CRNA Scientist

I have spent a lot of time and consternation considering the problem of the anesthetist technician and the apathy exhibited by this type of practitioner. I believe this lackadaisical attitude springs from a root problem which lies in the nurse psyche. Nurses are issued orders and warned against thinking and acting too freely (so as not to cross the line into the practice of medicine). Also, no one tells a nurse that they can be a scientist, thus enabling them to realize and practice within this paradigm. Additionally, many nurses who want to be CRNAs seem to just be reaching for the brass ring. Once it is in their hand, many just hang on until retirement, sometimes loosely. Physicians, on the other hand, are extremely driven individuals considered by society and trained to consider themselves as scientist.

Well, I too consider myself a scientist. I had to study anatomy, physiology, chemistry, physics, pharmacology, math, statistics, etc. to achieve my degree. Once I became a CRNA, the study didn't just stop. I still read textbooks, journals, and the internet to stay abreast of the ever changing advances in our field. I attend meetings and am a member of forums such as the Learn to Sleep Google group and Yahoo’s Clinical Anesthesia forum to learn from others, and hopefully teach when the opportunity presents itself.

Like a scientist, I develop hypotheses on a daily basis regarding my patient and some deviation from their normal homeostatic state. I then test this hypothesis with an appropriate clinical action. Then, I collect data and analyze it to determine if my educated guess was right. Based on these results, I gather knowledge and learn. I know this is happening because I am developing better clinical judgment and avoiding some problems that I used to have to fix (or at least anticipating the problems that I have no power over and will have to address, i.e. surgical blood loss).

There's an old saying "you are what you eat". I agree, but take this axiom one step further. I think that you are what you consume. All anesthetist consume science and the scientific method on a daily basis, whether we realize it or not. So, once we clearly see ourselves as what we are, perhaps we will hold ourselves to a higher standard of knowledge acquisition and retention. So, dust off those old books, read your AANA journal, join an online forum or discussion group and embrace that scientist inside.

How to Establish Instant Rapport

Forming a strong relationship and establishing trust are critical components of patient care. Our patients are literally putting their life in our hands. Many times, this complex, verbal and physical ritual must be performed within three to ten minutes.

The first and most important point to realize is that each patient is unique and special. That sounds sort of hokey but it instills basic respect for the individual. Next, the fact that we occupy our position and the clinical garb that we adorn ourselves with establish credibility and a certain air of authority. However, there is much more that we can do to facilitate and expedite this sacred bond of trust.

1. Look the patient in the eyes and introduce yourself as a Nurse Anesthetist in training or Student Nurse Anesthetist. Let them know that you will be helping them take a nap, monitoring their vital signs, and by their side during the entire anesthetic.

2. Touch the patient. Shake a hand, squeeze their shoulder, or pat their leg. This initiates the caregiver/patient relationship and facilitates the bond.

3. Smile and project warm confidence. Take a note from the Beach Boys and throw out good vibrations.

4. Rapport is a two way street. Share information about yourself as you get to know the patient, e.g. “I had this surgery too”.

5. Seek to understand. Show empathy.

6. Address the family. Look around the room or bedside and say hello. Talk to your pediatric patients and get on their level.

7. Be factual about risks and complications, but keep hope alive. Use age/ education appropriate terminology.

8. Freely provide pertinent clinical facts and answer questions truthfully, but frame the information properly. People will believe what you tell them.

9. Diffuse anxiety and disarm hostile situations. Seek to be the calm in the storm. Use humor when appropriate.

10. Finally, give them what they need. Two milligrams of Versed is a great drug for anxiety, but it may do nothing for someone who takes their TID Xanax and Klonopin with a Harvey Wallbanger chaser. The same goes for narcotics and the guy that’s writhing in pain even after he chewed up his AM OxyContin and put on two Duragesic patches.

I know this seems like a lot to consider and implement in such a short period of time. However, there will be situations where you will have to draw on each and every one of these points, plus all the psycosocial stuff you learned back in nursing school and maybe an episode or two of Dr. Phil. In the end, the best approach may be to find a colleague who is really good at this and study/emulate their techniques.

This is a great article on communication and rapport. Communication gaffes: a root cause of malpractice claims. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1201002