Life After CRNA School With Marissa From Sassy Anesthesia Cover Photo

CRNA school is a lot of work. It’s not just about learning how to do everything, it’s about learning how to do everything well. And after you graduate, you have to keep learning. That’s why we’re here: to help you make sure your CRNA career is a success! In this video, Marissa Mulder a.k.a. Sassy Anesthesia talks about how to make your dreams come true after you graduate from nurse anesthesia school.  Marissa discusses life after CRNA school; you’re going to have a lot of questions, and you’re going to have to make some tough calls. But remember: this is only part one of the journey, and we can’t wait for you to join us!

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Life After CRNA School With CRNA Marissa

We’re going to talk about what life is like after CRNA school. We have a special guest. Marissa, welcome to the show.

How are you?

For those of you who don’t know Marissa, you may know her if you’ve been a part of the Academy. We were discussing this before we went live, and from the beginning, she is an avid mentor, and she mentors on Instagram and her blog, @SassyAnesthesia. If you don’t follow her, make sure you check her out. She caught my attention early on. I was like, “I loved her style and what she did.” I could tell she has a passion for helping others equally, and not only became a strong ICU nurse. During her time as an RRNA, she was mentoring during the entire time that she was in school. She recently graduated. We’re bringing her on the show to discuss her journey.

Another thing about Marissa that you should know is that she was also providing mentorship for our academy students by doing resume edits, which I am so incredibly grateful for. She is also a new CRNA and has joined Arizona State’s Association of Nurse Anesthesiology PR Committee. Kudos to you for graduating and jumping right into the State Association. That’s amazing. We’ll touch on a little bit later for those people reading who are getting ready to graduate and are like, “How did you do that? What do I need to do to get involved?” and things of that nature. Welcome. I’m so happy to have you.

Thank you. I’m so excited to be here. It’s been a long journey. I’ve known Jenny right from the very beginning. It’s crazy to have stayed in contact with you when I got accepted into school, and now we’re here talking about life after graduation.

It’s fun. One of the most rewarding aspects of what I do is getting to follow people’s journeys. Everyone’s probably wondering what your journey was like in the beginning. How did you know CRNA was the path that you decided to take?

I knew I wanted to become a CRNA when I was about thirteen years old. It wasn’t something that came to me later on in life. I knew in high school that I wanted to be a CRNA. I went on a medical mission trip to Honduras. I wasn’t much of anything to help at that point. I just shadowed because I wasn’t even a nurse at the time. I was young. I was able to go and shadow in the operating room, labor and delivery, optometry, dentistry, everywhere.

My parents brought me along because I thought it would be helpful for me to see if I fell in love with anything there. I found myself in the OR. While everybody was very focused on the surgery itself, I found myself wandering to the head of the bed, and it is history from that point. I fell in love with it immediately. I went back the next year and shadowed the anesthesiologist again, and wanted to go into anesthesia.

I want to emphasize to everyone reading that you mentioned a couple of key things. One is the exposure. Not everyone gets that opportunity. I never would even have thought about a mission trip in high school. One other key aspect that is available to everyone, and it’s very easy to access, especially early on in nursing school, is shadowing. As a nursing student, one of the easiest and best ways to get your foot in the door is to confide in a clinical coordinator during nursing school that you want to explore the operating room and make it a point to try to get in early and gravitate towards the head of the bed.

You don’t have to say, “I’m going to shadow CRNA.” You can simply say, “I would like some time in the operating room and see what the CRNA does.” Keep that in the back pocket. For those of you reading this episode early on, that’s a great way to solidify your passion and desire. Correct me if I’m wrong, but it sounds like a solidifier in you to make this happen for yourself.

Both of my parents were in the medical field. My mom was a nurse, and my dad was a respiratory therapist and then pacemaker rep at the time. They had both guided me in the way of nursing anesthesia versus going to the medical school route. That was the only reason maybe because my mom had a nursing background that I did decide to go in that direction. I did go back and forth between medical school and nursing school, but I’m very glad that I chose a nursing school route, for sure.

Nearing The End Of CRNA School

First of all, congratulations on your graduation. That’s so exciting. I am sure our readers are like, “Let’s get into the juice. Let’s hear all of the things.” We’re going to focus this episode on the end of school. There was so much in between that I’m sure we would love to address in another episode. We’re going to focus on helping those who are gearing up for the end of their journey. That creates a lot of unknowns, uncertainties, and maybe questions. I would love to know and to start with, did you find it hard to focus towards the end of your clinical or academic time in school?

Yes. You’re going hard for so long that near the end of it, you start to get burnt out and that’s normal. Anyone who says that they haven’t gotten burnt out is lying. It’s hard and a long journey. You’re excited to get started and be on your own. It’s almost there but not quite. It is hard to stay focused. Lean on your classmates and stuff like that. Even the last six months of clinical is where it starts to kick in or set in, hopefully, that you are about to be on your own and that depends. That’s a separate conversation on whether or not you decide to go independent or whether you go practice in an ACT Model, etc.

Sometimes you’re just going so hard for so long that just near the end of it, you really start to get burnt out. And that's normal. Anyone who says that they haven't been burnt out is lying. Click To Tweet

I was going to start working at an independent CRNA-owned company and so, it put the pressure on me. There are CRNAs around to help you but sometimes there’s none, and sometimes you are the only anesthesia provider in that hospital in that outpatient center, which is where I work now. Making sure that you use the last few months of your clinical to soak up every bit of piece of information that you can because you’re going to be on your own soon. People are going to be looking at you for answer, and you’re the only one that can provide them sometimes. It’s scary.

I love the fact that you knew that going into your senior year. Did you seek out different opportunities that you may have otherwise not? Did you try to challenge yourself by putting yourself in the hard work cases or getting cases that maybe you had lower numbers on? How did you work towards making sure you felt comfortable at graduation and that you could go out into independent practice?

What was nice is that I decided to sign with the last clinical rotation that I had. That in itself was very helpful because I already knew what it was going to look like when I was independent. The CRNAs all knew me, so they would help a little bit and stand back for induction. They’d hide behind a door to make it seem like you are on your own.

You want to start feeling like you’re practicing independent. With that, I almost had to lie to myself. A good way to practice is to tell yourself that your preceptor isn’t in the room, even if the preceptor is in the room, like, “He or she’s not right there. What would you do if this happened? What would you do if she hadn’t stepped in for that spinal? What would you have said to that patient? If you couldn’t get that spinal, would you have done this?” The mindset does change once you’re on your own and nobody else in that room can help you. It’s a trip, but it’s been good so far.

