by Aussie Nurse Educator | Sunday, March 13, 2022 | Advice & Support, Peri-Anaesthesia
Hey Friends,
Today’s blog is for new graduates and new nurses who have landed a position in peri-anaesthesia, or you are a nurse who is interested to give this fantastic clinical area a go. As many of you know, I am not only a peri-anaesthesia nurse specialist; I also completed my new graduate year in anaesthetics and recovery! This blog post is sure to provide you with plenty of value as you learn the clinical specifics and progress with your journey in peri-anaesthesia nursing.
I wanted to share the key areas in peri-anaesthesia nursing with you and what I found helpful to learn as I progressed in the area. We will look at what I found helpful starting as a grad, including the knowledge, skills, hints, tips and more!
Let’s have a look!
Important Aspects of Peri-Anaesthesia Nursing
- A breakdown of the important aspects of peri-anaesthesia nursing for new nurses – a FREE guide for YOU!
The Role of the Peri-anaesthesia Nurse
Anaesthesia Nurse
The anaesthetic nurse is the assistant to the anaesthetist. They:
- prepare the environment and equipment for the patient
- prepare equipment for administering the anaesthetic
- receive the patient into the operating room, establish rapport by asking and answering any questions, and check identification and consent
- communicate relevant patient information to the other members of the intra-operative team, both nurses and doctors
- assist with intra-operative patient monitoring and ensure the patient’s safety, comfort and warmth
- assist the anaesthetist at the end of the procedure as the patient emerges from the effects of anaesthesia.
Position statement on the assistant for the anaesthetist – CLICK HERE
Knowledge and skills
The anaesthetic nurse requires:
- good assessment skills
- a knowledge of anaesthetic methods, anaesthetic agents and equipment
- an understanding of fluid balance and respiratory monitoring, cardiac monitoring and haemodynamic monitoring, and the ability to identify any changes that may have impact on the patient
- knowledge of airway anatomy and physiology, airway management strategies and anaesthetic complications.
Becoming an Anaesthesia Nurse – Education pathway
This role is suitable for both registered and enrolled nurses. Registered nurses need to complete a Bachelor of Nursing degree and a postgraduate degree that focuses on anaesthetic nursing. Enrolled nurses need to complete a Diploma of Nursing that includes medication administration and a Diploma of Anaesthetic Technology.
Post-Anaesthesia Care Nurse
The Post Anaesthesia Care Unit (PACU) nurse receives the patient into the PACU (also known as the recovery unit). They:
- undertake respiratory, cardiovascular and neurological assessment and monitoring as the patient recovers from the effects of anaesthesia and surgery
- monitor emergence from anaesthesia, dressings, intravenous lines and drainage tubes
- implement and document post-operative treatment regimes including pain management.
Knowledge and skills
The PACU nurse requires:
- strong knowledge of and ability to manage post-operative complications and respond to patient deterioration quickly and efficiently
- advanced airway management skills
- the ability to quickly recognise respiratory compromise and take necessary action
- excellent assessment skills
- strong knowledge of pain management methods and medications
- excellent communication skills
- the ability to work as an effective member of a multidisciplinary team.
Becoming a Recovery or Post-Anaesthesia Care Nurse – Education pathway
This role is suitable for registered nurses who have completed a Bachelor of Nursing degree and a postgraduate degree that focuses on post-anaesthetic care.
Enrolled nurses who have completed a Diploma of Nursing that includes medication administration may work in second-level recovery care where patients require a period of supervised monitoring, privacy for the discussion of procedural outcomes and discharge instructions, bathroom facilities and provision of food and fluids. Criteria for discharge from second stage recovery include pain and nausea control manageable with oral medications, return of cognition to pre-procedure levels, and the ability to be mobile safely.
