http://www.nurse-anesthesia.org/blog.php/9-My-journey-from-RN-to-CRNA This is a resource created by and for both the student and established Nurse Anesthetists. en Fri, 24 May 2013 13:29:49 GMT vBulletin 60 http://www.nurse-anesthesia.org/images/styles/BlueDemon/misc/rss.jpg http://www.nurse-anesthesia.org/blog.php/9-My-journey-from-RN-to-CRNA http://www.nurse-anesthesia.org/entry.php/584-Looking-back-over-the-last-couple-years Sat, 08 Jan 2011 01:51:57 GMT Wow, what changes we have seen... Jobs tightening up, the website exploding with new members, schools putting out too many students and even more... Wow, what changes we have seen...

Jobs tightening up, the website exploding with new members, schools putting out too many students and even more attacks by out detractors with a background of major wins for our profession... and ive been working ;)

We have seen an iphone app come to fruition as well as a major and minor website upgrade.

My wife has graduated anesthesia school and is working now.

We are buying a house and getting out of this nightmarish apartment.

Wow, how things change ;)

There is a light at the end of the tunnel SRNAs, just get through it. ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/584-Looking-back-over-the-last-couple-years http://www.nurse-anesthesia.org/entry.php/514-Logical-fallacies Fri, 17 Sep 2010 03:57:56 GMT One of the most interesting things to me is debate (go figure). So I have spent alot of time learning about debate techniques and how to try and win!... One of the most interesting things to me is debate (go figure). So I have spent alot of time learning about debate techniques and how to try and win!

There are many different debate failures and I thought I would post some of em here, i know I make them often and im sure many others do!

Argumentum ad nauseam or the argument to the point of disgust; i.e., by repetition. Essentially this is the fallacy of trying to prove something by saying it again and again. But no matter how many times you repeat something, it will not become any more or less true than it was in the first place. Of course, it is not a fallacy to state the truth again and again; what is fallacious is to expect the repitition alone to substitute for real arguments.

Argumentum ad antiquitatem (the argument to antiquity or tradition). This is the familiar argument that some policy, behavior, or practice is right or acceptable because "it's always been done that way." This is an extremely popular fallacy in debate rounds; for example, "Every great civilization in history has provided state subsidies for art and culture!" But that fact does not justify continuing the policy.

Argumentum ad hominem (argument directed at the person). This is the error of attacking the character or motives of a person who has stated an idea, rather than the idea itself.

Argumentum ad ignorantiam (argument to ignorance). This is the fallacy of assuming something is true simply because it hasn't been proven false. For example, god must exist because science cannot prove he does not.

Argumentum ad logicam (argument to logic). This is the fallacy of assuming that something is false simply because a proof or argument that someone has offered for it is invalid; this reasoning is fallacious because there may be another proof or argument that successfully supports the proposition. This fallacy often appears in the context of a straw man argument.

Argumentum ad numerum (argument or appeal to numbers). This fallacy is the attempt to prove something by showing how many people think that it's true. But no matter how many people believe something, that doesn't necessarily make it true or right. Example: "At least 70% of all Americans support restrictions on access to abortions." Well, maybe 70% of Americans are wrong!

Argumentum ad verecundiam (argument or appeal to authority). This fallacy occurs when someone tries to demonstrate the truth of a proposition by citing some person who agrees, even though that person may have no expertise in the given area. For instance, some people like to quote Einstein's opinions about politics (he tended to have fairly left-wing views), as though Einstein were a political philosopher rather than a physicist. Of course, it is not a fallacy at all to rely on authorities whose expertise relates to the question at hand, especially with regard to questions of fact that could not easily be answered by a layman -- for instance, it makes perfect sense to quote Stephen Hawking on the subject of black holes.

