Subreddits and Succinylcholine with CRNA Chrissy Massaro and Anna Jobe (Confident Care Academy)

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi friends, happy Friday!

(00:06):
Wow, March is ending and April is coming in real quick.
How are we into the fourth month of the new year already?
March and April are actually super memorable months for me because 8 years ago, I had my
first ever procedure or surgery, a cardiac ablation.
I think I mentioned this in the previous episodes, but I needed a cardiac ablation procedure
back in 2016 due to superventricular tachycardia or SVT.

(00:31):
My heart was beating so fast and for no reason, like literally no one's making my heart beat
that quickly that time, or now, or recently.
Sad life.
So I needed the procedure.
This procedure also marked the first time I ever received anesthesia.
The second time was when I had my appendectomy over a year ago.
I remember being so afraid both times before my ablation and appendectomy, mainly because

(00:55):
being a nurse, you know of all the complications and side effects, right?
You always think you're that small percentage of statistics on the textbook and on the internet.
Mostly, I think I'm always just afraid of the anesthesia.
Like what if I never wake up?
Or what if I get paralyzed and then they start operating me and I cannot speak out?
Oh my gosh, just thinking about this makes my bone weak and my whole body shudder.

(01:16):
Because you hear stories like these and you're just like, that could be me.
But truly, this is why the field of anesthesiology is so important and just deserving of a friend.
Full reverence.
The artistic and scientific ability to put someone to sleep, make them comfortable during
an otherwise physically traumatizing process, and then wake them up again.
It's literally a God given expertise.

(01:38):
We have had several physicians in the podcast over the seasons whose expertise are in this
field of anesthesia.
But there's a quote unquote hidden gem within the nursing profession that actually specializes
in this very domain.
Nurse anesthetists or CRNAs.
These are the crux of our podcast topic today.
As a working nurse now, I have obviously met several CRNAs at this point, especially working

(01:59):
in both inpatient and outpatient surgical and procedural fields.
I am quite aware of their existence and their expertise, but I honestly cannot say this
was true when I was a student nurse.
Which is crazy to me now that I think about it.
In my four years of nursing school I have never heard of a CRNA and I'm not sure why.
I've heard of midwives and P's and informatics and educators and management and even nurses

(02:23):
in politics, but I am not sure why I've never heard of nurses in anesthesia.
Well, I am so honored because I have two friends to talk about this beautiful and most times
controversial profession today.
A hidden gem and often not understood by the general public and patients.
The field of nurse anesthesia has actually been in existence for over 150 years since
the 1800s during the American Civil War.

(02:45):
Nurses like Catherine S. Lawrence were one of the first nurses to provide anesthetics
in the battlefield to wounded soldiers.
Today CRNAs exist both inside and outside the operating room, practicing in every setting
that anesthesia is delivered.
Today CRNAs represent more than 80% of the anesthesia providers in rural US counties
and provide approximately 65% of over 50 million anesthesia services in the United States every

(03:11):
year.
In today's episode we make CRNAs a hidden gem no more.
I am so honored to be joined by my dear friends Chrissy and Anna of Confident Care Academy
to talk about the CRNA profession, critical care nursing as a whole, the importance of
learning and advanced education within nursing, and navigating the murky political waters
of the field of anesthesiology.
Chrissy has been a CRNA for five years, previously working as a nurse in the cardiovascular ICU,

(03:36):
and Anna is a resident registered nurse anesthetist, almost completing the journey to be a CRNA,
and previously worked as an ICU travel nurse in the CVICU and COVID-19 ECMO units.
Today let's spill some tea or dare I say some milky propofol.
Enjoy!
Hi!
Hello!
So good to see you like in person, so fun.

(04:01):
I know right?
Are we all in New York or what's going on?
I know Chrissy's in New York.
I'm in Utah right now, not for long.
Not for long.
That's a temporary thing for school.
Are you trying to come to New York after?
Are you trying to join the NY crew?
The recruitment is so strong, it's hard to say no to the New York crew.
Every time I go back, I'll probably be looking for work there when I finish grad school.

(04:25):
Yes, hi Chrissy.
I was thinking earlier that how many months has it been since you and I and Katie Duke
and Canada, we're trying to find the time to meet up and New York just doesn't let it
happen altogether.
We should try again!
Whoever can come can come, and then we'll do it again, and then a different group of
people can join next time.
We'll just stay in series.

(04:46):
There's a lot of people in New York.
That would be a great meet up.
Yeah, I mean we also had Facy's here in a method in the group chat.
So it's just, you're right, too many people, especially within the nursing field too, right?
But you know, we made this happen, this trifecta.
Thank you so much.
I'm so honored to both have you on.

(05:08):
You know, I've been wanting to invite both of you for CRNA Week.
I'm like, it's probably going to be a busy week for them.
So I was like, let's hold it out until the summer and you're finally here.
If you could first please introduce yourself to everybody.
Thank you so much.
Oh, thank you.
Do you want to go first, Anna?
Yeah, sure.
My name is Anna.
I am a second year SRNA, student registered nurse anesthetist.

(05:31):
And I was a travel nurse for about two and a half years before that.
That was kind of when I got into the nurse education and content creation space was in
the COVID ICU travel nursing era.
And then before that, I was a staff nurse in Baltimore.
So I've kind of moved around a lot.
I ended up meeting Chrissy through TikTok in 2020.

(05:51):
And then from there, it's been really cool to just create a community of nurses.
And I'm also like on the education path myself.
So that's been really, really fun.
Yeah, well, I'm Chrissy.
I've been a nurse anesthetist since 2017.
And I've been a nurse total for 10 years now, which is really crazy.
So I started out in a CVICU right out of school, just by pure luck.

(06:17):
And then I was there for just a little bit less than two years before I went back to
CRNA school.
Since then, I've worked in two major academic medical centers.
Now I'm in New York City.
I do all sorts of specialties.
I do cardiac anesthesia.
I do OB anesthesia.
Occasionally, I work in pediatrics as well.
But that's kind of new to me.
I'm still scared of the kids.
But it's great.
It's really fun.
And I feel like I was really lucky to connect with Anna over TikTok because we both share,

(06:44):
I think, a lot of similar stories and a lot of similar life experiences.
Both of us ended up in CVICUs where a lot was expected of us.
And for different reasons, we ended up being under resourced.
I feel like I personally was under prepared from nursing school.
I had not had like a preceptorship or any experience in the ICU.
And when I got there, I realized there was really no opportunities for continuing education

(07:09):
for nurses in the critical care phase.
There's almost no resources anywhere to deepen our knowledge or to get to the level that
we needed to be in order to reach the level of performance I was expecting of us.
There's no textbooks, no nothing.
So we're a competent care academy.
The idea was born.
Every day I would be in CRNA school and I would be getting all these life-filled moments.

(07:31):
And I was like, if only I knew this as a nurse, my job would have been so much easier.
And I think Anna is now experiencing some similar things.
Like, oh my God, why didn't I just know that?
So it's really nice.
We kind of co-lectured together and we really are just excited to bring this passion project
to life where we're really just sharing our knowledge with the community to empower them.

