Monday Monday so Good to Me

Monday, Monday
So good to me.
Monday, Monday
It was all I hoped it would be.

Oh Monday morning
Monday morning couldn't guarantee
That Monday evening
You would still be here with me.

Monday, Monday
Can't trust that day.
Monday, Monday
Sometimes it just turns out that way.

On Monday morning
You gave me no warning
Of what was to be.
On Monday, Monday
How could you leave
And not take me?

Every other day
Every other day
Every other day
Of the week is fine, yeah.

But whenever Monday comes
But whenever Monday comes
You can find me crying
All of the time.

Monday, Monday
So good to me.
Monday, Monday
It was all I hoped it would be.
Oh Monday morning,
Monday morning couldn't guarantee
That Monday evening
You would still be here with me.

Every other day
Every other day
Every other day
Of the week is fine, yeah.

But whenever Monday comes
But whenever Monday comes
You can find me crying
All of the time.

Monday, Monday,
Can't trust that day.
Monday, Monday,
Just turns out that way.

Oh, Monday, Monday,
Don't go away.
Oh, Monday, Monday
It's here to stay
Monday, Monday
Oh, don't go away

By Wilson Phillips

It is one of those Mondays. Maybe you don't remember the Momma's and the Papas but I seem to recall hearing this in the distant past some Monday. Just turns out that way, Mondays do. This Monday was not a day of crying but for going to school; Nurse Anesthesia school didactic and its here to stay.

Cardiac risk factors in the non-cardiac surgery patient are the topic of discussion today. This is a little complex for me so we turn to the ACC/AHA guidelines for a little help. I was able to find this document without too much trouble this afternoon. Here is the question, "do we go ahead with this ankle fracture surgical repair in this 55 year old Hispanic woman with a history of diabetes and hypertension and recent MI." Oh, she had a myocardial infarction 4 months ago and currently has intermittent angina. Her blood pressure this morning is 165/90 and her medications include metoprolol, isordil, metformin and aspirin. She is able to climb two flights of stairs without getting too short of breath.

So what do you think? Are we ready to go to the operating room to fix her broken ankle? OK, we do this case being a little nervous with her potential to re-infarct again. Blood pressure and heart rate are well controlled during the anesthetic using opiods and short acting beta blockers. Cool, case one down.

The next case is an Armenian gentleman aged 54 who is scheduled for a fem-pop bypass graft (he has vascular disease even at this age), a heavy smoker for the past 30 years and a family history significant for coronary disease in both parents and an older brother. During the history he tells you that he is not able to climb one flight of stairs because his legs hurt too much so he can't comment on whether or not he gets short of breath. No cardiologist has seen him. Do we take him to surgery today?

The ACC/AHA guidelines for Cardiac Risk in the non cardiac surgical patient can help with these kinds of decisions. Now maybe you thought this was all fun and games but when your butt is on the line and you have this guy's future and health in your hands it makes you think twice, maybe more than twice.

As a student we are thrown into these situations and we have a clinical supervisor breathing down our necks asking us questions while we are trying to get organized and straight in our heads if we even want to take this guy to the OR. "So little grasshopper, why didn't you call me last night with this information you worthless piece of student dog meat". Oh No Mr. Bill!

Some of us are not getting very much sleep mulling all these things over trying to figure these things out, finishing up the anesthesia plan of care for the next days and studying for exams. This is not to mention that some of us have husbands, wives and children that need a little, I mean little attention once and a while. Maybe it's the worry about how to keep our patients safe that bothers me the most. Even after all the study and diligence to make sure that every base is covered, there maybe just maybe something that will get overlooked that could make a difference. It keeps me thinking late at night.

Sometimes I wake up at 2:30 in the morning with my mind ruminating on the case that was a little difficult that last day. Wondering why I missed a couple of important points that my clinical instructor was "pimping" me about. I knew that stuff, why did I blank when he asked me all those questions. Maybe it was because I was trying to do something in the OR and my mind could not jump rope and chew gum at the same time, who knows.

