CRNA 66 | Shadow Experience

Have you already thought about what questions to ask during your in-person shadow experience? Don’t be TOO shy to ASK! Tune in to find out what are some good questions you can actually ask when shadowing a CRNA.

TODAY, we’ll talk about how you can feel more confident asking questions when shadowing, why you should still be documenting your experience even if it’s not required by your CRNA school, how to know what things you should document and MORE!

Be sure to get the FREE Shadow Documentation Form below!

01:30 – There is no such thing as a silly question. Don’t be afraid to ask!

04:46 – When is the best time to ask the CRNA you are shadowing?

09:45 – How shadowing the same CRNA can be a great way for you to establish a relationship with them and get a great reference letter in return

11:36 – Some questions you can ask – why they ask about a certain anesthetic plan, why patients are positioned a certain way and pain needs anticipation

15:05 – Writing down observations around induction and why CRNAs do certain things (taping the eyes, moving the head a little bit, etc.)

17:20 – Ask about medications – calculating fluid management, their favorite anesthetic and their least favorite, and why

21:41 – Talking about what has been the scariest thing to happen to them as an anesthesia provider

24:08 – How and why do they find being a CRNA rewarding

Grab your FREE Shadow Documentation Form here!


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Questions to Ask During Your Shadow


In this episode, we are going to cover some questions that you should be asking during your in-person shadow experience. I get asked this question a lot by people who are nervous about their in-person shadow experience and want to make the most of it but also want to understand how to go about asking appropriate questions, so they do not feel silly. I think that ultimately is what people are fearful of. They are fearful of feeling silly. First, I want to stress to you. “Please, do not feel silly. It is okay.” You do not know until you ask. If any CRNA gives you some little attitude, they are just not the right person then, in my opinion.

We have all been in your shoes and most of us are very humble, grateful, and excited to teach. The vast majority of CRNAs do not bite and we are happy to take students who want to be there to observe. We welcome you. For the most part, I have had other nurses say this, too. This profession as a whole, if you compare other nursing specialties, we are a unique breed if I say so myself. The majority of CRNAs are humble because they understand how much they worked, how hard they worked to become a CRNA, and how scared and how unsure they were about themselves. A lot of us can relate to that feeling. Therefore, we have a soft spot for people who are also now in those shoes.

A lot of us are encouraging and helpful and want to bring you into this profession. We want to nurture you and want to help you and guide you. There is no such thing as a stupid question, and I want to make sure that you feel comfortable asking questions. That is what this episode is going to be all about. You can grab our freebie, which is our Shadow Documentation. I can also have a summary of these questions for you as well. That way, if you do not want to take notes during this episode, you can get the full list of questions to ask during your in-person shadow experience, as well as the documentation part, which I am going to touch on.


Documenting Your CRNA Shadowing Experience

It is important to document your shadow experience even if your school does not require this. Some schools have their own documentation forms. If that is the case, you use their form, but if they do not, you should still be documenting your experience because it allows you to reflect on it later down the road. It also allows you to submit it as additional documentation.

It shows how robust and determined you are, especially if you have shadowed 3 or 4 times over the 3 or 4 years. It will allow you to compare your first shadowing experience documentation to your last shadowing experience documentation. I promise you, you are going to be blown away by how much more understanding you have from your first to your last.

I think that is a cool thing too. When they ask you, “Why CRNA?” You are going to have a very good understanding because you are going to be able to reflect on all your shadow experiences that you have had because you have it documented. You have it all written out. I do guide you in this shadow documentation form and on some of the things to document.

Focus on what you’re doing to avoid mistakes. Click To Tweet


When To Ask Questions

First, what are some good times to ask these questions to the CRNA? I want to also start by saying that it depends on what your day looks like. What type of case are you seeing? Are you in an open-heart case that maybe is a big case? Are you in a really fast turnover case on an ENT day? Are you in a robotics case where it is slow where you are going to have ample time to sit and potentially chat?

