Could nursing education even attempt to mirror a 80-hour workweek residency?

[flightnurse2MD]

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I’m a prelim surgery intern and worked 80.5 hours last week. Yea it sucks, but I can already tell a difference when it comes to writing notes and my efficiency in managing patients on my service. I remember during nurse anesthesia school, the most I ever worked in one week was 48+ by doing two 24-hour shifts on OB. Sure, you could read, study, and take all the exams to become knowledgeable, but there’s something to be said about the repetition you get when working those kind of hours. With that being said, could nursing education in any specialty even attempt to do this?

 

[anbuitachi]

I’m a prelim surgery intern and worked 80.5 hours last week. Yea it sucks, but I can already tell a difference when it comes to writing notes and my efficiency in managing patients on my service. I remember during nurse anesthesia school, the most I ever worked in one week was 48+ by doing two 24-hour shifts on OB. Sure, you could read, study, and take all the exams to become knowledgeable, but there’s something to be said about the repetition you get when working those kind of hours. With that being said, could nursing education even attempt to do this? Especially when residents are funded through GME and APN students are not.

Don't SRNA pay to go to school? If they pay, then it probably wont matter if its funded or not since the hospital isn't paying them. So yea I dont see why they can't do 80 hr weeks. With that said the chances of that happening in the next 1000 years is probably 0%

 

[Psai]

Hahahaha

Nurses can't even handle missing their mandated hour long lunch. Have you ever seen a crna stay past their designated time slot? The mentality is just so different.

 

[urge]

I’m a prelim surgery intern and worked 80.5 hours last week. Yea it sucks, but I can already tell a difference when it comes to writing notes and my efficiency in managing patients on my service. I remember during nurse anesthesia school, the most I ever worked in one week was 48+ by doing two 24-hour shifts on OB. Sure, you could read, study, and take all the exams to become knowledgeable, but there’s something to be said about the repetition you get when working those kind of hours. With that being said, could nursing education even attempt to do this? Especially when residents are funded through GME and APN students are not.

Just imagine how much better you would be if you worked 120 hrs/week.

 

[flightnurse2MD]

Hahahaha

Nurses can't even handle missing their mandated hour long lunch. Have you ever seen a crna stay past their designated time slot? The mentality is just so different.

I got a buddy who starts nurse anesthesia at Duke this Fall. I spent the last 3 years trying to convince him to go to medical school, but he chose otherwise. I took a look at their curriculum and even in their last year- students have FOUR clinical days a week. He told me he’s going do 12-14 hour days to see as many cases as he can. I don’t know how it is over there, but academic centers tend to relieve nurse anesthetists at 3p-5p depending on their schedule- four 10-hr days or five 8-hr days.

 

[anbuitachi]

I got a buddy who starts nurse anesthesia at Duke this Fall. I spent the last 3 years trying to convince him to go to medical school, but he chose otherwise. I took a look at their curriculum and even in their last year- students have FOUR clinical days a week. He told me he’s going do 12-14 hour days to see as many cases as he can. I don’t know how it is over there, but academic centers tend to relieve nurse anesthetists at 3p-5p depending on their schedule- four 10-hr days or five 8-hr days.

Yea its hard for me to imagine them go out and practice independently in some states.. sounds dangerous

 

[Robotic Wis-Hipple]

Nurses go nuts if they work more than 12 hours in a day or 36hrs in a week without overtime pay, gtfo of here.

 

[vector2]

I’m a prelim surgery intern and worked 80.5 hours last week. Yea it sucks, but I can already tell a difference when it comes to writing notes and my efficiency in managing patients on my service. I remember during nurse anesthesia school, the most I ever worked in one week was 48+ by doing two 24-hour shifts on OB. Sure, you could read, study, and take all the exams to become knowledgeable, but there’s something to be said about the repetition you get when working those kind of hours. With that being said, could nursing education even attempt to do this? Especially when residents are funded through GME and APN students are not.

You say that they could read, study, and take all the exams, but the thing is, they can't and they don't. I've seen our CRNAs teaching SRNAs. When they're with one of their seniors, their primary concern is with making them fast and efficient while feeding them platitudes about self sufficiency as if being able to push drugs and pull the stylet solo was the end all be all of anesthesia.