I love the fact that you said to challenge yourself to act like your preceptor’s not in the room. It’s hard depending on where you get to rotate through your time as a student or as an RRNA. You may or may not have as much autonomy. The CRNAs involved with you may be a little more hands-on and that could be that site or particular people. You are going to rotate through sites where you’re going to notice the culture’s a little different, the environment’s different, and they may be like, “You got it? Good. I’m going to sit over here. You call me if you need anything.”

It can be vastly different. For me, I was at a site that was very heavily overseen. We didn’t have too many opportunities to be by ourselves, and I was there for almost 12 months of my 24-month training. It was a lot of my training. I remember feeling like, “I want to know I can do this on my own.” For those of you who were experiencing the same frustration, I remember thinking when I graduated, I don’t know if I’m going to know when to extubate someone safely because I’ve always had someone to say, “You’re good.” I was like, “Dang it, I wish I wouldn’t have been so reliant on that as a student.”

When I first started, I was like, “Am I ready? Am I going to be able to make that judgment call?” You’re ready. Yes, you can. As Marissa said, it is to challenge yourself to think, “If I had no one else in this room, would I make this call?” A lot of times, I’ll have students that I work with look up to me. They don’t even have to say anything but they look to me and I almost look away because I’m like, “They’re looking for a confirmation eyeball look.” A lot of times, if my students, especially that are seniors that are asking me questions, I throw back at them like, “What do you think?”

Not in a way that’s aggressive or mean but I want them to think through it because it’s going to help them, and I’m not always going to be there. I’m going to say to them when they’re going to extubate ask me, “If you think it’s safe, it’s your call.” I don’t know if they like that answer but I do that again, not to be mean. I want them to make the decision. If I truly thought something was unsafe, I would stop it but I want to see them struggle with the spasm. “If we have a little spasm, it’s okay, because it’s going to happen. It might as well happen when I’m here, and I can be that second set of hands to tell you exactly what are your next steps to break that.”

I love all that advice. I love the fact that you got an independent practice where you rotated. I have known students to seek out independent practice where they don’t rotate or seek it out in a way where they ask their program to potentially rotate there even if it’s not in the set rotation. Some schools have sixteen clinical sites. You maybe get put at four, and you’re like, “I want to get this one site that I didn’t get selected to go to.” Ask, you never know. They could rotate people or switch you around. Other schools don’t have that many sites, so you’re set with what you’re set with, which was my experience. Know what you’re going into as far as what are the options.

Even now, I work at a place with my first job out of school. It’s same program that I went to but different cohort meaning we had students in Toledo, Ohio, Akron, Ohio, Cincinnati, Dayton, and then Columbus. We had city cohorts within the State of Ohio while the students who were in the same program for CRNA school that were in the Toledo cohort had a different clinical experience. What was unique about that experience was that they did this all the time.

The last three months of their clinical rotation, the student coordinator would go to the student and say, “What do you need? What do you want more experience with?” They might get a 2nd open heart rotation, a 2nd OB rotation, Peds or whatever they felt they were rusty on, they now had the last three months to spend more time doing it, which I thought was cool. I’m like, “I wish I would’ve had that opportunity as a student,” but that goes to show that I didn’t know to ask, and maybe I could have. Not all sites do Peds or OB. Again, it’s the luck of the draw but know it’s an option.

You said it was hard to stay focused on the last six months. You’re facing burnout. I want to touch on that too. When you have a new student, they have a sparkle in their eye. They’re all excited. Typically, we can tell that for seniors, it’s hard to muster even a smile. I have a lot of compassion because part of me is like, “They try so hard and put a lot of effort.” They’re like, “I’ll stay and finish this case.” I’m like, “You need to get out of here.” At a certain point, depending on what is going on, do you need to pull more LMA? You could.

I’m not saying that’s probably not the right attitude that some preceptors would take, but by the same token, if it’s 4:00, and you have a senior student, I’m usually like, “Get out of here. You don’t need please LMA. I trust you. I’ve seen you perform. You’re okay.” I have students who say no, and I have students who are like, “I’ll stay.” That’s a mistake because if your CRNA told you to go, they’re not testing you. Maybe they are. You might know them better than I do personally. They might be trying to be nice, and be like, “I remember what it was like to be a student. You’re not paid.”

There are times when I tell my student, “Go,” and you can always confirm this with them too. I always say, “You can do this. You don’t need the skill because I’ve seen it done, and you’ve done it very well. Go ahead and get out of here, even if it’s a half hour early.” Sometimes if I don’t say that, what you can say back to your preceptor is, “Do you think I should stay here to work on my skills? Do you think I would find value and stay to the end of this case?” They’ll say yes or no. That’s a black and white question. If they say no, then thank them and go. What do you think about that?

I agree with you. Some preceptors are doing that to test. That’s my experience. I’ll never know at the end of the day. It also depends on where you are in your rotations. Is it your first or last rotation? I don’t know if maybe all students recognize that maybe they need more experience. There’s something to be said for that as well. I tried my best to stay. All of my rotations were pretty heavy. Some people have light rotations, and some people have heavy, mine were always five days a week, and I was there at least until 4:00 PM or 5:00 PM every single day. A lot of people sometimes don’t have that. Some people have more or less. That was my schedule.

I felt like it was decently heavy all the time, so near the end I got pretty tired. You’re tired the whole way through but near the end the senioritis is more of you want to be done and that you want to study for boards. That’s where the anxiety is starting to kick in. That in combination with feeling like you’re going to be independent soon, it’s a lot more anxiety senioritis than celebratory senioritis in a way.

I like that advice too. I’m obviously 100% don’t recommend ever asking to leave. Please don’t ever do that like, “Pull me out.” Don’t ever ask the lead because you’ve got to study. That would get you on the bad list pretty quickly. What you need to do to navigate that, because sometimes it’s unknown, is to talk to other students who’ve been to that rotation. They will be able to tell you, “This environment is you better make sure you stay to finish your day or else,” or they’re going to say, “They’re pretty laid back here. They’ll let you go early if there’s something going on.” If it’s early, maybe hang out for a little bit, offer some breaks and if you’ve done that, then they’re going to give you their blessing and get out of there.

Talk to current students and figure it out. I’m always a big proponent, even as a CRNA to do this- Before I leave for the day, I check on my coworkers. If there’s someone who I know has been stuck in a room, I offer them a bathroom break. That is the courteous way to be. I’m not saying as a student, but I’m saying, keep that in mind because you’re getting ready to graduate like, “I scratch your back. You scratch mine.” It truly comes in a big circle around. If you’re a team player, people will help you out too. Trust me. You will know the people that are not team players very quickly, and you don’t want that to be you. It’s a good habit to make.