All in all I am having a great time. Everyone is kind and understanding for the most part and it's usually just me that is making life really tough. We are our own worst critics.

OK, did you think about our Armenian fellow. He is not going to surgery today. This is based on the ACC/AHA guidelines. He has intermediate risk factors and is scheduled for a high cardiovascular risk surgery and needs cardiology consult. Seems reasonable now while I am sitting at the desk with all of the data in front of me but in the heat of the moment it's not so clear sometimes. I guess that's why we are in training and have seasoned clinical anesthesia around to make sure we don't fall in the ditch.

Live for the Weekend

There are those that live for the weekend. Right now, this weekend, has been a rejuvenation time for me. The first two weeks of clinical rotations are done and the fatigue of those two weeks melted away today with a little bicycle ride through Sierra Madre down to South Pasadena and around back to Monrovia. The stress faded with the bright clear skies and cold breezes of this mornings ride. This is good. So, I live for the weekend too.

What is it with the Traffic Police? These last two weeks it has been bicycle ticket hell along the San Gabriel mountain range. Yesterday, the City of Monrovia passed out over 50 traffic tickets to bicyclists. Yes, over 50 tickets for failing to stop at signs and such. These tickets go on your driver's license and carry the same weight as a moving violation in a car! Insurance rates will increase and the whole nine yards. Traffic School anyone?

Evidently what has happened is that a few concerned citizens have complained to the local City Council concerning the bicycle 'gangs' in their neighborhoods. There is a racing club based in Montrose that have very fast rides through the streets from Pasadena to Duarte and the locals are tired of them running stop lights. What happens in these large very fast groups is that a cyclist will get dropped from the lead group and will hurry through stop signs and lights to catch up. It's easier in the main group because of the draft advantage not to mention the shame of getting dropped by the lead group.

The little bicycle group I ride with would never be called a racing club. We might get tickets for loitering but not for speeding. This morning as we rounded a small side street going out of Monrovia, a Traffic Cop, pulled up along side of us with all his lights flashing and yelled at us to "stop blowing through stop signs". We looked at him like he was a little crazy. Really, he had an extremely rude attitude; it was amazing how angry he was. We waved and were on our way without any additional incident. Later on we heard the news at the rest stop that several of the riders were stopped and given tickets. These people are out of control, really.

Several of us are talking about going down to the City Council and local Police Station to complain about the harassment. These Traffic guys are going out of their way to make it difficult for the cyclists. Another tack is to talk to the local coffee shops and restaurants that we haunt to let them know that if this keeps up we will take our business to another city and local. Lets see if that raises any eyebrows at the local City Council.

In the end no one wins here. Going through some of these hillside communities is going to be slow going but that is the way it is for now. It must be stated that safety is the number one concern for every bicycle rider and we know that we share the road with pedestrians and motor vehicles. Being polite and courteous is the best attitude to keep safe. Obeying the traffic rules is the best policy even in large cycling groups. No one is contesting this but the harassment is a little too much right now from the local constables.

The Tale of Two Women

This is the end of week two of our clinical rotations at LAC-USC. I have to tell you that I am tired. Maybe this weekend I will have more imagination or wit to be readable but for now what is left is what you get. The progress that all of the students have made this past two weeks has been really wonderful. My feeling is that all of the preparation and study is paying off. The physicians and staff that we have worked with in this short time here at the County Hospital have really been wonderful and ingratiating. Personally, I feel very grateful to be afforded this opportunity and to be exposed to this group of people.

Today I had the opportunity to go to the Women's and Children's Hospital and was assigned to the GYN OR. The two cases that were in the room today were both hopeful and tragic. The first case was a young woman that wanted to have her tubaligation reversed so that she may have a chance at having children with her new husband. The second OR case was another young woman that is going back for her second laparoscopic surgery for ovarian cancer. Two women with two terribly different situations.

