Episode 82

Episode 82: Typical Day Of A CRNA

Sep 14, 2022

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In any job we take on, we are able to work more efficiently when we prepare for it. And what better way to be ready as a CRNA than to know what to expect. Listen to Jenny Finnell as she shares insights on what happens in a typical day of a CRNA. She takes us with her as she goes through her routines and gives tips on how to better manage tasks, cases and our time to make sure that your day goes through as smoothly as possible while providing the best care for your patients.

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Typical Day Of A CRNA

Day In The Life Of A CRNA

What is your day going to look like as a CRNA? In this episode, we’re going to break down what a day in the life of a CRNA looks like from the time you arrive on your shift to the time you get to go home. Let’s go ahead and get into the show. What I would love to start off this episode by saying is that every shift’s going to look a little different. Sometimes your days are also going to look totally different, depending on what cases you’re doing, the type of anesthetic you’re going to be doing and the type of patient population can change, too.

That’s one of the perks. One of the things I love about this career is the fact that it keeps you on your toes. Also, there are some days where you plan out what you think you’re going to do, and then at the last minute, something changes, gets canceled or added on, then your day completely changes. Let’s go ahead and start with when your workday starts.

Starting The Day

Most of you are working as ICU nurses or nurses in general. You’re accustomed to twelve-hour shifts and working 7:00 to 7:00. As a CRNA, what I also love about this profession, at least from my experience as an ICU nurse, I was relatively limited on the type of schedule I could have.

I couldn’t go straight days because I had to have probably 6 or 7 years of seniority to qualify to work straight days. My options were two things, straight nights, or day-night rotations, 2 weeks on, 2 weeks off. I did the 2 weeks on, 2 weeks off for probably about a year of my ICU experience. I hated it. I was miserable. I literally thought I had a thyroid issue.

I thought I was anemic. I was like, “What’s going on?” I feel terrible and tired all the time. I had a bunch of blood work done only for them to be like, “You’re normal.” I’m like, “This is what it’s like working the night shift and rotating back and forth all the time.” My body is totally screwed up. That was my experience.

At that time, I decided to make a little more to work nights. I might as well go to straight nights. If I’m going to be miserable, whether I’m day-night rotation or straight nights, I might as well make a little bit more money and be miserable too. I decided to make more money and remain miserable. That’s what I ventured on to. I went to straight nights.

Honestly, I liked nights also because it was a little more chill environment. There weren’t that many people in and out. It seemed a little more laid back. I know a lot of you probably can relate to that. Don’t get me wrong, stuff could still go crazy. In fact, on nights, you have less resources available to you. That could be more challenging.

I enjoyed it. I liked the night shift crew. That’s what I did. That being said, as a CRNA, I felt like even from day one, even when I was a new grad, I had the option of what shift I wanted to work. I could do 8s, 10s, 12s. You don’t start off typically doing 16s and 24s as a new grad, but within six months, I did. Relatively quickly after I started, I got trained to do open hearts and then I started doing 16- and 24-hour shifts. That’s also an option. If you like straight nights and that’s how you work well, I will warn you that there’s probably not a whole lot of places, none that I even know of personally, that allow you to do straight nights.

You don’t do surgeries full staff all night long. I work at a facility now where CRNAs do a 7:00 PM to 7:00 AM shift, a standard shift that you could take. That’s optional obviously, if that’s what you want. I also think that maybe they rotate people through that, so they’re not always stuck doing that. That being said, it’s like one CRNA. It’s not like they have multiple CRNAs who are all doing the night shift. Know that if that’s your jam or your thing, you may have a harder time finding a hospital that offers that type of shift. I’ve worked at three different places and now work at a fourth place as a locum. They don’t have an in-house call. They have an at-home call at the smaller place I work.

Communication is really key in anesthesia practice. Click To Tweet

It’s not even a trauma center. They don’t usually do a whole lot during the night. They don’t need to be on call. Sometimes, when I worked at the level one trauma centers, stuff comes in. Sometimes you have crazy nights where you’re barely scraping by with the staff. You have to get everything done. Same thing with weekends. Sometimes weekends were crazy. We were like, “This is a Saturday. Why are we booking these cases on a Saturday? This can wait.” Sometimes it didn’t happen. You were running almost a full schedule on a Saturday, at least with the staff you had. You were room to room all day long.

That being said, it varies for shift work as far as what you want. The flexibility as a CRNA to do more days and to have an option between 8, 10, 12 hours is nice.  At one of my other places of employment they allowed us to do two 13s and a 14, which got them their 40 hours in just three days a week. You could still do 12s and 36s, but when you do 36s, you take a pay cut for four less hours a week that you’re working. It does seem like a decent pay cut when you graduate to being a $100 an hour provider; four hours a week does add up in your paycheck.