That depends. I also think you need to be very cognizant of what is going on at the moment. If the CRNA looks like they are thinking, doing things, or collaborating with the surgeon or the attendee, that is not the best time to ask a question because they are not going to be able to give you their full-on attention. If anything, it could also be distracting. Be aware of various times in the case and when it might be appropriate to ask a question versus not appropriate to ask a question.

I do encourage you because sometimes you are like, “What if I forget the question?” I get it. Bring a notebook with you and write the question down. When things calm down, when you feel like it is not as crazy and chaotic, then ask the question because you have it written down, so now you will remember. That is my suggestion around that. Another good time to ask questions is first thing in the morning before pre-op, not during the pre-op. I have also had students come into my room when I am trying to get ready for, say, an open-heart day. I am drawing up all my drugs, which is a lot of drugs.

They are asking me question after question; I want to answer their question, but I also want to focus on what I am doing so I do not make a mistake or I need to be quick and efficient because the case starts in fifteen minutes. There have been times when I say, “That is a great question, but I will have to come back to that.” Keep in mind that if they have to tell you that, do not take it the wrong way. Know they are doing it for safety and efficiency. They still have to make sure and keep both those things in mind.

First thing in the morning before pre-ops is a great time if they have the time. I want you to hone in on the fact that you are there to observe and write down questions. If they are drawing up certain drugs, you are not sure why, but maybe you think it is not a good time to ask, then write it down. You can even tell the CRNA like, “I have a list of questions. You let me know when it is a good time that we can talk about them.” That is cool because then, it puts it in their realm of saying, “I will let you know a good time we can chat.”

Usually, if we will induce the patient, in the meantime, you are taking notes. You are writing down your questions that you are having about the induction process or about what drugs were used or the gas. Finish the induction, get the patient settled in position, incision, and the patient is doing great; it can be a little while before you are in the maintenance phase of anesthesia. At that point, charting and then this may be, “Now, I have ten minutes before I have to start preparing for the emergence,” depending on how fast the case is. You could have 10 minutes, 5 minutes, or 2 hours. It just depends on the case.

A nurse anesthetist and other healthcare professionals getting ready for a surgery
Shadow Experience: If the CRNA looks like they’re thinking or doing things or collaborating with the surgeon or the attending, that’s probably not the best time to ask a question because they’re not going be able to give you their full attention.

That is the moment where it would be easier for them to answer your questions on what I call the maintenance phase of anesthesia. If it is a fast turnover room where you induce, go to sleep, and then wake up, you may not have time to answer a lot of questions until a lunch break or at the end of the day. Just be aware of that.

Also, you can ask for certain cases, meaning if you have the option to pick what case you want to observe and you know are going to have a lot of questions, ask for a robotics room or let the anesthesia provider who sets you up for the experience know like, “I would love a day that I could have more time to ask the CRNA questions, so if you could put me in a case that you think would be a little bit slower, that would be more beneficial for me.”

If maybe you have already seen a few slow CRNA days and now you want to see a rapid day with a CRNA who is doing twelve tonsils, you can ask for that experience. Know that if you are picking a room like that, you are not going to be able to have a lot of time for questions other than first thing in the morning, during lunch break, and after the day is done because the CRNA is going to be chasing her or his butt the whole day to keep up. Those are some tips for when to ask questions.

Other tips are waiting for the patient to enter the room once the CRNA seems like they are ready. As I said, not while they are actively getting things ready, but if they are standing there and they are still waiting for the patient to show up and you feel like, “This CRNA is just killing time.” That is a good time to start talking to ask any questions. I mentioned the maintenance phase of anesthesia. If you are prompted, that is where it is nice if you say, “I have some questions. You let me know when it is okay to ask these questions or when it is a good time to discuss,” and then they will prompt you. They will say, “What questions do you have?” They will tell you when it is okay so that you can rely on that too.