Circulus in demonstrando (circular argument). Circular argumentation occurs when someone uses what they are trying to prove as part of the proof of that thing. Here is one of my favorite examples (in pared down form): "Marijuana is illegal in every state in the nation. And we all know that you shouldn't violate the law. Since smoking pot is illegal, you shouldn't smoke pot. And since you shouldn't smoke pot, it is the duty of the government to stop people from smoking it, which is why marijuana is illegal!"

Cum hoc ergo propter hoc (with this, therefore because of this). This is the familiar fallacy of mistaking correlation for causation -- i.e., thinking that because two things occur simultaneously, one must be a cause of the other. A popular example of this fallacy is the argument that "President Clinton has great economic policies; just look at how well the economy is doing while he's in office!" The problem here is that two things may happen at the same time merely by coincidence (e.g., the President may have a negligible effect on the economy, and the real driving force is technological growth), or the causative link between one thing and another may be lagged in time (e.g., the current economy's health is determined by the actions of previous presidents), or the two things may be unconnected to each other but related to a common cause (e.g., downsizing upset a lot of voters, causing them to elect a new president just before the economy began to benefit from the downsizing).

Nature, appeal to. This is the fallacy of assuming that whatever is "natural" or consistent with "nature" (somehow defined) is good, or that whatever conflicts with nature is bad. For example, "Sodomy is unnatural; anal sex is not the evolutionary function of a penis or an anus. Therefore sodomy is wrong." But aside from the difficulty of defining what "natural" even means, there is no particular reason to suppose that unnatural and wrong are the same thing. After all, wearing clothes, tilling the soil, and using fire might be considered unnatural since no other animals do so, but humans do these things all the time and to great benefit.

Non Sequitur ("It does not follow"). This is the simple fallacy of stating, as a conclusion, something that does not strictly follow from the premises. For example, "Racism is wrong. Therefore, we need affirmative action." Obviously, there is at least one missing step in this argument, because the wrongness of racism does not imply a need for affirmative action without some additional support (such as, "Racism is common," "Affirmative action would reduce racism," "There are no superior alternatives to affirmative action," etc.).

Post hoc ergo propter hoc (after this, therefore because of this). This is the fallacy of assuming that A caused B simply because A happened prior to B. A favorite example: "Most rapists read pornography when they were teenagers; obviously, pornography causes violence toward women." The conclusion is invalid, because there can be a correlation between two phenomena without one causing the other. Often, this is because both phenomena may be linked to the same cause. In the example given, it is possible that some psychological factor -- say, a frustrated sex drive -- might cause both a tendency toward sexual violence and a desire for pornographic material, in which case the pornography would not be the true cause of the violence.

Red herring. This means exactly what you think it means: introducing irrelevant facts or arguments to distract from the question at hand. For example, "The opposition claims that science itself must be a religion?" When the debate is about their belief and not yours.

Slippery slope. A slippery slope argument is not always a fallacy. A slippery slope fallacy is an argument that says adopting one policy or taking one action will lead to a series of other policies or actions also being taken, without showing a causal connection between the advocated policy and the consequent policies. A popular example of the slippery slope fallacy is, "If we legalize marijuana, the next thing you know we'll legalize heroin, LSD, and crack cocaine." This slippery slope is a form of non sequitur, because no reason has been provided for why legalization of one thing leads to legalization of another. Tobacco and alcohol are currently legal, and yet other drugs have somehow remained illegal.

There are a variety of ways to turn a slippery slope fallacy into a valid (or at least plausible) argument. All you need to do is provide some reason why the adoption of one policy will lead to the adoption of another. For example, you could argue that legalizing marijuana would cause more people to consider the use of mind-altering drugs acceptable, and those people will support more permissive drug policies across the board. An alternative to the slippery slope argument is simply to point out that the principles espoused by your opposition imply the acceptability of certain other policies, so if we don't like those other policies, we should question whether we really buy those principles. For instance, if the proposing team argued for legalizing marijuana by saying, "individuals should be able to do whatever they want with their own bodies," the opposition could point out that that principle would also justify legalizing a variety of other drugs -- so if we don't support legalizing other drugs, then maybe we don't really believe in that principle.