Clocking In

Keep that in mind. I never found a place that will pay you for 40 when you work 36, but if that exists, let me know. Ultimately, I would start my day say at 6:30. It’s usually when I can plan, 6:30, 6:45. I’m not usually arriving anymore at 6:30, but when I was new or a student, 6:30 was usually when you were in the changing room or the locker room. Now I’m usually rolling into the parking lot at 6:45 and I go into the building and get dressed. I’m in the OR by 7:00 AM. When I first started, we did clock in at my first job, but then they did away with that, which was nice.

The only thing about clocking out is if you were to stay over, you have to track that time. At one of my places of employment, you wouldn’t have to clock in and out, but if you were to stay over, you had to keep track of that and fill out a time sheet. That way, if you went over four hours overtime in a pay period, you would get paid that out, but you only got paid out if you went over four hours in the pay period. In a two-week period, if you work five hours, you get paid for those five hours. In a two-week period, if you only worked three hours over your typical set 80 hours in that pay period, you wouldn’t get paid out those three hours, which was crummy.

I didn’t like that. I’m sure that happened way more. They probably got a lot of free hours. It also equally panned out where some weeks maybe I’d get off an hour or two early. Usually, in a two-week period, it equaled out. It wasn’t a huge deal, but know that every place may be a little different. Again, 6:30, I would say, is, on average, when you can expect to start your day. Typically, that means for me anyways, with my commute of twenty minutes, which is not bad, I’m usually leaving my driveway at 6:20, sometimes 6:27, sometimes 6:30 when I’m like, “I got to run.” Usually, 6:15 to 6:20-ish in the morning, I leave my parking spot to get to work.

This is all going to look different for everyone, but I’m going to wake up a 5:00 or 5:20. Where I also work that’s an hour drive away, I’m getting up at 4:20 in the morning; I leave my parking spot by 5:15 in the morning so I can get there at 6:15 because they start their ORs at 6:30. Depending on where you work, maybe ORs start more like 7:00 AM versus 7:30 AM. In the other places I have worked, ORs typically start at 7:30 AM. On occasion, a surgeon would request a 7:00 start, but that was not common. If that was the case, you would know the night before and you have to plan for that to get there early. Where I work, that’s the 1099, the more rural smaller hospital, they routinely start cases at 7:00 AM.

Prepping For The Day

Meaning getting there at 6:30 is like getting into the other hospital at 7:00. You have a half hour to get your room ready essentially, pre-op your patient and get ready to go. I am in that parking lot at 6:15 in the morning versus 6:45 in the morning. I’d be late. Keep in mind, depending on where you work, they may start their ORs a little bit earlier than others.

Typically you have about a half hour in the morning to go to your room, set things up, look up your patient, figure out what kind of anesthetic you’re going to provide and any kind of equipment you need. You drop your drugs, check your vent, and make sure your computer’s working. You go see the patient and you assess their airway.

You ask them questions, you make sure they’re MPO, drug allergies, all the things and make sure that they’re ready to go and then obviously wait for them to see the attending. If that’s where you’re working at, if you’re working with an attending anesthesiologist, wait for them to see the surgeon. That being said, there are places depending on what your practice is like, you may be prepping your own patient, signing off on that, and taking them back to the OR.

A doctor sitting at a computer looking at it with a clipboard in his hand with a nurse in the room in the background

CRNA: When working on night shifts you actually have less resources available to you so that could be more challenging.

You may not need an attending to sign off. You may be able to pre-op your own patient and go back to the OR. It depends on your practice model and where you work. If you want to read the entire episode about that, I do have an entire episode on comparing and contrasting the differences between opt-out states, supervision or direct model of practice.

You always take responsibility for assessing and pre-oping your own patient. I also work at a children’s hospital that typically doesn’t have tons of people go into a room and assess a child because it’s going to create more anxiety for the child. We do rely pretty heavily on the attendings to do the pre-op mostly. We speak to them about any issues that we need to know about. It was different for me coming from an adult hospital where I always saw my patients regardless of who else had seen them. I always try to lay eyes on them if I have time. I’ve essentially gotten accustomed in trusting what the attending is telling me is going to be happening for the case. It works out fine.

Pre-Operations Routines

The other place I worked was a supervision model that I tried my best to get over and pre-op on because oftentimes, we didn’t have as much interaction with the attending. If I wasn’t laying a solid pair of eyes and doing a good thorough pre-op, sometimes I feel like things got missed or I had things that I needed to get addressed that didn’t get addressed.

Sometimes I’d be doing my airway assessments as they’re rolling them down the hall at night. I wasn’t a fan, but that’s how sometimes things roll. Depending on where you work, the speed and the pace can be different. When I worked at the surgery center, it was fast-paced. You didn’t have an anesthesia tech, so you were turning over your own machine, taking out your own trash and stocking up your supplies.

