comfortable shoes, even if they're ugly. You'll be standing on them for 12+ hours.
12. You should chart and document like how girls should pick clothes: just enough to cover your ass; sometimes less is more. 
13. Turn on the lights in the patients room or you might miss something on your assessment. Turn off your lights in your patients rooms so they go to sleep and stop bugging you. 
14. Learn to prioritize: take things one step at a time, accomplish the small and simple tasks first and get them out of the way. It leaves you time to tackle the bigger issues, like the drsg change on the sacrum of your 600 lbs patient.
15. There's always going to be that lingering thought that you forgot administer this, fax or document that, or call so and so for whatever reason. You are human and can only do so much; endose that shit to the next shift. Leave work at work; when you get home, the scrubs come off. 
16. A good nurse takes good care of their patients. A great nurse takes good care of their patients but does great documenting. 
17. Nursing will never be easy or stress-free; you will never be comfortable in your element. If you ever get to that point, you're not doing it right. 
18. Reorientate and negotiation doesn't work. Restrain your patients for, you know, their safety. Addendum: It's ok for med-surg patients to walk around. 
19. If 90 year old dementia grandma says she's going to buy you a pie, sometimes she's serious.
20. Best idea over: Obesity differential. You should get an extra dime an hour for every 10 lbs over ideal body weight if your patient is morbidly obese, and an extra quarter an hour more if they're immobile. 
21. Adventitious heart and lung sounds? No symptoms, no problems.
22. Got gas? Best place to release is to go crop dust in your comatose, intubated, C-diff+ patient's room.
23. The worst part about C-diff isn't the smell or the isolation procedures. It's getting bleach on your scrubs. 
24. The speed at which ER brings your admission is direct proportional to how stable the patient is. Severe sepsis with a suspected ruptured AAA on 3 vasopressors? Patient rolls through door while you're on the phone for report. Suicidal patient that just needs ICU for 1:1? Arrives at change of shift. 
25. You wouldn't donate blood if you knew some of the patients who would be receiving it. 
26. Your gut instincts is just as important as your physical assessment skills. 
27. If you work night shift, which inevitably you will, your phone's "do not disturb" mode is your best friend. Your manager WILL call you at 3PM after you just finally fell asleep to ask you to come in early to do overtime.