I came home today thinking about how we can touch another life. What is it that becomes important to others in our interactions? The important point of what I did today was in the facility of the anesthetic induction and skill during anesthesia. What I agonized most over was how these women were feeling and the outcomes of their surgeries. I found myself talking to both of them while they were sedated coaching them and telling them that they were going to be fine. Hoping more than knowing, praying more than comprehending the enormity of the outcomes of these operations over which I had no control. What I did have control of I managed with the utmost of passion. These women were safe during surgery and came through their anesthetic extremly well. I have had great teachers.

Now, if God would only listen to me for a little while.

Train Trauma at LAC-USC

Today was a bad day for commuters in Los Angeles especially for those that took the early morning trains through Glendale and Burbank. The tragedy, loss of life and chaos that happened today will be remembered for a long time.

Three trains were involved in a crash and derailment due to an alleged car stopped on the tracks near the Amtrak station in Glendale this morning. All the papers are filled with the story. I don't know about any of the sad details of what went on at the scene but what I do know first hand is the trauma that came to LAC-USC and the operating rooms here at the County Medical Center. When this kind of terrible thing happens every one rallies to do the best that can be done to help these poor victims. Going to work is never supposed to be tragic. Unfortunately for so many people this morning, this is exactly what happened.

We can read about tragedy, tsunami and earth quake in other parts of the world. These things happen, lives are lost and we are left wondering why and to deal with the aftermath of these events. Each day we need to remember that life is precious and to rejoice in sun while it is shinning.

Metal Tiger Web Site

Recently, a project I have been working on has taken off. The web site at metaltiger.org is flying after a lot of work. The Kittyhawk is skyward once again. For right now the site is being mirrored from this site to that one; check it out anyway. I am sure that you will enjoy the very simple layout in WordPress.

First Week of Clinical at LAC-USC

I just finished the first week of clinical rotation in the OR at LAC-USC Medical Center. Oh My God! This anesthesia program at USC is better than I could ever have imagined. We were in the OR for three long days this past week and just from what I saw during these days I could discuss for a month. The only problem is there is no time to describe all of the surgical cases or the scenarios that came up. What I will relate is a few of the basics of what I learned during the first week of clinical here at Unit #1. "Just the facts, madam, just the facts."

The basics come first. We went over the anesthesia machine check and setup thoroughly. By the end of the week I feel confident that I could set up the anesthesia machine completely and run a systems safety check. This is good. Second, is the cart set up. Every anesthesia provider has a little bit different take on how to set up their cart; the layout of the medications and where the airway equipment is kept at the ready varies from person to person. The basics are the same and this is what came through.

There are standard concentrations for the medications and established ways that are for the most part followed from OR room to room. The idea is that when a relief anesthesia provider comes in there will not be any misunderstandings about what is drawn up in the syringes since the concentrations are standard throughout the hospital operating rooms. That is another very good thing. The way some of these people label their syringes is a crack up. "Now the tape has to go this way, not that way......." etcetera. Individuals have varying degrees of tolerance for how other providers set up their carts. The main thing is patient safety and having established concentrations from OR to OR for the drawn up medications is one way to establish safety.

Time is limited right now so I will add to the story tomorrow, promise.

First Day of Anesthesia Clinical

This is it. The day has finally arrived to start clinical rotations at LAC-USC Medical Center in the Anesthesia department as a Student Registered Nurse Anesthetist (SRNA). After all of the academic preparation, this is the payoff.

Today was spent with the staff at the Los Angeles County Medical Center doing orientation duties, receiving lockers, pager assignments and generally getting used to the large place. Our clinical assignments were made for tomorrow and we were able to call the Certified Registered Nurse Anesthetist (CRNA) staff members that we will be working with in the morning. For me, I will be covering the Emergency OR for general surgery. Sounds exciting but from what I am told most likely the day will be slow. For the first day of our anesthesia rotation at the LAC it will be nice to be with a very experienced staff member. The physician attending staff at the LAC Hospital is a wonderful group, very experienced and used to working together with CRNA's. The relationship that is fostered at the LAC is a strong collegial one with Dr. Philip Lumb as head of the Anesthesia department in the Keck School of Medicine at the University of Southern California.

