I stood there, holding a fresh latte for you as we passed. You headed out from the night shift, and me heading on to the day shift. You were frazzled but, as always, kept it internal. As you took that first sip, I could see some relaxation wash over your face. “You know,” you said, “what we do can hurt people. Like, really hurt people.”
We hugged as you thanked me for your coffee, leaving to collect your belongings and depart. I turned to walk away but felt a chill I knew the coffee couldn’t thaw.
“What we do can hurt people.”
Not that I did not realize the risks associated with doing anesthesia. I do. But it goes well beyond the occasional bruised lip or blown IV. In anesthesia, we get accustomed to a sort of tunnel vision where we meet a patient in pre-op, have a 5-minute conversation, complete an anesthetic, and leave them in the care of a PACU RN before they are usually fully conscious. That’s the job. That’s what we signed up for. The nursing foundation we have compels us to use those pre-operative minutes, precious as they are, to establish a human bond with our patients and their families. We build trust, and we educate.
Sometimes, though, our interventions cause more harm than we intended. We walk in to alleviate a young, healthy woman’s agony from relentless uterine contractions during labor, and she is bed-bound for days with a severe post-Dural puncture headache, unable to form a bond with her infant in that precious time. A nerve block to prevent postoperative pain turns into local anesthetic toxicity. These examples are rare but no less real.
So what is a CRNA to do? Do we shy away from practice, or do we assume the risk head-on? I believe that one of the reasons female CRNAs have lower self-assessed confidence with some of the technical aspects of the job is that we take these risks into account, and the fear clouds our sense of competence. Remember, competence and skill are not parallel lines but rather a tangled yarn of technique and emotion.
I’m currently struggling with a few colleagues who claim my anesthetic techniques are “fancy.” While I want to snap back, “you mean evidence-based,” I would like the conversation to proceed productively. I encourage my students to expand their horizons out of the foundations of anesthesia. Still, I do understand and emphasize with the safety of remaining in a narrow box of anesthesia because it “works.” Where exactly do the boundaries exist between trying something to benefit our patients without deviating from the comfort of our safety net?
I don’t have the answers. I like to dip my toe in the water and swirl things around, but I also have the safety net of both experience and the ability to wade through new evidence: good and bad.