When I'm with one of my CA-3s, I expect that they are already 98% competent with the monkey skills. If say I'm in a lobectomy with one, I expect them to be able to multitask and go over the pt's RCRI criteria, justify whether a central line is needed, explain a differential for hypotension, tell me what preop FEV1 would make them concerned about post op complications, explain bronchial anatomy, go through the algorithm for treating OLV hypoxemia, tell me the allowable blood loss, interpret the baseline abg- all while they put in the DLT, bronch to confirm position, and put in the a-line solo. When the case slows down, we go over thoracic anesthesia review questions or I find a journal article for us to look at.

It doesn't matter to me if nurses spent a thousand hours a week in the hospital because, unlike our residents, they do not have the same opportunity to learn from a board certified physician and will always end up not knowing what they don't know.

 

[dchz]

When I'm with one of my CA-3s, I expect that they are already 98% competent with the monkey skills. If say I'm in a lobectomy with one, I expect them to be able to multitask and go over the pt's RCRI criteria, justify whether a central line is needed, explain a differential for hypotension, tell me what preop FEV1 would make them concerned about post op complications, explain bronchial anatomy, go through the algorithm for treating OLV hypoxemia, tell me the allowable blood loss, interpret the baseline abg- all while they put in the DLT, bronch to confirm position, and put in the a-line solo. When the case slows down, we go over thoracic anesthesia review questions or I find a journal article for us to look at.

I feel good that this is easily within my grasp. What journal do you usually do?? that's what's missing from my routine i guess.

 

[flightnurse2MD]

You say that they could read, study, and take all the exams, but the thing is, they can't and they don't. I've seen our CRNAs teaching SRNAs. When they're with one of their seniors, their primary concern is with making them fast and efficient while feeding them platitudes about self sufficiency as if being able to push drugs and pull the stylet solo was the end all be all of anesthesia.

When I'm with one of my CA-3s, I expect that they are already 98% competent with the monkey skills. If say I'm in a lobectomy with one, I expect them to be able to multitask and go over the pt's RCRI criteria, justify whether a central line is needed, explain a differential for hypotension, tell me what preop FEV1 would make them concerned about post op complications, explain bronchial anatomy, go through the algorithm for treating OLV hypoxemia, tell me the allowable blood loss, interpret the baseline abg- all while they put in the DLT, bronch to confirm position, and put in the a-line solo. When the case slows down, we go over thoracic anesthesia review questions or I find a journal article for us to look at.

It doesn't matter to me if nurses spent a thousand hours a week in the hospital because, unlike our residents, they do not have the same opportunity to learn from a board certified physician and will always end up not knowing what they don't know.

Is this to be expected at all academic residency programs? What kind of training do residents get at a community hospital program. I’m under the impression you are just there as a form of cheap labor with minimal teaching/educational expectations.

 

[anbuitachi]

I think that has more to do with different skill sets... being fast/efficient is one skill, being able to multitask is another skill. They dont have to be CA3s. CA3s can suck at multitasking. Some are just better at multitasking than others. They can be experts at putting in DLTs, and answering those questions, but may not be good at doing them at once cause that goes into multi tasking. Just like some can shop online all day and drink water at the same time, while others despite having done each one 10000 times, can only focus on one at a time.

 

[vector2]

Is this to be expected at all academic residency programs? What kind of training do residents get at a community hospital program. I’m under the impression you are just there as a form of cheap labor with minimal teaching/educational expectations.

It's variable from program to program and attending to attending. Obviously big money academic centers are going to have more resources by way of renown guest lecturers, equipment tutorials, journal access, journal clubs, textbook/ipad funds, M&M, multidisciplinary rounds, etc., but intraop attending teaching is mostly just dependent on how much the attending wants to do. I go out of my way to teach residents because I'm fresh out, I personally love learning, and I think we have a duty to shape them so they can perform and think at the top of their game. Some of my older colleagues are more the type to start to case, pass on a pearl or two, and leave the room. But, ask me again in 5 years after I've had a taste of burnout whether I still do any hardcore teaching...I'll be curious to know that, myself.

I think that has more to do with different skill sets... being fast/efficient is one skill, being able to multitask is another skill. They dont have to be CA3s. CA3s can suck at multitasking. Some are just better at multitasking than others. They can be experts at putting in DLTs, and answering those questions, but may not be good at doing them at once cause that goes into multi tasking. Just like some can shop online all day and drink water at the same time, while others despite having done each one 10000 times, can only focus on one at a time.

