During this year’s CRNA Week (#crnaweek), there are many nurse anesthetists who are remembering why they got into the profession, and even more are reflecting on how the face of the profession is changing.
John Bing, BSN, CRNA, American Association of Nurse Anesthetists (AANA) Region 6 director, and national AANA board of directors member, says one of his steadfast missions is to make sure the field continues to attract top nurses, but that it is especially welcoming to aspiring minority nurse anesthetists.
Bing knows first-hand how hard it is being a minority in the field. When he first started out, he was often the only African American in the OR, he says. At times, people assumed he was part of the housekeeping staff. Although he laughs about it now, Bing has made it a direct part of his mission to attract more minorities into this field.
He even takes on leadership positions with the primary goal of making sure he is representing the minorities in the field. “You need to see that in leadership,” he says. “If others don’t see that, they won’t see a place for them. I make sure they see it.”
“Many times you would go in and you were it,” he says of when he started out. “Maybe you were the only one in the hospital or the department. Now you go in and you see a fair amount [of minorities].”
As a president of the Diversity in Nurse Anesthesia Mentoring Program, Bing also makes sure his students know why he enjoys this profession so much.
One of Bing’s specific approaches is to make sure he talks to patients as the anesthesia takes effect. He finds out what they like so they can chat about it—sports, cooking, books, kids—anything that helps them relax. “That’s like a sedative,” he says. “It calms them down and they remember that.”
And while he’s monitoring a patient, Bing does exactly what he teaches his students—he assesses his patient over and over and over. “You must rely on your instinct,” he says. During travels with students to countries like Nicaragua, Bing teaches students that not every machine is calibrated the same or even correctly.
“The machine is a guideline,” he says. “You are ultimately responsible for anything that happens. You can’t blame the machine for anything. Look at the patient.”
Bing says that while he’s checking blood pressure every five minutes or so, he is constantly “circling the block,” as he calls it. All the machines are incredibly helpful, but they should only confirm what a nurse anesthetist is seeing, hearing, smelling, and touching.
And getting stale in this profession is not an option, he says. “I say to my students, ‘Tell me how this patient could die today,’” he says. That forces students to look at the big picture and not just look for complications, but to look for other factors that could impact that patient on that day.
Bing clearly enjoys working with his students, but he understands first-hand how sometimes they are not the ones who chose the profession. “The last thing I thought I would be was a nurse,” he says with a laugh. As an African-American, there were few role models that looked like him.
A chance look at a jobs list that revealed six pages of nursing jobs, convinced Bing, an athlete in high school and college, to take a look. Bing says he turned to his buddy he was working out with and said, “We get to be around girls and have a great job!” But he still didn’t expect to land in this field. Eventually, nurses in the recovery room where he worked nudged him to give it a try.
Now, Bing’s mission is to attract minorities into nurse anesthesiology. He speaks to kids in schools, paying special attention to making the field appealing to boys and young men. As it is, 49 percent of nurse anesthetists are male, he says, which is a high number considering less than 10 percent of all nurses are male.
But Bing lets kids know that there are chances to be out on a helicopter go team or even in the midst of trauma situations. “Men like that kind of stuff,” he says and it certainly gets the attention of younger kids who don’t know those possibilities exist.
Add in the good salary, the camaraderie, and the fair amount of autonomy, says Bing, and a career as a CRNA shows kids who might not initially consider a nursing career that the path is open to more possibilities than they ever imagined.
From January 22 to 28, the American Association of Nurse Anesthetists (AANA) is sponsoring National CRNA Week to honor nurse anesthetists.
John Bing, BSN, CRNA, AANA Region 6 director, and national AANA board of directors member, says most people don’t quite understand what a nurse anesthetist does and, in fact, there are not very many of them.
Many people believe a nurse anesthetist puts them to sleep, leaves, and then returns to wake them. Far from it, says Bing. “The job of a nurse anesthetist is always assessing,” he says. They are with the patient all the time, from the moment they greet the patient, through the entire procedure or surgery, and when they are brought out of anesthesia.
The job, says Bing, is like no other. “We are there pre-, inter-, and post-op,” he says. But he understands why the job is mysterious to some. Even Bing’s mom thought he just gave people a pill to make them go to sleep, he says with a laugh.
But nurse anesthetists appear happy with their jobs. On the just-released 2017 U.S. News and World Report Best Jobs list, a nurse anesthetist’s job placed fifth on best health care jobs and placed sixth on the best jobs overall. The reported salary median salary is $157,140.
Bing says he appreciates being able to develop a relationship with a patient in such a short amount of time. Being present through the entire procedure gives nurse anesthetists the ability to monitor every nuance of the patient’s reactions and behavior, he says. And the interactions before the anesthesia is administered means nurse anesthetists have the chance to build up trust and get to know a patient as a person. The patients remember that, says Bing, and you get to know them as a person.
