Look into the nursing specialty of the nurse anesthetist. I got the chance to talk with this month’s Featured “Get to Know Nurse” Don Wood. Don’s a certified registered nurse anesthetist at South Broward Endoscopy Center in Cooper City, Florida. I asked him about his start in the nursing profession and what drew him to oldest of nursing specialties.
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Hosted by Jamie Davis, RN, NREMTP, the Podmedic.
MP3 Audio Podcast
Transcript of the Interview:
Jamie: Don, it’s great to have you here on Nursing Notes Live, why don’t you fill us in a little bit about your nursing background. What drew you to become a nurse?
Don: Well, my initial entry into nursing was based on some of the stuff I did when I was in high school as a volunteer fireman. At that point in time, up in Jacksonville, Florida, the fire rescue division had just become the fire rescue division, branching out from just fire suppression into having an ambulance service. As a volunteer fireman, when they expanded out into the county, I would have [enrolled] throughout the rescue units to go ahead and sort of get them directions. There was this new area and the west side of Duval County didn’t help out. Going to some of the classes they went to you could see how things were advancing. At that point in time, advanced first aid was the big thing. There were no EMTs who were out there or paramedics or anything like that. But seeing the advanced medical procedures that were taking place – airway management, IVs, that type of stuff – in my mind I was seeing the nurses would be a great addition to that type of unit they would have out there. So when I got out high school, I applied, and was accepted into the nursing program at Florida Junior College and entered that in 1971 in August. I graduated 1973 and continue to work in the emergency room and also in the intensive care unit. There were some hospitals in the Jacksonville area.
Jamie: You really got started in your healthcare career back in the days of Johnny and Roy from emergency – for those who are old enough to remember that.
Don: Very much so. That was back when they had the – it was called the LifePak/33. The “33” is because that was the designed weight for that particular portable defibrillator which is a very, very early model, they missed – it actually weighed 34 pounds. That was quite hard carrying around. But again it’s been interesting to see the development within emergency medicine, how that has gone along so far over the years. We have made a very, very big impact on healthcare these days.
Jamie: What drew you then to become a nurse anesthetist? Was it the advanced airway management? Or was it just – it is the oldest of nursing specialties so certainly it was around when you were getting started.
Don: Well, there were a few nurse anesthetists at the hospital where I was working at, that was at St. Vincent’s Medical Center in Jacksonville, Florida. I had switched from the emergency room up to the intensive care unit and working the night shift up there. Oftentimes they will go ahead and [unintelligible] the anesthesiologist to say why they hadn’t brought the patients up from the operating room. It was very fascinating for me to see the total care they had provide to the patient. And getting a taste working in the ICU a little bit more autonomy and being able to do a little bit more decision-making on our patients we had up there based on some of the advanced monitoring we were getting at that point in time. It seemed that it’s quite an interesting field. I talked to one of the anesthesiologist and spent a day with him in the operating room. I was just totally fell in love with the whole idea of providing anesthesia care. I went ahead and applied for anesthesia program – actually I applied for a couple of them – and was accepted at Richland Memorial Hospital in Columbia, South Carolina. At that point in time, they were just switching from the eighteen-month programs to the twenty-four months programs so mine was one of the newer twenty-four-month programs that I went to. I graduated from that, 1977, and had been providing anesthesia ever since then. I’ve seen a lot of changes. I’ve seen a lot of improvements. We’ve made anesthesia much safer over the years. But still I really, really enjoyed doing this job.
Jamie: What are some of the things that you enjoy most in the ways that you combine your nursing care background with the anesthesia care?
Don: Well, it happens in a very short period of time. It’s very intense. And that’s when you go in and meet your patient whether it would be a preoperative visit or when they come in to the holding area before they go into the operating room. This is a very short period of time where you need to go ahead and assess your patient. Have them gain confidence in you and be able to find out about your patient. Not only their medical problems but also their thoughts that they have, some of their fears they may have, some of the misconceptions they may have. These days quite often I’m asked what kind of medicine I’m going to give them off to sleep with. When I say “Diprivan” they go, “Oh, that’s a Michael Jackson drug.” So you can see where there’s some anxiety this built up and you have to go ahead and address that. You can’t just say, “That’s not going to happen to you.” People don’t want to brushed off. You have to address those fears. I explain to them that we stay with them the entire time. My standing joke is the fact that (1) I’m a nurse anesthetist, I’m not a cardiologist; (2) I will stay with them the entire time. That last part: “I will stay with you the entire time” really seems to hit well with the patients. They know they have somebody there just for them.
