From the Head of the Bed

This episode covers advice for the last six months of anesthesia school, transitioning out of school and into the first six months of your CRNA practice! The year encompassing your last six months of anesthesia school through your first six months of practice is a big one!  There’s such a learning curve you will encounter from studying for boards to landing your first anesthesia job through your first several months of practice.  It’s an amazing time and well worth all the hard work and effort! Check out the podcast and please feel free to offer your own insights/advice in the comments section. Topics covered: * Wrapping up anesthesia school:  your project/thesis, landing a job and tips for boards * Transitioning out of school – it goes by fast! * The first six months of practice:  tips for your practice, your ability to influence others and finances! I mentioned this article in the podcast: Assante, J., Collins, S., & Hewer, I. (2015). Infection Associated With Single-Dose Dexamethasone for Prevention of Postoperative Nausea and Vomiting: A Literature Review. AANA Journal, 83(4), 281-288.

Cherie Burke, DNP, CRNA discusses the concept of positive deviance in healthcare.  Highlights include how to effect change as healthcare providers and the power of focusing quality improvement proactively on what goes right in an organization verses reacting to errors and negative outcomes.  Dr Burke is a practicing CRNA with nearly 30 years of clinical and teaching experience.  She holds a Doctorate of Nursing Practice from LaSalle University with her doctoral research focusing on patient safety.   Topics Discussed: * Positive deviance as a methodology of outcome analysis * Positive deviance as a professional behavior of healthcare providers * How to harness the power of positive deviance in anesthesia practice and education * The limitations and risks of positive deviance as a research tool and professional practice   Highlights: “Positive deviance is really about… taking those things that people are doing right and sharing them with everyone so that everyone is doing things to improve our patient’s care, our patient’s outcome.”  Dr Cherie Burke “We have to really encourage innovation.  We’re at a tipping point in healthcare.  We’re going to have to do major, major innovation to be successful and to survive in the healthcare arena…  Nurse anesthetists are going to have to be creative.  We’re going to have to figure out how can we continue doing high quality care with excellent outcomes, safety [and] efficiency.”  Dr Cherie Burke   Resources:  Bradley, E. H., Curry, L. A., Ramanadhan, S., Rowe, L., Nembhard, I. M., & Krumholz, H. M. (2009). Research in action: using positive deviance to improve quality of health care. Implementation Science, 41-11. doi:10.1186/1748-5908-4-25\ Ford, K. (2013). Survey of Syringe and Needle Safety Among Student Registered Nurse Anesthetists: Are We Making Any Progress?. AANA Journal, 81(1), 37-42. Gary, J. C. (2013). Exploring the concept and use of positive deviance in nursing. The American Journal Of Nursing, 113(8), 26. doi:10.1097/01.NAJ.0000432960.95762.5f Lawton R., Taylor, N., Clay-Williams, R., & Braithwaite, J. (2014). Positive deviance: a different approach to achieving patient safety.  BMJ, 0:1–4. doi:10.1136/bmjqs-2014-003115 Prielipp, R. C., Magro, M., Morell, R. C., & Brull, S. J. (2010). THE OPEN MIND. The Normalization of Deviance: Do We (Un)Knowingly Accept Doing the Wrong Thing?. AANA Journal, 78(4), 284-287. doi:10.1213/ANE.0b013e3181d5adc5 Rosenberg, T. (2013, February 27).  When deviants do good.  The New York Times, Retrieved from http://opinionator.blogs.nytimes.com/2013/02/27/when-deviants-do-good/?_r=0