Pharmacology (including GA + Muscle Relaxants & Reversal) used in Anaesthesia & Post-Anaesthesia Care
Different types of anaesthesia – General, sedation, local, regional, combination
Main anaesthesia medications
Muscle relaxants – depolarising and non-depolarising
Patient Monitoring
Invasive monitoring – CVL, ART
5 Lead cardiac monitoring
Capnography
Common Respiratory Complications
Recognising & managing these complications
Acute Pain Management
Comprehensive pain assessment
PQRST pain assessment
Multimodal Pain Management
Emergencies in the Peri-operative Environment
Look at the management of these emergencies:
- Anaphylaxis
- Local anaesthetic toxicity
- Malignant Hyperthermia
- Difficult Airways – Cannot Intubate, cannot oxygenate
- Laryngospasm
Patient Assessment
- Respiratory
- Cardiovascular
- Neurological
- Neuro-vascular
- Circulatory
- Fluid Balance
Caring for the Patient having Regional Anaesthesia
- What are they?
- Why are they used?
- What are the benefits?
- How do they differ from GA & sedation?
- Can you have a GA &/or sedation with regional anaesthesia?
- What are the differences between these types of regional anaesthesia?
- Epidural
- Spinal
- Major joint
- Extremity
Study Guide for your Journey in Peri-Anaesthesia
Knowledge Areas
Foundational knowledge to brush up on prior to starting or to reflect upon along the journey within the first few weeks to build confidence and nail your skills!
- Specific Roles of the anaesthetic and post anaesthetic care unit nurse
- Pharmacology utilised for general anaesthesia, sedation, local and regional blocks
- Monitoring a patient before, during and after anaesthesia
- Respiratory complications
- Airway anatomy + physiology
- Airway assessment + management
- Acute pain management
- Peri-operative emergencies
- Patient Assessment
- Caring for patients who have had regional anaesthesia
- Devices and equipment utilised in peri-operative and peri-anaesthesia clinical practice
- Medications:
- Propofol
- Midazolam
- Opiates: Fentanyl, Morphine, Hydromorphone, Alfentanil, Remifentanil, Buprenorphine
- Ketamine
- Droperidol
- Dexamethasone
- Ondansetron
- Parecoxib
- Paracetamol
- Atropine
- Ephedrine
- Metaraminol
- Rocuronium
- Suxamethonium
- Clonidine
- Epinephrine
- Neostigmine
- Sugammadex
- Desflurane
- Sevoflurane
- Isoflurane
- Oxycodone
- Targin
- Tramadol
- Ropivacaine
Skills
You will be exposed to, practice and develop advanced nursing skills surrounding airway, breathing, circulation, disability, pain and exposure. Familiarise yourself with these clinical skills in peri-anaesthesia and identify your roles as an anaesthetic or recovery nurse.
Airway Skills
Basic airway management skills for Nurse’s video
CLICK HERE
Skills covered include:
- Chin lift, jaw support, head tilt and jaw thrust
- Non-invasive airway management devices – oropharyngeal and nasopharyngeal airways
- Differences with Adults vs children & infants
Airway Management
- Suctioning
- Airway cart and equipment
- Suction airway
- Assist ETT Intubation with manual and video laryngoscopes
- Cricoid pressure
- Verification of ETT placement: CO2 detector, auscultation, CXR
- Use of bag-valve-mask
- Assist with tapes
- Insertion LMA
Clinical Competencies
The required clinical competencies ranges and depends on the specific clinical area you are in and the type of peri-operative services the hospital provides.
Common competencies include:
Anaesthesia & Post Anaesthesia Care Nurses:
- Patient Assessment
- Patient Monitoring
- Management of the unconscious and semi-conscious patient
- Airway management including the removal of LMA upon the emergence of GA
- Assisting anaesthetists
- A-G patient assessment
- Manage pain and primary assessment complications in the immediate post-operative stage
- Manage the thermic state of the patient
- Use various pieces of equipment for the care of the patient including:
- Use of doppler
- PCA
- Transducers
- Chest drains
Non Clinical Skills
Communication Teamwork Time Management
Resources for the Anaesthetic Nurse
- Emergency Department Notes
- Handover from Emergency Team
- Pre-operative Assessment
- Progress Notes
- The patient
Resources for the PACU Nurse
- All of the above
- The patient (sometimes)
- Anaesthetic Record
- Anaesthetic Handover
- Scrub Nurse Handover
Getting prepared
I was always searching for the best and up to date information. Along the journey, I found and developed some great resources. I decided to collate them all together here in one place for us all to enjoy!