The end of the day is a great way to share your big takeaways, what you gathered out of the day, and also make some connections, so hopefully, you can come back and chat with them again. Get their number and their email. It is a great way to try to establish that relationship. I do think it is cool if you are able to get in to shadow the same person more than once, especially if you end up needing a CRNA reference for CRNA school.


References For CRNA School

If you know that ahead of time or if you know you need a CRNA reference for CRNA school, start building that relationship early and try to come back and shadow the same CRNA multiple times. You are going to have a killer reference letter versus picking a CRNA that you only met for two hours once and asking them. They are not going to know you as well.

It's pretty cool if you're able to shadow the same person more than once. Click To Tweet

If you have been in there and you shadowed the same person 3 or 4 different times, you got to tell them your background, your story, who you are, and why you are pursuing CRNA. They are going to be able to make that reference letter a lot more personable. Keep that in mind when you are seeking out shadow experiences and do not feel bad if you do not have that. It is okay. Always do the best you can. References do not make you, but they can break you. It does not really matter. 99% of candidates have great references, but the 1% or 2% that do not, that makes you like, “That is a big red flag.”

The reference is not going to get you accepted. It is just a hoop you have to jump through. As long as it is not a bad reference, like someone saying, “I do not recommend this person.” it is going to help you, but it is not going to be the end all, be all. Having a great reference letter that is very personable is going to stand out to the panel, but a lot of times, it comes down to your interview along with other things as well.


Questions To Ask When Shadowing

Some examples of things to ask: Maybe ask the CRNA why they chose a certain anesthetic plan. Was it related to something in the patient’s medical history? Do they have heart issues? A history of a stroke? Are they a smoker, asthmatic, allergies, liver disease, kidney disease, etc.? Is it based on the patient’s medical history and why that is? You chose to do a mac versus a general and why, understanding why they pick certain drugs, plans or certain types of anesthetic.

Maybe they did a TIVA. If you do not know a TIVA, you can look it up, but I will share it with you right now. It means Total IV Anesthetic. All it is is propofol and Precedex. If someone is doing a TIVA, Total Intravenous Anesthetic, it means that the patient typically has a history of postoperative nausea. Sometimes we have done it where patients have had a recall but that is not very often. I have done it before on top of having some gas because, for whatever reason, they have had recall issues with anesthesia. Hopefully, I am not freaking people out. It is so rare. It is not common.

Usually, when you ask about a recall, they remember waking up on the table. It is not in the middle of an open abdominal case. They tend to remember when they get lighter, they are waking up and they hear the surgeons talking, or they are still suturing a little bit and closing the patient. That is when I think the majority of recall happens when people lighten you up because you are waking up. The surgery is done, but are they still suturing? They might be, but you can get sutures in the office too. Why they picked a TIVA versus a general, etc.?

Maybe ask about positioning like, “Why would you position a patient this way, or what are some things you had to think about because you had to position this way? I noticed you took some extra time and padded this, why is that?” The CRNA can explain to you about the brachial plexus and how you have to pat it and protect it. Why do the arms need to be supinated? Things like that. Asking about why patients are positioned a certain way and maybe some of the effects of that would be a cool thing to understand.

A surgeon putting stitches into a patient
Shadow Experience: The end of the day is great because it’s a really great way to share your big takeaways, what you gathered out of the day and also make some connections.

Anticipating pain needs, how do they understand what the patient needs as far as pain needs? Sometimes, patients come to you who are already routinely taking narcotics. That goes into consideration when we are thinking about post-operative pain. The case itself goes into consideration as far as how much pain.

Some procedures are just not painful, especially if they can localize well. They are not going to be painful afterward. Other cases are excruciatingly painful, so how do you handle that? Also, keep in mind that you do not want to over-narcotize your patient because you need them to be breathing without a tracheal tube in their mouth at the end of the case.