I sat down with Jon Bradstreet, MSN, CRNA to chat about how SRNAs and CRNAs can prepare for the job market.  Jon Bradstreet, MSN, CRNA is the Chief CRNA and Director of CRNA Services of Maine’s largest CRNA group and only level one trauma center, Maine Medical Center, in Portland, Maine.  In this episode we cover everything from Curriculum Vitae’s (CVs) to tips for interviews and the job hunt.  If you’re an SRNA wrapping up your anesthesia training or a CRNA considering a job move – check it out! Key topics: * CV Preparation – what works and what’s fluff on your CV * When to and how to contact prospective employers * Tips for interviews including: * What chief CRNAs are looking for in your interview * Questions you should be asking in your interview * Things to consider doing and avoid doing in an interview * When to follow up on an interview * Tips for promoting yourself as a CRNA * Advice for how to prioritize important aspects of jobs including location, practice type, group culture, compensation packages and more * Advice for CRNA couples who are in the job hunt together Parting words from Jon Bradstreet, MSN, CRNA: “Have fun… we have a great profession and we have a great lifestyle.  We’re very lucky to do what we do for a living.  Always keep that in mind – how fortunate we are in this profession.  And then finally I think I would say listen to your gut.  It’s taken you very far in life already… don’t repress what it’s telling you as you’re in that interview.” Links: Maine Medical Center  

Jon caught up with Dr Juan Quintana, president of the American Association of Nurse Anesthetists, and Kristie Hoch, president of the Maine Association of Nurse Anesthetists, to chat about the value of being a member of the American Association of Nurse Anesthetists (AANA).  Membership in the AANA is open to Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs). Dr Juan Quintana, CRNA, DNP, MHS, leads a CRNA-only anesthesia practice in Texas and well as an anesthesia billing firm.  His expertise lies in the areas of anesthesia practice models, economics, billing and reimbursement.  According to his website, “Dr Quintana became the first CRNA to serve on the Medicare Evidence Development and Coverage Advisory Council (MEDCAC), an independent body that provides the Medicare agency guidance and expert advice on the science and technology affecting healthcare delivery.”  He currently is serving as the president of the American Association of Nurse Anesthetists. Kristie Hoch, APRN, CRNA, MSN, works in CRNA-only settings and Anesthesia Care Team practices in Maine.  She serves as the chairwoman of a group of CRNA chiefs in her organization in addition to serving as the CRNA recruiter for her company.  Kristie recently served on the Program Committee for the AANA, which is the committee that plans the Association’s Annual Congress and is currently on the AANA’s Communications Committee.  She is wrapping up her term as president of the Maine Association of Nurse Anesthetists where she has been very active in promoting CRNA services across the state.  During her term as president, MeANA was awarded the Best Public Relations Effort by Small State Association honor from the AANA. Highlights: “The future for CRNA’s is brilliant; absolutely brilliant.  Everything is designed right now to move CRNA practice into the forefront…  If you’re in CRNA practice, if you’re a student thinking about going into CRNA practice, you’ve made an excellent choice.”  Juan Quintana “There’s not a question in terms of the anesthesia that I provide because it’s always going to be what I would give my mom.  So it’s going to be the absolute best.”  Juan Quintana “The AANA supports your right to practice.  Over forty-four thousand CRNAs across the country have a much stronger voice than you alone would have.”  Kristie Hoch Resources: American Association of Nurse Anesthetists Maine Association of Nurse Anesthetists The Future of Anesthesia Care Today  