Check it 👇🏼
🔥 The Ultimate Resource List 🆓
HERE
Rory’s experience as a Grad in Peri-anaesthesia
I was a New Graduate in Peri-anaesthesia straight out of University. Now, I am a Clinical Nurse Specialist & Clinical Nurse Educator. I have previously worked as a peri-operative Clinical Nurse Educator.
CLICK HERE to hear about my journey, from a University Student Registered Nurse to New Graduate Registered Nurse.
by Aussie Nurse Educator | Sunday, January 23, 2022 | Birthday, Wins
Hey Friends,
I have some exciting news for you all! It is the first Birthday for the Aussie Nurse Educator this coming week! I wanted to chat about WINS and how I always win by celebrating my birthday (personal birthday) exactly how I want and need to. On reflection, of last year, I realised I first posted on the Aussie Nurse Educator Instagram when I was away on my honeymoon in the summer of January 2021. The date was 26th January and it started with the standard ‘coming soon’ post…and the following week I began posting content for you all. This was day one, win one….I started.
Birthday’s are very important to me! Something I cherish and make the day all about!
Following my time at school, I worked full time during University and since then, I have always taken my birthday off! Completely! I get up and I do exactly what I want to do for the day and absolutely immerse in the day and enjoy it, for me! There was one year, about 3-4 years into my nursing career, I decided that I was going to work my birthday to help the team I was working with. It was an extra shift I was asked to do. I said yes. I thought I was doing the ‘right thing’. I didn’t realise how much I was going to hate it. I turned up on my birthday for a great nursing shift, 0800-1630, the dream birthday shift, right? It was a busy recovery unit and after arriving we spent about an hour where we were quite busy constantly, however, following this, we were pretty standard in terms of the patient flow and acuity, plus we had enough staff! I was not needed from about 2 hours into the shift. I was immediately annoyed. I had gone out of my way, on my special day and then I wasn’t even required!
I realised at that point, I have to do these things for ME. I love this day and I had always had it off! It is MY DAY! I love helping people and stretching myself! Especially for my immediate team, however I wasn’t even able to effectively ‘help’ them due to how I felt about me not looking after ME and what I NEEDED! So, from that day forward, I take my birthday off, for me! No excuses and I do not let any factors get in the way of me enjoying my day!
This year my birthday (personal) is on a Monday and I have already begun planning the day off! My wife and I usually spend it away, camping in our van with our beautiful english staffy, Sassy. As I mentioned above, the Aussie Nurse Educator (me, ? – I now have two birthdays), has a birthday this week. Due to the first post date being the 26th January 2021, the 26th January 2022 is the Aussie Nurse Educator’s Birthday ?
On the topic of wins, its important to celebrate them! Regardless of whether they are big or small – they mean something to you! I take my birthday for me and my win is that I choose to do so!
Enjoy the week, take care.
by Aussie Nurse Educator | Sunday, January 16, 2022 | Goals
Hey Friends!
We are back for the year – 2022!
I had a good couple of weeks off over Christmas and New Year which was absolutely fantastic!
I started off the year with releasing another newsletter! That was issue 4 and 5 is only just around the corner! I have been loving the feedback and sharing it all with you! Want to join the rest of us? CLICK HERE to sign up to my NEWSLETTER.
This week, in my stories there has been a lot of chat about GOALS!
I love reflecting and looking at where I want to develop myself personally and professionally as the new year commences.
At the end of last year, upon reflection, I realised that I set out to achieve a lot last year….and…I did it ALL! I was stoked with achieving it all!
The toughest thing I did was remain dedicated. After many years, I found the help I needed for my ADHD. I did this as I started noticing an effect on the people around me, at work and in my relationship with my wife, that was no longer functional and ok for them…or me.
This presented other personal and wellbeing challenges which has increased the load and learning curve with the management…..however this is the main area I am working so hard on in 2022. I want to be a better me! AND I WILL BE!
The constant grind working on my mental health and wellbeing is something I will always be working on, its something to just constantly learn about and improve on yourself and try and enjoy each and every moment!