(07:56):
Because at the end of the day, bedside nurses are the ones who are taking care of our communities.
And they're the people who need to be empowered most.
Yeah, definitely.
I mean, thank you for the introduction.
I mean, you know, I started this podcast series as a, actually, Instagram livestream series
back in, I think, late 2020 when, you know, we had COVID, especially in here in New York

(08:17):
City, I was working the COVID ICU at that time as well.
Prior to that, I was working in Cardiothoracic, mostly stepped down, though I do float sometimes
through the CCU.
And I saw how much misinformation is going on online.
And I was like, why don't we bring in the actual experts or people in those fields,
actually talk about their daily work or what they're really seeing within the four walls

(08:38):
of this facility.
And then I think it kind of progressed as it became a podcast here since, wait, why
don't we get like different people within healthcare to just talk about their fields
and you know, there's so much misinformation and there's so much subreddits online.
And I think it's fueled by people who know nothing about that specific topic and who

(09:00):
are not in the fields that we are in, right?
And I must say, I talked to Chrissy about this many times, I feel like CRNAs are the
butt of so much of those misinformation online, right?
And I hope that this would also be a way for my podcast also to kind of show my followers
that, oh, what is this profession?
I must say, when I was in nursing school, I don't think I've ever heard of a CRNA until

(09:23):
I was in the CCU.
And so I was in cardiothoracic unit.
I was like, wait, I could do this as a nurse.
There's, you know, there's advanced roles in nursing in anesthesia.
And so that's why I'm so grateful to you both to share both of your platforms with me and
you will just really dive in to what you do, which I can tell is so exciting, especially

(09:45):
I've talked to our friend Stacey's CRNA method as well, just overflowing passion.
But before all of that, you know, CRNAs, before we touch a topic, I think the root of it is
being a registered nurse, right?
Being a nurse.
Well, I think for all of that, I wanted to ask what were your journeys into nursing?
Like what was your inspiration into pursuing the field of nursing in itself?

(10:06):
So growing up, there was a fair amount within the communities that I grew up in, which is
kind of, I grew up in North Carolina, into South.
There was an encouragement just kind of broadly towards teaching and nursing.
Like those are the two jobs that like women are typically like pushed to inside of that
community.
So I was always aware that nursing was a job that would be potentially something that I

(10:27):
would be like encouraged to pursue.
But I didn't really think about becoming a nurse seriously until I was about 12.
And my grandpa moved in with us and he lived with us for about a year so that he could
be within an hour and a half of the heart transplant facility.
He ended up getting listed and he ended up getting a heart at Carolina's Medical Center.

(10:48):
So my first really exposure to health care at all was being in somewhat of a caregiving
role as like a middle schooler for somebody who was within my family who was really, really
sick and he ended up getting a heart transplant.
So then I'm visiting, I'm in the CVICU at Carolina's Medical Center.
They let me like write on the little heart pillow.

(11:08):
And I just remembered my grandpa, like he was a different color when I went in there,
like day one post-op.
He was pink.
He was well perfused, which like that's not verbiage that I knew at the time.
I was just like, oh my pop.
He looks like awake and like pink and like alive again.
He had just been like gray for like so long.
And then the nurses were really, really intentional and good at explaining things to him.

(11:33):
And also to me, I thought that they were just the coolest people ever.
So I guess at age 12, age 13, I was one of those, I'm going to be a CVICU nurse.
I knew that that was specifically where I wanted to end up.
I knew that I wanted to work with heart transplant patients.
And that was really impactful to me because my grandpa then got another 11, 12 years of

(11:55):
life after he got that heart, which was really, really cool to see.
So I knew really from, I think like middle school that nursing was something that I wanted
to do.
And specifically I wanted to do critical care cardiac nursing.
Wow.
And you did it.
I love that.
Anesthesia I discovered for kind of a long way.
That's like, I think I discovered anesthesia like in nursing school, but I knew CVICU from

(12:18):
like the very beginning.
How about you Chrissy?
So I never wanted to be a nurse.
People in the family are not in medicine.
I have an aunt who's a nurse, but like, I think that one of my favorite parts of having
a social media platform is like sharing the information of what nurses actually do because
they're so misrepresented in the media.

(12:38):
And I feel like I had a very different image in my head of what nursing looked like.
So nursing was not my first degree.
My first degree, I majored in psychology and I majored in biology in Spanish.
I had thought about becoming a social worker.
That was actually the first major I applied to when I went to school.
I was thinking about becoming a clinical psychologist.
Then I studied abroad in Mexico, had exposure to an anesthesiologist who I shadowed and

(13:02):
she kind of took me under her wing and that kind of pivoted me into like medicine, medicine.
I was like, okay, do I go to med school now?
Do I go to PA school?
Nursing was so far from my radar.
So in order to start getting shadowing hours and to figure this out, I took on a second
part-time job.
I already had one part-time job in school.
I was working with adults with autism as a community support professional.

(13:23):
And I added on a second job as a nurse's aide in a surgery center.
I had like a neighbor friend who worked there and just, oh, we're hiring.
So they like trained me there and I was like the nurse's aide and they had one anesthesiologist
who'd be out and like pre-opping the patients and discharging patients and he'd be available
for emergencies.
And then the CRNAs were in each room actually providing the anesthesia.

(13:45):
And that was the first time I heard of a CRNA.
So I would just like love learning from Dr. Boxer.
Like he would just like teach me things all day.
Like I just ask him questions about the patients and like I had to like go through all their
charts and organize things.
So I asked him about these different diseases and medications they were on.
And he one day asked one of the CRNAs if I could shadow them.
So he brought me into the OR, I had the shadow of the CRNAs.

(14:08):
And the CRNA, you know, it's my second time being exposed to anesthesia, she had me like
ventilate the patient, like squeeze the bag to breathe for the patient.
And I thought it was so wild.
Like I'm breathing for another human right now.
Like this is wild.
So the nurses there, the anesthesiologists there, and the CRNAs there all really encouraged
me to pursue becoming a CRNA.

(14:29):
So I finished up my degree and I went back for a second degree in nursing.
It was an accelerated BSN to become a CRNA.
I still kept an open mind.
Like you know, I was happy to just get like any nursing job and just pursue like anything
in nursing when I graduated.
I wasn't necessarily in a rush to get there.
But then after applying to like 100 different jobs in three different states, the nursing

(14:51):
market was like garbage in 2013.
Like post recession, people did not retire and like all the part-time moms like went
back to work.
Like there were no nursing jobs.
I happened to get into a new grad program.
It says babysitting for a surgical resident at the time.
So I get into the CVICU and it's the hardest year of my life by far.

(15:13):
But it was amazing.
I feel like I grew this appreciation for nursing because I didn't realize like what nurses
really, what the role truly was or what nurses were really capable of.
So I kind of went into nursing not to become a nurse and then I become a CVICU nurse and
then I fall in love with nursing.
And I think that's one of the best parts of being a CRNA is that being a nurse is so core

(15:35):
to our foundation and it is like the perspective from which like it drives our care and our
thoroughness and our assessment and our attention to detail.
And you know, anesthesia really is such an intertwining of medicine and nursing.
It's really not one or the other.
It's two.
So that's how I became a nurse.