Dr Shawn Collins, DNP, PhD, CRNA discusses his research on Emotional Intelligence of Student Registered Nurse Anesthetists (SRNAs).  Highlights include the relevance of emotional intelligence to the practice of anesthesia, models of emotional intelligence and ways that emotional intelligence can be developed as a skill. Dr Shawn Collins currently serves as the Director of the Graduate Nurse Anesthesia Program and the Interim Associate Dean of the College of Health and Human Sciences at Western Carolina University (WCU).  Dr Collins completed his anesthesia training at the Erlanger Medical Center at the University of Tennessee – Chattanooga and went on to obtain his Doctorate of Nursing Practice from Rush University before obtaining his PhD in Leadership from Andrews University.  He maintains his clinical practice at several CRNA-only clinical sites in both North Carolina and Iowa.  At WCU, he was integral in the development of the WCU Doctor of Nursing Practice Program and served as its first director.  He is currently developing WCU’s DNP program for entry-level education for CRNAs. Podcast highlights: * Overview of Dr Collins’ article:  Emotional Intelligence as a Noncognitive Factor in Student Registered Nurse Anesthetists * Discuss models and theories of emotional intelligence * Discuss the significance of emotional intelligence in the practice of anesthesia for SRNAs & CRNAs * Discuss how emotional intelligence is a skill that can be developed * Discuss the positive correlation of emotional intelligence to scores on the NBCRNA’s National Certification Exam Resources: Collins S. Emotional Intelligence as a Noncognitive Factor in Student Registered Nurse Anesthetists. AANA Journal [serial online]. December 2013;81(6):465-472. Available from: Academic Search Complete, Ipswich, MA. Accessed September 19, 2015. Collins S, Andrejco K. A longitudinal study of emotional intelligence in graduate nurse anesthesia students. Asia Pac J Oncol Nurs [serial online] 2015 [cited 2015 Sep 19];2:56-62. Available from: http://www.apjon.org/text.asp?2015/2/2/56/157566 (We’d like to highlight that podcast producer, Kristin Andrejco, was a co-author, along with Dr Collins, of the above study published in the Asia Pacific Journal of Oncology Nursing.)

Jon talks with Dr Shawn Collins, DNP, PhD, CRNA about the transition of CRNA education from a Master’s of Science in Nursing (MSN) to a Doctor of Nursing Practice (DNP).  We discuss the history, rationale and implications of the change and compare various doctoral degrees CRNAs may obtain such as DNP, DNAP, PhD and EdD. Dr Shawn Collins currently serves as the Director of the Graduate Nurse Anesthesia Program and the Interim Associate Dean of the College of Health and Human Sciences at Western Carolina University (WCU).  Dr Collins completed his anesthesia training at the Erlanger Medical Center at the University of Tennessee – Chattanooga and went on to obtain his Doctorate of Nursing Practice from Rush University before obtaining his PhD in Leadership from Andrews University.  He maintains his clinical practice at several CRNA-only clinical sites in both North Carolina and Iowa.  At WCU, he was integral in the development of the WCU Doctor of Nursing Practice Program and served as its first director.  He is currently developing WCU’s DNP program for entry-level education for CRNAs. Please see the links below for a detailed history on Doctor of Nursing Practice degrees and the process of CRNA training moving from MSN preparation to a DNP. Sources: 2014 Trial Standards for Accreditation of Nurse Anesthesia Programs: Practice Doctorate. Published by the Council on Accreditation of Nurse Anesthesia Educational Programs, Park Ridge, Illinois. Revised on 5/30/14. Hawkins, R., & Nezat, G. (2009). Doctoral Education: Which Degree to Pursue?. AANA Journal, 77(2), 92-96.

Jon caught up with Caleb Rogovin, MS, CRNA, CCRN, CEN to talk trauma anesthesia.  Pharmacology, massive transfusion protocols, fluid management, room set up, team communication and personal coping are all covered in this episode.   Caleb Rogovin, MS, CRNA, CCRN, CEN has an extensive background in trauma critical care and anesthesia.  Caleb worked for years in emergency medicine and critical care, earning a Master’s degree in Trauma Critical Care before returning to school to become a CRNA.  He has served as a trauma critical care educator and administration as well as a faculty member of nurse anesthesia programs.  Caleb currently works as part of the anesthesia team at Temple University Hospital in Philadelphia, Pennsylvania.   Topics Covered: * Approach to trauma:  room set up & team psychology * Pharmacology:  induction sequence and hemostasis * Massive transfusion protocols and fluid resuscitation * Communication in the OR:  perhaps your best tool in trauma resuscitation   A couple of highlights: “You don’t judge them.  You just take care of them.”  – Caleb describing his approach to trauma patients. “You don’t need lactated ringers or normal saline… what is falling out of your body is blood.”  – Caleb explaining fluid resuscitation in massive transfusion protocols.   Links & Resources: The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study: Comparative Effectiveness of a Time-varying Treatment with Competing Risks Cook County Hospital’s Blood Bank Page – the world’s first blood bank. A bit about Caleb from the AANA.