And this field rarely gets stale, he says. CRNAs have to be recertified every four years, so continued learning is mandatory. One of the special draws for nurse anesthetists is the ability to work with people from the moment they are born until the day they die, says Bing. These nurses work with all ages and have to know the intricacies of how the human body reacts to the anesthesia at each age and with virtually any condition. “We get everybody,” says Bing. “And it is all acute.”
As a group, nurse anesthetists stick together, says Bing. With as high as 89 percent reporting approval for their job satisfaction, he says, they enjoy the work. And the AANA doesn’t encourage sub groups, he says. The group acts as one. “Eighty-five percent of our professional nurse anesthetists belong to our parent professional organization,” says Bing. “We don’t want to go out and have splinter groups. We are better together.”
The AANA is urging nurses to spread the word during National CRNA Week and suggests things like career days in schools, inviting legislators to a breakfast or coffee gathering, or even casual and formal public speaking opportunities to let people know about the profession. And use #crnaweek to spread the word o a wider audience.
It’s also a good time to celebrate what nurse anesthetists do. “In this country 100,000 people give anesthesia,” he says. “That means there are 3.5 million people per anesthetist. That makes [them] pretty special.”
On January 25, IV Nurse Day celebrates the infusion nurses who complete the high-tech and exceedingly patient-sensitive process of infusion care.
The 2017 theme, “IV Nurses: Outstanding Skills. Outstanding Care.” gives acknowledgment to the specific skills IV nurses bring to a care team. Sponsored by the Infusion Nurses Society, this day has been an annual international event since 1980, says Mary Alexander, MA, RN, CRNI, CAE, FAAN, and chief executive officer of the society and of the Infusion Nurses Certification Corporation.
The IV Nurses Society has 7,000 members across the globe in more than 40 countries and territories outside the US. Approximately 3,500 of the members are certified as well. And they work in many settings—about half of infusion nurses work in hospitals and the other half work in alternate sites like infusion centers, physicians’ offices, or in home care settings.
“The care we provide is something all patients can relate to,” says Alexander. “Patients go into a hospital and almost everyone gets an IV.”
While IV certified nurses are not the only ones who can place an IV, the additional training gives the nurse the skills and the experience to do it well, she says. To place an IV properly, nurses must asses the patient, determine the appropriate device, and the proper management of care once the IV is in place.
As some patients can have an IV for a few short hours or in extraordinary circumstances for the rest of their lives, proper placement and care is paramount to patient comfort and safety, says Alexander. Infusion nurses are also then responsible for patient or caregiver education upon discharge. They need to convey accurate information about how to care for an IV and why it’s important for the patient to have it.
“It’s vitally important that clinicians are experienced and know what they are doing,” says Alexander. Because the lines bring solutions directly into a patient’s bloodstream, any complications can be life or death.
Patient safety is every nurse’s top concern, but infusion nurses also have a direct impact on patient satisfaction. Alexander says when patients are asked about their hospital stays, some surveys indicate the quality of food and the experience a patient had with an IV as the top influences of their overall satisfaction with the hospital.
IV Nurse Day recognizes all the work infusion nurses do, says Alexander. “We are all over the place,” she says, “You won’t find us in one specific place. We are an important part of the health care team when we are looking at the overall care of the patient.”
As part of the team, IV nurses can educate others on the team as well. Having an IV nurse on the team means the other team members are able to focus on their own tasks. Because of their experience, IV nurses save costs and labor because they generally get an IV placed correctly on the first attempt. That improves cost, reduces the risk of complications, and makes for a much happier patient.
If newer nurses are interested in this certification, Alexander strongly suggests getting some overall clinical experience prior to fulfilling the IV nurse certification process. And for nurses who are not yet certified, but interested, the Infusion Therapy Standards of Practice outlines some of the common guidelines for this specialty.
“The more you do it, the better at it you get,” says Alexander. “It’s good to recognize infusion nurses do a fabulous job and patients appreciate what we have to offer.”
Alexander notes that while some might expect IVs to eventually be replaced by a different process, she doesn’t see that happening in the very near future. And IV nurses also bring an extra component that’s hard to quantify. “To me, it’s high-touch, hands-on caring as well as high tech,” she says. “That’s extremely important.”
Top 5 Tips for Graduate school
So, you are thinking about completing your Master’s degree. You may be just graduating with your bachelor’s, established in your career, seeking career advancement, or an overall career change. You should commend yourself wherever you currently are in your professional journey. Graduate school is essential for career progression and as daunting as the challenge may be it is feasible and worthwhile. However, there are certain things that I wish I had known previously to enrolling in my first graduate courses that would have saved me a ton of grief on this grad school journey.