Jamie: It’s one of those things that really – I always love to talk to advanced practice nursing careers because when I interview them, I always hear the same things. That it’s those patient contact moments that really are very special. And one of the reasons I think that advanced practice nurses are so successful in building a strong patient relationships whether they’re nurse practitioners or nurse anesthetists or other clinical specialist. It’s really interesting to see how that happens.
Don: Yes. And when I worked – I did OB anesthesia for about seventeen years up in Jacksonville – that was a really big change because a lot of the people who had rotate up from the operating room, did not have those people skills because when you work in labor and delivery, now you’re not only dealing with the patient who will be awake the entire time but also you’re working with the family. And they can’t be ignored. They are part of the total picture for that patient and they want to make sure that the patient is being taken care of well. They have questions. They have concerns. And if maybe a patient was going to have a C-section, I talked to her about a spinal anesthetic. You could usually see grandma over there in the corner suddenly have the furrowed eyebrows and this questioning look on her face and you look at her and say, “I bet you’re worried about her having a spinal headache like they used to have a lot when you were having children then.” They would almost like be surprised that you knew what they were thinking. And that I could then address the problem as to how things have changed and improved and the chance of that headache is now quite a bit less and everything. It was interesting working with the entire family and quite a special time working labor and delivery. I really, really enjoyed that.
Jamie: So patient education is still really a big part of what you do in your nursing practice?
Don: Very much so. There’s a lot of people out there that have some idea of what’s happened or they have had an experience in the past and they want to know is it going to be the same. I had a patient today who said, “You know, when they put me to sleep back in 1986,” he said, “It just took me forever to wake up.” That was probably somebody who had sodium pentothal – very, very slow to wear off. Nowadays, with the propofol that we use, it has made outpatient surgery, outpatient procedures so much easier to do because the patient wakes up with a very clear head, wakes up very quickly after the procedure is over. And I was able to go ahead and explain to them that they would be talking to me in the recovery room before I could finish up my paperwork. That within probably 45 minutes they would be ready to go on home. I think that was a big difference but they weren’t expecting that because they were still thinking about that 1986 experience.
Jamie: You mentioned the difference in what we used to do versus what we do now. There’s a lot of change that has occurred over the course of your career in nursing in general and as a nurse anesthetist, what’s one of the most striking changes you’ve seen?
Don: I think probably, number one, the monitoring. When I went to anesthesia school, in Columbia, South Carolina’s big county general hospital. For thirteen operating rooms, we had six EKG monitors. At that point in time, the way we watch the patient’s pulse was we had to use a stethoscope on their chest. We have hooked in to an earpiece and you kept a finger on the patient’s temporal artery so you could feel the pulse. Nowadays, we have the pulse oximeter which is a tremendous advance. You can see things when they start to happen as opposed for waiting for the patient to turn blue or anything like that. Everybody has a CO2 monitoring. We were able to watch a patient so much closer and it’s much easier to take care of a small problem than it is to wait for it to be a big problem. The other thing is the medications we have. We’ve replaced Valium with Versed – much, much more effective amnestic. Also we replaced the sodium pentothal and some other drugs at that time with things such as etomidate and Diprivan. Again, we could not probably be doing all the outpatient surgery that we do nowadays with sodium pentothal. It just wouldn’t really work. You’d have patients who are going to have a lot of nausea, vomiting post-op and probably have to be admitted to the hospital with that. Those are probably the two biggest things I’ve seen along the way.
Jamie: What about looking forward as you look forward at the career of – the next generation of nurse practitioners? What do you see as one of the things that they will be looking forward to in their career?