Anyway, enough about my reflection….
Today I wanted to chat to you all about Goals. Setting our goals is important. It is important to have something to work towards.
When it comes to the goals, how do we know if we have achieved a goal? Do you monitor your goals and their progression? Do you set a clear path for their execution?
All something to consider…
When I look at what I want to do and setting goals to get it done, I use a few things that may help you with yours.
These can be broken down to simply – Break it down, Identify needs and wants, sort out the why, assign priorities, consider the resources, set the goals, schedule and plan.
This is just a break down of what I do.
Let’s have a look together.
Break it all down
I break the areas of my life down to ensure I am working on, planning and progressing in all areas of my life equally or to the degree I want to be with that area.
For example: I have these areas I look at
- Personal
- Wife – Aims
- Relationships
- Mental health and Wellbeing
- Physical Health – Including Fitness (training) & Nutrition
- Computers & Technology
- Work
- Nursing Clinical
- Nursing Education
- Aquatic Rescue
- Pre hospital care
- Business
- Aussie Nurse Educator
- Life Saving Education
- Rory Tanner
These are my main core areas of my life I constantly work on.
Identify your NEEDS & WANTS
Identifying between a need and a want can sometimes be difficult. The way I think about it is a NEED is something that the area requires to function, or to maintain its ability to do its main role and is directly involved in the want.
A WANT on the other hand is something that will help you but isn’t needed right now.
As a new graduate nurse, I needed to do lots of things and I had many goals. You NEED to develop your skills as an RN and you would also WANT to develop these skills. This is consistent with each other and fuels and motivates you forward.
New graduate nurses also NEED to be able to complete all the shifts required of them including night shifts. You maybe don’t WANT to do night shift though.
There is an issue with the WHY (why are you here doing this?) and this also presents another NEED on top of the other…. – I now need to learn how to perform at my best on night shift and deal with the thought, ‘I don’t want to’.
You need to work on the WHY!
For me, I couldn’t do nights! My physical and mental health suffers way too much! Hence why you don’t find me in the ED ?
Sort out your WHY
Why do we do what we do? Powerful question! For me? Well, because I like it and it literally floats my boat! I do it because I am passionate and interested, which builds my motivation to do it!
If you do not have a solid WHY, you will probably fall away and not achieve that goal…
So WHY do you NEED to do this and all these night shifts? Here is a couple for you.
- Because you committed to becoming a Nurse. Nurses do shift work. Full stop. It is part of your training and development as a Nurse and person.
- It is extremely important to your clinical area, other colleagues, the hospital, health services and your patient. All of which you as a nurse, work for and serve professionally! Remember you chose this!
- It is vital for you to develop the skills to manage these shifts, yourself, others and your patients overnight. This is a hard learning curve. When to eat, when to sleep, when and what to do. You have a lot of support when you are junior! Reach out and use that support! You are not weak, dumb or behind! You are learning and you will get there!
Did we say you have to do it forever? No! I didn’t. Just sort out your short term and long term WHY!
Assign Priorities
You need to know how much priority (a rough percentage) you want to place on each area and sub-area of your life. This will change based on the year, the stage of life and more! There is no right answer!
The key is to assign and stick to it!
There was a time, actually two that I can remember, where I was struggling. It was all because the PRIORITY was not set or it was wrong!
In my first year of nursing as a new graduate, I was doing a lot of things and the areas of my life suffered due to a shift in priority. I went way up into the work area and left too much of the personal area behind…not good.
Have this clear from the start and keep it in sight!
Consider the Resources
What do you have available to help you?
This will depend on the life area and overall goal. These can be internal or external resources. Identify the things that will help you achieve each specific goal.
The common items for me: ADHD, mindset, productivity skills, social connections, network, macbook pro, ipad and iphone
Set the Goal
To set your actual goal, you should consider using a structure like SMART GOALS.
SMART goals stands for Specific, Measurable, Achievable, Relevant, and Time-Bound.
Defining these parameters as they relate to your goal helps ensure that your objectives are attainable within a certain time frame. This approach eliminates the grey areas and guesswork, sets a clear timeline, and makes it easier to track progress and identify missed milestones.