Learn the APA Manual
Do you briefly remember being introduced to this in your undergraduate English and Research classes? You know, the blue book that you couldn’t wait to toss as soon as you completed those courses! Well, don’t get too excited and toss that manual out just yet. The APA manual will be your bible at the graduate level. It is best to not only familiarize yourself with it but read it cover to cover. In all seriousness, there will be no mercy for APA formatting issues at the graduate level, and failure to comply will hinder your ability to graduate. Let’s be honest; graduate school is very expensive so do not lose points over APA errors and get your bang for your bucks when it’s time to cash in on that top G.P.A.
Grad school will push your writing capabilities to the maximum. When I first started, I went in under the false pretenses that I was a decent writer. After all, my highest scores were always in English and Language Arts. However, never underestimate the power of proofreading your document, or having someone else review it. It is important to remember that you are not supposed to be writing as if you are talking in scholarly writing. Read every single thing you submit out loud at least two times before turning it in. You will be surprised at some errors you will find in your documents once you hear it out loud. I swear by Owlet Purdue, Grammarly, and PERRLA to assist with the completion of my papers.
One of the biggest mistakes that I made during my Grad school journey was “taking a break”. Apparently, life happens to everybody, but if you can help it, you should stay on the course to graduate on time. While taking a leave of absence is certainly an option, there are some universities have a time limit on the amount of time you can spend on the completion of your master’s degree. Taking a leave of absence sounds a nice break until you return and you are under even more pressure to complete your degree. Stay on track and graduate on time. Put yourself out of grad school misery. Try not to prolong it.
My zodiac sign of a Libra makes finding balance very high on my priority list. Regardless of your sign, it is essential to find a way to balance everything you have going on in life. Many of us are career focused, have spouses or partners, children, and community obligations. There are going to be some times that you will simply have to say no to others as well as avoid taking on too many additional duties. You have to be able to take care of yourself before you can take care of others. Do not feel guilty about taking a step back or going on a much need hiatus to keep everything together. Remember that this is temporary, and there will always be opportunities to restock your plate once you have graduated.
Cost vs. Reputation
This has been an ongoing debate for such a long time. I will give you my honest opinion and say that it is best to go for value in regards to selecting a school to attend. There is absolutely nothing wrong with investing yourself, but please do not break the bank along the way. Try your very best to avoid debt, save up, and develop a reasonable budget that you can use to finance your educational goals. If you are shelling out a ton of money, ensure that the institution has a reputation that fits your tuition bill. Student loan debt is a serious problem. Remember that you will need to pay that money back, and if this degree does not make a high paying job seem promising to you it may be necessary to scale back. Remember, grad school isn’t cheap!
Wrapping it All Up
I hope that you avoid the pitfalls that I incurred during my grad school journey and that these tips will help ease you in your transition and prepare you for entry into grad school. A graduate degree is totally obtainable; it’s just a different academic dynamic. I’ll see you on the other side!
“ Once you know yourself, in this living stillness, there is nothing in this world that is greater than you”
One of the elements of discovery is “stillness”… I am sure you are thinking, ” What does that really mean? As healthcare professional, how can I incorporate STILLNESS into my life when I have been trained to move and move fast because it is the difference between life and death?”
Guess what, IT IS POSSIBLE! Let’s break this down a little bit more.
Many people see the word “stillness” and automatically think it means to have no movement which is true to a certain point, but from the perspective of discovery, “stillness” is the state of being or being one with yourself. Not thinking about the kids, what you have to cook for dinner, the bills you need to pay, but can’t… the job you dread, the co-worker or friend that gets on your nerves, etc. I mean you DO NOT think about any of that, just simply BE!! In the state of being is where we really and truly get to “know thyself” and not what everyone else tells us about ourselves. In stillness we allow the voice of the holy spirit, which is our GPS navigation system, to guide us through the streets called life. In stillness we learn to quiet the mind and not allow anything that is going on around us affect us. So when you are in a state of stillness, it doesn’t mean that things are not going on around you, it means that they are not going on within you. Let me make it a little clearer for you, you can be at work on a 35 bed med-surg unit with 10 physicians and 3 respiratory therapist on the unit, family all over the place, a supervisor who is screaming at staff, and a co-worker who scrolling through her social media timelines chilling while you have 10 outstanding task and not let ANY, I mean ANY of it affect you internally. The key is to create an intention of stillness which can be achieved by having some intentionality about how you are carrying yourself in a given moment and focus on what is within your control.
Now that we have what stillness means from the perspective of discovery out of the way, I can hear you saying “ Nicole I don’t have time for that”, I have to take care of my family, walk the dogs, manage all the household chores, manage the financial accounts, and I am sure that the list could go on and on but guess what you CAN practice stillness through all of this (I am not telling you what anyone told me but what I know)!! And to be honest if you want to live a life purposefully as a healthcare professional according to Gods’ will then it is a non-negotiable.
So let me share 4 tips that helped me to begin my practice of stillness and make the practice of stillness a ritual in my life.
