We explore nurse anesthetists, the oldest recognized advanced practice nursing specialty this month on Nursing Notes Live. In this episode of the podcast, I got the chance to sit down and interview nurse anesthetist Kenneth Wofford, assistant professor in the graduate school of nursing and nurse anesthesia program at the Uniformed Services University of the Health Sciences in Bethesda, Md. Here’s that interview with Kenneth.
Jamie Davis: Ken, welcome to Nursing Notes Live. It’s great to have you here on the show. I’d like to start off, first of all, by thanking you for your service in the Navy as a nurse and to our country.
Kenneth: Thank you. It’s been a pleasure.
Jamie: Let’s start off and ask you, first of all why you wanted to become a nurse?
Kenneth: Well, for me, it’s a very natural transition. I joined the Navy back in 1992. I came in as a hospital corpsman, actually, as a medic. At that time, I was looking for future opportunities to expand my skills and get an education and I had met and worked with nurses in the course of becoming a corpsman. I had seen what they do and found that to be pretty fascinating. Certainly it’s a job that offers a lot of value to you as a person. There’s no wondering why you go to work. There’s no aspect of futility to it. Every day is very rewarding.
Jamie: Great. It’s interesting. I actually as well started in the civilian sector as an EMT and then paramedic before I became a nurse and had much the same thoughts as I was interacting with nurses in the capacity of bringing patients to the ER and things. I really saw that they had a purpose and a sense of calling that I didn’t see in other professions necessarily.
Kenneth: The other thing about nursing that you realize as you start to look into it is that it’s usually broad. There’s room for almost everybody within nursing. If you like computers, we have nurse informatics folks. If you like kids, we got nurses who do primarily with pediatrics. If you don’t like hanging out in a hospital, we have Community Health Nursing. So there’s room for almost any preference for work environment or work style within nursing as long as you have that core commitment to help others.
Jamie: You’re a nurse anesthetist now and educator. I’m curious if you can just kind of go over the path that your career took that drew you to becoming a nurse anesthetist?
Kenneth: Well, for me, I was an ICU nurse for four years. And I became a CCRN, a Certified Clinical Care Nurse. The parts of that job that I really found the most fascinating was the Systems Analysis piece of it. You would take care of people who are basically have malfunctioning physiological system. On a day-to-day, hour-to-hour, minute-to-minute, you would have to try to figure out what was not working properly in the system and will apply the appropriate interventions to try and restore homeostasis, keep them alive for another few minutes, another hour, another day until they could heal enough to get better, get on their feet and get out. As I started to look at the pieces that I enjoyed versus the pieces of it that I found a little less feeling at a particular job, really anesthesia offered me a chance to do the things that I really found the most fascinating about it. That chance to be able to look at and analyze systems and intervene and do all that work in a very short time span minus a lot of the other things that I was not as fascinated in the ICU such as the administrative aspects and things like that. From there, the other part about being in anesthesia, they really value the autonomy. We take care of patients in collaboration with our surgical peers and in collaboration with other anesthesia professionals. So really it’s you who make your own decisions. You choose how you’re going to take care of them. What pharmacology you think would work best for a given situation. So you look at the patient and you look at their history and you make a decision about how you’re going to care for him and you get to see like in real time how your plans work out and then adjust on-the-fly to give them the best possible experience, the safest possible experience.
Jamie: Now I have heard some of the other nurse anesthetists that I interviewed in the panel discussion recently talk about CRNA is really the future of anesthesia care. Do you have any thoughts to share about that?
Kenneth: I think in a lot of respects that is true. Now there is certainly room for other stuff as an anesthesiologist, with anesthesia care, but what you’re seeing now is the tendency for the anesthesiologist to move more towards a role as a broad-based very diverse critical care manager, if that makes sense. That really manages the patient from the emergency room to the surgical experience and all the way through their critical care recovery kind of area. And so that’s a niche that they feel very well. As far as caring for patients in the actual surgical setting, CRNAs do that just as well as the anesthesiologist does at a lower cost and with just the same patient outcomes, the same safety and so on. So why would you not use us is always the question if we can do that piece of job just as well. Which is not to say we couldn’t fill the other pieces with additional preparation but that is really the niche that things are moving towards as our team-based care evolves.