Jeremy Stanley, CFP, President and founder of CRNA Financial Planning-an AANA Member Advantage partner , joins the podcast to discuss the intricacies of freelancing. Jeremy has over 18 years of experience helping nurse anesthetists pursue financial success and is a sought after speaker and author of “The Wealthy CRNA.” Topics Include: * Advantages/Disadvantages * options to structure your business * incorporation * how to find freelance opportunities * retirement saving options are all discussed. Highlights: * Advantages: potentially higher hourly rate, scheduling flexibility, potential to save more for retirement, potential business expenses and possible tax deductions, more control over your practice * Disadvantages: must find own work opportunities (or have someone else do it for you), running your own business, cost considerations (incorporation filing fees, legal setup fees, professional insurances, current benefits * Differences in how you are paid (W2 vs. 1099): Payroll Tax, W2 deductions, Alternative Minimum Tax, 1099 Deductions * Various business structures: Sole Proprietorship, S-corporations, and LLC’s * Incorporation * Finding freelance work opportunities: anesthesia placement service, seek out and apply on job posting sites, develop relationships with facilities, groups, or individual surgeons, LinkedIn, contact CRNA Financial Planning * Retirement saving options: SEP IRAs vs SOLO 401k

Mark A. Kossick, DNSc, CRNA, APN, professor at Western Carolina University, discusses the cardinal elements and evidence based recommendations for EKG lead selection during anesthesia. Dr. Kossick is a tenured professor at Western Carolina University, the author of a textbook and handbook on electrocardiography, and serves as an AANA Journal reviewer. Dr Kossick provided specific and detailed show notes to this podcast that can be found here: Shownotes Mark Kossick Bio

Jon, Kristin, Brad & Cass sit down to talk about communicating with preceptors.  This talk will be helpful for SRNAs who are hitting the clinical environment for the first time.  This podcast was recorded during our anesthesia training and hopefully will give new SRNAs a student’s perspective on communicating with preceptors. Topics discussed: * Importance of communication skills in the perioperative environment * How to prepare for clinicals * Tips for making pre-clinical phone calls to preceptors * The use of cell phones/electronic devices in the OR * Common questions preceptors ask students * Transitioning from day one of clinical to being a senior anesthesia student * Importance of being teachable, flexible, humble and thankful     By the way, the max dose of methylene blue is… 7-8 mg/kg. “Methylene blue 1 to 2 mg/kg over 5 minutes (maximum dose, 7-8 mg/kg) reverses methemoglobinemia, but the patient should be monitored for the reoccurrence of symptoms” (Ouellette, 2011, p. 126). And if you’re looking for the “smooth and in” video Cass eluded to, here it is.  To be honest, it’s pretty cheesy.  We were shown this video in the first weeks of anesthesia school and told that our goal was to be “smooth and in.”   References Ouellette, R. G., & Joyce, J. A. (2011). Pharmacology for nurse anesthesiology. Sudbury, MA: Jones & Bartlett Learning.

