Ever wondered what a nurse anaesthetist does? Ever even heard of a nurse anesthetist? Neither had I until I met Jennifer Williams online and we formed somewhat of a friendship. Herself and her husband Tim are both Certified Registered Nurse Anesthetists (CRNA) in the USA. Despite this role not existing in Australia to my knowledge I was very intrigued and wanted to learn more. Jennifer was kind enough to write a piece for us explaining what a ‘day in the life of a CRNA’ consists of, take a look!
Hi my name is Jennifer Williams. My husband, Tim Williams, and I are both CRNA’s. A CRNA is a Certified Registered Nurse Anaesthetist. The requirements for becoming a CRNA are as follows:
- Typically one year of ICU experience as a Registered Nurse (RN)
- A Bachelor of Science in Nursing (BSN)
- Masters of Science degree (MSN) with a focus in nurse anesthesia
CRNAs practice anaesthesia in many different patient care settings ranging from Level I trauma centres hospitals, surgery centres, and dentist offices.
We work for a large Anaesthesia group in an Ambulatory Surgery Centre that employs both CRNAs and Anaesthetists We typically work 7-3pm or 7-5 pm Monday- Friday without call or weekends!! Our cases vary hourly and include:
- cataract removals
- orthopedic cases not requiring overnight stay
- female laparoscopic procedures
- plastic reconstructive surgeries
- hernia repairs
- sinus surgeries
Our patients here at the surgery centre have to be on the higher side of healthy and stable and must be able to go home on the same day by meeting a set of discharge criteria.
Our typical day begins at 5:30 am! We wake 3 children up, get them Dressed and breakfast, and off to Daycare- which I could call “a day there”! We arrive at work at 6:50 am and surgeries begin at 7am or 7:30am. Our surgery center has 4 operating rooms. We receive our assignment the night before to be prepared. We typically stay in one room all day with turnover times between cases being less than 10 minutes! Healthier Patients= More Efficiency! We might perform anywhere from 3-12 cases a day in one room!
We have one Anesthesiologist supervisor overseeing 4 CRNAS. They interview the patients and clear them for surgery prior to us meeting them and then an IV is started by our Pre-Op Nurses.
Today I have an ENDOSCOPIC SINUS SURGERY! My work begins in the operating room before hand. There are a system of safety checks with our anesthesia machine we perform first, make sure we have oral suction, bed positioned right, the correct endotracheal size tube, correct intubation blade with functioning light bulb, eye tape protection, and all medications drawn up and ready to be used.
For this procedure, I will draw up Versed to be given in pre-op after my interview, Fentanyl(narcotic of choice at our surgery center), propofol (Diprivan) for induction, and Anectine (Succycinicholine) as the paralytic for intubation. We also give steroids and anti-emetics for sinus surgery. Then I head to pre-op to interview the patient. I introduce myself; review their NPO (nothing to eat or drink after midnight) status, allergies, correct surgery and site, health history, and any prior anesthesia complications. Once the surgeon, Anesthesiologist, circulator nurse, and I have all done this, we will proceed. I give my Versed IV (intravenously) for the ride to the operating room. Once in the operating room, I place EKG leads, blood pressure monitor to assess every 3 minutes, pulse oximeter, and Pre-OXYGENATE for 5 minutes before induction. I proceed with my narcotic, propofol and wait until the patient is asleep (we check for an absent lid reflex) we then lubricate eyes and place tape to prevent corneal abrasions and at this point the patient is apneic. We ventilate with a bag and mask and then push our paralytic drug. Once it circulates, we intubate with the laryngoscope and blade. We confirm visualization of the vocal cords, chest breath sounds bilaterally, and presence of end tidal carbon dioxide. Our tube is taped and we turn the head of the bed to the surgeon. Inhalation gas of choice is turned on and the patient is placed on a ventilator with correct settings. Surgery cases vary according to surgeon and extent of correction.
Once the surgeon is finished, we turn our gases off and start getting the patient to breathe again on their own. Their carbon dioxide builds up and respirations return. We suction their airway and deflate the cuff, extubating easily. We transport the patient to the recovery room where we connect them to an Oxygen mask, same monitors, and give a full report to the nurse. When vital signs are stable our work is done! We repeat this hourly!!! Cases and situations may vary but this is the average.
Anaesthesia is described as moments of sheer terror mixed with hours of boredom!
I will finish my 8-hour shift and head home to my most important role- MOMMY! This is a Day in the LIFE of a CRNA!
– Jennifer Williams CRNA