CRNA's are the Nations largest anesthesia providers, reportedly performing over 50% of anesthetics and in some reports up to as much as 65% of all general anesthesia. To learn more about the practice of the Certified Registered Nurse Anesthetist, the resources of the National organization, American Association of Nurse Anesthetists (AANA) may be resorted to.

Metal Tiger Reloaded

Learning how to navigate in PHP and mySQL on the web server has been so much fun. It's like smashing your little toe with a small hammer again and again and again until you just can't stand it any longer. Does any of this sound familiar. Maybe its just me, it usually is, I am slow like that. Sometimes lessons come hard to the hard-headed.

From the beginning the goal was to put the Metal Tiger site using WordPress in the root directory of a new web site. Simple goal really. The first time installation of WordPress was attempted, all went smoothly. The trouble was the install was into a subdirectory www.metaltiger.org/blog which left the root open for the index.html file to display all of its horrible glory. After two days of futzing around I came up with an idea. Two days to get an idea, again I'm slow remember. The files have been manipulated using WS-FTP uploading to the server. The idea came that it would be possible to rename the folder that was necessary to upload to the server to the same name that all of the root directory files were in. Brilliant idea! Now when I transferred the files they were in the root directory and the execution of WordPress install will take place there. The result is that WordPress will be in the root directory where it is supposed to be for this site. After backing up all of the files in the httpdoc directory on the server, I uploaded to the root directory all of the WordPress files through FTP. Presto-Chango! It works!

There you have it. www.metaltiger.org is up and running now. The plan for the web site is simple; learn WordPress and have some fun doing it. If you enjoy any of the stuff there just let me know. The Metal Tiger is a mythical creature and it may take a while to tell all of the tales that have been told concerning him. Actually, its not a him or a her because the Metal Tiger is really more of an idea. More later too much futzing around to do right now.

Bicycle Ride to Pasadena

Mout Fuji
originally uploaded by David Godden.

Today we road through the San Gabriel Mountain foothills on our way to Pasadena for coffee. The skies cleared for a while today after so many weeks of rain.

I have enclosed a picture taken from a vantage point a small way up the road to Mount Fuji thinking that you would appreciate the view. Our ride today was not as spectacular as this but you get the idea anyway. Every Sunday, the Velo Monrovia bicycle group from "Stan's" place heads out around 8:00 in the morning; summer time take off is at 07:00 give or take the stragglers showing up a little late. Today was no exception. Our trip was quicker than usual due to an overabundance of male testosterone that pops up every so often.

Picture this, several itchy racehorses couped up for three weeks due to rain. The first clear day and all of the riders gather at the old mill. No one can keep their horses in check very well and the best thing to do is let them run off their excessive energy. After ten miles or so of dead out running the horses are easier to control and everyone is happy. Such was the setting today.

Instead of horses, picture thirty or so bicycle riders with too much TV under their belts and glycogen to burn. Our ride today started out fast and speeded up until the rest stop. Unfortunately I was dropped but was able to close in at the appointed rest stop as the lead riders tired so that I was only less than thirty seconds behind. No one noticed that I was a little bit off the back, thank God. The rest of the group straggled in after five to ten minutes or so. Its always nice to stay with the lead, it makes for tall tales later.

After the rest stop the group was softened up enough to ride on together. Comrades in arms, warriors all, beat the path back to home and family. Another day full of laughs, lies and friendship.

Word Press and the Metal Tiger

For the past two days I have spent the majority of my time playing. That's good you say. Yes, play is good; being productive is better. These two days were spent installing WordPress blogging software on a new server.

I wanted to find out more about WordPress and all of the stuff that goes with managing a PHP site. There has been a lot of things to learn and the going has been a little slow but I am glad to say that the new site http://metaltiger.org/blog is up with a basic layout. If you want to see what a really nice WordPress site looks like, take a look at Susan Kitchen's 2020HindSight blog. Very clean and great content. I love her site and it's powered by WordPress software. The WP software is open source and free too, how is that for a deal! The people that have developed WP and the support have really been terrific.