As a senior, it’s hard because like Marissa stated, you want to study, and you’re stuck in clinical all day. You have all this stuff you have to do. You also have a potential something else you want to do for yourself like go to the gym, see your family or whatever it is. You’re underneath this pressure and watching the clock. Be careful because sometimes it can give the wrong taste in the preceptor’s point of view that you’re not passionate about it, you don’t care, you’re not present or not doing a good job. I have had students who get to their senior year who don’t do any pre-op anymore. They skip pre-op all together and that’s a big no-no.

Here’s another thing too. You will see CRNAs do this. I’m not saying this is right and not at an independent practice more than likely, but I’ve worked a lot of ACT Models, and a lot of times, we’ve relied heavily on the attending to do the pre-op because the room turnover is so quick that you don’t always have time to make it to pre-op to pre-op your next patient. You should always try.

Social Media And CRNA

Sometimes it’s walking the hallway as you’re walking back to the room. That being said, I’ve seen students, should I even dare to say, laziness that some CRNAs can adapt and that’s always going to play negatively in your favor. Remember, your time in clinical is a job interview. It’s true. Not even just for that facility but for the entire state or maybe even for the entire country. The first thing a chief CRNA will say is, “Who knows so-and-so?” and you better believe they know someone who knows someone who knows someone. It’s a small community. Not to stress you out. I hope that it wasn’t my intent, but I want to at least put the warning out there.

People should know that. Some people forget how small this community is, and they’re not aware of that. Everybody knows everybody. I felt like that a little bit more since my social media, but everybody does know everybody.

A group of healthcare workers putting their hands together for a high-five
Life After CRNA School: Some people forget how small the CRNA community is, and they’re not aware of that. Everybody knows everybody.

I can go on social media, and it’s awful.

It’s a whole other episode.

That’s the thing, too. A little blurb on this because it can be very dangerous. Posting your journey is great and that’s mentorship. I get it. You have a passion to let people see your journey, so they can hopefully follow in your footsteps. That’s a great thing to do but be so careful, especially when you post pictures inside a real operating room. Simulation lab, no big deal. There are no HIPAA violations for that. You can picture the dummy. Take a picture of his nostrils and post his name. That’s totally fine. We made the mannequin. No one’s going to care.

I see it all the time. It takes one small mistake. If I’m speaking perfectly honest, I have made that mistake and it backlashed on me big time. It takes one small nonchalant, slight oversight on your part to post something that can get you in a whole heap of trouble and kick you out of the program. It’s not worth it. Post study pictures and sim lab pictures, but be so careful about posting operating room pictures.

I don’t know if you even notice. I don’t do anything on my social media anymore in real operating rooms because it’s not worth the risk. I love my job. I want to keep it. Also, be careful what you post too as far as test pictures. I’ve seen all kinds of stuff. I don’t know who’s looking at that. Be thoughtful of who might be coming to your profile to visit. From what I’ve been told by program faculty is they tend to scope out your profile when they interview you. If they go in there and see a whole bunch of pictures, they’re like, “I don’t know if this is the best representation of our profession or humanity.” Be careful. That’s all. I’m going to leave that to you.

For anyone that’s reading, your school is looking at your profile. If it’s private and even if it’s not. If you’re friends, and this isn’t coming from me because my social media has a following, I’m saying even for people that you’re friends and family only, it doesn’t matter. You need to be friends with one person in your class that maybe doesn’t like that photo that you took at certain time of the day, and they can send that to your program director. That didn’t happen to me, but I’m saying that it can happen. Keep your social media very pure.

A group of healthcare workers sitting around a table talking about information shown on ipads and charts in front of them
Life After CRNA School: Your school is looking at your profile. If it’s private and even if it’s not, if you’re friends, or anything. Your profile affects their judgment.

Don’t mention your school’s name. That’s another big one too. It’s always best to leave that out. Even when I bring students on the show, if we’re using their name, we’re either asking permission or we’re not mentioning schools. Sometimes we use fake names because I want to protect them. I don’t want them to get in trouble. Schools all tend to have a social media policy. We’re getting totally off track, but sorry about that. It’s still worth hearing, especially towards as senior year approaches because your potential future employees could then be looking you up on Instagram.

CRNA Board Exam Prep

Let’s get into CRNA boards prep. I’m sure people who are approaching the near end are like, “How do I make this work?” Everyone’s fear is not to pass. The reality is on a positive note, it’s very unlikely if you’ve worked hard and done well in your courses in CRNA school that you are not going to pass. I have seen students make a huge mistake, which we’ll address but let’s go ahead and get into what was your typical routine, what was your study plan, and how many hours, that type of thing.

Bouncing off of how pretty burnt out I was, I knew that I wanted to take boards very early. In fact, I ended up taking boards the day before I graduated, which is the big risk there. Some people don’t even get that opportunity because it is last minute when you get your approval to test. Some people, depending on how quickly your school submits all the forms, once you’ve completed all your clinical completed absolutely everything that’s required for your transcripts, then your school can proceed to check you off to test for boards.

I got my approval to test in a very short time span. I had made up my mind already on when I wanted to test because you get it last minute. It was the week of graduation, I believe. I was studying as if I was going to take boards the day before graduation, not knowing if I was even going to get that test date. What my school did is if you got greater than a 450 on your C-Score the second time around, we got our last week of clinical off, which was awesome. I was able to do that for the C, so I got that last week off. I had about two straight weeks that I studied for boards nonstop and that was it.

We used APEX throughout our program. I was not the biggest fan of APEX and I know a lot of people don’t agree with me on that and that’s fine. What you guys need to know is what works for you. APEX, for whatever reason, didn’t completely register well for me. It was a little bit of too much information overload. I felt the questions were extremely difficult and the boards are difficult, so don’t get me wrong there.

Maybe that’s how they’re trying to prep you in that regard. I used about 50% APEX and 50% Prodigy. Prodigy is an older program, but I liked that it was almost like anesthesia for dummies in a way. It simplified things for me in a way that I understood. At the end of the day, what you study for boards, you know how you study. If APEX works for you, don’t use Prodigy. If APEX doesn’t work for you, find something that’s not APEX. That’s all you need to know. There’s no right or wrong way to do this.

I was one of the only people in my class that did it that way. Most of my class did APEX. If APEX works for you, use it. It wasn’t my favorite, that’s all. It was about two weeks and nonstop setting. I took maybe a half day off in between that. I’m somebody that I don’t like to draw things out. I don’t enjoy studying. I like to get it done. I don’t want to draw it out. I was up maybe at 6:00 AM and would study until maybe about 9:00 PM.

You didn’t go on a gym break or anything in the middle?