When I got there in the morning, not only did I have to get my room ready, drop my drug, go see the patient, do the pre-op, all the other things, but I also had equally to make sure my room was stocked for the day. Intermittently throughout the day, I’d have to grab extra supplies. It depends. Where I work now, we have amazing anesthesia techs who pretty much spoil us. They’ll do the machine check even.

Some places won’t have the techs do the machine check, but they’ll at least put new tubing, wipe down your stuff for you in between cases. That can vary. Typically, in the morning, I get there at 6:30, in the operating room by 7:00, maybe have some coffee, go to my room at 7:05 and by 7:15, 7:20, for the most part, I’m ready to go to my room. I have ten more minutes.

I go see my patient. I talk to the attending. I do any last-minute checks as far as do I have the right equipment. Depending on where you work, too, you may either go over to pre-op with the nurse to grab the patient or you may be able to wait in the room and have the nurses bring the patient back to the OR and get started. It depends on where you work and what the routine is. Where I rotate as a 1099, we are expected to go get the patient with the OR nurse. We leave the operating room, go with the patient and come back to the OR with the patient. In other places I have worked, it wasn’t as common to do that. You would essentially get to hang out in the operating room until they brought the patient back. Be cognizant.

If you’re taking an ICU patient with a giant bed that’s hard to push, even if it’s not the expectation, you go and help the poor nurse push this giant bed down the hallway. Even if it wasn’t an expectation, I do it because I want to be a good human and help my OR nurse. That being said, even though I’m telling you guys a typical routine, it depends.

If you’re going to get the patient, again depending on the case, you could give some pre-medication like midazolam or Versed to help them relax a little bit to hit the road. One of the CRNAs I trained with as a student called it roadies. I don’t know what else that could mean, but he called it roadies. For the road, roadies. I have a feeling he used it for other things, too, when he was a young college buff.

When you give yourself your own break, it really lessens the burden on the free person who's trying to give a lot of breaks. Click To Tweet

That being said, you can give them pre-medication. Be cognizant. I’ve rotated my time as a student through practices that would routinely push Versed and fentanyl. I don’t routinely do that because you don’t know how fentanyl is going to interact with a patient sometimes, especially when you’re giving it in addition to Versed.

I’ve seen patients slow down enough to where they get hypoxic pretty quickly when you’re giving both fentanyl and Versed at once. If I give any roadies, I usually stick with Versed only. I spoke too in kids. I don’t typically see the kid prior. Sometimes I do. Sometimes if the kid’s anxious, if they go to the pre-holding area, if they’re in-patient, for example, I’ll see the kid and give Versed before returning to the OR.

If they’re not in-patient and don’t already have an IV, the attending can prescribe midazolam oral that they can drink, which they sometimes spit out all over their gowns. Sometimes it works, but they take it orally, and they have to make sure they do that in enough time because you don’t have an IV. They come back to the OR and you’re doing a mask induction. Administer the IV after they’re asleep.

It depends on the type of anesthetic, the type of case you’re doing, as far as how involved you are and going back to the OR. In the adult world, I get my room ready and drop my drugs to the best that I knew was going to be expected. I’d go to pre-op. I would see the patient. I would read through the charts. Sometimes, if you have computer charting, you can read through the chart prior to going to pre-op.

I also equally would grab the physical chart and see if there are any additional things, like check for their blood band or if they need a type and cross thing. I would do my own assessment. I would do my head-to-toe assessment. I’d ask them questions. I’d see if they have questions. I’d introduce myself and make them feel more at ease. I’d also be judging and sensing how anxious they are and in baseline pain. Those two things are important.

If they’re already in baseline pain, that’s a good indication that you have to be ready to give them something sooner rather than later. I’d be planning on giving them some fentanyl prior to moving over to the bed. Also, ask them what helps their pain and what their home regimen is because it gives you a good indication of what their requirements will be for you back in the OR.

The anxiety too. If it crawls out of their skin and they’re anxious, make sure you have some Versed on hand. There are some times when I don’t give Versed. If they don’t need it, if they’re chill, especially if they’re older than 60 years old, 65, you can have spry 70-year-olds. Just because they’re 70 doesn’t mean I don’t give them Versed. I use my judgment. If they’re spry, which means lively and good shape, I’d still give it if they were anxious. If they’re fragile and frightened and maybe they have kidney disease or something like that, I don’t need it. If they’re not anxious, I don’t give it.

I don’t always give Versed. It’s not given that I give it. When you’re starting your day, you’re equally planning for what drugs you need to give, what you would avoid, what nuances of the case with the patient’s history, and what the surgeons will require. When I go to pre-op and assess my patient and touch base with my attending, I may or may not be able to physically see my attending meet, meaning he might be already prepping someone else. He might be in the OR already. Sometimes I call him if I have a question saying, “Touching base.” Other times, I have questions and I’m going to run through in my head that when I do see them coming to the OR I ask them. It depends on the importance.