(15:56):
It was like through the anesthesia world.
It's beautiful that I feel like both of you had like, okay, I'm going to be a CVICU nurse.
Okay, I'm going to be a CRNA.
I guess let's say a nurse in the ICU, right?
How do they decide what we see as the roles in the ICU?
Is that maybe a critical care and P when it comes to nursing or CRNA?

(16:19):
And I know there's some nurses also go to PA school, right?
How can a nurse decide, oh, I'll be a CRNA and a QKNP or maybe even PA?
How does one decide that?
There's one answer shadowing.
You have to shadow and shadow a lot, like not just one day, right?
Like, because you might have a really cool day and not realize like what the boring days

(16:40):
look like.
Or you might have a boring day and not appreciate what the cool days look like.
Right?
So not just an anesthesia, but same thing for like PAs.
Like you need to talk to people in that work, follow people on Instagram and binge watch
their content, watch their YouTube videos, watch the day in the life, read everything
you can on the internet, but then shadowing in person is just going to really blow it

(17:00):
out of the water.
I shadow multiple people.
Everyone's going to have different perspectives.
In multiple roles too.
I think often you get your 19 year old who's very ambitious.
They want to go into healthcare.
They want to help people.
They want to like save the world.
And they also want to be able to have a retirement fund.
So they're looking for something that's going to provide job satisfaction and a little bit

(17:21):
of financial security.
And so they go and they Google like top things.
Top salaries and healthcare.
And they're like, I'm going to be a pediatric orthopedic neurosurgeon, cardiac anesthesiologist.
Like, you know, like they, they look for these lists on a blog and they have no idea what
that role entails or no idea what the day in and day out of something looks like.

(17:42):
And the only way you're going to figure out things that you're kind of suited for is by
shadowing.
And then also I think by getting a real feel for what the training process is to get to
that end point, because sometimes people also like the idea of an end goal, but they don't
see the like seven years of training that it takes to get there.

(18:02):
And so you really have to then calculate like, is that investment of time, effort, money,
financial costs?
Like, am I going to really enjoy the work?
Because you don't want to invest all of this time into training and all of this money into
training for a role that you might not actually really like at the end of the day.
And like Chrissy said, it's one word.
I'm using many words, but I'm going to go back to Chrissy's one word shadowing.

(18:24):
You really have to shadow and not just want to shadow multiple times, multiple roles to
see really what's going to be good fit for you.
Yeah, definitely.
And I think shadowing is really a way for you to get the bread and butter and the end of
the life of the role that you're shadowing.
And speaking of day in the life, I mean, for the past 16 years, we've already been talking
about your professions and, and it's going to be one soon as well as CRNA, which is certified

(18:48):
registered nurse anesthetist, or I believe the name changes, certified registered nurse
anesthesiologist, right?
Yeah, many states, right across the United States, obviously have CRNAs, but I think
outside of the United States, it might be unknown to these countries, right?
How would you explain what the profession of the CRNA is?

(19:09):
Chrissy's got a shirt with this, like in the dating world, right?
Like how you like your one liner of like what we do.
And I think it's a good one liner, but it's more than one.
Just get a little ready to explain it to patients even as you know, I said, give anesthesia
in the operating room, right anywhere where there's surgery or a requirement for anesthesia.
So any sort of anesthesia service where they're providing care, you know, it's like a politically

(19:32):
hot topic and I get in trouble whenever I say this on the internet.
But the truth of the matter is that nurse anesthetists in the United States have a scope
of practice such that we can do everything that a physician anesthesiologist can do,
right?
So if you have limitations on your scope or role, you can provide anesthesia independently
in all 50 states, technically, but there are always facility dependent limitations to how

(19:55):
that might look.
So there are contexts depending on where you work, where you might work in a hospital where
all the anesthesia services are staffed by only CRNAs.
So you are truly exactly fulfilling the same roles as an anesthesiologist.
You might work in a facility where you're in a big academic medical center and it's
a team model.
It's an anesthesia care team.
And so there'll be a CRNA in up to four rooms under medical direction.

(20:19):
That's one way that we bill for anesthesia services.
And there will be one physician who will also bill for those rooms and they'll be available
to help you with induction, any emergencies that come up, if you have any questions, like
you could think of them as like your teammate, your console, you're kind of like sharing
the patients essentially.
But the CRNA is the person who's in the case from start to finish.

(20:42):
The anesthesia care team works beautifully when you have two team members who have mutual
respect and work well together.
I think that especially in really complicated cases that require a lot of hands, I think
it works beautifully.
I think patients get amazing care this way.
But there's also plenty of cases where CRNAs work alone and provide excellent care as well.

(21:04):
So it's like a little dicey to talk about the job because I think when you talk about
it, people assume that when you give this information that we're devaluing the role
of other professionals in the field and we're not.
One person having the skill set does not diminish the skill set of the other.
I think this also circles back to what you said at the very beginning, Chris, about this
wasn't even presented as an option in nursing school.

(21:26):
It's not something that's really understood by a lot of nursing faculty because a lot
of nursing faculty have a master's or a doctorate in like education specifically, right?
Or sometimes they have like an FNP degree.
It's rarely people who are in the anesthesia world who are doing any of the undergraduate
level nursing education.
So yeah, like you might not even hear about CRNAs until you get out into working in the

(21:50):
ICU.
And that might be like the first time that you hear of it.
Until pretty recently, I feel like there was this understanding that we were the best kept
secret to some extent, which is funny because even over the last 15 years, CRNAs deliver
over 90% of all anesthetics in rural America and about 50% nationwide.

(22:12):
But the patient doesn't always necessarily understand that it's a CRNA and not a physician
or like people don't know what the role is.
So I think it's just not very well understood.
Like it's kind of like, oh, we're CRNAs.
We've been here.
We're always here.
But there's also an element of if we do our job really well, the patient won't really
remember.

(22:32):
So I think it's good that we're online and we're in social media spaces to, I think,
really just empower new nursing students about their choices so that they can make the right
decision for them as they're considering their career options.
And that's part of why we do some of what we do.
I agree.
I would like to add too, I think part of the reason why we're a best kept secret is you

(22:56):
have a very short amount of time to get to know the patient before surgery.
And a lot of people when they introduce themselves to the patients, they say like, oh, I'm part
of your anesthesia team.
Or like, oh, I'll just be taking care of you today.
Oh, I'm the anesthesiologist person.
Like they don't say I'm the nurse anesthetist or and I think it's really important to use
that very specific language and then explain what it means.

(23:16):
So every single time I meet a patient, I say, hi, my name is Christina.
I'll be your nurse anesthetist today.
That means I'm taking care of you and giving you anesthesia during your surgery.
I work in a team with Dr. So and so who will also be responsible for your care as well.
Let's go through your medical history.
And people get that it's like not hard to wrap your brain around.
It takes 10 seconds.