Maybe they will use low-dose ketamine or they will use remifentanil for the majority of the case, but it is not a lot of post-operative pain needs where they cannot have them move at all and they cannot paralyze them, so they choose remifentanil. Why is that? It will allow you to have these open discussions about what technique they are using and how they are planning on not only handling the inter-operative pain control but also post-operative pain control.

How do they gauge the patient’s needs when the patient cannot tell them they are having pain? That would be a cool conversation to have with the CRNA. I would encourage you to write down your observations with induction and have questions around why they did certain things like, “What is the purpose of taping the eyes? I noticed that you moved their head a little bit. Why did you do that?”

They can explain how they get the review of the cords. Hopefully, you will get to see the cords. They will bring you over and allow you to look down and see into the cords. Whether they style out of the two or did not style at the two, they use a Mac blade or a Miller blade, maybe they use the bougie or GlideScope.

Asking them questions about why they chose certain things will allow you to have a better understanding of why we do what we do. You might watch them push the induction drugs, but you watch them chase with Neo-Synephrine or they did not do that in the prior case. You can ask why they anticipate needing to do that for this patient versus the other patient.

Always do the best you can. Click To Tweet

Being observant, taking notes and asking things like this: You observe the fact that the patient bottomed out their pressure or they got really hypertensive. Asking questions around like, “I noticed when they did that, you did this, you turned up your gas, you gave more propofol. You gave some ephedrine and some Neo.” Start asking questions around how they anticipate those needs and how they know how much to give.

Future CRNA, if you have been around for a while on this show, you have probably heard me talk about the importance of documenting your shadow experience. Some schools will provide you with a shadow documentation form for you to fill out while others do not. I do believe it is important to document your shadow experience from the very first time you step foot in the OR.

This will allow you to see your growth over a period of time. It also allows you to submit additional documentation with your CRNA application, which will show persistence and perseverance throughout your journey to become a CRNA. I have created a free Shadow Documentation form for you to use. I hope you grab it. Cheers to your success!

Medications are always a great thing to ask questions about; why did they use the different medications they used? Maybe they are giving some hydralazine at the end of the case, and you could say, “Why would you pick hydralazine over labetalol, Lopressor, esmolol, or any other medication that can control their heart rate and blood pressure?”

Asking these types of questions as far as why they picked a certain drug, “Why did you pick Cleviprex over Cartine? Why did you pick ketamine over fentanyl? Why did you pick etomidate over propofol?” I do think it is worth your time to understand the typical drugs used in anesthesia so you can ask these pertinent questions, but also ask lighthearted questions, such as “What is your favorite type of anesthetic to provide and why? What is your least favorite anesthetic to provide and why?”

I promise you, we all have our least favorite and our most favorite. It is interesting to hear the why behind it. I guarantee you will, hopefully, get more than one shadow experience and you will probably find that all CRNAs are a little different as far as what they like to do. It is just a personal preference, but it could be very insightful because it will allow me to say, “Interesting. I think that I would agree with that. I do not know if I would like it as much because of that reason as well. That is what I do like. They do not like that but I do like that.” There are some CRNAs who love neuro. I do not like neuro, but asking why they do not like neuro. For me, I do not like them being 180 degrees away prone.

A person writing in a notebook with a laptop nearby
Shadow Experience: It’s important to document your shadow experience from the very first time you step foot in the OR; this will allow you to see your growth over a period of time.

I think brains are just gross. The whole taking the skull off is just not my cup of tea, but open-heart is amazing. First, the head is right by me and they are supine. I feel like I have more control. That is a control issue. That is why I do not like neuros because I do not feel like I have as much control. I do not like them turned away. It is fine, but you have to be very vigilant and diligent in making sure no one extubates your patient. It can happen. The tubes are hanging everywhere. It can be, for me, another added level of stress because I am always paranoid about it.

“Extubate my patient prone and Mayfield tongs 180 degrees away.” What would you do? I would go get the glide and re-intubate them as quickly as possible. You can try to supine them, but by the time you do that, they are going to be blue. That could be a story for another day and I am sure it has happened before. What are some considerations when waking this patient up from surgery?