If it’s important, I make sure I touch base with them sooner than later. If it’s more like little piddly things like excavation plan or post-op plan or whatever, I know I can ask them back in the room, but I make a mental note of it. Usually, you can find your attending in the morning somewhere circulating the hallways. I try to touch base with them, whether physically or on a phone call, as well as the surgeon. I like seeing the surgeon in the morning.

A nurse holding a medical mask and stethoscope in their hand while looking at a patient in their hospital bed

CRNA: Be cognizant. If you’re taking the ICU patient who has a giant bed that’s hard to push, even if it’s not the expectation you go and you help the poor nurse push that giant bed down the hallway.

That way, if I have questions, I can ask them up upfront. Otherwise, I do the same thing. If it’s urgent, I ask. I find a way to find the surgeon and ask. If it’s not as urgent, I can wait back to the OR, but I make a mental note to ask them. The OR nurses, too. I like to touch base with them. I don’t necessarily always have questions for them, but sometimes I do.

Take A Break

You take a team approach when you’re starting your day and you’re easing your day by making sure you’re communicating. Communication is key in anesthesia. That’s how your day gets started. Depending on where you work, you’re either rolling back in the OR at 7:00 AM or 7:30 AM. Some cases don’t start until 8:00 AM or 8:30 AM.

If you have an 8:00 AM start and that’s your first case of the day, well then, you’re taking your own morning break. You’re getting your own break. You’re giving yourself a check, a dot. Typically, you’ll keep track of who’s getting breaks throughout the day. You’ll have a CRNA who’s designated to give breaks, the free CRNA who could be taken at any moment for an add-on and then you have no one free to give breaks.

Sometimes that does happen too. Typically, you’re keeping track in some shape or form of have you had a break. That’s a morning break, lunch break or afternoon break if you’re past 3:00 PM. Know that the only mandated break by law is a lunch break. Know that morning and afternoon breaks are not mandated. They don’t technically have to give you a morning break or afternoon break, but they do have to give you a lunch break or you technically should bill them for that lunch break that you never got to take, FYI. Most places subtract your lunch break out of your pay, in case you didn’t know that. I went completely oblivious, thinking I got paid for my lunch break and I’m like, “I don’t get paid for my lunch break.”

I don’t know why it had never occurred to me. If you have an 8:00 or 8:30 start, then you’re giving yourself your own break. Sometimes you’re giving someone else a break. That morning break is only fifteen minutes. If you have an 8:30 start, you’re ready to go. You’ve done your break. Give another couple of breaks to your coworkers who had a 7:30 start. You can come in the room at 7:45, 7:50 and give them a break and probably have 10 or 15 minutes before your case returns. That’s the nice peer-to-peer help out when you can.

At the minimum, it’s always nice when you give yourself your own break. It lessens the burden on the free person who’s trying to give a lot of breaks. Trust me, from being the CRNA who was a free person a lot at my first position, it is hard to go around to every room and give breaks all day. Not only is it you’re thrown into a situation that you mentally weren’t prepared for sometimes, you’re like, “This is a crazy chaotic mess in here. I have to give you a lunch break.” Sometimes it happens, but it’s tiresome to give breaks all day.

When someone took their own break or even if it’s like a 15-minute, 10-minute break, it was always like, “Thank you for not just sitting in the break room for ten minutes and then still also demanding a separate fifteen-minute break.” Remember that. When you graduate and you’re a CRNA, take your break and give yourself a check if you’ve got ten minutes. That’s what I do. That helps.

Managing Cases And Turnovers

Versus, “I only have ten minutes. I won’t eat my breakfast, but I’ll sit here and then expect someone to come to get me out of my room when we’re already short staffed.” If you start your first case at 7:30, it depends, your case could be half hour, 20 minutes, 10 minutes. You’re going to be a new manipulation that’s literally five minutes and you’re done. It takes them longer to go to sleep and wake up than it does to do the actual procedure where you can go into a case at 7:30 and it could be a six-hour case or an eight-hour case. It could be the only case you do all day. It depends on your lineup for your cases for the day, as far as what the rest of your day will look like.

There could also equally be a lineup of cases, and then you could have some cancellations, but then they could shift and move things into your room to help the flow of the day go better for the rest of the staff. Things can change pretty abruptly pretty quickly. Pretty much from there, when you’re done, when you’re waking up a case, you’re waking them up.

Plan for your day as best as you're able. Sometimes you have to do what you can with the time you are allotted. Click To Tweet

As long as you’re not going to the ICU intubated, you’re extubating them. You’re taking them over to PACU. You’re giving them a report. Depending again how quick your room turnover is, you’ll either have time to run to the pre-op to see your next patient or if it’s quick and you barely have time, you may be pre-oping them as they are rolling down the hallway because you haven’t even made it back to your room yet.