(23:37):
And then the patient understands that we're there.
It's important that we are transparent with patients about what they're getting.
I think it would be very alarming for a patient who didn't know that we insisted to then find
out like who's this person taking care of me.
Like if I forget something happens on the back end, like something goes wrong, for example,
and then you go to the chart and like, who's this lady like, you know, like you think that

(23:58):
only doctors provide anesthesia.
You're like some nurse gave me anesthesia, right?
Like it's important to be transparent about what this looks like and what our role is
and what we're capable of so that the public has trust in us as well, not only just for
nurses and to update Anna's statistic.
65% of all anesthetics in the US are given by CRNAs.
So like if you're getting anesthesia for any surgery, odds are it's more likely than not

(24:20):
that a seronase is involved in your care, whether that be in a T model or on their own.
So it is important that we be transparent.
And then again, letting nursing students know about this because I think a lot of nurses
view going into the field of anesthesia as abandoning bedside, abandoning nursing, like,
oh, you're not a nurse anymore.
And it really couldn't be farther from the truth.
I promise you this being a CRNA is the nurse-iest nursing job I ever had.

(24:46):
I have unlimited time with my patient.
My eyeballs are on my one patient from start of case to end of case the entire time.
We're positioning, we're staring at the monitor, we're tucking, we're like cleaning that like
all these little things that you're doing.
Eyelids so they don't have corneal abrasion.
That's so nursey.
It's so nursey.
I like to do this crazy eyelid tape when they have fake lashes on so that lashes don't come

(25:10):
off like it's right.
As an ICU nurse, I was pulled away from the bedside constantly.
It was constant phone calls running around, running up and down the halls, running to
supply closets.
Now I sit there and I physically care for you.
It's the nurse-iest nursing job on the planet.
It's the most bedside of all bedsides.
It's closer to the bedside than ever before.

(25:38):
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(28:41):
When something is not really talked about, so much different opinions and misinformation
kind of like found out of that, right?
And I know Chrissy and I talked about this too in the videos before that.
Most of the vitriol going on online, that doesn't happen in real life between like physician
and anesthesiologist and CRNAs and other members of the care team.

(29:02):
I mean, I had my appendectomy back in November.
I mean, the one who administered my anesthesia was CRNA.
And you can just tell that it's just like a family in the OR.
Like no one's, no one's like trying to fight it.
Everyone's just there for the patient.
That the patient falls asleep well and that the patient wakes up right afterwards the

(29:22):
procedure.
I guess I wanted to also, again, there's so much information online.
What do you think is the most false you have read or seen online and regarding your profession?
Oh, there's so much.
So I think, go ahead, yeah, you go first Anna.
There's a lot of misinformation about scope, scope of practice.

(29:44):
I would say that the perpetuators of these myths, I will say, are often young people
on the internet commenting from anonymous online accounts and they are often on like
a pre-med track and they haven't done all of the research themselves.
And then it comes from a place of feeling like insecure and threatened in a future profession

(30:06):
that they are not currently a part of.
So like there's some scope of practice misinformation about assumptions that CRNAs can only do like
GI cases or assumptions that CRNAs can't do big head cases, big heart cases.
All of the, at the end of the day, like Chrissy was saying, working as a team together doesn't

(30:27):
mean that the other people on the team are less valuable.
We really all work together and in real life, most of the time everybody has a really good
working environment.
There is, I think, the level of anonymity online where people sometimes they hide behind
like an anonymous user account and they say things that they would never say to your face.

(30:49):
But also I think we can do a better job, like Chrissy was saying, of educating the general
public about who we are and what we do and also educating and empowering future students
into what their role looks like so that they can make good decisions.
But yes, there is circulating misinformation online.
It's usually not from reputable sources.
I also think people really want there to be a clear line in the delineation of roles.

(31:14):
Like they just want that to exist so that they can choose or have some clarity or just
to feel better about themselves perhaps.
So they really want there to be a red line in the sand of like, this is where doctor
ends and serine begins, right?
Like, doctor do this, nurse do this.
That they're just, they're vying for that.
And the problem is that we blend so much, we overlap so much.
Unless you're a physician who's done a fellowship in something that a serine wouldn't do, like

(31:39):
becoming a critical care anesthesiologist, for example, like, okay, I'm not going to
run an ICU outside of a COVID-19 pandemic, which serine is different ICUs during the
pandemic.
But other than that, like aside from, you know, 2020 and 2021, yeah, like that's not
something we're doing, right?
And like, we're not okay.
But when it comes to in the operating room, the blend is just, there's just no line.

(32:00):
There's no dividing line.
A lot of people on the internet will kind of assume like, well, when it's a big case,
it's going to be the doctor.
When it's a small case, it's going to be serine.
That's not true.
In fact, when it's a big case, it's probably going to be both of us.
Or oh, well, if there's like a line to be placed, it's probably going to be this person.
Well, actually, it's probably going to be the CRNA because they have to run to another
room, right?
And like, I'm the one who's doing it every day.

(32:21):
So like, this is just the workflow we have, or maybe it's just the person who's more
skilled.
Maybe as a CRNA, you haven't done that many central lines.
And the person you're working with, the physician has, maybe they're a cardiac anesthesiologist
and they do them every day.
So that's the person who's going to do the line, right?
The person who's better suited for it.
I used to do cardiac anesthesia at my old job.
In my new job, I'm in a B a lot.

(32:42):
I had a hemorrhage a few months ago where a central line needs to be placed.
And I was the person who had done the most central lines the most recently in the room.
So even though we had multiple anesthesiologists and multiple CRNAs, a few people tried, it
was a difficult stick.
I was like, listen, I do this all the time.
And I stepped up and I put in the central line.
That's what was best for the patient in that moment, right?

(33:03):
It wasn't like, this is the doctor's job or this is the CRNAs job.
No one was fighting for that title or that role.
There's no ego in an emergency.
There's no room for that if you actually care about the patients.
So unfortunately for people at the internet, there is no line in the sand.
We all overlap.
We all have different skills.

(33:24):
Some people are better with nerve blocks than others.
Some people are better with epidurals than others.
And it's really all about maximizing people's potential to give patients the best care.
Ask this question in the chat.
Do I worry that the people who are commenting kind of the hateful ideology are in the room
with me?
I do not worry that because almost, I'm going to say like 75% of the time, if there's an

(33:47):
anonymous commenter, it's coming from somebody who is not currently attending.
They're not currently a fellow.
They're not currently a resident.
It's usually coming from somebody who is very young and is trying to choose their path and
has a lot of insecurity that they need to sort through.
I'm not going to say that there has never been a coworker who maybe is on an anonymous

(34:08):
forum, but at the end of the day, people, once they get out into the actual healthcare
setting, we realize that it's a team environment and we work really well together.
I can't think of a time where I've had an altercation either in the OR or in the ICU
because at the end of the day, it's about the patient.

(34:28):
So we work together for the patients at the end of the day.
I think that online is kind of separate from the, I think the online discourse is pretty
separate from what you see day in, day out in the OR.
Yeah.
I mean, the internet and social media really is like a figment of reality, right?
It's not real life.
The things that's being talked about online, it's not based on like what really happens

(34:53):
on a day-to-day basis.
And I agree with Anna.
It's really all insecurity from people who are not even working in the field, right?
They're not even in the room.
Not even in the room.
They have no idea.
Yeah.
And like what Kirstie was saying too, it's like, I mean, we have a term in healthcare,
it's called interdisciplinary.
It's inter because there's no such thing as donation marks, right?