I would go on a walk around the block on lunch break and then that was it. That was me and I knew that was how I studied and a lot of people aren’t like that. I know people that are like that though. When you go into your study hole, you go into your study hole, and then you walk out of it. That’s how I studied.

You walk out with a unibrow, a mustache, and hairy armpits. You’re like, “I’m back.”

I made my own study guide and that helped. I did a lot of my own drawings on my iPad. What worked for me is I’m pulling from a bunch of different resources and putting it into a few pieces of paper. Whenever I would find a heavy topic on APEX and Prodigy, it was also heavy in our lectures in school maybe a year prior, and they’re like, “This is on board,” I’m like, “Red star.” I knew it was important, and so I would put everything that was complete that I had to know like local anesthetic maxes. It’s going to be on boards that you got to know.

It was on two pieces of paper on my iPad. I would brain dump everything, and it was full of information. It was a horrible two pieces of paper. It was packed with writing. I would brain dump it every couple of days. If I knew I got a question related to that topic and I blanked out, I didn’t want to have to rely on it from memory. I wanted to be able to visually see it and I could see where it was on that piece of paper, “It was in the middle and on the left side. It was underneath that flow volume loop that I drew out. That’s what it was. That’s the answer.” It was familiar to me. That was how I studied.

You must have a little bit of a visual memory then too.

Definitely visual, yeah. They give you a piece of paper on boards or it was a whiteboard. Right off the bat, once I clicked start on my board exam, I did write down a few things. Everybody does that. Maybe not everybody, but I did.

I did too. I had, like you said, some concepts, especially ones that you knew were trickier and harder that if you got questioned around that you’d want to be able to think through a little bit with whatever you had. Good job on your C because I’m pretty sure the average is more of 420-ish. Am I wrong about that? Am I remembering correctly? Maybe you had to get above 420.

A lot of schools want you to get around 450.

Back in my day, my goal was to get above a 420. Things have probably changed since then.

It depends on your school but 450 was the goal at least for now. On my second one, I ended up getting 493. I was pretty shocked. It’s because I’m thinking about that, this is something a lot of people in my class didn’t do necessarily. Take your Cs seriously. The first time around, a lot of people go in, “I want to see where I’m at.” It causes so much stress for the second C that does matter, and you want to know that you’re going to get a 450 or a 430 or whatever your school requires.

You want to know that you get that, so you’re not walking into boards being like, “Crap, I only got 415. Am I going to pass?” No. I knew that because I got greater than a 450. If you get greater than a 450, it shows that you have a 90th or 95th percentile. Don’t quote me on that, but it’s around at least a 90% chance that you are going to pass boards on the first try, which is why they use that number. You want to go into boards feeling confident because you’re already going to walk in not confident, and then I knew that I did good on both of my C exams. That was one thing I didn’t have to worry about. Study for your Cs. I see the argument, “I want to see where I’m at,” but it’s not worth it in the end.

Are you not going to study for boards because you are, so why don’t you study for your C?

The C did help me study for boards and why I felt so confident to take it before graduation is because I had studied so dang hard for the Cs.

I love that advice. That’s not a good mindset to have because again, you’re not going to wing boards so why would you wing the C. You want to have confidence like you said that you did well. It’s funny that you said two weeks. I studied for two weeks, although I took mine two weeks after graduation. My last day of CRNA school, I had a 24-hour clinical. It was literally impossible. It was brutal.

No one wanted to end at the children’s rotation because that’s where we do the call and the 24-hour shifts and, of course, I got selected, I was like, “Dang it,” but it’s all good. I survived. I remember coming out of that parking garage in the morning and seeing the sunrise and being like, “I’m done.” It was pretty cool to see the sunrise on my last day of clinical, and I was exhausted. I was like, “I’m going to go pass out,” but it was a good feeling.

As far as taking breaks or to grind it out, do all day, that is very personal. I personally liked chunks of 4 hours, and then I would go to the gym for another 4 hours. I’d maybe again do some activity around the house because for me, what I noticed when I study for that long is I tend to get fatigued to the point where I don’t think I’m being constructive. My brain gets fatigued, and I don’t think I’m absorbing anything anymore, at least not in a concrete way. Every four hours, I had to take at least a 20 or 30-minute break.

Now that you mentioned it, I did do the Pomodoro method. For people who haven’t heard about that, it’s basically your time blocking your time. I would set a 25-minute timer and I would do a 5-minute break. After a 25-minute study, 5-minute break. In the middle of the day, I would do a half-hour lunch, whatever. It is important to acknowledge like what Jenny said.

There will be a time when you feel like you’re forgetting the easy stuff, and then you’re like, “Now, I’m done.” Where people go wrong is that they continue to study. It’s because they feel like that they add on another week of study, and then they go and fail boards. I’m not saying that’s going to happen to you, but I know several people that happened to because they had studied so much. They had reserved maybe a month off after graduation and then started to feel like, “I’m forgetting the easy stuff. I used to know that.”

A nurse anesthetist reviewing information on an anesthesia machine and making notes in a patient chart
Life After CRNA School: There will be a time where you feel like you’re forgetting the easy stuff. And that is where people go wrong: they continue to study.

They would panic and then keep studying even more instead of you needing to give yourself a day off. You have to do no study for an entire day. You’ve been going for a month straight. You’ve been going for three weeks straight. They wouldn’t do it. They would go to boards, and then they didn’t pass. It is important, like you said, to recognize. When you are starting to feel that way, take the entire day off the next day. Go out to lunch even though you don’t want to go hang out with friends, even watch a movie inside. You have to change your brain in the way that it’s thinking to mix it up or you will start to forget the easy stuff that you used to know for sure.

One of the things I remember doing, too, was that I felt weird doing it because almost everyone I know would grind out and stay up late until the night before to study. I knew for a fact that I would do better on a good night’s sleep. Sleep with all the anxiety of boards. That in itself is going to be hard. I remember it was probably 6:00 PM the night before boards and I’m thinking, “I should go for another few hours.” I took a Core Concepts Quiz, which was incredibly hard like you said. I was studying Prodigy. APEX wasn’t around back then or at least it was in its infancy.

We were doing Prodigy. I liked Prodigy. I thought I had it memorized though because I had been using it during the entire program so much so that I’m like, “I don’t know if I know this or I’m just memorizing it.” I did buy other things. Back then, it was Valley and I did Core Concepts and the Core Concepts kicked my behind. It was brutal. I was in tears and I’m like, “I’m going to fail.” It was because I was taking it, I was beating my confidence with every question. I got to the end of the results and I scored 75% or 76%, and I was crushed. I was like, “My C is failing.” I saw the overall average, and I was 90-something percentile. I was like, “Shoot.”