You ultimately have to make sure you’re ready to go for the next case, usually before you’re done with your previous case. I often get drugs drawn up for the next case, make sure I have an airway, make sure I have the equipment I need, even before I’m even done with my first case. It doesn’t always work out beautifully like that.

If it’s quick and you’re all hands-on deck like a mnemonic where you’re pretty much masking or getting them deep. Your hands are busy the whole time. You don’t even have time to chart, let alone get ready for the next case. In those situations, I can plan for it. I’d get ready before even starting my day for the second case. If I know that in my first case, there’s going to be no time to chart and get ready for the next case, I will then take the extra five minutes in the morning and get ready for my next case before I even do my first case.

That way, you can be more quick and efficient after you’re done with that busy case and go right into the next case. You have to plan for your day as best as you’re able. It doesn’t always work out pristine, but there’s been cases or times where I’ve had to tell the OR they need to give me five minutes. I’ll come back in the room and maybe I got stuck over on PACU because my patient started having emergence delirium. I’m giving Precedex and more pain medication or whatever it is. I’m tied up in PACU, attending to the last patient for 5, 10 minutes. I closed up my chart. They’re already turned over ready with the next patient, but I haven’t gotten anything ready because it was a busy case.

I have to say I need five minutes because I haven’t had time. They have to honor that. They can bring the patient back, but I’m not going to be ready. They’re either going to get charged OR time, which is quite expensive. They’re going to sit on the cart and wait or on the bed and wait for me to get ready, or you can give me five minutes and let me turn over my room and get drugs drawn up and then I can say, “Go get the patient.” When they do get to the room, I give my full-blown attention to the patient versus trying to get everything cleaned and ready to go.

Know that ultimately the pace of the OR falls on you a lot. Not always, but it can. Equally so, you may deal with some disgruntled looks by the surgeon who’s like, “Keep the pace.” It’s always about safety. If it’s not safe, it’s not safe. You have to take your time to do what’s right for the patient. You have to. If you don’t have drugs drawn up, you do what you can.

For the most part, most of them understand. I haven’t had a terrible experience with that overall, to be honest with you. There are certain situations where maybe they give me a bit of gruff for speed at times, but other times, I can pick up the pace and they can. They can tell I can keep up, but then oppositely, if the patient demands my attention afterward, I’m going to give my all to my patient.

If it means at the expense of starting the next case on time, then so be it. My patient is my patient. I will never leave their side if they’re not okay. If I’m tied up in PACU, it’s for a good reason. Most understand that but also be quick to know that you can call your attending to the bedside and PACU. Be conscious of that as well and use your judgment of when that’s necessary and not necessary. If a patient’s critical, then you don’t leave their side. Also, in the PACU, if you have drugs readily available, like fentanyl, Precedex, whatever it is, sometimes kids can get crazy. Adults can too, but emergency deliriums are a real thing.

They could be risking pulling out IVs and harming themselves and the nurses. It’s important that you chill them out. You have drugs you can push. The nurses don’t. They’re at the mercy of what their order set is. You can titrate a lot safer and quicker than they can. If I have to give Propofol in PACU, I do. It depends. Typically, I like Precedex more than that, but if I have to give 10 milligrams, 15 milligrams, 20 milligrams of Propofol to try to prevent someone from ripping out their IV, that is what I do. The nurses can’t push Propofol. I tend to the patient as needed. I don’t just say, “I’ll call the attending over here to take care of it. Bye.” No, I don’t do that.

A nurse anesthetist looking at medications in an IV drip with other nurses looking at a patient on an operating table

CRNA: Ultimately, you have to make sure you’re ready to go for the next case usually before you’re actually done with your previous case.

Depending on what’s going on, the speed of the day is set with you. After giving a report, I typically like to go back to my room, make sure I’m good to go, and drop off my narcs if I have drugs to waste or whatever it is. At that point, as long as I’m ready to go for the next case now, and if you have an anesthesia tech who’s turned over your machine, you can go to pre-op and see your next patient. Do your airway assessment, head to toe and read through their chart. If you don’t have an anesthesia tech, now you have to wipe off your machine and put new tubing on. If you haven’t gotten stuff ready for the next case, you’ve got to get your tube, blade, oral airway, drugs, and labels. Look them up and read through their history.

That’s why you can save a lot of time if you’re doing this before even ending your previous case. Depending on that situation, you may be stuck in your room the whole time, getting ready for the next case. The OR nurse could be ready to go get the patient. Maybe you didn’t make it to pre-op. That’s okay. Sometimes that happens as long as you have what you need from the electronic chart and a good game plan as far as what you’re doing. You don’t have to always go see your patient, although you should always strive for it. I’m being realistic with you guys of what you’re going to see. That’s what you’re going to see, in a beautiful, perfect world. You’d get to pre-op and see your next patient.