Straw man. This is the fallacy of refuting a caricatured or extreme version of somebody's argument, rather than the actual argument they've made. Often this fallacy involves putting words into somebody's mouth by saying they've made arguments they haven't actually made, in which case the straw man argument is a veiled version of argumentum ad logicam. One example of a straw man argument would be to say, "Mr. Jones thinks that capitalism is good because everybody earns whatever wealth they have, but this is clearly false because many people just inherit their fortunes," when in fact Mr. Jones had not made the "earnings" argument and had instead argued, say, that capitalism gives most people an incentive to work and save. The fact that some arguments made for a policy are wrong does not imply that the policy itself is wrong.



Tu quoque ("you too"). This is the fallacy of defending an error in one's reasoning by pointing out that one's opponent has made the same error. An error is still an error, regardless of how many people make it. For example, "They accuse us of making unjustified assertions. But they asserted a lot of things, too!"



Interesting stuff! ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/514-Logical-fallacies http://www.nurse-anesthesia.org/entry.php/508-Wondering-what-the-future-holds Tue, 07 Sep 2010 05:30:11 GMT Interesting conversation the other day... I was sitting with a couple of people from my group and we were discussing the future of anesthesia in... Interesting conversation the other day...

I was sitting with a couple of people from my group and we were discussing the future of anesthesia in general. It is always interesting to see the drastic difference in opinion from one person to another.

One fella was saying how we should work like DOGS now because 5 years from now we (CRNAs) will be making 90K a year at best and floor RNs will be lucky to make 40K.

Another fellow (one of our MDAs) was talking about how he thinks he wont have a job in 5 years because CRNAs will take over everything.

Still another guy said he feels it will all stay the same and while salaries will not increase they are not likely to go down. He called it a "cyclic event in anesthesia" after looking back at his 30 years in practice.

I tend to think a bit differently than all of them. In my opinion the future of healthcare will be driven by economically responsible and high quality safe anesthesia care. I think there will be room for both CRNAs and (albeit much less in the OR) MDAs. I generally feel that salaries will not change much either way. I think we have capped now and that the MDAs are on the way down. Overall, I think there will be a bolus of new CRNA jobs as we see more practices expand the use of CRNAs and opt out occur in all states in the next decade.

I do not see a doom and gloom future for us, I see it as bright and full of opportunity for those willing to take the leap. For those not willing, who are looking for jobs spinning knobs on a stool going home at 3 pm.... good luck.:nono: ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/508-Wondering-what-the-future-holds http://www.nurse-anesthesia.org/entry.php/505-A-year-in-practice-looking-back Mon, 06 Sep 2010 04:01:31 GMT Wow.... So here I am a year since I have been in my practice. It is amazing just how differently I practice now since day 1. My comfort level is... Wow....

So here I am a year since I have been in my practice. It is amazing just how differently I practice now since day 1. My comfort level is significantly higher as well. I would say I do almost nothing like what I did in training. Just some quick examples of that...

- Noone where i trained used ketamine, i use it all the time

- noone where I trained was comfortable with deep extubation, i do it all the time

- noone mixed drugs to get a better outcome, i do it all the time

- Everyone ordered diagnostics up the Wharton I order very little

Those are just a few things. Interesting how we change! ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/505-A-year-in-practice-looking-back http://www.nurse-anesthesia.org/entry.php/495-Thinking-about-a-Doctorate Mon, 15 Feb 2010 16:30:59 GMT Ok So now I have been out of school for 8 months and am really starting to think about this doctorate buisness. What to do? PhD, DNP, DNAP or EdD?... Ok

So now I have been out of school for 8 months and am really starting to think about this doctorate buisness. What to do? PhD, DNP, DNAP or EdD? These are the ones I have been considering..