That was helpful. I studied some last minute. They were Valley. Our program called them Golden Pearls. They were key concepts like, “How to put an OR fire and the fire triangle and all that stuff.” No joke, I had several questions on those key concepts. I called my program director the night before and I was like, “I feel like I’m ready but I want to stop. I’m done. I’m burnout. I can’t do it anymore. I need to stop,” I’m nervous but I talked to him.

Don’t be afraid to rely on your program director for that extra piece of confidence the night or the week before or whenever it is. They are rooting for you. They want you to succeed. It was helpful to talk to him too and get that extra little pep talk like, “Come on. You can do this. This is why I know you’re going to be successful. This is your C-Score. That’s your core concept score. You’ve done all these things. You’re going to be okay.” That was nice knowing that he was backing my decision on taking it and things like that.

Now that you mentioned Valley, I can’t believe I forgot, but that was my favorite. I blacked out all the boards. I loved the Valley Sweat Book , it was amazing. I probably split it in thirds. It was APEX, Prodigy, and then Valley. I read the entire sweat book. They have their practice questions on there, and you’ll definitely see some duplicates in there for sure.

You don’t have to buy all of them. I like the suggestion of at least trying one other method because you don’t know if you’re going to like it better until you at least try the thing. Don’t be afraid to invest and to try some out. I don’t know if any of them offer free trials. It’s never going to hurt. A lot of times what I would do too when I would cross cover material, like you said, certain material in Valley that was maybe OB, would be different from when Prodigy. Buy a little bit in the way they present it. It was helpful to see two different presentations of the same concepts.

What I ended up doing near the end when I had those couple pieces of paper that I combined everything in was I would go through that Valley book and then APEX. It is hard at the end because you realize that there are still differences in resources which gets frustrating. I highly recommend Valley. If your school provides APEX for you and if you are looking for supplemental information, I would get the Valley Sweat Book over anything.

Valley also, I don’t know if they still do, but they offered an in-day event where you can have like a CRNA board.

I’m pretty sure they still do.

That’s another option too. You get the book with that, and going with your classmates, it was fun. We might have had too much Christmas ale because we turned around that time of year, and I was like, “Do I remember anything?” It was fun. It was good but during the day we didn’t drink. It was only that night. We talked about board prep and you took it the day before you graduate, which is insane. That’s cool that you had two weeks prior to that. At least our program had a rule that two weeks was the minimum that they wanted you to prepare.

I know people who have done less than that, and it depends on you though. One last thing on this topic, and it’s because you know what you’ve done throughout the program and at least our program, it was the second week it felt like. They were like, “Buy board prep.” We’re like, “What? We just started yesterday.” “You got to start prepping for boards two years from now.” They mapped out exactly what you should be doing all throughout your time. Some students did it. No one was holding your hand and making sure you were doing the assignments but our program would say, “You should do X, Y, and Z amount of Prodigy every single week throughout the duration of your program.”

That’s why when I got to the end, I had done it a couple of times all the way through. It was insane. That’s why I was like, “I’m pretty sure I have this memorized.” I knew I was ready because I had already done a full board prep more than once, not everyone did that. The ones who didn’t follow that direction or that guidance were the ones in my opinion, who struggled more because now there are cramming and cramming is not effective. Your long-term memory needs time like years sometimes.

When you’re forgetting old concepts from the beginning of the program, and you’re not trying to pick it back up until the very end, it’s going to be way harder to have that recall because it’s not going to be reinforced throughout the duration. It’s something to keep in mind. Anyway, let’s talk about the time that lapsed between graduation and your first day as a CRNA. Was it the next day after graduation?

Graduation Day And Starting Your First Job As A CRNA 

No, I had to fit in some celebration there somehow but it was a quick shocker. I don’t like to sit down. I don’t know how to not do anything. It was about two and a half weeks after I graduated. Shocker, again. I was able to get credentialed quickly through this company. It’s not the company that I’m working with full-time. It’s a company, and I don’t know how to put it but they credentialed people quickly, I guess. It was for a pain center.

A lot of these outpatient centers, for people to keep in mind, you get credentialed a lot quicker than say a hospital. Hospitals, and maybe this is just an Arizona thing, but I feel like three months is pretty normal to get credentialed at a hospital. While I was waiting, I did find this company that was able to credential me that quickly, and so I started working at a pain center two and a half weeks after.

I didn’t think to look at a pain center for fast credentialing. I’m glad you mentioned that. I graduated in August and my first day of work was mid-October. I took my boards two weeks after graduation. I did have a decent amount of time and that was the starving period where I was like, “I’ve got a credit card. I can rack it up, and I can’t wait for my first paycheck.” That’s good to know.

The biggest takeaway with this is if you are going to a big hospital who’s credentialing, they’ll usually tell you. They’re pretty upfront in the beginning, “This could take up to three months.” I have been credentialed now for a locum position and that equally was torture. It was normally the process that takes forever. Anticipate that financially is my piece of advice. For me, I had run dry. All of our funds were gone, and it was an incredibly stressful time.

I remember thinking, “We’ve got to pay the bills for another month.” I wish I had planned for that better, but you live and learn. I want to share that advice. If you can save a little bit, not that you have a nest egg, but if you can save anything to make sure you can pay your minimum bills during that waiting period or ask your parents to move in with them or support you, whatever it ends up being, you may need it.

There are a lot of costs that come up, especially if you’re doing 1099, setting up your LLC, getting CPA. There are a lot of extra costs near graduation. Plan ahead for it.

Even hospitals usually have application fees that are over $100 sometimes. That’s great advice too. There are other expenses. What was your first day like as an official CRNA? Do you remember walking into the OR and did it feel different?

The first day went great. It was at that pain center. It wasn’t in an OR. It was in a small pain center. It was a small little room. It wasn’t with the company that I had clinical with. This was a new company. They didn’t know me. I didn’t know them, so I had no idea what I was walking into. I didn’t know if there was going to be three rooms or there’s going to be other CRNAs or MDs there. That’s something to be said for people who are still deciding whether or not you want to be independent or work in a supervised ACT or whatever care team model you want to work in.

Make that decision before you sign up for jobs like this because I was the only independent CRNA there. There was no other anesthetist there. There was just me. There was no MDA there. I knew that was a slight possibility going in there. I didn’t know for sure. I was hoping maybe there would be backup, but there was not. I could have asked, but I was comfortable enough to show up on that first day and go for it.

What did you do on that first day? Was it sedation for procedures?

Yes. It was sedation for epidurals, RFAs, medial branch blocks, and all those pain procedures. I know not everybody gets to experience this in school. I only had one day in clinical of doing pain before doing this. The patient is prone, but there’s no airway. It’s them breathing on their own. The fun part is that they are prone with no airway, and you have to give Propofol for most parts, unless it’s a cervical epidural in which you give fentanyl due to the location of that injection.