Jamie: Definitely. Now you also are an educator and I understand you primarily worked with the people that are in the military at this time?
Kenneth: That’s correct. Yes.
Jamie: Okay. So it’s kind of a different aspect. I’m curious, do your students come in more prepared in understanding the different specialties of nursing or do you have to explain nurse anesthesia to them?
Kenneth: No, not at all. Well, for nurses, the Master’s degree and now the Doctor of Nurse Practice is always in the practice level. So when a student shows up to become a nurse practitioner or a nurse anesthetist, they already know what nursing is about. Our average student has spent somewhere between four and eight years practicing as a registered nurse prior to coming here. The application system for students who are interested in becoming nurse practitioners requires them to do things like shadowing of nurse practitioner of the specialty that they want to join. Actually showing up and being in the environment that they want to work to. So they really have to understand what they’re getting into, what the actual job will be like once they graduate. So I think in some ways the difficulty of the courses sometimes catches them unaware because you can tell somebody about it but you can never appreciate until you’re here. But they do most definitely know what the job is about when they show up.
Jamie: So do you get common questions or concerns as far as students looking and going into this type of practice? Do you get people before they apply to this particular specialty talking with you about is it right for them?
Kenneth: Yes. I certainly do. Those are conversations that – if a person comes to me and ask for a recommendation, there’s conversations that I have with them to make sure that they’re in the right head space and they’re wanting to do it for the right reason. Of the nursing profession, it is fairly lucrative. We are well-paid but the pay is for a reason. It is because you carry absolute responsibility and we require to make decisions very quickly sometimes on very limited information. So the reason you get into it is because you enjoy that kind of work. Because the extra money is suddenly not worth it at three o’clock in the morning when you happen to make really hard decisions without a lot of backup.
Jamie: Definitely. Your students come to you in your particular setting really well prepared at least as far as their critical care background and their preparation for picking a particular specialty. But I’m curious as well, what kind of things do you recommend to someone maybe that hasn’t reached the point where they’re applying yet but they want to develop the skills for becoming a nurse anesthetist? Are there particular skill sets as a nurse that they should focus on? Is it communication? Is it focusing on their anatomy and physiology? Is it developing assessment skills? Is it a combination of all of that?
Kenneth: Yes, it’s really a combination of all that. Before I had applied I had been fortunate enough to work in some big ICUs relatively briefly. But then I spent a lot of time actually in community hospital ICUs where we took care of patients with only an attending physician as back up - no residents, no other trainees - and because of that, we had to learn a lot of independent thinking. Because if you were going to – when a patient’s condition started changing the expectation was you had already done some preliminary investigation and then when you would actually call whoever their attending physician was you actually already had all the information they needed to make a decision. You are actually prepared to make some recommendations. Because of that, you have to develop your assessment skills. You have to develop critical thinking skills. You have to develop teamwork skills in the respect that you knew where some of the boundaries were with different people. As nurses, you have to work together because I may not know something but my partner on the floor might be able to help me. So I would consult – jokingly speaking - consult with them saying, “Hey, have you ever seen this before? What do you think we should do in this situation?” And it’s really a combination of all those things together. The most essential piece for anesthesia that I would say are assessment skills, firm understanding of human physiology and pharmacology and then critical thinking, the ability to look at a complex system and sort out what parts that are actually working, what parts that are not working. And really those skills are built in the ICU especially ICUs that give you both exposure to relatively big cases and give you some autonomy to manage them.