Enable Referrers

My first bit of confusion started when I tried to add a link. I received this notice that I must 'Enable Referrers' before the link would post. Enable Referrers? I scratched my head for a while on that one. After searching for a long time through all of the documentation in WordPress, I gave up and asked about it in one of the on line help support forums. It took a while before a kind response came that I did not know what I was doing and he supplied a link with a page on how to turn on Referrers in the browser. Great!

The trouble ended up being in my security software. Zone Alarm to the rescue. Sometimes we get locked up with security and loose the tools we need to do our work. Does this sound familiar? Eventually I opened up the security in Zone Alarm for my own site and presto changeo, the links now work. Thank you James Huff the wizard of web.

Bicycle Ride up to Claremont Ca

Other play today was conducted on the bicycle. The Velo Monrovia group did a 48 mile ride up through Claremont. All of the canyons are closed due to mud slides so we stuck to the foothills on the route. We ventured up Azusa canyon but one mile up the CHP officers had the barricades up and were turning people back. The heavy dump trucks and dirt/boulder movers were there in force. I think that it will be a while before all of these roads are open. Tomorrow is another day and I will get some more riding in. Good thing too. After three weeks of sitting on my rump watching the rain, I need a couple of good days riding just to clear away the cobwebs. Hopefully, I will be able to get some pictures of the snow on the local mountains during the ride tomorrow.

The Metal Tiger Organization

Well the MetalTiger.org project is under way now. By tomorrow the site should be available on line. You have to note that this site is under construction and will be done using WordPress blogging software for site management. That's a mouthful.

For those that are wondering what a Metal Tiger is, there is a story behind the creature. According to Chinese tradition, the Metal Tiger is a special being created when all of the stars are aligned just right; a wonderful creature capable of fabulous things. The way to know if you are in the presence of a Metal Tiger is just to ask, I am sure that he or she will tell you all about it.

I have been privileged to have met such a person and live to tell about it. This web site will tell the story.

Its Raining, Its Pouring, The Old Man is Snoring

The weather has not let up for the last couple of weeks. If this rain keeps up, the claims for drought retrictions will have to be lifted. As it is, our water table is down about fifty percent and we will need a couple of years of good rains to bring it back to normal. Drought conditions here is the soutwest have really been terrible for the last 5 or 6 years.

According to Susan Kitchens of 2020hindsight.org, the average rainfall in Los Angeles is 17.6 inches per year. Somehow I thought it was a little lower than that but its a good starting place. So far this year we have to be over that already don't you think. By the way, Susan has a wonderful blog powered by WordPress and is worth looking at.

Now the moment you have all been waiting for. I will warm up the old vocal cords a bit first ..... mee, mee, meee, meeeeee .... aye, ee, ahh, ohh, ooooooo! I am ready now. Mistro, strike up the orchestra:

Its Raining

It's raining, It's pouring,
The old man is snoring;
He went to bed
And bumped his head
And couldn't get up in the morning.

Did you enjoy that. I knew you would. Nothing like a little singing to get over the rain outside. Everything is true except the bumping the head part.

Japanese Lap Pillow

In a story posted by Reuters.com, the Japanese Lap Pillow is the next big thing. I can see why. The little misses is out of town on business and you can't sleep. The Lap Pillow to the rescue! Or, as the ad states, the target market is for bachelors in their 20's or 30's before marriage. Just the thing to keep them home at nights I imagine.



The Reuters story goes on to discuss the success of the Lap Pillow this last Christmas shopping season.

The 9,429 yen ($90) pillow, which comes with one red and one black skirt, went on sale in late November and maker Trane Co Ltd says shipments have reached 3,000 in just a few weeks. "We created this item to help tired people relax," said Makoto Igarashi, Trane's managing director.

Well I guess I'll settle for the real item. This looks a little creepy to me.

To be fair, there is a Man Pillow on the market, but this is old news. Ok girls, you can get an "arm pillow" on the web anytime. Now you know that we run a fair and balanced thing here. Extremism is one thing but you have to be balanced after all.



So, if the rain does not stop and you want to cuddle up for a little nap, there are no more excuses.