It was fine. I did have a couple of patients that didn’t handle the Propofol well. I don’t think it was anything that I did. Everyone reacts to sedation differently, and it’s hard to find that fine line of maintaining an airway when you don’t have one and pushing Propofol where it’s safe enough for the doctor to inject in a very sensitive location.

The needles in their back and don’t you move but you have to keep the way open.

Keep breathing.

Those are hard cases. Kudos to you. That takes serious gut. Holy moly, what a way to start for your CRNA career. That’s awesome.

It ended up being a good day. Lots of laughs were had. Sometimes pain is like that. They’re wiggling but you can’t push anymore. That’s the nature of it. It worked out well. I still do pain, so it didn’t scare me.

I was going to ask that. Do you know what I love about this? I’m reflecting on it and I like that mindset of putting yourself in the situation. I’m not saying do things unsafe, so don’t take it that way. I’m saying don’t be afraid to try new things. Don’t be afraid to do something you’ve never done before. That’s where you get the most growth. You said you still continue to do that. It was scary and challenging but that made you better for it.

Throughout your entire career as a CRNA, have you exercised that muscle? Trust me. Sometimes you’ll work in a place where they’ll ask you, “Do you feel comfortable in here?” If you need reinforcement, get reinforcement but don’t ever say no because you don’t want to put yourself in a situation of growth. I did work with people like that. I worked with people who never one, “Did they ever do a pediatric case?” They never did anything that they didn’t feel comfortable doing. You will only get comfortable doing that if you do it.

I truly have my school to thank for that and some of our clinical rotations were out of state. Every three months, it was something that was completely unfamiliar and most of them were CRNA-independent. After I graduated, I was comfortable being thrown in with whatever anesthesia. I didn’t need to ask, “What anesthesia machine do you have?” It didn’t matter because I knew how to use all of them. “What gas? What’s this? What’s that? How do you store your medications? Where’s your emergency equipment? It’s this little janky thing,” or whatever.

I’m comfortable with it. It doesn’t matter. You get used to, “Your drugs are in this little toolbox.” It’s everywhere. After having so many different rotations that were unique, some of them more rural, some of them were very established, I felt comfortable. That first day I was like, “I’m not nervous. I’ve done this before with all my other rotations.” I walked in, “Where do you keep your drugs? Where’s your emergency equipment? Who are my resources? Me? Great. Let’s go.”

For those of you, Marissa went to school in Arizona, but I’m in Ohio, and we get students from Arizona, especially when they come in the winter, I’m like, “Sorry.” Most of them have never been through a snowstorm before. I’m like, “Here you go. Tap the brakes. “You don’t hit them. You tap them.” That being said, not only is it flying out to a completely new state, but being put in different clinical settings forces you every time to know. When you are a travel nurse, you have to quickly adjust to your environment and quickly know, “What are the most important things I need to know to do my job and to be safe?”

Almost in a way that you were almost in a good position to do a role like that right out of school because seriously you get comfortable. They can get very comfortable. They’ve been somewhere for ten years, and I’m speaking for myself too. The more comfortable you get, the harder it is to break that and challenge yourself. I strive to do it. It’s not easy.

Going from, again, doing adult open heart and I did occasional Peds and some OB, but then going to a pediatric hospital and then an orthopedic center that did regional block that I hadn’t done since school. All of those things were incredibly hard and forced and challenged me to relearn again. It’s rewarding when you do that with your career. It allows you to utilize it to its fullest, which is why you went into anesthesia. It’s fun, and you get to do a lot of different things. I love that. That’s a great story. It also makes you laugh because not too many people probably tell me that but that’s awesome.

The OR was scary. I’ll touch quickly on that because that’ll probably be most people’s first experiences on their own. The OR was intimidating the first couple of weeks, being, “I’m the only one in that OR. Let me make sure I do have my extra blade and my tube.” You always do it in school, but you have your safety net there the entire time. Once you’re on your own, you’re triple checking everything. You’re like, “What am I going to do? Let me check my drawers.”

I can’t tell my preceptor like, “Can you go grab Fentanyl? There are no more syringes in here.” Little stuff like that where you’re like, “I never checked the stock of the meds as much because it was easy for me to go run out and go to the other room to get one or I’m out of glyco.” Little stuff like that you realize after you graduate, you’re like, “I need to do a thorough checkout in my room before I get started because it’s just me.”

Life As A CRNA

Don’t get too reliant on techs. Trust me. You’ll get burned. Everyone will get burned, and it’s not intentional burning. It’s not like they do it intentionally, but they’re human and occasionally don’t hook up your suction or they hook it up and don’t put the Yankauer on. You’re like, “I need it,” and then you’re like, “I don’t have one.” It happens or you’ll come in an OR and I’ve had gas left on. I’m like, “I’m sure that’s not the environment”. You’ll see all kinds of stuff. Always doing your own check is essentially what you’re saying, which I love. What are some unexpected challenges that you faced or you have faced being on your own as a CRNA?

We talked about this already. You are your own support person for the most part. In this hospital that I recently switched over to, we don’t have a float. It’s just the CRNAs are in their separate rooms. You have to think ahead and be like, “If I have an airway emergency, does my nurse know where the GlideScope is? Do they know where the LMAs are in the drawer? Do I have one pulled out already, so they can grab it because they don’t know that?” It is very independent and if I called overhead, everyone might be in a room. There might not be anyone to come in and run and help me out.

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It’s scary. Little things like when you’re in school, pay attention to how your preceptor is doing PACU orders. We never could order them as students or if we did, it was under our preceptor. Think ahead of like, “Maybe I shouldn’t order this medication for this comorbidity.” Little stuff like that which you do know about, but when it’s you and you’re the one ordering, there’s a lot more weight to it than when you’re ordering it under your preceptors. Try your best to think ahead like, “If I was ordering this under my name and something happened, I’m the one in trouble.” Understand PACU orders. That was something else that I didn’t think about too often because that’s the least of your worries.

For those of you reading this, if you have a seasoned PACU nurse too, some of those PACU nurses are knowledgeable because they’ve been around for so long. They will help you. Sometimes I even ask the surgeon too. I’ve often referred to what the surgeon typically does for certain things too. We have limited resources and I worked at a place where again, you were the only one in the operating room. You didn’t have anyone come and help you induce or things like that. You rely very heavily on your OR nurse to help you. Sometimes you have to demand their attention. Don’t be ashamed to do that. Say, “I need your full attention, please come over to the bedside.”