(35:18):
Especially in the OR and in the ICU.
And I think one of the questions a lot, especially from nursing students too, is what do I do
as a nursing student to reach that point of being a CRNA?
And I think I'll point this to Anna who's in the heart of it, who's in the mesh of
it all.
What is the training and the education path from being, let's say, another guy college

(35:43):
student to be like, oh, I want to become a CRNA someday?
Oh, I've got the blueprint for you.
All right.
But let's say this.
Let's say that you are just starting nursing school, you finished all your prerequisites.
You're in year one of nursing school.
Two years for nursing school.
You're in an ADN program.
You're in a BSN program.
Doesn't matter.
Either one is fine.
Go ahead and take a general chemistry class, take a microbiology class and take a statistics

(36:08):
class if it's not already required by your nursing school.
Those are the three that you're going to need to apply.
And then go ahead and get yourself a per diem job and then ICU of your choice.
I'm partial to SICU and CVICU.
Those are my favorites.
I would recommend those.
But any ICU, get your foot in the door as a nursing student working part time while

(36:28):
you're in school.
That is going to guarantee that you can interview for and then gain a new grad job in an ICU.
You start off in an ICU.
You work there for two years while you're there.
You're really digging in deep and you're actually trying to understand the pathophysiology
and the pharmacology of the medications that you're working with, which leads into Confident
Care Academy, which we will talk about.

(36:51):
Confident Care Academy is in-depth lectures and it really helps you every step of the
way as you are becoming a confident and competent critical care nurse.
We have pharmacology lectures.
We have physiology lectures.
We have sample report.
We have lectures on how to give report.
Like it's really everything you need as you're stepping into the critical care world and

(37:11):
we'll talk about that even more.
But while you're in the ICU, really try to actually soak up the knowledge.
Learn how to run a room when you are placing central lines.
Learn how to predict what's happening next in an emergency.
Really soak all of that up and then at your two-year mark, go ahead and apply.
But you need to pick your top three to seven schools.
When you pick your top three to seven schools, then from there you will then cater any other

(37:36):
lingering prerequisites out and then you go from there.
So yes, in the two-sentence summary, get a job in the ICU while you are still in nursing
school.
Make sure that you take a medical-based general chemistry course, not an introduction to or
a basics of general chemistry.
You want general chemistry, microbiology, statistics.

(37:58):
Get a job in the ICU while you're still in nursing school and then start in the ICU as
a new grad and then apply two years.
That's the very short version of that.
I'm very curious.
You know, there's only so much space in the OR, right?
And the CRNAs need their training.
I guess resident anesthesiologists need their training.
Based on what you have seen, both of you, how does that work out when it comes to, I

(38:19):
guess, being present for cases?
Does one get chosen or the other?
Everybody has their own assignments that day.
So you're never going to share a case with another learner that's actually forbidden
by the Council on Accreditation.
Like if they find out that a school is like having students share cases, schools are in
big trouble.
And that goes for the residents.
I don't know, I can't think what the name of their governing body is too, but they're

(38:40):
not supposed to be sharing cases either.
You're not allowed to count those.
There are places that will have like only SRNAs.
There are places that will only have residents and there's places that have both.
So a lot of times it just depends on what the learners need at that time.
A lot of residency programs, residents will go through blocks.
So they'll do like neuro anesthesia for a few weeks, cardiac anesthesia for a few weeks.

(39:02):
They go through blocks.
Different CRNA programs may or may not follow that block model as well.
So they just might get put in the block pool and then like, okay, you guys are all doing
neuro together.
Okay.
So a lot of times the schools on different timing, like our SRNAs were on a different
timing than the residents.
They would rotate away to different hospitals for different types of specialties because
there's only so many thoracic cases.

(39:23):
For example, people just don't get lung cancer anymore in the same way they used to because
people don't smoke as much, right?
So thoracic surgery is getting more and more rare and yet you still need a lot of numbers
to graduate.
Both the physicians need it and our CRNA students do.
So for thoracic, for example, a lot of times that's a specialty that a lot of schools just
say, okay, like the CRNAs go to like this place and they do the thoracic numbers and

(39:44):
the doctors will care.
If it's something that there's plenty to go around, like we had tons of cardiac at my
old job.
We like had cardiac coming out of our ears.
They were like begging to put bodies in there.
Like it was fine.
Like it was just, you know, you get this room, you get that room.
It wasn't a big deal.
So people, you know, yes, although the vitriol of the internet does not bleed into real life,

(40:04):
like we are very collegial at work, there are political things that do come up in real
life like this, right?
Like sometimes might have a hospital that will prioritize one learner over another.
And that's like an unfortunate reality.
It's not always the case, but it can happen sometimes.
You know, sometimes there are people who are very politically involved who might want to
kind of like draw territory lines here and there.

(40:26):
So it is important to be honest with people that like this is something you'll see with
your entire career.
If you're in medicine, no matter what role you choose, right?
Whether you stay in nursing, whether you go back to med school, or you become a PA, like
there's always going to be like little political things going on, a little territory battle.
So we should be transparent about that.
But for the most part in the OR, it's, you know, everybody gets like their case assignments

(40:49):
for the day.
They're still making a master's schedule and you're not generally in competition with
one another.
Yeah.
I mean, I guess when you're talking about, you know, scurrying in, getting those training
hours, it's really part of the CRNA curriculum, right?
And we talked about from, I guess, being undergrad and then getting to CRNA school.
I just want to talk about CRNA school itself.

(41:12):
When I watch Anna's story for drawing arrows after arrows, and I think it's patho, I'm
just like, my brain's just bleeding.
And I guess, Chrissy's also laughing.
My brain's bleeding too sometimes.
I guess when you make your, you know, your lectures for CCS.
But I'm just looking at Anna's stories and then the time lapse and just like, my brain

(41:33):
is bleeding right now.
We're now going from, you know, from undergrad to applying to CRNA school.
CRNA school itself, how do programs generally look like?
Yeah.
So there's, I'll say two different base kind of structures.
You can have an integrated program, which Chrissy did.

(41:54):
And that is where pretty early on in the program, you are doing your core didactic and you are
also in the operating room very early on.
And then the other kind of format is you do front loaded, which is you do all of your
classroom learning first, and then you're just in the OR.
So you can either have an integrated program or a front loaded program.

(42:14):
Both kind of models, you are going to end up with very similar clinical hours.
We have a clinical hour requirement and a case number requirement that you have to meet
in order to graduate.
And all of these programs deliver well above those clinical hours.
As a kind of a basis of comparison, therefore, it's about four times the number of hours

(42:37):
or cases are required to finish anesthesia school versus some other MP programs.
So you, it's a lot, your 50, 60 hours in the OR for about three years.
And for me, what that looks like is I have a year and a half of classroom learning, and
then I have a year and a half of I'm in the OR 50, 60 hours a week.
And I start clinical in January of next year.