Quickness/efficiency and multitasking (especially the thinking portion) are inextricable when it comes to anticipating needs during an anesthetic, but even if they were totally different skillsets, a competent anesthesiologist needs to be good at both. If you're a CA-1, you have the slack to take your time when intubating and putting in lines cause you're not at an expert level and your focus should be on the task at hand. By the time you're a CA-3, you should be able to do most procedures blindfolded while thinking about all the other aspects of case management. You will fail as an attending in an busy ACT practice (or even solo in say a difficult cardiac case struggling to come off pump) if you can't think/do 6 different things at once. Literally the other day, I had someone holding the phone up to my ear as I'm doing a central line because I had to coach a borderline incompetent CRNA in the other room how to manage a bronchospasm in a morbidly obese pt who got light when flipped prone. To be clear, multitasking (in addition to delegating and prioritizing) is absolutely essential and no CA-3 should "suck" at it by the time he or she is finishing up.

 

[IMGASMD]

By virtue of training/education, even if they have a DNP and tries to call themselves doctors, nurses are entirely species different than physicians. From the moment we become doctor, after we received our MD/DO, we are taught that the patients are ours. It is our responsibility to cure/fix the patient. This process is as short as, one year, as long as, it takes. What I found troubling is that if you look at CRNA’s education, they claim over 8000 hours of education; when in fact more than 5000 hours of that is when they’re critical care nurses. They’re carrying out physicians orders. These are what the word is, orders. They have no sense of responsibility, because these are orders from someone who had been trained to take full responsibility of patients care.

If we really look at medical direction, one of the components is prescribe anesthesia plan, which to me is still essentially saying that the CRNA suppose to follow the plan.

Regarding working hours. I’ve stayed past my hours, because my patient is unstable. I don’t want to transition care. I’ve worked without bill the patient. Somehow I find hard to believe, base on their education/training, any nurses are welling to do that.

—————————————
More thoughts. Some of you, may jump down my throat about that last paragraph. I am not saying I am a hero, (as someone called me in another thread), what I am trying to say is that I have learned to use my own judgment.

A lot of what we do, let’s be honest, is conventional treatments. We’ve learned through experiences, when A happens, we treat with B. What really separates doctors to noctors is that we’ve learned early on to accept responsibilities and to do our own risk/benefit analysis. I’ve decide because I believe it is the right thing to do. I stay passed my 80 hours in residency to treat “my” patient. I think it is stupid to bill a patient for a procedure when the patient barely got any benefits from that. Or I would try something new, because I’ve read it in A&A. I don’t need to ask for permission. I do me, noctors are unable to do that independently and probably shouldn’t do it independently.

/rant

 

[kamilo6]

Have you seen this yet?

American College of Cathopathic Physicians

 

[vector2]

I feel good that this is easily within my grasp. What journal do you usually do?? that's what's missing from my routine i guess.

I usually see first if there's anything new in A&A and/or Anesthesiology that piques my interest or that I think is of educational value (e.g. I work in a level I trauma center so something like this that just came out is a must-read for my residents). If I have time during a heart, I bring up the toronto TEE website so the resident can get a better anatomic understanding of what they're looking at on the echo. If i want to go over a specific topic (hyperalgesia from remifentanil, fluids vs pressor for plastic surgery/ENT flaps, crossclamp vs shunt for CEA etc), I'll spend some time searching on pubmed and see if there's anything from a relatively high impact journal to bring back to the OR to go over. If I'm feeling especially lazy or the resident's case has been killer, I'll just dump off the article and let them read it at their leisure.

 

[coffeebythelake]

Have you seen this yet?

American College of Cathopathic Physicians

View attachment 236848

this was created by a deluded, newly graduated male nurse practitioner who upon further research had an online undergraduate nursing degree and an online nurse practitioner degree. yet another nurse who wants to play doctor.

 

[It's lupus!]

Have you seen this yet?

American College of Cathopathic Physicians

View attachment 236848

It's been up a few months but no one has taken it seriously as far as I can tell. The AANP has not acknowledge or even encouraged it's existence. I wouldn't worry about someone who sits at the begginning of the dunning-kruger curve trying to call himself a "physician".