Every surgeon is like, “You have a smooth emergence, please. No bucking.” That is much easier said than done. Some cases are much more vital than others, like a carotid, for example. You do not want to have a giant hematoma because if they do, it could compromise their airways. Not to mention bleeding from their brain, two bad things versus a lap-appe.

You do not want them to cough but it is not going to compromise their airway or their profusion to their brain or a thyroid. Another same thing- you do not want those to cough because you compromise their airway and bleed. Those types of emergencies can be very different in the sense that what precautions are you going to take and how pertinent is that you do not have that patient cough at all.

Neuro cases are the same thing. You do not want a neuro patient to buck, cough, and get hypertensive because now they could bleed back into their brain. It has happened to me. It was not because they were bucking, but they woke up and their blood pressure exploded really quick despite medication on board.

They bled, had to go back to CT and go back to evacuate the hematoma. It was a lot but the patient was fine. These types of things can happen. Taking extra precaution in how you wake those patients up is key. Asking and talking that through with the CRNA would be helpful. How much fluid do you give and how do you know how much to give? How do you calculate fluid management in a patient? How do you calculate insensible loss? How do they go about that for certain cases if certain cases have a more insensible loss?

References don't make you, but they can break you.” Click To Tweet

A big abdominal case with GI guts everywhere, they are going to have more of an operation going on than a little elbow fracture. The GI case would require a lot more fluid than someone having a fracture done. What is the scariest thing that has happened to them as anesthesia providers? I think this is really a unique question to talk through because all CRNA providers will have these moments of like, “This was when this went down. This is what I did. This was probably the scariest time.” I have had multiple scary times in my profession, but definitely, a small handful stands out to be the worst. I would love to talk to a student about that, how I handled that, how I went through that, and even how I handled having a patient die. It does happen.

I think in the realm of the ICU world that you are used to, you see death all of the time. You do not see death all the time in anesthesia. Thank goodness. Otherwise, no one would want to go have surgery and go under anesthesia if everyone died. 99.9% of the time, anesthesia is a very happy place and rewarding career. You are essentially removing the suffering from patients versus watching them suffer as you do in the ICU. Do not feel like you are going to see a lot of patients die because you do not, but it would be nice to talk to a CRNA about that, how they handle that, and how often they have seen stuff like that happen. It will give you a good idea for your own understanding of what you can expect in this career.

All of this is the reason for your shadow experience, so you can gauge whether this is the career path for you. As I have mentioned in other episodes, sometimes, students get into anesthesia school and clinical and are like, “This is not what I expected. I do not want this. I am out.” That is not a good place. You do not want to be there. Your shadow experience is to determine not only do you understand what you are getting yourself into, but do you want it? Do you want this for yourself?

If you go into your shadow experience, get goosebumps, get all excited, and you are like, “I want this even more now,” then you know this is for you. You’ve got to give it your all. Give it your best effort to get into CRNA school because if you do not have that goosebump passion drive to pursue this, things get rough, you get a rejection, or you have a setback, you are going to need the pull from that intense passion and say, “No, it is not never. No, not yet. I am going to keep going. I am going to figure this out. I want this.”

I encourage you to shadow to get that passion and that fire within you so you can persevere, not just to get in, but all the way through the end until graduation day. You want to understand what this profession is about and see if it is a good fit for you. You can ask why do they find this career rewarding and where do they see themselves in ten years? Have they worked any other anesthesia jobs? These are all really great questions because you are going to get some insight as to how and why they find this career rewarding for them.

It is funny, my reward in my career has shifted throughout my years as an anesthesia provider. When I first started, the reward for me was getting tons of experience, getting my hands in everything, seeing it all, and getting some really good experience. That was what I wanted. I found that rewarding, exciting, different, and challenging. I thrive and I still do enjoy a variety.

a person holding a smiley face sign
Shadow Experience: Seek out experiences that bring you satisfaction and joy. See how you can improve your skills.