(43:00):
I think there's pros and cons to both different program structures.
At the end of the day, if you get into a CRNA school, you should go, like don't worry about
whether it's front loaded or integrated, just go for it.
And I think one of the big lessons with CRNA school is that it is so different from nursing
school and that you have to be very inquisitive and you are not going to be screen fed information.

(43:21):
So you have to take the lectures as a starting point, and then you have to go read not only
one textbook, but three textbooks and board prep material and practice questions and case
studies in order to do well on the exams.
And you're not going to be given a study guide to do that.
You have to go and you have to put all these hours in on your own to really get that deep

(43:42):
level of knowledge and understanding.
And then on the flip side, you then also have to let go of wanting to make a 99% on everything
because you're going to be in the operating room the next day and you need to show up
and you need to be able to do a good job with your case.
So it is very much a full time job.
I'll say that working with Chrissy and being a nurse educator has helped with my study

(44:05):
habits because it's my day in and day out job is to work with Chrissy who has all this
wealth of knowledge.
So I benefit a lot from working with her, but it's still a full time job.
Like CRNA school is 100% full time.
You're going to be in the operating room at least 50 hours a week and that doesn't include
studying on top of it.
So how do you get into a mindset of like, this is a marathon, not a sprint.

(44:27):
How do I show up every day and make sure that I'm doing everything that I can for my patients?
And then also get into a mindset of like, this is just the way it is.
This is the way it is for the next three years.
And I just need to get into that like mindset of I need to do what I need to do and I need
to feel my brain and feel my body so that I can study well, show up to the OR, take

(44:48):
feedback.
And this is why it matters so much to shadow because you need to know that this is the
right choice for you.
Like this is not just say, oh, I want to apply to grad school.
And at the other end of it, I can work in New York City and make a lot of money.
No, this is a huge time and mental energy commitment.
And you need to know that it's something that you're passionate about and that you actually

(45:10):
enjoy because otherwise the investment is not worth it if it's not something you're
passionate about.
Yeah, definitely.
And I just feel like definitely in the full time job, my friends are starting CRNA school
soon.
And I mean, when I saw Anna's story, I'm like, I feel like Anna just started and she's already
like how many semesters have you done?
I feel like time is just flying by.

(45:30):
Flying.
So it's 682 days until I graduate, but who's counting?
But it is absolutely flying by.
I think that I'll blink twice and school will be over, but you stay so busy that it really
does feel like it flies by and it builds so sequentially.

(45:51):
So you stay busy and then each time you're learning something new, you're adding it in
and then it really just truly flies by.
And Chrissy's experience, I love, do you want to talk about how it's changed a little bit
over the last couple of years, Chrissy?
Like, or just essentially how like you did everything.
But in a shorter time frame.
Oh my God.

(46:12):
I know I actually like precepts like students in the hour and they're like really complaining
about like their heavy week and I'm like, you don't know.
So the master's programs had the same clinical requirements, but most programs were in 27

(46:45):
months instead of 36.
And you could counter argue like, well, you need to do a DMP project or like, oh, you
know, all those extra classes.
But like that required a lot of time in the operating room every week sooner, even if
you were front loaded versus, you know, integrated more of our time in a shorter amount of time.
And then while you're taking classes, I was in an integrated program.

(47:06):
It was two years long, 24 months long.
And we had some of the highest number of clinical hours in the country out of any program, even
though we were three months shorter than other programs.
So my first semester was classroom only.
We had five classes and it was a full course load and we learned basics of anesthesia and
like we did our pharmacology and assessment and like all those like basic foundational

(47:28):
classes.
Semester two was like, you know, more anesthesia curriculum.
We still had, I think it was the second semester of five classes and then we started going
to clinical four days a week.
So I would have one day where I'd be in class for like eight hours straight and then a second
day a week I would have an eight hour clinical day.
We got to leave early this day because then we had to drive to campus and do two night

(47:52):
classes back to back and then go back to clinical the next day.
And we were there from, you know, your day started at seven, ended at five usually.
But really we got to clinical at five thirty in the morning to set up for the rooms and
to like grab our patients and stuff.
So you know, they're 12 hour days.
We didn't have breaks.
There was no, we had one vacation after our first semester before our second one started.

(48:15):
We had one week off the whole program.
During holidays, if your clinical site required you to be on the call schedule, you worked
the holiday.
We had three sick days for the whole program.
And anytime there was a break in semesters, we would go into the hour five days a week
to get all those hours in.
So those would be 60 hour weeks.
And then we took overnight and weekend call.
So it was really heavy.

(48:37):
It was nonstop.
There was no break.
And you just had to be very efficient and grind.
Now that program was very different.
Now it's a 36 month program, the University of Pennsylvania, because it's become a DNP
program.
I recommend the program, by the way, the program directors, Don, and Ben and, and student
auto are amazing people.

(48:58):
I cannot recommend them enough, but you know, the program now they have like two semesters
of classroom before they hit the hour.
And then they ease their way.
And I think the first semester at first, we had them in the hour only like two days a
week.
And then we ramped up to three because they just have so much more time to hit those numbers.
And they still go like above and beyond their numbers.
But yeah, it was, it was,

(49:19):
Girl, just intubate me now.
Just intubate me.
I'm tired for you.
I'm tired for you.
I mean, I guess this was so important, I guess to really, I think Anna said this too before
in one post that you should know your learning method, right?
The way you learn, like before you enter TNA school, I think is what you were saying, or

(49:39):
like to navigate it within the first few, I guess, weeks or semesters of school, because
so much information, I guess it's like drinking from a running, you know, fire hygiene, right?
And I guess that's what CCA does, right?
Is giving also these lectures.
I mean, I watch the YouTube videos and I listen to the podcast.

(50:00):
I'm like, oh, this is the way to teach.
And this is such a great way to learn.
I guess I wanted to ask what was your process in, you know, like maneuvering the way that
you structured all of these lectures.
For us, Profit Care Academy came from a place and a vision for both of us where we wanted

(50:22):
to give all of the people who come after us resources that we didn't have.
Like we over and over again, just wish that we had had a centralized place to learn the
mechanism of action of vasopressin and which receptor sites it's working on.
And then how does that relate to cardiac surgery?
And then we wanted lectures on cardiac surgery specifically.

(50:44):
We wanted lectures on respiratory failure, ventilators, all of these things.
We were just scrambling at bits and pieces trying to learn from our attending physicians,
trying to learn on YouTube.
We were looking things up in textbooks and there was nowhere where there was this comprehensive
place to learn how to be a nice new nurse.
So that is really where the desire and the vision for Comfort Care Academy, I think,

(51:04):
came from in large part.
As far as kind of the process for how we figured out the best way to deliver that information,
I think that's a whole podcast episode in and of itself because that's been a learning
experience on how people like best to consume educational materials.
It's actually been a very fun project for us to learn to figure out lecture versus podcast

(51:25):
versus EDS versus practice questions.
All of that has been super interesting.
And then, Chrissy, if you want to share, I guess, the vision of where we are now and
then want to have built out.
I think that we have to leave the final thing as a secret for now.
I don't think we're ready.
I don't think we can tell people yet.
Oh, no, I agree.
I agree.
But as far as like what we have currently written and then like what we want to have

(51:48):
written by the end of the year.
We're like, OK, cool.
Yeah, because we have a secret coming for you guys in like two years.
So for right now, I think the hardest part about learning as a nurse is most resources
on the Internet are either patient facing or their physician facing.
So either it's very, very simple and it's like, you know, like a cute little article

(52:10):
from the Cleveland Clinic.
Like, what is mitral valve regurgitation?
It's like your valve is a sloppy and a surgeon might fix it.
Go see your doctor.
OK.
And then, you know, you go to YouTube and then you see like maybe a cartoon that's like,
OK, like this is what it's up.
Like this is what the mitral valve regurgitation is.
OK, great.
What do I do with that information?
Right.
Like, what's it mean?