They’re the ones getting things for you. I remember one time, laryngospasm, for example, having socks drawn up, not just in a vial but drawn up. I had it drawn up but I had to say, “Grab that syringe. Grab Succinylcholine.” “What?” “Grab that syringe right there with a red label. Grab it, push 1 cc, 1 ml.” Don’t say 20 milligrams. “How much is 20 milligrams? I have no idea.” They don’t know. Nurses know in cc. I’ve learned now through experience, too, that usually when you’re giving direction to someone who doesn’t know a drug very well, you have to be very specific about what you need. They’re not going to convert mics to milligrams.

They’re going to be like, “What?” Make sure you understand who you’re giving directions to and being very specific about what you need them to do for you. I like my cath lab nurses, shout-out to them. You guys can hold a freaking airway because a lot of those attendings have Propofol sedation privileges, and they push too much, and you don’t have anesthesia involved. Those cath lab nurses know how to hold an airway. I knew that.

There are several times when you’re waking up and back when I worked, the cath lab was in BFE, which was far away from the main OR. Even if you had an emergency or something went wrong, you’re waiting. Even if someone ran over there, it would take a few minutes and a few minutes when you’re struggling, it feels like a lifetime.

If I had to, I’d know that they could at least hold my airway while I got drugs drawn up for whatever else I needed. Understand what the skillset of your OR staff is. Shout-out to my PAs. They can do A-lines IVs. Even the surgeons, do my A-line. If you had something emergent happen, and you need your all-hands-on deck for their airway, but you need an A-line because they’re crashing, assign it to someone in the room. If you don’t have anyone else there that anesthesia-wise to help you, you get that PA you get that attending or the surgeon to start working on it.

Especially if they’re a vascular surgeon, they’re the best. They’re going to be able to get that A-line. The same with ENTs. Airway issues, you got an ENT surgeon. Think about who’s in the room. It’s my big piece of advice. Think of who you’re with that day and what are their strengths and what areas you could maybe be more direct when you speak to them.

Knowing how to set the standard of how you are going to practice, and what I mean by that is, how you like to position your patients. If you start going along with the room as you’re new, the OR staff are going to know that, “She’s going to do whatever I ask her to do. I want to position the patient down here when they have those phone pads, and you can’t move them.” I don’t do that right off the bat. I don’t intubate my patients halfway down the bed. I don’t think it’s safe. I want the head right up against my stomach because if anything happened to that patient, what happens?

“The patient was halfway down the bed, that’s not safe practice.” “No, it’s not.” “Now I lost my job.” There are certain things that it’s like, “I’m not okay with that. The patient’s going to be up here.” As people start to work with me, they’re going to not ask me that anymore. They’re going to be like, “Marissa likes her patients at the head of the bed or she likes me right there to hand me the tube,” or little things.

If you’re a new grad, stick to what you’re comfortable with because it’s going to be safer for everybody. Don’t flow with what the OR is pushing you to do. If they’re trying to rush you be like, “I want to wait this long to do such and such,” whatever. If you set that standard early, they’re going to know how you practice. They’re going to know what you’re going to tolerate and what you won’t. That’s going to make a more comfortable environment for you.

What I’ve always found too is I try to always lead with this mindset because it helps me be very kind and courteous to everyone I interact with. That goes a long way in the operating room, trust me. When the staff is doing something that you were like, “This is clearly not safe. Why would you ask me to do that?” Nicely say, “I’d prefer them up here and here’s why.” I just tell them, and then they’re like, “I didn’t think about that.” They’re thinking about their efficiency. They’re going to have the toe task by the surgeon. They want to speed up their process. If they’re already down at the end of the bed where they want them to put their knees up in stirrups, cool. You save them five minutes instead of having to boost them down there.

That’s what they’re thinking about. They’re not thinking about, “What if you lose that airway?” That’s not their role. You have to think through that for them. That’s all about educating your staff. Some staff are very knowledgeable on that aspect. Some are not. Some will try to push the limits. They just will. It’s a matter of what Marissa said, setting that boundary and letting them know who they’re working with.

The other thing that’s also confusing for the staff in their regard is every CRNA is different. Some CRNAs will be okay with that, and they’ll be like, “Let’s do it. That’s fine.” You know what your comfort level and your skill sets are. When I make decisions, I think, “What would happen if the worst-case scenario unfolded? What would I do?” If I can think through a way that I know I can safely manage that in a very efficient manner, cool. If I think, “This is probably pushing the limits,” you might delay it. It could cause them to desat a little bit longer, whatever it is. “Let’s not do it. Here’s why.”

At the end of the day, no matter who you’re dealing with, whether that’s the surgeon himself, it’s your call. I’ve looked at a surgeon and said, “We need to cancel this case,” in the middle, after induction, and it was canceled. I didn’t say you need to cancel this case and not give them a reason. I explained thoroughly in a very passionate, disturbed, concerned way about why this needs to be canceled.

I equally had a surgeon one time- They were pounding a rod in someone’s back and practically went systolic to the heart rate of ten. I’m treating it right but we need a heart rate to circulate that unless I’m going to jump on their chest, and they’re prone. I tell the surgeon to stop, and they’re like, “I can’t stop now.” I’m like, “If you want them to live, you will. They don’t have a heart rate and my atropine is not going to circulate. I have no heart rate. I can start chest compressions. You want me to start chest compressions?” They then were like, “You have my attention.”

They came up afterward like, “I’m sorry.” I’m like, “It’s okay. You didn’t know what was going on. I had to thoroughly explain you have to stop because I can’t circulate this medication with no heartbeat.” It was one of those things where it might seem like common sense but when they’re focused on what they’re doing their surgery, they may not think about the heartbeat. Airway, breathing, circulation, that’s our job. I love all these pearls of wisdom. This is great. What would you say you enjoy the most about being on your own as a CRNA?

The first thing that comes to mind since it’s so fresh, is not being in CRNA school & that freedom. You learn so much from your preceptors, but it is nice. If you’re with the nicest preceptor on Earth, you always feel like you’re being judged even if you’re not. It is nice to finally do your own thing and not be like, “I wonder if they thought I did okay. That looked pretty good. I wonder if they saw that. I did something stupid. Dang it. I don’t normally do that but they saw.” That self-talk being gone is nice.

Not having to do anything after the hospital, and you’re home, it does get better. If you’re in school, it doesn’t. It’s so worth it. I have some free time now. I’m able to see friends again. I’m able to watch TV again. It’s a great career. The hospital I work with is awesome. The CRNAs I work with are awesome. It’s an exciting time.