Jamie: I’ve interviewed quite a few military nurses. I think you’re my first Navy nurse though. There a lot of nurses, new nurses, entering the job market right now and some of them are considering a career in the military as a nurse. What would be your thoughts for them? Are there things that they should be thinking or asking themselves: “Is the career in the military as a nurse the right job for me?”
Kenneth: I can only speak as an individual.
Jamie: I understand that. Obviously you have some level of success in this career path and I want to encourage nurses to consider the military service if it’s possible.
Kenneth: Well, you have to sort out what your own values are. And if those values include service to your country then it is the right place to be as it has been the right place for me to be for the past 23 years. And it’s got a number of significant benefits. It is a very steady income. You really don’t wonder where your next meal is going to come from. Not that many nurses wonder that anyway. The rate of change in the within the service is relatively slow often compared to outside places. Our practices tend to be relatively similar for one place to the next. We tend to manage under pretty consistent principles from one day and the next understanding that everything changes over time. So there’s a lot of security built in the job. There is also a tremendous amount of opportunity. It really tries hard to be a true meritocracy. If you perform well and meet those expectations that the military has of you - and they’re very overt, what they expect of you is really written large on the wall - there is no ceiling for you beyond which you cannot move. And opportunities for education if you want to be a practitioner, if you want to get future education, the military will pay for all those things so long as you perform. The downside of it is that you ultimately give up some of your own determination, self-determination about where you want to live, under what specific circumstances you might want to work because you have to fill the missions and needs of the military. But to me it’s always been a very worthwhile trade-off. I’ve got to go a lot of places and do a lot of very interesting things that I would not have been able to do had I not been in the service. The pro is it is very exciting and that it is a huge source of opportunity. The con is that you do – when they tell you to move, you move. It does not happen arbitrarily too often but it can.
Jamie: I appreciate that and you’re sharing your thoughts on that because I always encourage some student nurses that I speak with, and I teach as well, and I see some of them really being good fits for that going in that direction and I encourage them to reach out and talk to somebody because I think it is a tremendous opportunity for the person with the right mindset that seeks an opportunity for service beyond just being a nurse who is in service as well but going beyond having service to the country. Thank you.
Kenneth: Yes, and also it goes beyond just being a nurse as well. When you come in the Navy, you’re not just a nurse, you’re an officer. In many ways that is your first role as a naval officer. Not that you’re ever going to neglect your nursing responsibilities, but you have to become a leader. There are some people who are not necessarily interested in that role. They just want to take care of their patients and do their thing. The Navy would probably would not necessarily be a good home for them, at least not after the first two years. They might do a tour and then leave. But if you are interested in leadership and truly learning how to lead people, there’s no better place.
Jamie: I completely agree. Final question and I usually ask this of all of our nurse interviewees here is: what piece of nursing advice did you receive early in your nursing career that you’ve carried with you throughout your career as a nurse?
Kenneth: The piece that I have gotten very early in my career that’s really influenced me throughout is to always advocate for your patients regardless of the cost to yourself. What we hold with our patients is really a sacred trust. Especially in anesthesia, they’re quite literally helpless when they’re under our care. We’re the ones who are charged along with the operating room nurse. We’re the two nurses in the room who are really charged with advocating for the patient’s welfare. And so if you always look to your patient’s interests and always advocate for those very rigorously and very religiously, you’ll always be able to go home and look yourself in the mirror. Even if it costs something career-wise, it is always worth doing.
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Make sure you check out the entire July 2015 issue of Nursing Notes where we take a look at the nurse anesthetist specialty. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month where I sit down with our panel of nurse anesthetists including Sharon Pearce, president of the American Association of Nurse Anesthetists and CRNA at Carolina Anesthesia and Associates in Greensboro/Winston-Salem, N.C. and John M. O’Donnell, professor and chair of the Department of Nurse Anesthesia and director of the Nurse Anesthesia Program at the University of Pittsburgh in Pittsburgh, Pa. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes as well as our new podcast player on DiscoverNursing.com!