Don: Well, I think nurse practitioners in general are going to be finding that their role is going to be greatly expanded. Nursing is at a crossroad right now, which I think will be a very good crossroad for nursing. In fact, nurses are considered one of the most trusted professions out there. That’s from the Gallup Poll for ten out of the past eleven years. Also we have the Institute of Medicine report on the future of nursing which is really a big push for nurse practitioners to be able to function more fully all the way across the country. Third, with the Affordable Care Act, we’re going to be having a lot more people that will be coming on in to receive health care. They’ll have insurance. They’ll be more likely to show up and receive the health care that they need as they go along the way. Those three things, I think, will really make a big push for nurse practitioners in general to be utilized a lot more. As far as anesthesia? I don’t see any decrease. We have a large amount of nurse anesthetists that are going to be reaching retirement age pretty soon. Again, I’ve been doing this since 1977. I’m one of those people [unintelligible] doing anesthesia for 34 years at this point. I’m going to be looking at retirement at some point in years coming up. And I think that as that happens, we’re going to be finding the need for nurse anesthetists who will not only stay the same but will actually increase as time goes on.
Jamie: When we talk about the need for more advanced practice educators in the schools, they’re really talking about all of those advanced practice degrees not just creating more doctorates and more educators, but really creating every branch of the advanced practice nurse.
Don: That’s correct. Again we have to have those people with the doctorate level education to be the instructors. A lot of the nurse practitioner programs are going to the doctor of – the DNP, doctorate – and also the PhD level. As anesthesia progresses, they too will advance from where they are now with the Master’s level – training being the requirement – to either a doctorate nursing practice or the PhD in order to be the entry-level for practice. We’re going to have to have the people with those degrees to be the instructors, to begin with, in order to go ahead and bring all those people along with the students and educate them to that level.
Jamie: As we wrap up here, Don, when you talk to a nurse who’s thinking about a career change into nurse anesthesia or perhaps a student that’s looking at an end-goal of becoming an advanced practice nurse as a nurse anesthetist, what are some of the advice you offer them?
Don: Number one, you need to be sure you have a good background in order to go ahead and may be looked at quite favorably by the nursing anesthesia schools. By that, I was talking about having a good two years of critical care experience. So if it’s somebody who’s already a nurse maybe they can go ahead and see about switching on over from the position they’re on – maybe on a floor, something like that – to one of the intensive care units. Working with invasive monitors and with ventilators is a very, very big plus. I work with a nurse who had been in labor and delivery for quite a few years and wanted to get in to anesthesia. She went ahead and switched on over, did some extra training, and started working at a Cardiovascular ICU. Did that for a couple of years, applied for a nurse anesthetist program; she was accepted and I believe she graduated last year. That was CRNA. She’s just practicing up on the Jacksonville area. One of the big things you need to be looking at is your invasive monitoring. The other thing you need to be looking at is the fact if it’s somebody who has an Associate’s degree you have to get that Bachelor’s degree. All the nursing anesthesia programs now require that you have a Bachelor’s degree in nursing. So do go ahead and make that commitment to go ahead and re-start your education and bring that along so that when you make that application, it will be complete. You can go in and you can get started right then.
Jamie: Great advice. You talked about just encouraging people to move forward. That’s one of the things I love about nursing and one of the things I just enjoy so much is the fact that it really has a background in mentoring, in personal contact not just with our patients but with each other and helping new nurses to come in to the fold.
Don: We really have to look at that because, again, [a lot] are retiring. I know that some people are not really fond of having students around. I look at it this way. I need to make sure that any student that they assign to me or they’re going to be in the operating room with me gets the full experience that they came there for. Number one, that person maybe taking care of me in the future and I want them very well-trained. But the other thing is this also keeps me on my toes. If I have students around, you have to be able to explain not only what you’re doing but why you’re doing that to be a good effective teacher or mentor for that person. To be able to see how they’re responding to your explanation of things. Do you need to rephrase it? Do you need to put in to a different way or with a different type of illustration for them to understand it better? When we do that, then we can go ahead and not only promote them but we’re reinforcing ourselves to what we’re doing. Why are we doing that? Myself, I’m also taking my own advice as far as advancing my training. Since I’m the [most] educated person in my family – my wife having her MBA, my daughter having the Master’s in Nursing – I’ve just gone ahead and applied and had been accepted into an RN to MSN program. So even at my age at 58, I’m going back to school to go ahead and get that extra education.
