Survival Guide for Life as a CRNA Clinical Student

Life as a clinical student is stressful. Whether you're in your undergrad nursing years, a nurse practitioner student, or completing a CRNA program, the demands of hands-on learning are many. One of the best ways to deal with the stresses of clinical student life is to learn from those who've been there. So, CRNA student, Anna, has agreed to give MidlevelU readers the inside scoop on clinical life as a nurse anesthesia student. 

<--break->Anna is nearly two years into her 28 month CRNA program. She began her career as a CCU nurse and quickly recognized she wanted to further her education. After evaluating her options and completing an arduous application process, she landed on the nurse anesthesia path.

If you are thinking about becoming a nurse anesthetist, Anna's thoughts will give you direction as you enter your first clinical placement. If you are planning to pursue a career as a nurse practitioner, the specifics of your clinical rotations may look a bit different, but many of the principles she brings up apply. Here are her insights and advice to help you survive clinicals as a graduate nursing student. 

What does a clinical day in the life of a CRNA student look like?

My clinical day looks differently depending on my current rotation. As CRNA students we rotate through all different surgical specialties. The typical surgical day begins around 7am, so as a student you must arrive at 5:30am to prepare for your first case. This time is used to draw up medications and check equipment. Depending on the type of surgery, preparation may be more or less involved.

Once equipment and medications are in order, I introduce myself to the patient and complete an anesthesia focused health history. I review and order any relevant lab results and perform calculations we will need for the surgery such as allowable blood loss. 

Finally, I make my way to the operating room for the surgery itself. I assist the CRNA I am paired with on the case. When the surgery is over, I monitor the patient in the recovery room for a few minutes to make sure they are stable and pain is controlled. Then, I repeat to process for the next scheduled surgery. 

Do you feel like your preceptors are good teachers?

I feel very lucky at the hospitals I rotate with. The anesthesia group my classmates and I work with really embraces students. Occasionally, I encounter providers who aren’t as interested in teaching or are impatient with students. But overall, the attitude toward students is very good. People go out of their way to teach me.

For the first 6 months or so of my CRNA program, I was not much help as a student. I was more of a burden. Every nursing student has been there. As you get further along in your education however, you become more independent. In your last year of school, some days you are not paired with a CRNA preceptor at all. Rather you are paired in a 1:2 anesthesiologist to student ratio and treated more like an employee that a student. At this point you are more of a help than a hindrance. The CRNAs and anesthesiologists are glad to have you on their team.  

What advice can you offer for fostering a good student-preceptor relationship?

Recognizing the dynamic that you may be making more work for the MDs and CRNAs you are paired with is critical to having a good day as a student. These individuals don’t have to work with you. Saying ‘Thank You’, being flexible, and working on good relationships by acknowledging your preceptor's efforts is key.

Also, acknowledge your weaknesses and be open to feedback rather than waiting for criticism to come to you. Understand that these providers are trusting you with things that could kill somebody - the relationship is stressful for them, too. Communicate frequently and openly to stay on the same page regarding your care plan for the patient. 

Finally, your reputation as a student in your program will become known. The group of providers I work with is small. I have found that being professional even though you are not an employee will serve you well.
 
Do you find CRNA clinicals to be challenging? How so?

Every day is a challenge on multiple levels. There is the interpersonal aspect of being a student and the clinical aspect. I think most of my classmates would agree that the interpersonal aspect is the most challenging. We are all students with strong clinical skills so while we have a lot to learn, navigating the dynamics of working with multiple different providers proves to be the most difficult. 

In regards to clinical challenges, the most common frustration is that you can operate on two similar cases and have things go completely differently. For example, one case might go smoothly and in the next the patient might go into an arrhythmia in the middle of the surgery.  So, you are thrown off when you thought you had that type of case down. Each time you start a new rotation you go from being confident to incompetent. And, you have to adjust to learning from someone totally new. You have to be ‘on’ everyday. You are constantly proving yourself. 

Regarding the challenges of interpersonal relationships, providers approach teaching differently. Some are direct while others are more friendly and warm. It’s hard to constantly adapt to different settings and different clinical leaders. Surgical cases can be long and slow. So, you have a lot of face to face time with one person. I come with a few questions prepared that I find make good small talk. Also, I use this as a time to ask questions about clinical topics that might be difficult to ask during busier times of the day. I recommend getting to know your preceptors - it’s harder for them to be hard on you unnecessarily if you have a personal relationship. 

What has been the most surprising thing to you so far about your CRNA clinical experience?

I think the most surprising thing for me has been how much I have learned. Recently the new CRNA class shadowed us as second year CRNA students. I recalled my shadow day one year before and it hit me how far I have come. Coming to the realization that one year ago I had barely even set foot in an operating room and now within a year I can run anesthesia cases on my own was eye-opening. The learning curve has been steep but I feel confident and competent in my skills. It’s good to be on the other side. 

What advice do you have for future CRNA students to help set them up for success in their clinical rotations?

For new students, my advice would be to learn to let things roll off your back. Remind yourself that 90% of the battle is just showing up the next day. Even the best students will have bad days. Even if you have perfect performance, some MDs or other CRNAs may treat you poorly or call you out on something you don’t know. React professionally and let it go. You can’t take it personally. Working as a CRNA is an entirely different level than working as an RN. It can be intense. Maintain an upbeat attitude and don’t let things get you down.

For established students, my advice would be don’t get laxidasical or too comfortable. Remember that professionalism and being precise is key. Continue to show up early rather than pulling into the hospital 5 minutes late. Take initiative - if you don’t have any cases, find an interesting one to observe or help a provider with pre-op interviews. Small things make up the overall impression people have of you as a student and future CRNA. 

 

"Thank You" to Anna for sharing her experiences and advice. What advice do you have for nursing, nurse practitioner or CRNA students about to embark on their first clinical experience?

 

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