I always strive to do that. Am I worth me slowing down the OR to go do that? No. If anything, what I would do is I’d grab my roadies and I’d head over there with the nurse. As the nurse is doing her own checks, I would do my quick assessment and help him bring him back to the OR. That’s what I would do if I knew I wanted to see the patient, but I didn’t have the time. As long as I was ready in the room, I would head over there with the nurse to get the patient. There’s time to get the patient and you’re still busy trying to get stuff ready and drawing up drugs. You would say, “Walk slow.”

As they’re going to take at least 5, 6 minutes with the patient, so you’ll have those five minutes to finish getting ready, you’d still have to make sure you’re ready. If that’s the case, you won’t get to pre-op the patient. When they come into the room, you can do your airway assessment. You can ask them pertinent questions. You should have already reviewed their electronic chart as long as you have electronic charting, or at that time, you would also review their paper chart.

Where I used to work, there was all paper charting. There’d be times when I didn’t have time to pre-op my own patient and they come back to the room and I’d be looking through their labs because I’m doing a spinal when I don’t know what their platelets are, and no one reported off to me. I didn’t have anyone call me and say, “Jenny, this is the pre-op on this patient.” When they rolled in the room, I had to take a minute or two to look through their chart, review their allergies, do the airway assessment, and look at their labs.

Sometimes you have to do what you can with the time you are allotted, but always make sure you do it. If that’s back in the OR, it’s back in the OR. That’s how the flow can go and how it can change and differentiate. There are other times when the turnover is so slow. Like in a robot room, those are usually longer turnovers where they’re taking down a DaVinci, which is the robot that does the surgery, well technically the surgeon does the surgery, but the robots were docked and with the trocars and stuff like that.

Those rooms can take longer than theirs. You have time to take a nice long break or give a break to a coworker who didn’t get a morning break because your turnover will be slow, so you have fifteen minutes. There would be times when, if it’s during lunchtime, I will take my lunch during that time. That way, I could check myself off again. Lunch can happen as early as 10:30 and as late as never. I’ve been offered a lunch break at 10:30 before because the day is so busy and the breaks CRNA knows that in order to get all the lunches done, they have to at least start offering lunches at 10:30.

When I know I’m the eight-hour person and I’m first out, which means that maybe you’re leaving at 2:00 that day or sooner, I’ll take my lunch at 10:30. I may not be that hungry, but I’ll eat something, even if it’s just a snack, knowing that maybe in between cases, I can grab some other snacks. That’s fine with me. You do have to be flexible.

Remember, you’re working as a team where typically when someone’s giving a break or the break person they’re looking at, “The staff is working until 7:00 PM. I’m going to probably hit them closer to the end because if they take lunch at 11:00, they’re going to be hungry by 3:00. They may not get another break until 5:00 PM.” They may not get their lunch until 1:00 or even maybe 2:00 because there are a later staff person.

When your breaks are unpredictable, it can add to your stress and essentially you can get kind of bitter. Click To Tweet

Lunch breaks depend on where you work. Sometimes they’re pretty predictable as far as you usually always get one. Other times, they’re not. It’s 2:00, 3:00, before you get a break. It may be you and your shift and you take your lunch before you leave. In some places, if you don’t get a lunch break, then technically, that’s billable hours that you should make sure you’re getting paid for. How often is that done? I don’t know.

It depends on where you work. Where I work as a locum, I legit track my hours so I would get paid if I never took my lunch, but if I was a true W-2 CRNA, and you’re not clocking in and out, or even if you are clocking in and out, you’d have to fill out a separate time sheet that showed that you should get paid for that lunch that you never got.

You have to take some initiative and make sure you’re doing that and speaking up for yourself, if that’s routinely happening to you now. Luckily, in my few years of being a CRNA, I would say in one month’s time, you might get a lunch break late a couple of times. It’s not frequent. It’s maybe once or twice a month at most. Some places could be more like once a week, though. It depends on how poorly staffed you are. Every place is hurting for staff. Nurses are not immune. CRNAs are the same. We’re weak.

Places are desperate for CRNAs. I get texts, emails, phone calls. The place I took up here on locum position, I can be PRN and locum because that’s how badly they need me. They’ll take whatever they can get whenever they can get it. They’re happy to have help. They had people retire. A lot of CRNAs are retiring in the next 2 to 3 years. This is a good time to go become a CRNA. The job market is hot right now and they can’t usually find enough staff.

That being said, depending on the staffing, your breaks may or may not be super great. One of the hardest times in my career, and it’s always been hard, I’ve had three kids now, returning to work after you have a baby and you’re pumping or trying to maintain somewhat of a pumping schedule; it can be incredibly hard and stressful.

