Month: August 2016

As a Certified Registered Nurse anesthetist we perform a dual responsibility to our patients and their families. A nurse and an advanced practitioner. 

Our patients are at a vulnerable state where they are undergoing a tough time. In an instance of a pediatric patient, the CRNA has the opportunity to meet families before their children goes to sleep with general anesthesia. Often times patients are kept NPO and the time of the procedure gets pushed back to compensate for the teeming amount of patients in our hospitals. As the CRNA we are not only performing anesthesia we are both the nurse and the anesthetist. It is our duty to alleviate anxiety physically and emotionally.
We have the nursing touch of comforting patients through a tough time in their lives, for this one procedure or two. It is our duty as a CRNA to educate patients on how they will feel and to hold their hand and provide them the voice of comfort and smiling face ensuring that they have made it through this.

It is our duty to assess and find out their history. What pain regimen or sedation have worked in the past to provide optimal comfort. It is important that we as the CRNA are the listeners and often learn from our patients and family as they do in fact know themselves the best.

In the field we are our patients advocates and always keep patient safety as our top priority. As a CRNA we do not forget nursing basics, we build up on them. We are CRNAs also promote lifelong learning and enforce evidence based practice in our routines.

In addition, CRNAs give back to the community and provide our services to third world and disaster relief areas.

My brother drops me off at the Fifth avenue entrance of the Mount Sinai Hospital, conveniently located on the border of Spanish Harlem and the Upper East Side. I hear a good morning from the security guard and I make sure to look up from my coffee cup to greet him back. After all, who knows if I’ll see him again. Pray some duas, (prayer in Arabic) and exhale on completion as I approach my unit. I started in the Cardiothoracic ICU a year ago. Prior to that, I was a med surg nurse with six ambulatory patients but now as I enter the automatic doors I am greeted with one and sometimes two bed bound patients, often attached to the trumpet of the ventilator and din of the cardiac monitors. As their ICU nurse I begin to make their problems my own.

When 7am hits, bedside handoff is given, I check my drips, ventilator and my patients intact sacrum, get an initial ABG, and make my voice heard during AM rounds. I am amazed at that the next time I look at the clock that often three hours have passed. The pace is very fast, clinical judgment and critical thinking are at its peak. I am in my element. The constant monitoring of the patient’s physiological changes, hemodynamic status,  titrating vasoactive drips, and preventing barotrauma from high ventilator settings keep me driven to stay ahead of the patient. To envision the worst possible scenario and being able to tackle it long before it surfaces. Working in the CTICU i have developed meticulous attention to detail and being able to keep my composure through tough times, whether it be an open chest or dealing with a family of a patient with a total artificial heart who is now deciding to withdraw care.

The ICU has prepared me to look much further than hemodynamics and to understand patient suffering internally understanding their histories, lab values, CVP, PAP, and putting it all together. Similarly, externally we look at their psychosocial status, did anyone come to visit? How can I effectively teach the families to care for their loved one LVAD when they get home?

After shadowing a CRNA, I knew that this is where my worlds would converge. Not only would I keep my nursing skills but I would be able to do much more. Being able to be an advanced practitioner to under my patient’s physiological status to adequately help alleviate suffering internally and also being able to explain it to their families thereafter externally that their family did well and was up and talking again. Furthermore, after CRNA school, I hope to take my degree further than the walls of American institutions. I hope to  take my skills as an anesthetist to aid in relief efforts around the world. To educate others on proper techniques of anesthesia and nursing practice so they can be empowered to do it on their own.

As the day ends, I say goodnight to the security guard and run past the revolving doors accepting that the day does not end there.  I get to into the subway and sit there and — people watch, often seeing my patients faces on them. These people can all be my patients one day. I wish i can tell them to stop smoking or eating that bag of chips. I don’t want you to have a heart attack dear, I think in my head.