Kristin talks with Eric Carlson, MSN, CRNA who shares a gripping personal tale of managing an unexpected difficult airway during an emergency Cesarean section.  Eric found himself in a “cannot intubate/cannot ventilate” situation which evolved into performing a cricothyrotomy followed by a surgical airway.  Eric’s vulnerability, humility and professionalism in bringing this story forward is astounding.  Don’t miss his account of what happened and the personal and professional ramifications of those involved in this difficult situation. Eric Carlson, MSN, CRNA has been a practicing CRNA for over 30 years.  He did his anesthesia training at the University of George Washington and was recruited into the Air Force to continue his anesthesia training.  He worked as a CRNA for the Air Force at Keesler Air Force base in Biloxi, Mississippi and then pursued employment at All Care Clinical Associates in Asheville, NC, where he currently works. Topics Discussed: * Personal case study of a difficult airway during an emergent C-section * Decision making in emergencies * Communication strategies in emergencies * Challenges faced during this particular case * Legal ramifications * Algorithms for airway management * Benefits to advanced airway training     Update, June 2015: This interview was posted by the North Carolina Association of Nurse Anesthetists in an email on 15 May 2015 to members titled “Spotlight on CRNAs” where a North Carolina CRNA is introduced at greater depth to the membership.  Of note, Eric was interviewed by Dustin Degman, CRNA, who has also contributed to our podcast in the Combat Trauma Anesthesia series.  In the interview, Dustin talks with Eric about his experience with the difficult airway case that he speaks to in the show featured on this page.  This interview is posted with the permission of the NCANA.   Eric Carlson, CRNA Interviewed by Dustin Degman, CRNA You were recently on the pod cast “From the Head of the Bed” where you explained a case that, I guess you could say, changed the way you practice today. You got to give your history, the beginning of the scenario, and there was a moment that you said “I had a difficult airway case”. I must tell you that I was completely locked-in at that moment. Nothing was going to distract me from listening to the next 25 minutes. What I want to ask is, what about that event changed you most, either as a person or in practice? This is a challenging question to answer. I am sure the event changed me both as a person and a CRNA practitioner. At the time of the event, I was very early in my career and riding high in self confidence. The event changed my level of confidence and reinforced the significance of the risks we take as CRNAs performing our job every day. I had to actively work on rebuilding my confidence over the ensuing months, slowly, I was able to regain some of the loss, but for better or for worse, I probably did not get back to the level I had been. In the long run, I think it made me a better CRNA because I realized that bad things can occur in our line of work at any time and you always need to have a back-up plan in mind. Be prepared for the unexpected. As a person, the event may have made me a more humble individual and helped me realize that we are all susceptible to very challenging occurrences in our profession. People, who know you, know that you are a wonderful provider. Your patients, colleagues, and the students really look up to you. Is there something you would like to share about being a great mentor? I appreciate the feedback and compliment. I consider myself very fortunate to have made the decision to become a CRNA more than 30 years ago. We all have many forks in the road when we have to make a choice t...

Jon and Ian discuss the history and economics of anesthesia delivery models.  Ian overviews the various types of anesthesia care models, some of the historical context for the development of those models and explains how anesthesia providers can optimize the delivery of anesthesia care in terms of billing, efficiency and quality outcomes.  We also discuss some of the challenges facing researchers in terms of gathering and interpreting “big data” on quality outcomes related to anesthesia care.  If you’re interested in the behind-the-scenes story on anesthesia care in the United States, this podcast is a good place to start! Ian Hewer, MSN, MA, CRNA is an Assistant Professor and the Assistant Director of the Graduate Nurse Anesthesia Program at Western Carolina University.  He is a Fellow of the American Association of Nurse Anesthetists’ Journal Writing Fellowship Program and has published articles in the AANA Journal, the International Journal of Nursing Research and the Social Science Journal.  Ian is currently pursuing his PhD at the University of North Carolina – Charlotte in Health Services Research with research focusing on the economics and outcomes of various anesthesia care delivery models. Topics discussed: * Types of anesthesia care models in the United States * Types of specific billing modalities for anesthesia services and the implications for anesthesia care models * The difference between medical direction and medical supervision and defining these terms in relation to billing & reimbursement verses standards of care of anesthesia providers * What “opt-out” means in terms of reimbursement and CRNA practice autonomy * Historical economic and political evolution & context of anesthesia care * The challenge of gathering & interpreting anesthesia quality data * Current trends in anesthesia quality research * Ideas on structuring anesthesia care models for success in a future where healthcare must become more efficient and cost-effective while maintaining safety and high quality * Suggestions for anesthesia providers in educating themselves on trends in healthcare economics * Thoughts on CRNAs becoming doctorally prepared clinicians and how this evolution will influence anesthesia in the United States   Background information: Kane & Smith’s 2004 article titled An American tale – professional conflicts in anaesthesia in the United States: implications for the United Kingdom, published in the 2004, vol 59 edition of Anaesthesia, provides a particularly in-depth review of the development of anesthesia in the United States.  The types of anesthesia providers and models of practice are reviewed along with many of the key dates, legislation and publications that have influenced the anesthesia field in the United States over the last 100 years.  Professor Hewer touches on many of these dates and developments and we encourage listeners to reference Kane (2004) for more detail. Chronology of important dates in US anaesthesia (quoted from Kane, 2004) 1846  First anaesthetic administered 1847  American Society of Anaesthesiologists formed 1909  First formal Nurse Anaesthetist training program 1931  American Association of Nurse Anaesthetists formed 1932  Anaesthesia recognised as a medical Specialty by the American Medical Association 1960s  Johnson administration healthcare reforms 1966  Medicare program allows anaesthesiologists to bill them directly for overseeing hospital-employed CRNAs as well as personally administered anaesthetics. Graduate Medical Education program 1980  Forrest study published 1981  Bechtoldt study published