For men reading this, please pity your fellow woman coworkers who are childbearing age. Check on them. Offer them extra breaks. They need it. They need to feed their baby. That has always been a stressful part of being a working woman. I’m also a mom. My obligation and what I want to do is I want to feed my children. The way that I know is the healthiest, that’s the best. It’s not always possible. We’ve used formula in all of our kids, but I always try. Sometimes when your breaks are unpredictable, it can add to your stress and essentially, you can get bitter. You’re like, “I hate work. My boobs hurt.”

I had a coworker who had twins. We had a busy day. This is from a place of routinely you always get breaks. It’s rare. I’ve worked there for almost two years and there have only been two days like this in the two-year period. It’s a wonderful place to work, but she didn’t get a break and she had twins. She was like, “Jenny, if you knew how painful my boobs were, I was literally almost in tears.” I can’t even imagine. It hurts. Not to mention, TMI, but you can leak everywhere. How embarrassing is that to have a wet shirt and you’re like, “No one’s getting me out so I can go to drain these suckers.”

Totally side tangent, but more power to your working moms. Women are amazing and the fact that we’re able to juggle all of that over and over again. That’s the break being a CRNA. Depending on where you work, it’s better than others. Typically, morning break, lunch, and afternoon break if you’re working past 3:00 PM. If you’re working until 3:00 PM, your lunch break is the last break. Don’t get me wrong, CRNAs notoriously use the time between cases to grab a bite to eat or take a break, depending on your room turnover. Even if you’ve had multiple breaks, you keep taking more.

If you have the time and turnover, why not? That part’s nice. You could technically have 5 or 6 built-in breaks throughout your day if your room turnover is slow. You could have an extra five minutes, but routinely, I use that time to go to the bathroom, and get a drink of water. Sometimes I’ll go and shove a cheese stick in my mouth and go back to the OR. Sometimes I take some chocolate in my pocket and I’m putting them underneath my face mask during the case, or even gum. I’ve eaten in the OR. I’ve also drank in the OR. I have routinely seen it done. Obviously, I probably shouldn’t advertise that, but if you’re stuck in a long case, you’re not going to get out.

A time sheet, binder that says "payroll" on it with a calculator and pen nearby

CRNA: Fill out that separate time sheet that shows that you should get paid for that lunch that you never got. Take initiative and speak up for yourself, if that’s routinely happening to you.

I’m going to drink some water. I’m not going to be dehydrated. Behind the drapes, no one can see me. I’ll turn my head and put it underneath my mask, take a sip, and put it back in my bag. That being said, some places don’t allow you to bring bags to the OR. At that point, I’ll hide my water bottle in one of my drawers in my vent or the bottom of my blue bell, for example. If I know I’m going to be in a room all day and breaks are scarce and that’s the way the place operates, I bring my water and some snacks. Maybe not like cheeses or anything like that, but I’ll bring candy or suckers. There have been times when I do grab little circle cheese things. I’ll bring cheese back to the OR.

Repeat Routines

As long as it goes to your mouth quickly, it’s not like you’re taking on your mask and eating a whole meal back there now. It’s more like snack stuff. I’m being realistic with you as far as what happens back in the OR. At this point, you’ve done a few cases. You may or may not have had your lunch. At any time during the day in your eight-hour day, your assignment and cases can change, but you keep doing the same thing as far as you go to sleep, you maintain the anesthetic, you wake them up, you drop off in PACU or the ICU, give report, set up your room, go to pre-op, induction, maintenance, emergence, report. Do the same thing over and over again.

Clocking Out

It’s a giant circle. However, every situation is going to be unique. Every case is going to be different, or they may be the same. You may have a lamp of AB official all day long, but I guarantee every patient’s going to be slightly different. Some patients may have a pacemaker and may need a magnet put on them. It depends. At that point, whether you’re an 8:00 person, typically, you can get relief anytime between 2:00 PM and 4:00 PM, 5:00 PM. That’s a wide range. I did a whole episode on some of the cons of being a CRNA. One of the cons of being a CRNA is an unpredictable end of shift, depending on where you work. I have worked at places that are predictable. I never get stuck, which I love.

I like a predictable end of shift. I feel like if I was supposed to be there for eight hours, I get to go at 3:00 or 3:30. Sometimes, you’re at the mercy of how they run the OR schedule. If they run it wide, you’re going to be stuck. Meaning, the eight-hour people may routinely get stuck until 4:00 or 4:30 because they want to get cases done, but then they slow way down. The 5:30 is good to go home early because they’ve run the schedule wide all day. It depends on how many add-ons happen during the day. If you’re a level one trauma center, a lot of add-ons typically. It’s usually right around 1:00 or 2:00. It’s like add-on city. You’re like, “No, I was going to get out on time and now I’m going to be stuck.”