The Captain's Blog by Ruben Robles

The Captain's Blog by Ruben Robles at rsquarednet.net has been up and running now for a little while. In it, all things from open source software, PHP Nuke and MySQL are discussed.

Most of this is over my head but I enjoy window shopping anyway. Ruben at rsquarednet has a cool hosting service as well. Anyone looking for hosting can click to his site as above or check in on his blog.

Weather Report from the Desk of the Extremist


Johnny Mountain of ABC Channel 7
Rain, wind and cozy reading by the fireplace are in the forecast for the duration of the weekend. According to Johnny Mountain, the rain is going to keep coming.

The plans for bicycling this weekend has been somewhat put on hold. The one window of opportunity for a little ride was Thursday morning but unfortunately I had errands to run and could not get on the bike. Last night the rain woke me up somewhere at O'dark thirty. The thunder and lashing rain here in the foothills of the San Gabriel mountains has really been something these last few weeks.

The weather report, according to the National Weather Service, for Saturday is more rain with temperatures up to the mid 50's, wind 15 to 25 mph from the southeast. You can see the entire report for the Los Angeles Valleys as a service of the National Weather Office.

The Last Day Working and CRNA Scope of Practice

This sounds like a spaghetti Western film staring some of the oldsters. Any minute now I expect to see someone strike a wooden match against their boots and light up an old half smoked crooked cigar, saunter across the dusty street and push in the swinging door of the local saloon. Marshal Mat Dillon of course would be there to straighten out any rough stuff so not to worry little chil'ens.



Well, this is not an old Western but the last day that I get to play at nursing for a while, cause you see partner, I got things to do at the County Seat and I have to be moseying along. The fact is, Anesthesia School 2nd semester starts this coming Monday at LAC-USC hospital and I AM FREAKING EXCITED about that.

CRNA Clinical Practice

The first semester of clinical practice for me as a Student Registered Nurse Anesthetist(SRNA) will be at the Big House, the Mother of all County Trauma Centers, The Los Angeles County Hospital just across the street from the USC Health Science Campus. Orientation will start on Wednesday with Jim Carey and the Gang of Four (Terry Noris, Kari Cole, Michele Gold, and Dr. Philip D. Lumb). These are all wonderful role models and excellent clinical examples; the best of the best in anesthesia. What a life I get to live.

The Board of Registered Nursing here in California just posted a Statement of Practice for CRNA's in California. Now this IS important. It can be viewed at the California BRN's web site or here for a slight fee. Just kidding. I encourage everyone to read the description of the scope of practice for the CRNA. This has been a hard fought battle to get this posted by the California BRN. The scope of practice of Nursing and the CRNA is only in the domain of the Board of Registered Nursing and not Medicine. Much more on this later.

USC Orange Bowl Half Time Report

The Orange Bowl this year is a showdown between the defending National Champion USC Trojans and the Oklahoma Sooners. At half time the Trojans are dominating this game. Amazing isn't it!



According to the experts, this game is going to be close with most favoring the Sooners. To quote Trev Alberts of ESPN Sports:


It doesn't get any better. You couldn't have imagined a better championship game. Both teams are so balanced between the run and pass that it will come down to which defense can make the opposing offense one-dimensional. Since the return of cornerback Antonio Perkins, the Sooners' defense has been dominant. USC has struggled at times to pressure the passer.

At the half time the score is 45 to 7 Trojans. With four turn overs in the first half and all turned into 7 points each by the Trojans, the second half looks like its going to be a long one for the Sooners. Go Trojans. Who will say that they are not National Champions after this game will have to hang their head in shame. From the sports desk of the Extremist, GO TROJANS!

Nurse Anesthesia: Choosing a School

Becoming a Certified Registered Nurse Anesthetist (CRNA) is a challenging career choice to say the least. For anyone interested in Nurse Anesthesia I highly recommend spending some time at the American Association of Nurse Anesthetists (AANA) web site. There is so much information there that will guide and enlighten any one that is looking to pursue a career in Nurse Anesthesia. USNews.com web site has a list of all 85 Nurse Anesthesia programs listed alphabetically with links. It is another interesting place to start your search for a school.