If you’re planning on becoming a CRNA or even if you’re currently in CRNA school, this talk is for you!  Jon talks with Mason McDowell, DNAP, CRNA and Kara Michalov, MSN, CRNA about success strategies for nurse anesthesia school.   Topics covered: * Advice for how to be successful in grad school. * Thoughts on figuring out your study plan, budgeting time and preparing for exams. * Whether or not to work during school. * Tips for starting clinical as a SRNA. * Advice for how to pick yourself up again after hard days. * Tips for approaching projects and/or thesis’s * Advice for preparing for boards.   Mason McDowell, DNAP, CRNA is an Associate Professor and former Assistant Director of the Nurse Anesthesia Program at Western Carolina University.   His Doctorate of Nurse Anesthesia Practice (DNAP) from Texas Wesleyan University included research focused on perioperative patient management and cardiac risk assessment. He is the author of the Hepatobiliary and Gastrointestinal Disturbances and Anesthesia chapter in Nagelhout’s Nurse Anesthesia 5th Edition.  He is currently serving as an anesthesia educator and clinician in Bere, Chad, along with his wife and two daughters. You can read about his ongoing experiences there at http://www.whyweshouldgo.blogspot.com. If you want to know what it’s like to practice anesthesia (and care for the whole patient, family & community) in remote and challenging environments, you owe it to yourself to check out Mason’s stories!   Kara Michalov, MSN, CRNA is a CRNA with AllCare Clinical Associates in Asheville, North Carolina. She is one of the authors of Intravenous Acetaminophen and Intravenous Ketorolac for Management of Pediatric Surgical Pain: A Literature Review, which was published in the February 2014 edition of the AANA Journal (Vol. 82, No.1).

If you’re a critical care nurse and you’re thinking about applying for anesthesia school, this show is for you!  Jon talks with Mason McDowell, DNAP, CRNA & Kara Michalov, MSN, CRNA about how best to prepare for getting into nurse anesthesia school. Topics Covered: – advice for how to prepare for nurse anesthesia school – advice for students with families, significant others & pets – what to study (or not) ahead of time – how to prepare for the Big Interview to get into school   Mason McDowell, DNAP, CRNA is an Associate Professor and former Assistant Director of the Nurse Anesthesia Program at Western Carolina University.   His Doctorate of Nurse Anesthesia Practice (DNAP) from Texas Wesleyan University included research focused on perioperative patient management and cardiac risk assessment.  He is the co-author of the Hepatobiliary and Gastrointestinal Disturbances and Anesthesia chapter in Nagelhout’s Nurse Anesthesia 5th Edition.  He is currently serving as an anesthesia educator and clinician in Bere, Chad, along with his wife and two daughters. You can read about his ongoing experiences there at http://www.whyweshouldgo.blogspot.com. If you want to know what it’s like to practice anesthesia (and care for the whole patient, family & community) in remote and challenging environments, you owe it to yourself to check out Mason’s stories!   Kara Michalov, MSN, CRNA is a CRNA with AllCare Clinical Associates in Asheville, North Carolina. She is one of the authors of Intravenous Acetaminophen and Intravenous Ketorolac for Management of Pediatric Surgical Pain: A Literature Review, which was published in the February 2014 edition of the AANA Journal (Vol. 82, No.1).