I want to do something that will have some beneficial impact both clinically and for my professional future.. so I decided to break them all down here from my own perspective..

PhD. Well, this is truly a pure research doctorate. It will likely cost more and take longer than any of the others. Personally, I am not that excited about research as I see my future in education. There is more public acceptance (read:respect) for the PhD than any of the other options. This is also true of university tenure, currently only PhDs and EdDs get this option. All of these can be done online.

EdD. This is an education directed doctorate. It was introduced at harvard univ. as an equivalent to the PhD. Generally it is about the same amount of credits (sometimes less) than a PhD. You can get tenure with this degree and it would be specific to what i am interested in.

DNP. This is the defacto standard for all advanced nursing in the future. It is highly likely that tenure will be avaliable in CRNA schools that are apart of nursing depts at universities (about 50% of the current number) in the near future. The DNP takes into account your previous masters classes and is a clinical extension of it. So it is generally 30-50 credit hours which is about half of the PhD. Makes sense, since once can go into a PhD with a bachelors and no masters. This is attractive for a number of reasons, decrease time and cost commitment being the most relevant. The DNP is flexible in that you can tailor it toward your interests.

DNAP. This is the non-nursing CRNA program schools answer to the DNP/doctorate requirement. This is highly specific to anesthesia and can be tailored to education or practice management. What concerns me about this is that there are only 2 of them. The DNP has and will take off but the DNP may disappear and therefore be irrelevant. Also, DNAPs may not be eligible to get tenure in universities or potentially might not be accepted in nursing school located CRNA programs.


So when i look at the options and think about what I want out of this, the DNP certainly seems to be the best option all the way around. Since this degree does not add to my practice financially I really do have to take cost and time into account when choosing.

Now time to look up school options. ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/495-Thinking-about-a-Doctorate http://www.nurse-anesthesia.org/entry.php/474-What-an-interesting-3-months-it-has-been Mon, 30 Nov 2009 21:06:59 GMT Aloha all Well here I am 3 months of working and I love my job. Fun all the time, independent practice and a range of patients. Probably the only... Aloha all

Well here I am 3 months of working and I love my job. Fun all the time, independent practice and a range of patients. Probably the only thing i dont like is working 5 days a week. I have never worked 5 days a week IN MY LIFE at one job. Very weird and now i understand the saying 'living for the weekend'.

I think that for next years contract neg. Ill be asking for a 4 day week. Something to consider when you are figuring out what you want to do. ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/474-What-an-interesting-3-months-it-has-been http://www.nurse-anesthesia.org/entry.php/461-2-months-into-practice Mon, 26 Oct 2009 13:05:40 GMT Well hey! I decided to wait and do a 2 month retrospective. See where I am. Well, I can say that I have become much more comfortable much less... Well hey!

I decided to wait and do a 2 month retrospective. See where I am.

Well, I can say that I have become much more comfortable much less stressed on a day to day basis. So it DOES get easier as you progress. The most difficult thing initially is not knowing the people, where anything is or even the resources avaliable. All of that simply takes time and I am getting more of a handle on it now.

After the last 2.5 years I have been feeling a little burnt out on the whole educational thing. While I have started doing lectures here in AZ again, I really have not put much into researching and finding a DNAP/DNP program I want to goto. Right now, I just cannot seem to imagine having to take anymore classes. Especially as I find myself working 5 days a week with every 4th weekend on call. On the weekends, I just want to have fun and relax. So who knows when I'll get started on the doctorate goal... it may be awhile.

AZ is an interesting place when it comes to the ebb and flow of patients. Essentially, the population in this area doubles in the winter from snow birds. This can make for long winter days in the OR. As a contractor, I do not have set hours and therefore never know when I am getting off each day as it is simply based on the case load. This is very different from how I have worked in my professional career. I have always had some semblance of set hours and never 5 days a week. I have to admit, I am finding the 5 day deal quite hard to adjust to especially when I never know what time I will be off. Essentially I am living for the weekend.