Choosing a school is not a simple matter. Most of us look to local resources to find academic settings that are accessible without relocation plans. At the AANA's web site there is a section on Accredited Programs which are listed by state. Here it is possible to start the search for a program of Nurse Anesthesia. For any one that is looking seriously to become an Anesthetist, exploring all of the programs, their requirements for admission, and the academic program details will prove extremely enlightening. For instance, what are the two academic degree options for Nurse Anesthetists programs?

All of the programs in the United States must be accredited and fall into one of two categories. Either the program is in a school of Nursing or it is not. The degree options are determined by this. Those programs within a School of Nursing such as Columbia, Rush, Duke or the University of Pittsburgh offer Masters of Science in Nursing degrees (the MSN) with a specialty in Nurse Anesthesia. For those that already have an MSN these programs may only offer a certificate of completion rather than another degree. This depends on the program. Often in these programs the students will be taking course work in the School of Nursing with other Nursing students in other programs such as the Nurse Practitioner option. I have a friend at the University of Buffalo , another MSN program, who has told me that her first pharmacology class is with all of the Nurse Practitioner students. Another point concerning the programs in a School of Nursing, there are a few requirements for the MSN that require general didactic course work generic to all MSN programs. These classes may be something like "General Health Care across the Life Span", or some such class. The requirements of the MSN mandate this course work in addition to the anesthesia class and clinical. That is something to think about.

The other programs of Nurse Anesthesia are located in programs in Medical schools, Biology departments and so on. These programs do not offer an MSN degree but as in the case of the University of Southern California offer a Masters in Nurse Anesthesia through the department of Medicine. The University of Michigan-Flint/Hurley is another program offered at a Medical school that is well respected. If you must have an MSN these programs are not for you. A benefit of not being in a school of Nursing and a candidate for the MSN is that all of the course work is science and directly applicable to the practice of anesthesia. Maybe my bias is showing here. As an example, here is the course work at USC program of Nurse Anesthesia:

Human Anatomy (3)
Systems and Integrative Physiology(4)
Pharmacology of Anesthesia Practice (4)
Principles of Anesthesia Practice I (4)
Advanced Pharmacology of Anesthesia Practice (3)
Pathophysiology Related to Anesthesia Practice (4)
Clinical Residency in Nurse Anesthesia I (3)
Advanced Principles of Anesthesia Practice II (4)
Clinical Residency in Nurse Anesthesia II (2)
Research: Investigative Inquiry (2)
Professional Study for Nurse Anesthesia (3)
Advanced Clinical Residency in Nurse Anesthesia I (3)
Advanced Clinical Residency in Nurse Anesthesia II (8)
Research Integration: Capstone Experience (1)
Advanced Clinical Residency in Nurse Anesthesia III (1)
Specialty Fellowship *(optional) (2)

For me, the programs located within a School of Medicine are more attractive. The reason for this is that I already have an MSN degree and do not wish to receive a post graduate certificate from an MSN program. This fits for me. Besides, the science is what I am looking for, not another nursing class, again my bias.

The final issue that I want to discuss today concerns the Graduate Record Exam (GRE). There are programs that require the GRE and there are others that do not. Two wonderful Programs of Nurse Anesthesia, The University of Kansas, and the University of Buffalo in New York are both MSN programs but do not require the GRE to be considered for admission. There are those students that struggle with this exam and there are programs where they can be competitive and do well on entrance. Many programs require the GRE and use it as a marker for success. Samuel Merritt College in San Francisco uses the GRE to weed out their applicant pool only considering well GRE endowed applicants.



So, good luck in your pursuit of your dreams. Here is a student, J.C. Thomas, from The University of Pennsylvania reflecting prior to fiber optic brochoscopic confirmation of double lumen tube placement. See what you have to look forward to. Good luck.