Sent from my Pixel XL using SDN mobile

 

[QueenJames]

You say that they could read, study, and take all the exams, but the thing is, they can't and they don't. I've seen our CRNAs teaching SRNAs. When they're with one of their seniors, their primary concern is with making them fast and efficient while feeding them platitudes about self sufficiency as if being able to push drugs and pull the stylet solo was the end all be all of anesthesia.

When I'm with one of my CA-3s, I expect that they are already 98% competent with the monkey skills. If say I'm in a lobectomy with one, I expect them to be able to multitask and go over the pt's RCRI criteria, justify whether a central line is needed, explain a differential for hypotension, tell me what preop FEV1 would make them concerned about post op complications, explain bronchial anatomy, go through the algorithm for treating OLV hypoxemia, tell me the allowable blood loss, interpret the baseline abg- all while they put in the DLT, bronch to confirm position, and put in the a-line solo. When the case slows down, we go over thoracic anesthesia review questions or I find a journal article for us to look at.

It doesn't matter to me if nurses spent a thousand hours a week in the hospital because, unlike our residents, they do not have the same opportunity to learn from a board certified physician and will always end up not knowing what they don't know.

I'm a third year med student and W....T....F.... is like 50% of the stuff you talked about.

Learning this type of stuff makes me antsy to do an anesthesia rotation!

 

[MirrorTodd]

I'm a third year med student and W....T....F.... is like 50% of the stuff you talked about.

Learning this type of stuff makes me antsy to do an anesthesia rotation!

Don’t sweat it dude. I’m a CA-1 and I could do maybe a quarter of that and certainly not all at once.

 

[Robotic Wis-Hipple]

I'm a third year med student and W....T....F.... is like 50% of the stuff you talked about.

Learning this type of stuff makes me antsy to do an anesthesia rotation!

Turns out Anesthesia is not just pushing propofol and doing sudoku 😉

 

[DeadSpace]

Don’t sweat it dude. I’m a CA-1 and I could do maybe a quarter of that and certainly not all at once.

Same. Probably 30% of that on a good day!

 

[IMGASMD]

Same. Probably 30% of that on a good day!

If you’re ca1, like just stared 10 days ago, and you understood 30% of that, you’re way ahead....... Even at 10%, I think you’re doing a bang up job.

 

[Psai]

If you’re ca1, like just stared 10 days ago, and you understood 30% of that, you’re way ahead....... Even at 10%, I think you’re doing a bang up job.

Thank god! Oh wait...

 

[IMGASMD]

Thank god! Oh wait...

You’ll be fine. In no time you’ll tube everyone with an opening.... 😉

 

[deleted171991]

I'm a third year med student and W....T....F.... is like 50% of the stuff you talked about.

Learning this type of stuff makes me antsy to do an anesthesia rotation!

Best doctor in the hospital is...? The critical care anesthesiologist. 🙂

 

[IMGASMD]

Best doctor in the hospital is...? The critical care anesthesiologist. 🙂

FFP take that attitude to that other thread... 😉

 

[deleted171991]

You’ll be fine. In no time you’ll tube everyone with an opening.... 😉

If God invents a hole, there will always be a ***** to stick a tube in it.

 

[QueenJames]

Best doctor in the hospital is...? The critical care anesthesiologist. 🙂

what about the critical care internist..??? 😉

 

[IMGASMD]

Turns out Anesthesia is not just pushing propofol and doing sudoku 😉

You people are really cramping my game here. Learned about anesthesia is more than sudoku, that 50% sale is not really a sale. AND there are two pricing plans for Uber.

What is this world coming to?!

 

[IMGASMD]

what about the critical care internist..??? 😉

You went there......

 

[deleted171991]

FFP take that attitude to that other thread... 😉

I don't deny that critical care is beautiful. Even when I stay late, I am still smiling at the end of the day.

I also know that my bosses couldn't care less, hence my usual "attitude". Life is short. 🙂

 

[deleted87051]

what about the critical care internist..??? 😉

If you have a bunion the best doctor is a podiatrist.

 

[deleted162650]

If you have a bunion the best doctor is a podiatrist.

I’ll take ortho foot and ankle thank you.

 

[deleted162650]

You’ll be fine. In no time you’ll tube everyone with an opening.... 😉

But enough about your personal life . . .