1. Deep Breath- Yep simply deep breath! I hear you saying “and what is that going to help”? When we take deep breaths it induces the parasympathetic system and slows down your heart rate, which leads to a state of relaxation (use this one when you have trouble going on all around you so that it is not going on in you).
2. Schedule Time to Be- Look lets keep it real we all live busy life’s that pull us in 50 directions and many us live by a Google calendar which tells where to be and when. Well guess what place your “Be Time” on there too. It has been proven that anything we do for 21 days becomes a habit.
3. Get off Social Media- Yep I said it!! Get off Facebook, Instagram, Snapchat, etc. stalking pages and looking at fairytale lives that often don’t exist and practice just “ Being” (I was once guilty of this one, LOL). With the hours we spend on these sites weekly, we can really get to “know thyself” and find our purpose as a healthcare professional.
4. Find a Location that brings you Serenity- Know I know I said the state of being can happen when trouble is all around you which means we can have stillness anywhere but to get to a place where we can do this, we can get practice by doing it in areas where we find peace. So that may be by the water, outdoors with the birds chirping, a certain room in your home, etc. Practicing stillness in a location that brings you peace prepares you to be able to do it anywhere.
These tips are the very tip of the iceberg for practicing stillness because stillness goes much deeper but I wanted to start with building a foundation for you to build upon.
Remember in Psalms 46:10 we were told to “ Be still and know that I am god”.
A law is defined as a system of rules that are enforced through social institutions to govern behaviors. As citizens of our respective countries we all try our best to abide by the laws that have been set forth by our government so we can avoid any havoc in our lives and remain in a state of freedom. But what about laws for success and or to navigate this thing called life…do we have a system of rules in these capacities? According to Deepak Chopra there is a system of rules that have been set-forth to govern our path to success and life. In the book titled “ The Seven Spiritual Laws of Success” we are presented with a set of laws that serve as a practical guide to the fulfillment of our dreams.
My first thought when reading the title of the book was “ok so now I have another set of laws that I must adhere to if I want to be successful and have a fulfilling life, here we go with more rules and regulations”. However, after reading the statement “ Success is a journey, not a destination” and that “the law of success and life is the process by which the unmanifest becomes the manifest; it’s the process by which the observer becomes the observed; it’s the process by which the seer becomes the scenery; it’s the process through which the dreamer manifest the dream” in the introduction alone, I knew there was something different about these laws. I had a sense that these laws were getting ready to go into a deep spiritual space in which I honestly knew needed to be rattled up within me, so I dived in head first.
After being intrigued by the introduction, there laid the seven spiritual laws to success which were The Law of Pure Potentiality; The Law of Giving; The Law of “Karma” or Cause & Effect; The Law of Least Effort; The Law of Intention and Desire; The Law of Detachment; & The Law of “Dharma” or Purpose in Life. Each of these laws made me have a “ That’s Right ”moment as they went deeper and deeper into my spiritual space.
The law of Pure Potentiality let me know that I need to be still! Often times with the daily hustle and bustle of life and all the different moving pieces of our lives we don’t have to time to just sit in stillness. God has an assignment for each one of us and wants to give us special spiritual instructions to carry out our divine assignments, to go in the direction he wants us to go, or operate in the capacity in which he wants us to operate in but we are not in a state of stillness to hear from him.
The law of giving impressed upon me that I am not given money, joy, peace, etc. to hoard it, but rather I am given these things to share with others and every time I encounter someone I must GIVE! I must give a prayer, a compliment, a word of encouragement, or a flower. My giving can be material or nonmaterial but the bottom line is I must give something.
The law of “Karma” or cause and effect made me realize that before I perform any action, I need to ask myself two important questions, which are “what are the consequences of this choice that I am getting ready to make? and will this choice bring fulfillment and happiness to me and those involved?” and if the answer to these questions are not favorable then I need to stop in my tracks and consciously rethink my actions.
The law of least effort made me aware that I am not obligated to defend my point of view to anyone, but rather take that energy and put it toward something more purposeful.
The law of intention and desire provided me with a sense of ease as it let me know that my attention needs to be in the present, then my intent for the future will manifest because my future state is being created in my present state, as I must accept the present as it is.
The law of detachment forced me to come out of my comfort zone and to go into the area of uncertainty which is where all possibilities are located. When we detach from the norm then we are no longer attached to the things in which we are truly fearful of because in attachment lies our fears and insecurities.
The law of dharma or purpose in life encouraged me find my divinity. I was created for a purpose that me on only me can fulfill. It doesn’t matter how many other people do what I do, only I can do it my way with the talents and gifts that I express only the way that I can express them. Once I had the courage to truly get to know thy self then I was able to serve humanity by living on purpose.
To sum up what these laws have done for me is simple, they are ensuring that I am a law-abiding citizen who lives on purpose!