Nurse Anesthesia: A Letter to James in Australia

Today I received a very nice letter by way of a comment to one of my blog postings from James a nursing student in Australia. He, like many of us, has questions about the profession of Nurse Anesthesia here in the United States. Most people, not to mention those inside of medicine and its related specialties, have never heard of Nurse Anesthesia let alone could describe what it is that they do. The idea that over 50% of all of the general anesthetics in this country are administered by a Certified Registered Nurse Anesthetist (CRNA), some report up to 65%, is a thought that has never touched the consciousness of the average man. So who are these CRNA's, where do they come from and what is the preparation that goes into becoming a Nurse Anesthetist? Big questions and far too few answers. Below is James original comment/post and a beginning of a response from me.

Hi David...
I have just finished skimming through your Blog. I am an undergrad nursing student who found your site while researching Nurse Anesthetists for a future career. I have some questions and I am not sure where I should post them. Anyway, it’s about the admission criteria for the MSN program. My undergrad marks should be very strong by full graduation time, but I would like to know what is the average amount of years of experience you and your peers have had in ICU-related nursing? Is anyone in that program with only the bare minimum of one year experience? If this is not the appropriate place to ask questions then is there an email address I could have for further discussion. Thank you for your assistance in these matters, it is quite difficult for me to find information from the other side of the world, Australia.
Your reply would be much appreciated.
Thanks
James


Hello
Thank you James for your thoughtful inquiry and questions concerning Nurse Anesthesia. I got your message and wanted to reply to you directly but you did not leave an Email address so the only way to give you an acknowledgment and answer to your questions is here in the blog directly. You may email me anytime at davidgodden(at)hotmail.com for a more personal response.

I too did a lot of research into which were the best schools for Nurse Anesthesia. Beginning with the American Association of Nurse Anesthetists (AANA), I explored many of the web sites of the schools here in the United States that are listed under Certified Programs. In the web pages of the AANA is a document describing what Nurse Anesthetists are at a glance. I guess that is the best place to start.

James, you asked about clinical preparation before being eligible to enter a program of Nurse Anesthesia. The requirement for admission to any school in the US is at least one year of critical care nursing. Different schools interpret what "critical care" is differently. All of them accept intensive care units (ICU) as critical care and exclude all else including Emergency Room experience or Post Anesthesia Care Units (PACU) while other programs are more liberal and examine each person's application for experience in critical care individually. My advise is to explore the AANA's web site and the schools that you like to find what a prospective school requires.

The answer to your question about only one year of experience is yes. There are some students that are accepted into Nurse Anesthesia programs with just one year or a year and a half of clinical experience. This may be because the rest of their application is exceptional while for others like myself it takes many years of ICU experience to get ready to apply. Do not be intimidated is the main thing. Get the experience that you need and go for your goal, period.

Academic requirements for most schools include an upper division course in statistics, physics and a year of chemistry including organic and biochemistry as part of your undergraduate nursing program. Many undergraduate programs do not include these as part of their curriculum so adding them now is very important if your goal is to go into Nurse Anesthesia here in the United States. Again, research the individual programs in the AANA web site directory for their requirements.

Finally, it becomes a little bit of a problem for foreign students coming to the US. I advise calling any prospective school now and to talk to the director of the program to see what you can do to make your transcripts attractive and acceptable to their respective programs. I have a friend here in the States who has a Nursing degree from Australia. She has to take classes here to establish a grade point average and to make up some deficiencies including the statistics, physics and chemistry before her application is accepted by a Nurse Anesthesia program here.

One last point about the application process here in the US. Most school require a minimum score on the Graduate Record Exam (GRE). This can stumbling block unless you prepare for it wisely. There are review courses here including Kaplan and the Princeton Review for the GRE. They all are worth while if you are serious about doing well on the GRE.

I hope that some of this helps. There is so much more to talk about but space and time do not permit now. The books that I have found to be essential for anesthesia practice are listed to the right under Books I am Reading Now. Good luck James and follow your dream. I have been struggling with climbing this mountain for a while now and appreciate anyone who wants to do more and make an impact on the world. The bottom line is that as a Nurse Anesthetist your input into patient care becomes very important and valued highly.