Jamie: And you mentioned your daughter. I think talking about mentoring and bringing new nurses into the career path. Not only do you do that with people you meet every day but if you have family members – I met so many people like yourself who had a child that has been inspired by their parents’ nursing career to go on into that job market themselves. Your daughter’s a nurse practitioner, correct?
Don: That’s right. She’s a family nurse practitioner. She works with an emergency room group. Just like dad, she’s a little trauma junkie too. She’s done very well with that and I oftentimes get telephone calls from her, “Hey, we’re having this problem with an airway, what do you think about such and such?” and able to go ahead and exchange things, ideas, and information back and forth on a peer level. It really changes the family conversation around the dinner table at Thanksgiving and everything. With the wide variety of people in my family that have different nursing positions and everything – my wife’s sisters are all nurses also – we oftentimes get in to some quite interesting conversations because everybody has a little different [plan] depending on their particular practice that they’re doing in nursing.
Jamie: Don, just thanks so much. You have brought so much back to the nursing profession. I know we didn’t get the chance to talk too much about your book but do you want to really quickly just talk about that?
Don: Certainly. I wrote a book called “The Intelligent Nurse.” Again, from having – being an observer of what’s happening around me in the hospitals and in nursing in general, to go ahead and try to spread out to nurses that we need to watch our communication. We need to build our communication skills, both verbal and non-verbal. Patients watch that very, very closely. They’ll believe the non-verbal before the verbal. Our leadership skills – I think we need to be training all nurses as they progress on up from the bedside on up. That leadership is a skill that they can use every single day. The other thing is, some of our marketing skills. We oftentimes don’t think of marketing as being a nursing type of skill. But we’re always marketing whether it’s good or bad. Too many times, we’re not marketing very well. But we need to be able to market not only health and wellness, how do we market that to patients, but also our profession. How do we market nursing to go ahead and encourage those that are around who may see us for them get in to the nursing profession. And lastly, for our organization, because the things that we see – when the patient says, “I went to such and such hospital,” they don’t know who the CEO was. They don’t know who the CFO or the CNO or any of those people were. But they remember: “My nurse took good care of me” or “My nurse didn’t seem like she really was interested in me.” That’s the type of thing we have to watch out for because we want those patients when they leave to be able to say, “I went to XX hospital and I was so well taken care of, if you have any needs, you should go there too.”
Jamie: It’s funny you say that. So many people don’t even remember the doctors that made rounds on them if it wasn’t their primary physician – somebody else covering on rounds – but they always remember the nurses. I’ve seen, time and again, that – there’s that little disappointment if they don’t know that you’re coming back the next day because you just happened to be [hitting] a break in your shifts. It’s interesting the types of relationships that you build with patients as a nurse. You’re so right. We really are the face of the hospital for many patients.
Don: Right. We just need to keep that in mind and not go in there saying things like, “Gee, I hope you’re night was better than my night was.” Patients are not interested by the fact that you didn’t have a good night but they want to know what you’re thinking about them and that’s probably there. That’s why we went into nursing is because we want to be able to take care of people, to provide the service that they need to become better and whether that’s just for the particular acute disease. We’re giving them the information that they need to improve their health and wellness even after they get home. I think that’s the big thing part of today, we need to be quite involved with the preventive aspect of nursing care also. That’s better and good to keep that patient out of the hospital than having to come back and see us again.
Jamie: Don, thanks a lot for joining us here in Nursing Notes Live and sharing a little bit about your career as a nurse anesthetist with our audience.
Don: My pleasure.
Jamie: Don’t forget to check out the entire May, 2011 issue of Nursing Notes, focusing on nurse anesthetists. This month’s Nursing Notes newsletter includes articles on the ways these nurses provide comfort and care to their patients, how nurses in this specialty deal with their high stress positions, and also a quick look at recent UZIT scholarship awardees.
You can read the entire issue online at www.discovernursing.com and don’t forget to catch our other Nursing Notes Live episode this month where we gathered a panel of nurse anesthetists and discussed the impact these advanced practice nurses have with their patients and changes on the horizon for them. You’ll find this and our other podcast episodes at www.NursingNotesLive.com, the Nursing Notes by Johnson & Johnson Facebook page, and in the podcast area in iTunes.