Right now, that is cool since it increases my income. However, i think in the future I will be negotiating for a more structured schedule for sure.

Some things to think about ;) ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/461-2-months-into-practice http://www.nurse-anesthesia.org/entry.php/453-A-month-in Sun, 27 Sep 2009 21:41:46 GMT So here I am, a month into practice.. I have had a couple of emergencies happen which i was able to take care of, I dont get stomach cramping... So here I am, a month into practice..


I have had a couple of emergencies happen which i was able to take care of, I dont get stomach cramping every morning before starting anymore (more like every second now :P) and I am getting to know where things are and who is who.

Im feeling alot better than when i started about everything!

No place to go but up! ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/453-A-month-in http://www.nurse-anesthesia.org/entry.php/444-Week-2-of-working-down! Sat, 12 Sep 2009 15:24:48 GMT Wow. So much to learn and get used to when you are a brand new CRNA both clinically and just functionally in a new job... it is unreal. The... Wow.

So much to learn and get used to when you are a brand new CRNA both clinically and just functionally in a new job... it is unreal.

The things that come to mind immediately.

- Where the F* is everything?
- Who can i trust to help?
- What is the 'system' of things here?
- How do i do that paperwork again?
- What surgeons are good/bad etc

So much to try and get up to speed on that isnt even vaguely clinical yet very important. Add to that being a brand new CRNA in an independent practice.... it can be very overwhelming.

Having said all that, things are going very well. I am getting better at central lines (i do 1-2 a day depending on the day), I am more comfortable inducing alone and troubleshooting by myself. It is a whole other world to be the sole decision maker, but i love it.

I am progressing more and more everyday! It is awesome! ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/444-Week-2-of-working-down! http://www.nurse-anesthesia.org/entry.php/439-My-first-job-independent Fri, 04 Sep 2009 03:44:38 GMT Hey all

Well let me tell you something. Working independent practice and being "the decider" results in an instant terror and excitement at the same time. You are hyper-vigilant!

There is a steep learning curve, especially for those trained in a very dependent environment. Let me tell you.... this experience has thoroughly reinforced my opinion that prior RN experience is not only a MUST, but MUST be excellent. There is no way I could do what I am doing without what I CAME to anesthesia school with.

Keep that in mind if you are considering independent practice post grad. It is not for you if you did not come with years of solid foundation as an RN. Moreover, do not fool yourself into thinking that "working a few years in an ACT" practice will "prepare" you for independence. While some may, most will not. You can either do it or you cannot, much like some MDAs can work indy and some cannot.

Im even more polarized in this belief that ever. ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/439-My-first-job-independent http://www.nurse-anesthesia.org/entry.php/429-So-I-am-a-CRNA Fri, 07 Aug 2009 02:15:23 GMT Its over. For all those wondering, NO it didnt fly by. Some days seemed like a year all on their own. I am glad its over! Im happy to move on! Its over.

For all those wondering, NO it didnt fly by. Some days seemed like a year all on their own.

I am glad its over! Im happy to move on! ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/429-So-I-am-a-CRNA http://www.nurse-anesthesia.org/entry.php/428-Fedex-guy-you-are-a-bastard Wed, 05 Aug 2009 14:06:42 GMT So here I am... waiting for the fedex guy... I imagine this is the sortof feeling everyone gets on the day you are supposed to get your results. ... So here I am... waiting for the fedex guy...

I imagine this is the sortof feeling everyone gets on the day you are supposed to get your results.

I woke up promptly at 6 am... cause the fedex guy is due to arrive by 3 pm today..... 6 am.. snapped awake...

I have this mixed feeling of anxiety and excitement all at once. It shut off at 100... that is good... right? Or did i just think I did well and really I screwed the pooch? You cant help but go there in your mind... especially on the day you receive your results!