I still do enjoy being challenged. I do think that is a big part of why I chose to become a CRNA, but once I started a family, now it became about, “How can I make this career work for my life, not the other way around?” Meaning I want to work so I can live, not live to work. My priority now is family and being home. That is what I want, so then it became, “How can I make this career flexible, so it fits my life?”

I have also found a lot of reward and satisfaction with that because I have a very flexible job. I have a lot of opportunities that exist. There are so many opportunities in anesthesia, you just have to look and network. The big thing is networking and professional advocacy within this profession. I promise you, it will unlock doors that you never knew existed. Network, go to state associations and the ANA.

Not only is it good for our profession, that you want to support your own profession, but it is a great way to network. Where do they see themselves in ten years? Retired or they are like, “I do not even know where I see myself in ten years. I am still providing anesthesia. I do know that, but am I going to be at the same job? That part, I do not know. Knowing how I am and how I crave for variety, I may want something else.”

The thing is, I would never limit myself to do the same thing forever. Complacency is definitely a word that I try to avoid. I like to challenge myself. I want to seek out experiences that bring me satisfaction and joy. For me, that is a variety and pushing my limits, seeing how I can be a better provider, learn, and keep improving my own skills. That is what I always strive to do in my profession, whether that is education, clinical skills, or just professional development. All of those things. For me, I find it very rewarding to always push forward, see how I can give back, and how I can give to myself.

Ten years, I do not know, but I know these are things I am interested in. I am going to always challenge myself to do more with those things. Have you ever worked in an anesthesia job? This is interesting because jobs are all so different. I have only had three, not that I have had a lot of different jobs in my years as an anesthesia provider, but they are all different and positive and negative for their own ways and reasons with different staff and surgeons. It is very unique. Unique is how I felt as far as was it for me or was it not for me?

You are never going to find a place that is 100% perfect. I will say that. You are always going to have some things that you are like, “Can I deal with this? Am I happy enough overall to where I can put up with some things that I necessarily do not like?” it is impossible to find a place that everything is pristine and perfect. It does not exist. Perfection does not exist, but you can pick and choose what is important to you and go from there. That being said, I respect all the different places I have worked for their own reasons. I have learned a lot from all of those places. I am grateful and thankful for that.

It was one of those things where you just always have to come back to a place of gratitude even if you went to a place where you did not thrive. Maybe you were like, “This was not for me.” That is okay because it is not meant to be for everyone. You are your own person, but having respect for your coworkers, the value and the training they provided you, the comradery, and the friendship is something that you are grateful for. You will always have that as a part of you and your experience will always exist.

Make sure you are always leaving a position with good intentions with the right mindset, knowing that you did, even if it was not for you, you did walk away with so much and you have so much to be grateful for. The fact is that, as a CRNA, you have so many options as far as various careers and different places to work. That in itself is a huge blessing. You will never be stuck in a place where you are not happy. Other people will thrive in that environment. Maybe it is just not for you.

I hope I can leave you guys with that. You have so much to look forward to. This career field is so vast. You can find so many things to do, whatever piques your interest. For me, I wanted to do open-heart right away, so I did that. I wanted to do OB, so I did that. I wanted to work with peds, so I did that. I wanted to learn how to regional, so I did that. That is what I am saying. I am always like, “What do I want out of my career? I will find a way to make it happen.”

You have the power to control the experiences you get as an anesthesia provider. Your future is bright and thank you so very much for tuning in. Be sure to grab your freebie Shadow Experience Documentation along with a summary of different questions you can ask and different tips for your in-person shadowing experience. I will see you next time. You guys take care.

Future CRNA. As always, I appreciate you and your loyalty. Thank you so much for tuning in. I would love to hear from you. Screenshot this episode and share it with your IG Stories with your biggest takeaway. Do not forget to include the hashtag #CRNASchoolPrepAcademy. Stay strong and I will see you next time.


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