You’d always see CRNAs hovering around the board. Another thing too, if you were an eight-hour person, they usually assign you an order out, so you’re not always stuck last out. If there are 5, 8-hour CRNAs, you’d be ordered 1 through 5. The fifth CRNA that’s eight hours would be last out, which means out of all the eight-hour CRNAs, they’d be the last one to leave. On a good day, the last one that leaves still leaves at 3:30. On a bad day, that last one to leave gets stuck until 4:00 or 4:30, maybe 5:00. That stinks. That’s why it’s nice not always being last out because then maybe the next day you’d be first out and then maybe you’re leaving at 2:00 or 1:00 to make up for being stuck late.

That’s also how the order out works. They do that with every shift, meaning 8-hour, 10-hour, 12-hour, and 16-hour. Although when I did 16s, there was only 1 of their 16. It was between one other person and me. Twenty four hours is 24 hours. You typically get to leave at 7:00 AM, 7:30 technically, but a lot of them peace out at 7:00 AM when they see their CRNA come in the building who’s taking 24-hour call. They give a quick report, and then they’re gone.

A lot of times, it’s before 7:30 or whatnot, but you’re not leaving early on 24-hour shifts. You’re not going to get out at 6:00 AM or 6:30 AM. The soonest you can leave as a 24-hour is 7:00 AM. Coming at 7:00 AM or whatever time you get there in the morning, and you leave at 7:00 AM the next day, where if you are another shift, like a 10-hour or 8-hour shift, you could leave as early as 1:00 PM if you’re 8 hours.

If you’re 10 hours, you could leave as early as 3:00 PM. After all the 8s are gone, then the 10 hours get to go home. If there’s nothing to do for the 10 hours, maybe they’d stick around until 4:00 to make sure there are no ad-ons, but then maybe they get to go home at 4:00. That’s how the shift pecking order goes as maybe you can call it. It’s nice and flexible. There’d be days where say, I have an appointment at 4:00 and I knew I had to be out at 3:30. If I was last out that day and I knew the schedule didn’t look like it would allow me to get out on time, I would trade with one coworker. I’d say, “Pretty, pretty please. I love you. I’ll repay you. I’ll scratch your back. What do you want, a massage?”

You can usually help your coworkers out and trade. What you would do is you would be first out, they’d be last out, then when the roles are reversed, when they’re last out and you’re first out, you would trade with them again. You’d repay the favor as best as you could. Sometimes I feel like it didn’t work out well. We were like, “I didn’t get a favor back.” You help out where you can as your coworkers because, again, a lot of us, especially pregnant women, have OB appointments and some of these appointments, like the last appointment is 4:00 and you’re racing across town to get to your appointment.

Get as much experience as you possibly can to be marketable and get the best jobs. Click To Tweet

You do what you can to help each other out. That explains the shift work. Depending on the day, if the day is busy, I usually get home and am usually exhausted. I’m being honest with you, guys. It’s usually a lot. You’re mentally engaged the entire time as you work as a CRNA, so it can be mentally exhausting. Other days, not so much. Other days are pretty laid back. You go home and you’re like, “I’m going to go work out. I’m going to go to the grocery store.” I often did those things anyways, because you have to, to maintain a normal life.

I clock out at 3:00 or maybe early 2:00. Now I have time to go to the gym. Maybe I wasn’t planning on going to the gym, but now that I have an extra hour and the kids don’t need to be picked up until 3:00. I have an hour to take mommy time, or maybe that was going to the grocery store. Depending on when you get out, it’s like a nice little bonus if you get out early. If you get out late, it stinks. You’re coming home disgruntled. You’re going to bed and getting up and doing it again the next day. You’re like, “I better get out early tomorrow.” I hope that gave you guys some good insight into what it’s like to live in a day of a life of a CRNA.

Keep in mind, again, as a CRNA, you can practice OB, which is labor and delivery. You can work at an endoscopy clinic. You can do a dental day, where you’re doing all dental cases. You can do open heart, general cases of any kind, ortho, urology, OB-GYN, anything under the sun. Your day by day is going to vary, which I enjoy. It allows you to pick what you like, meaning if you love working with kids and your hospital has kids, but maybe you don’t like them with kids, equally so you can say, “I don’t want any pediatric cases. I’d rather not do them.” We had CRNAs who would literally say, “I don’t like this type of case.” Don’t get me wrong. You can’t be picky and choose to say, “I’m not going to endoscopy ever.”

A true specialty, like pediatrics, open-heart, OB, you could have some say as far as whether you want to do those or whether you don’t want to do those. Some CRNAs would prefer not to do any of those specialties. Personally, I always enjoyed getting that experience because I felt like it made me more marketable and gave me better skills.

I knew my first job would probably never be my forever job. I knew that. The thought was “I’ll get as much experience as I possibly can get so I’m marketable, so I can get the best jobs. When I leave here, I will be a CRNA. People will want to hire me because I have good experience.” That served me incredibly well. That’s my recommendation. You do you. I hope you guys enjoy this episode. Thank you so much for tuning in.

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