Well... here is to sitting and waiting... good times. ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/428-Fedex-guy-you-are-a-bastard http://www.nurse-anesthesia.org/entry.php/426-Boards-are-over-F-yah! Fri, 31 Jul 2009 03:24:46 GMT Well So i went into the testing center and was terrified. I could feel the stress and it was not good. On the otherhand, I also felt elation just... Well

So i went into the testing center and was terrified. I could feel the stress and it was not good. On the otherhand, I also felt elation just to have this done.

The process at the testing center is exactly the same one as you had during the SEE exam. It was pretty quick and I was in the room testing.

Sitting there in front of the PC calmed me a bit, here it was. This was it.

One piece of advice i would give everyone about testing is that your time does not start until you hit the start button. What is important about this is that you now have as much time as you need to write out all the things you like on the paper provided. All your pornographic acronyms to remember stuff (What?!? thats not how you do it?)... So take advantage of that time.

Then the exam starts and it is exactly like the SEE exam. Question after question some you know right off, some you narrow down to 2 choices and some you look at and say "WTF?!?".

Then you come to question 100... the magic number where it shuts off or you continue on... The statistics from the NBCRNA make it clear that most people pass if it shuts off at 100 and most people do not when they go past that... so it becomes obvious how important that number is...

So there I was question 100... I read it, knew the answer made the choice and just sat there.... heart rate was 20 beats higher, palms sweaty.... i clicked the button and the exam was over... holy batshit-man.

That was a feeling i cannot explain...

Now the wait.. for the results. ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/426-Boards-are-over-F-yah! http://www.nurse-anesthesia.org/entry.php/417-Closer-and-closer Sat, 18 Jul 2009 19:54:11 GMT As the boards loom ever closer... I wonder if I am going to pass.. So many people failing this year, it is surprising. Moreover, the more you look... As the boards loom ever closer... I wonder if I am going to pass..

So many people failing this year, it is surprising. Moreover, the more you look at this stuff it seems that it stays only vaguely familiar. I dont feel like i can just 'whip' off the answers... with so much review i would assume I could... I cannot memorize like i used to when i was in my 20's.

This is easily the highest stress time in my life and I just dont really get stressed often. I feel like a hermit... and worry that even all this time Im putting in is not enough...am i really 'getting' it? I just dont know....

Ah well.. enuff doom and gloom, I can only do what I can do and if for some reason I fail then i will take it again and pass. Here :beerglass: is hoping that does not happen!

Back to the books... ugh.. ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/417-Closer-and-closer http://www.nurse-anesthesia.org/entry.php/409-Board-Study-F-Me Mon, 06 Jul 2009 00:15:17 GMT Ohhh my. So... your program being over seems like it would be a relief.. however, the truth is... you are not done at all... Unfortunately, you... Ohhh my.

So... your program being over seems like it would be a relief.. however, the truth is... you are not done at all...

Unfortunately, you have another month orso of study to do before you take the boards... and boy... is it hard to stay motivated to study...

So here I am.. taking a break...

Alot of ppl asked me what I planned to do for board review.. here it is..

I plan to take boards end of july..

3 Months prior to boards start to slowly do the valley modules. Finish by 1st week of july. One month left.

For those not familiar with Valley's module schedule, essentially there are 24 modules. Doing them allows you to go through the "Sweat Book" (their text book) and the "memory Master" (question book) two times. These books are about 600 pages... Each.. Every 4th module you go back and review the last 3 and that is how you do everything twice. I would suggest doing it how they plan it out, keeps it from getting monotonous and makes to feel good to meet goals (like a module a day or week etc).

Month of july I will do the Mem Master once through again. I will also do the Prodigy Exams one every second night (there are 5). For the last few days i will review the lightning bolts and bullseyes as well as new mixed reviews before the exam..

I hope it is enough... ]]> MmacFN http://www.nurse-anesthesia.org/entry.php/409-Board-Study-F-Me