SMART Breakdown – to help you set your goals
S: Specific
First step to be effective is being specific.
Three quick and easy questions here for you to ask in relation to the goal you want to set
- What needs to be accomplished you’re done?
- Who is ultimately responsible for it and who else is involved in the process?
- What steps need to be taken to achieve the goal?
- Where is it located?
- Which resources or limits are involved for me?
M: Measurable
Quantifying your goals (that is, making sure they’re measurable), makes it easier to track progress and know when you’ve reached the finish line.
Questions to get you started include:
- How much and how many?
- How do I know if I’ve reached my goal?
- What is my indicator of progress?
A: Achievable
Achievable, attainable and realistic to be successful. The goal should stretch your abilities but still remain in reach and possible. If you are setting an achievable goal, you may be able to identify previously overlooked opportunities or resources that can bring you closer faster or a more efficiently.
Goal answers questions such as these:
- How can I get the goal accomplished?
- How realistic is the goal, based on other constraints such as resources?
- Do I have the resources and capabilities to achieve this goal?
- If not, what is missing and what do I need. I.e. what’s the prior goal.
- Have others done successfully before?
R: Relevant
The WHY! Ensure it matters to you!
We all need support and assistance however it’s about remaining in control and being consistent with you. So the plans need to drive everyone forward but ultimately leaving you still responsible for achieving your own goals.
Ask questions such as:
- Does this goal seem worthwhile?
- Is it the right time to send this as it go?
- Does the goal match our other efforts and needs?
- Am I the right person to achieve?
- Is it appropriate and applicable in my current social economic environment?
T: Time
Every goal needs a target date so there is a deadline for you to work towards. Also setting something as a mini goal to keep you motivated. This section of the process is to help and prevent every day tasks from taking over to ensure you can still reach your goals.
A timer appropriate goal answers these questions:
- What is the time frame to achieve this goal?
- Does the school have a deadline?
- When did I want to or need to achieve this goal?
Schedule & Plan it out
This will be specific to you!
I am heavily reliant on technology to achieve my goals and this is a main resource in the overall process. Scheduling and planning is so vital to ensure you are being intentional with your time and being as productive as you can be, while leaving time for the other things in life.
I use a combination of the calendar app on MacOS and iOS connected to my google and iCloud calendars to schedule my life, year, months, weeks and days.
I use DayOne to journal my thoughts and monitor progress of the schedule and planning on execution.
I use Notion to do absolutely everything else!
Become accountable
Do what you need to do to become accountable. Some people are internally or intrinsically motivated. Others are external or extrinsic in the nature of their motivation.
I spent a considerable amount of time being an endurance athlete and during this time we were asked to identify how we were motivated. This was very powerful to performance.
See it’s not the performance that is the issue, you already want to do that. What about the training involved? All the hurdles and challenges. Identifying how you are motivated! Don’t get me wrong, you are not one or the other. It is like learning styles and the way you learn. We are a combination of them all, however most people find one area helps and drives them more than another.
I am internally motivated to achieve. All I have to do, is complete this process and commit that I want to do it and I am there getting it done. For example, I immensely enjoy the challenge of learning something new and then applying the skills and seeing them in action.
On the other hand, I had friends who were athletes and they were quite external in the way they spiked and fuelled their motivation. An example includes, focussing more on the competitive or performance outcome of what is happening. These people may be lifted by social media, winning the event or being seen by others as ‘good’.
I was always taught, as an athlete, that being more intrinsically motivated is better for in both the short and long term. Even if you are predominantly externally motivated, thats ok, you just need to identify what works for you and then do it.
Be accountable and work it out.
What is the benefit to you and how can you apply this in your life or into the future?
We need to know how it will benefit us! This ties in with the WHY and the motivation. Review each stage and each goal to ensure you are on track and working towards or are achieving that goal.
What area did we improve and what skills did we learn and / or develop?
How does this help us in the future?
Well, I know that was a tad long but….goals are important and this is how I sit down and consider my situation and what goals I want to achieve.
Thanks for stopping by! I hope you enjoyed the read!
Now, go write those GOALS if you haven’t already ?