(52:30):
And then you go to up to date and then it's like every single research article that's
ever had to do with like mitral valve regurgitation.
And then, OK, but how does this relate to my nursing care?
And you ask them at work and either people don't have time for you or they don't want
to answer or even if they can, like maybe they're giving a short answer or a very watered
down answer.

(52:51):
How do you get that in depth answer?
And it takes time to really explain those things.
Nurses are incredibly capable and smart people.
They will absorb whatever information they want to absorb.
So at Confident Care Academy, our goal is to have these lectures that are not designed
to prepare you for an exam, right?
We're not jamming in as much information as we can because you're not prepping you for

(53:14):
a test.
We're prepping you for the real world.
So we take an hour to talk about the valve diseases and what the implications for the
patients are.
This is what it is.
This is what it looks like.
This is the emergency that could come up.
This is what you're going to do if the emergency happens.
These are the surgeries that might take place for this problem.

(53:35):
This is how you'll take care of that patient after surgery.
Did you know that it's actually different than this type of patient?
You know, not all heart failure is the same.
It's like one of my favorite lectures to talk about, right?
And the way that we care for heart failure patients, they're all different depending
on what's going on at the level.
And nurses are very capable of understanding this.
They just need to take the time.
So for me, one of the people that I really leaned on as a nurse was I loved like the

(53:58):
Laura Gasparis like, like lectures and like listening to her talk.
And for me, I felt like her stories and her way of just breaking down these big concepts
into like plain language and making it funny made things stick in my brain.
And that's what we want to provide for nurses too.
It's conversation style.
Like we have a PowerPoint up, but we talk back and forth and we make it relatable.

(54:21):
And we speak just the way you and I are speaking right now.
We have a conversation where we go in depth into what these things mean in real life so
that you can listen to it passively.
You could listen to it on our app on the go.
You could wash your dishes, walk your dog, driving your car.
And in the meantime, you're learning about your patient population and maybe not every
detail will stick.

(54:42):
Maybe you want to revisit that lecture, but it's available for you as long as you remember.
But little nuggets of information will sink in and the clinical pearls do help people
in real life.
We get feedback from our members all the time.
People say, oh my God, this emergency happened today and I caught it because I just listened
to the lecture.
It's amazing.
It's the worst thing I could ever experienced.

(55:08):
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(58:03):
Knowledge is confidence, right?
Hence the name of the academy, right?
I mean, I remember, I think this is prior to COVID, probably my third month of being
a nurse and I was orienting the CVICU nurse and we had like fresh, post-op cabbage, like

(58:23):
literally just gut-wheeled out of the OR.
And I probably needed like an endovalent catheter with the amount of pee I would probably have
been peeing because of pee.
I'm like, I have no idea.
I'm not even taking care of the patient myself.
I'm just like, I have no idea.
What is this, Jeff?
I think that's true for so many new grad nurses and I guess nursing students who have the

(58:44):
chance to have rotations in the ICU.
And maybe even for a seasoned nurse who's going to the ICU for the first time, right?
I think there's so much to know in the ICU.
And obviously there's different types of ICU, situation of drugs, the different devices,
whether it's like Impello or ECMO or blah, blah, blah, blah.

(59:06):
I feel like knowledge is really confidence.
And I guess what would be your message to a nurse in the ICU, whether a new grad or a
seasoned nurse, just like I've always wanted to go to an ICU nurse, what would be your
message for them given that they are trembling each day right before the shift because they
feel like they cannot be the best ICU nurse that they want to be?

(59:29):
So hard.
We actually made it.
That was one of our first YouTube videos we ever made.
Remember that, Anna?
The anxiety is the new grad answer because we both experienced this.
I experienced this for sure.
I was nauseous before every shift.
I had so much anxiety my first year.
And again, what I would do to kind of manage my anxiety was I would always have a note

(59:50):
running in my phone, just the note that's on iPhone, where anything that would come
up that I didn't understand during the shift that I didn't get adequately answered that
day, I would just write them all down and the next day look up everything I could.
And that's again where the frustration came in of not having these resources.
I think with anxiety about work, if you can reframe it as a healthy fear and use that

(01:00:12):
as instead your drive to have that thirst for knowledge, that curiosity and channel
that energy into someplace good and productive, you're going to feel a sense of relief and
taking back control.
Every time you understand something you didn't before, the anxiety level comes down a little
bit.
And maybe it won't be an overnight change, but over the next few weeks to months as your

(01:00:33):
knowledge base grows and your experience level grows, you're going to reduce that super
steep learning curve.
It's going to go from 90 degrees to like maybe 75 and then 45.
Super steep, right?
Super steep.
It's so hard.
You're going to feel empowered.
I think that really studying and learning is the best way to handle that.

(01:00:53):
What do you think?
I completely agree.
And I'm just wanting now to feed people to the podcast because this was a really good
episode I think.
It was one of the first ones we did.
There was two.
There was survival tips, new grad survival tips, and then there was ICU anxiety.
I think that oftentimes people get into critical care.
They are overachievers.
They're idealistic.

(01:01:13):
It's often their first job.
So there's a lot of self-identity that is tied into this new job that you show up at
and then you realize you know very little about it and that people are extremely sick
and the stakes are very high, which for someone who is very idealistic and optimistic and
wants to do really well, this creates kind of a perfect environment for anxiety.

(01:01:35):
So giving these people who just want to do a good job an action plan I think is so empowering
to these new grad nurses.
So what's the action plan?
Just like Chrissy said, you pick one thing a week that you don't understand.
Coronary artery bypass graft surgery.
Okay, you're a new grad nurse.
You don't understand which vessels are being grafted with a cabbage.