Learning when you’re a CRNA versus learning when you’re in school, it’s different. The scrutiny that you feel like you’re under that pressure is lifted. I always remember this. The OB wasn’t a big deal, but I remember when I started my OB rotation as an actual CRNA, I did have to call for reinforcement quite a bit in the beginning. Once you learn how to troubleshoot OB, it becomes no big deal. The troubleshooting takes experience. It takes a hands-on experience to learn how to troubleshoot your own epidurals or spinals. Spinals were never an issue because I had plenty of those in school, but not so many epidurals.

That being said, when I started my open-heart team, I was with a CRNA for maybe a couple of weeks. This particular CRNA, God love her, she’s amazing. She’s a rock star but incredibly intimidating. She’s scary. I was never with her as a student. I didn’t rotate there, but she was intense. I feel like I got slapped back to school again. She was like asking me all these questions, and it was a reminder of like, “I’m so glad that I don’t have to deal with this every day, the way you did in school.” There is a brighter side. There is a pot of gold at the end of the rainbow. Keep climbing. You will get there. To wrap this up, is there any advice that you would give a student who was about to graduate?

Advice For Upcoming Graduates

Staying focused near the end on boards is hard. If you put in those strong couple of weeks after graduation, before graduation, whenever you have time to do that, don’t take boards unless you feel ready, obviously. When you do, don’t second guess yourself. Don’t compare yourself to anybody else when they’re taking it. If you need to come off social media, so you can avoid those, “I pass boards,” posts, do that. Only you know when you are ready. I knew 110% that I was ready to take boards. If you don’t feel like that, then maybe you aren’t ready. Remember that. Use those last couple of months to feel like you’re practicing independent.

Even if you’re not working for an independent practice, you still are going to be on your own. CRNAs are independent regardless of what model you work under. Tell yourself, “What would I do if so-and-so wasn’t in here? How would I have treated that? How did I stock my room?” everything. Practice like you are completely independent the last couple of months. Make yourself uncomfortable. Still, continue to ask questions that you may feel like are stupid.

I feel like near the end when I would have questions, I almost sometimes felt myself not wanting to ask them because it’s like, “I should know this by now you’re about to graduate in two months. They keep saying, “I’m about to graduate in two months. I don’t want to look stupid.” Especially because I knew that they were my employers at the time, they had already hired me.

Don’t be scared to ask those questions because they are going to come back. You’re not going to have anyone to ask when you’re in the room by yourself. You will, but a last-minute text to somebody that would’ve been nice if you knew it already. Don’t be as scared to still be a student up until that point, but try your best to be independent and good luck. It’s fun. It goes by quickly.

I’ll add, social can be a distraction on top of the fact that you might start facing more doubt. As far as feeling 100% ready, even if I’m not a 100%, I will never be more ready than I am at this moment. It was one of those exceptions where I’m going to go in this imperfectly, but I know I can do enough to pass. It was like, ‘I might not feel like a complete rock star, but I could at least pass this test.” That’s all you needed.

It’s impossible to know everything. That’s what a lot of people who had to retake it, that I had spoken with are like, “I don’t know everything.” You’re not going to know everything. If you did, it would take you a few years. No work, no school. As long as you know the big concepts, the ones that they keep reinforcing, you should be okay. When I mean 110%, I meant more mentally, not that I had every bit of information.

It's impossible to know everything. Click To Tweet

I want to make sure people reading that were like, “That sounds like a big thing that she does.”

You will not know everything. I did not know everything, nor did I care to know everything. I just knew that I knew enough 110%.

My other piece of recommendation too is don’t take a vacation before boards. That’s one of the things I wanted to point out. I know more people than not who if that is the case, they tend not to pass. It’s because you’ve already mentally checked out and you’re not taking it seriously.

That sounds horrible. I’d be thinking about boards the whole time. Do it after instead.

This happens more than you would think. I’ve known it a handful of times and I’m like, “Really?” They always regret it, especially if they don’t pass boards. Save your vacation for afterwards. I love homework, so don’t be afraid to ask questions even after school though. There’s no such thing as a stupid question. Even if you’ve been practicing for 25 freaking years, if you have any doubt, you’ve got to trust that gut. One of the things that you learned strongly as a CRNA is to trust that gut instinct that, “Maybe something’s not right.”

I’ve never regretted having a second opinion, meaning, “Come to the bedside. Lay some eyes on this person. Here are my thoughts. Do you agree or disagree? Why?” Not only that, but it helps you learn and grow as a provider to understand someone else’s rationale when you’re thinking through something that could be more complex.

I’ve only regretted it when I haven’t done it. Let’s put it that way. Usually, I’m like, “Dang it, I should have,” if something happens and you’re like, “I knew it, but I didn’t do anything because I thought, ‘This is on my mind or I’m not right.’” It’s hard. It’s not easy to make that decision of whether you should bring it up or get second set of eyes. I’ve never regretted asking for a second opinion on something that I’m questioning.

I was like, “Are they going to fly with extubation? Here’s why I think they might not fly. Maybe I should ask someone else if they agree before I yank the tube and now, I have to re-intubate this person. What if it’s a carotid? What if you burst the stitches because now, they’re coughing,” or whatever it is, be careful and never be afraid to use your resources. Even if it’s an app to confirm a dose, slow down. I don’t care if they’re dying. Slow down and confirm the dose.

Medical mistakes will kill them too. That’s why I always think, “They’re coding. They could die, but if I equally push too much or whatever, they could also die,” so slow down. Check your dose. Understand what you’re doing and what you’re getting ready to push and give. Communication is huge. Everyone has to know exactly what you’re thinking. Shout it out loud and proud. Deep, solid mama bear voice.

Yell it so people know to capture their attention because they’re busy doing other things. They will ignore you if you’re not being authoritative. You have to be like, “I need you now. Come jump on this chest. I’m doing this.” You have to start owning the room and being demanding, which can be fun. As a new grad CRNA, it’s intimidating. I’m pretty meek and mild as a person. I was told when I was a student that I didn’t have a big enough backbone to be a CRNA.

That was hurtful. What I will say is I can be kind. I treat everyone with kindness and respect. That’s what’s big for me, kindness and respect. I will make sure that if I need something for my patient especially, or even for myself, you’ll see me flip my switch pretty quickly and be demanding and authoritative. I’m going to be kind and nice to everyone but it’s one of those things where if you’re meek and mild, you have it in you. I know you do. You wouldn’t be going into this if you didn’t. Don’t ever doubt that. Marissa, thank you so much for sharing. This was a great episode and I appreciate you so much.

Yes, I’m so excited. Thank you.

Marissa, why don’t you go ahead and tell everyone where they can find you. Make sure they follow you on all the things.

I’m @SassyAnesthesia on Instagram and TikTok. My website is SassyAnesthesia.com.

Thank you so very much. It was a pleasure.


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