Part 3: Combat Trauma Anesthesia with Dustin Degman, MSN, CRNA.  Dustin and Jon wrap up their conversation with an overview of how people can get involved as CRNAs in the military and how we can support our troops. Dustin Degman, MSN, CRNA is an Associate Professor of Anesthesia at Western Carolina University works with AllCare Clinical Associates in Asheville, North Carolina as a CRNA.  He served Active Duty with the United States Air Force from 1998-2002 as a critical care nurse.  In 2010, he joined the Army Reserves as a CRNA.  Dustin was deployed in November 2012 to Forward Operating Base (FOB) Orgun-E in Paktika Province, Afghanistan where he was the sole anesthesia provider on a forward surgical team which provided damage control resuscitation to injured soldiers.  He has a special interest in trauma anesthesia and has served on trauma call teams in civilian centers as well as in his military service.  Many thanks to Dustin and the brave men and women who have served and serve in and with the United States Armed Services! Combat Trauma Anesthesia Part 1:  Key differences and challenges facing CRNAs serving in Forward Surgical Teams (FSTs) and managing combat trauma patients Part 2:  Damage Control Resuscitation principles and particulars Part 3:  Getting involved as a military CRNA and supporting our troops   Highlights: “…remember why you joined… For me it was to be able to have the honor in taking care of an injured soldier who is doing the upmost thing to take care of us as Americans.”  Dustin Degman, MSN, CRNA “If you see a guy in uniform, approach him… thank him… ask him what he does. People are very proud to say what they do for this country.”  Dustin Degman, MSN, CRNA   Resources: United Service Organizations Our Mission: The USO lifts the spirits of America’s troops and their families. Millions of times each year at hundreds of locations around the world, the USO lifts the spirits of America’s troops and their families.  A nonprofit, congressionally chartered, private organization, the USO relies on the generosity of individuals, organizations and corporations to support its activities. The USO is not part of the U.S. government, but is recognized by the Department of Defense, Congress and President of the United States, who serves as Honorary Chairman of the USO. (from http://www.uso.org/the-organization.aspx)   The United States Army Graduate Program in Anesthesia Nursing Mission Statement:  The US Army Graduate Program in Anesthesia Nursing (USAGPAN) supports the AMEDDC&S mission by producing clinicians educated in the complexity of practice at the doctoral level and competent in the unique skills of anesthesia nursing. The graduate nurse anesthetist is prepared to function as a leader advocating for quality patient care in times of peace, and when necessary, in times of war, civil disorder, natural disaster or humanitarian missions. (from http://www.usagpan.org) Here’s a great video overviewing military CRNAs that was produced by SRNAs with USAGPAN:  CRNA: Combat Ready Nurse Anesthetists – USAGPAN student video project.    Uniformed Services University of the Health Sciences Nurse Anesthetist Program Philosophy: The Nurse Anesthesia Program is dedicated to the graduate education of nurse anesthetists in the uniformed services. The uniformed services require that graduates independently provide quality anesthesia care in diverse settings throughout the world. The rigorous curriculum is designed to integrate scientific principles with anesthesia theory and practice, stressing unique aspects of the federal health care system.