(01:01:56):
You don't understand what that is.
Okay, you're going to choose the cabbage that week and you are going to really dig deep
and understand what's happening with that surgery and what's happening with that patient
population and then that is going to decrease your anxiety by a certain level.
And then you're going to learn that it is okay that you don't know everything right

(01:02:16):
now and you need to ask questions so that you can keep your patients safe, but not to
see you're not going to know everything on day one.
So allowing yourself to be a learner and then putting yourself in a position with good communication,
which is another podcast episode that you should check out.
The communication tips episode was another really good one.
So just giving yourself measurable goals so that you can keep learning and then also to

(01:02:40):
be learn to be kind to yourself because it is a stressful environment with a learning
curve that is like this.
And at Comfort Care Academy with all of the lectures and resources we try to make it 75
degree angle instead of a 90 degree angle.
If you're not ready to join the membership, definitely check out the Comfort Care Academy
podcast.
There's a lot of clinical pearls, but also a lot of broad informational educational tips

(01:03:06):
about picking an ICU, about communicating with provider teams, about anxiety, choosing
CRNA schools.
Like there's a lot of free information there.
Check that out and then come join us in membership.
I mean, I love the podcast and I remember listening to that episode and I think Chris
said something along the lines of like the concept of small wins, like celebrating the

(01:03:27):
small wins, especially when you're new to the ICU.
And he also thought the episode on the, I think it was the night shift episode where
you gave tips.
Yeah, I mean, the ICU is very daunting.
I mean, there was a viral picture on Twitter, I think a few years ago where it's like just
tangled up lines from different IV lines.

(01:03:50):
And then in the comments, it will be like, only an ICU nurse can fix this.
So it's like, if you're like the ICU nurse, the critical care is like really wired for
so much critical thinking.
I mean, it's in the name of the unit itself.
And also, I guess the relationship you build with your patients and their families in such
a vulnerable and such a sensitive space.

(01:04:13):
And I think I want to lead this on to, I guess we've talked so much about the CRNA profession
and CCA and the journey through it all.
And Chris has been in the CRNA for five years now and Anna has been in the CVICU and is
going to this new role, which I know is going to fly by.

(01:04:34):
At the root of it all, CRNAs are nurses, and we're all part of the healthcare system.
Especially in the United States, it's so much systemic flaws and so much brokenness.
Someone wants to be their dreams to become a CRNA, but it's wondering of how worth is
the road and how worth is it being one in the future, given the brokenness of the system?

(01:04:58):
What would be your message for that person?
And I guess that's also a tangent to a question of what makes anesthesia worth it for you,
both of you.
So I love that question.
Do you want to start Anna or do you want me to start?
I can start.
Really great question.
So as far as inequities and lack of diversity and the broken healthcare system, I can only

(01:05:21):
speak to my experience as a white woman within healthcare.
I do think it's so important within anesthesia specifically, the more education you have
and the more knowledge you gain in medicine and in nursing, the more you can really take
excellent care of patients.
So I feel like it's such an honor to learn about the G-couple protein receptors and to

(01:05:44):
really dig deep into the farm, into the physiology so I can take really good care of my patients.
And then I think it's equally important to try to hold the door open for people who come
after me.
And that's part of why we do what we do for Comp and Care Academy because we, and we also
why we do so much free education because we want for the healthcare system to become more

(01:06:07):
equitable.
We want to get more people within healthcare involved.
We want to open the door for people who are coming after us, maybe don't have some of
the same privileges that we have coming into this.
And then as far as is the day in and it's day out worth it?
I love the nature of the work.
It's incredibly satisfying to take care of one patient at a time and to alleviate their

(01:06:28):
pain.
To me, I think that is like such, it's so satisfying and anesthesia is so different
every single day.
Like one day you can be doing OB, epidural, labor and delivery, like seeing people bring
their baby into the world.
And then the next day you can be doing like trauma response, right?
And like you're in there dealing with like a response for a patient who like there's
gunshot wounds and they're very, very sick.

(01:06:50):
So I know that the work is for me something that I know it's impactful.
I love that it's different every single day.
And I think that it's important as we have these additional layers and levels of opportunity
to learn more to then pour that back into the community.
So I think it's absolutely worth it.
And it's definitely something I would recommend to people.
It is something they're interested in.

(01:07:11):
This is such a big two part question.
Yeah, it's like three, part A, part B, part C.
I'm like, where do I start?
So I guess my response for circling back to like, is it worth working in this broken health
care system?
Like it's hard.
The American health care system is broken because it's a for profit system.

(01:07:35):
Health care is a business, unfortunately.
And at the end of the day, yes, we do provide very good care to patients in the United States
overall, but we also have huge lacks in primary care, for example, women's health in any area
that is not necessarily profitable, like anything outside of surgery.

(01:07:57):
And so it can be really despairing to be, especially in your nursing journey along the
way, when you start to discover how broken the system really is and how stretched in
and undervalued nurses really are, and how our communities don't always get the care
they deserve because of the lack of resources and the understaffing and where money goes,

(01:08:19):
CEO's pockets instead of at the bedside where it really belongs.
It's hard.
There's a moral burnout associated with that journey.
I think in anesthesia, we get this privilege of being a little sheltered from it.
Because surgery is profitable.
So we're back in a space where you have, maybe you might have some stretch in resources where

(01:08:40):
you don't have every fancy tool or drug available to you.
But at the end of the day, no matter where you work as a serinade, it's still always
going to be one patient at a time.
And you are still in the OR primarily or the labor unit primarily.
So you're getting a little bit protected from some of those burnout moral issues.

(01:09:01):
You can look away from it, which is, I think, a bad thing because I think that's when a
lot of people forget about the issues and stop advocating.
And that's why it's still important on my platform for me to talk about nursing so much.
I don't want to forget that that's what's really going on in the rest of the hospital.
That's why we support unions and encourage nurses to unionize whenever they can.

(01:09:23):
And that's why we're always talking about nurse empowerment.
Our communities are suffering from this health care system and they do deserve better.
If you do have a passion for anesthesia, I do think it can be a little bit of an oasis
from that burnout.
It has its own issues that come with it, of course.
The job is perfect.
If it was perfect, it wouldn't be work.
It would be vacation.

(01:09:45):
So I guess that's the first part of your question.
I'll wrap up that section there.
As far as the best part is just the one-on-one care.
I love that we're able to be in so many different types of surgeries and provide such good care
for people.
I love that I get very nerdy about cardiac surgery because that was my nursing foundation.

(01:10:05):
So I really enjoy being in the cardiac ORs.
I actually love labor and delivery too.
When I first started my job, I was not comfortable with OBs.
So I kept saying, I hate it.
I hate going to my OB shifts.
But it's like a chaotic OB unit where I work.
We have a million labor rooms.
We're responsible for a million patients at the same time.
We have to know what's happening for upwards of 30-something patients at a time.
We're really involved in the medical management of the patient.
But it's a really cool opportunity to meet patients in a different space other than being
asleep.
You're keeping pain control.
We are really close-close to the patient.
We're really close to the patient.

(01:10:26):

(01:10:50):

(01:11:21):

(01:11:43):

(01:12:10):
puts their trust in you and I mean for both of you know being anesthesia it's like the trust for
someone to manage their fears and their physical pain and to rise back up again at the end of the
surgery to hopefully I don't know fix something or even get a new life right I mean what what what

(01:12:35):
what an honor and it's such an honor to talk to you both today so thank you so much I can't believe it
thank you for having us it's such an honor to be invited I love this this is awesome so I'm so excited to just share this space thank you so much
yes Anna and Chrissy thank you so much I hope you have a great rest of the day and Anna visit NYC soon

(01:12:56):
we've got to all grab dinner yeah I'll probably just have to move I mean there's nothing left to do I just have to come join y'all so
that's the only option bye bye Chrissy thank you so much have a good day bye everyone

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