The Language of Anesthesia
THE LANGUAGE OF ANESTHESIA
One thing I stress to my SRNAs is the importance of communication in anesthesia. I don’t just mean the “closed loop” communication with the surgeon, but the correct way to speak as an anesthesia provider. Whether you’re presenting a patient to your CRNA the night before to come up with an anesthetic plan, giving hand-off to a fellow CRNA for lunch break, or reporting to the PACU nurses, it’s important to sound like you know what you are talking about.
I always make the case that we learned how to speak in a very certain way in the ICU. CRNAs spend time as ICU nurses, some more than others, and pick up on “ICU Speak”. While that language served us well at the bedside, as CRNAs we have chosen to elevate ourselves and our careers to another level. The way we speak must be elevated too. The reason for this change in speech isn’t to sound like a know-it-all, uptight, elitist healthcare provider. The reason for changing the way you speak is because you are no longer an ICU nurse taking orders from a doctor, that changed the minute you passed your boards. As a CRNA you are considered an integral and equal part of the Anesthesia Care Team. Throughout your career, and even during school, you might work with CRNAs, MDAs and surgeons that are well known and respected in their profession; people that have written textbooks, revolutionized their field and have international acclaim. This might actually happen. I work with several world-renowned surgeons and Anesthesiologists at my facility. In order to be on par with these providers you have got to start talking and sounding like an anesthesia provider and not like an ICU nurse. (BTW I have nothing against ICU nurses, let’s be clear. I was one for many years and absolutely loved it. However, when you decide to become a CRNA you have to leave that mentality and speech behind).
What exactly do I mean by changing and elevating your language in the OR, for that matter why is it even important? Well, besides making you sound like a provider with a higher degree of learning, it allows your MDA attending to be able to talk to you like a colleague. Elevating your language will impress your CRNA preceptors during school as well, demonstrating how prepared you are for your clinical day. All of this is important because it helps build trust, and trust is the main component that has to exist between you and your preceptor or attending. Without trust your CRNA can’t feel comfortable letting you “do stuff”, your attending can’t feel comfortable leaving your room to monitor their other ORs (if you work in a Care Team Model). It all comes down to trusting each other, and the way we talk and communicate are the foundations of that trust. Another reason I teach my SRNAs to start talking in a more professional, clinical manner is because it makes them start thinking more thoroughly. It helps them change their thinking and approach to a situation from an ICU nurse perspective to a CRNA perspective.
So here are some examples of what I mean:
When presenting your patient to your CRNA preceptor or MDA attending:
Don’t Say: this guy is 56 years old and is here because he’s having stomach pains and needs to get his gallbladder taken out. He’s super healthy otherwise, so I think we should like intubate him.
Instead Say: Our patient John Doe is 56 years old presenting for laparoscopic cholecystectomy today. He has NKA and denies any medical or surgical history. He is complaining of worsening abdominal pain over the last 24 hrs, but denies nausea or vomiting. My plan is GETTA with RSI…..etc
When reporting intraop hypotension:
Don’t Say: So my patient’s blood pressure got really low so I just pushed some neo and opened up my fluids. Maybe I should go down on his gases too.
Instead Say: Pt progressively became more hypotensive than baseline, I treated his B/P with a direct acting adrenergic agonist (phenylephrine), started a fluid bolus and will consider decreasing the Sevo if those interventions don’t give me good results.
You see how much smarter, competent, and trustworthy you will sound when you speak in a language that is elevated? I know this seems like overkill, and of course you can’t talk like this all the time, but if you start making it a habit to change the way you speak at clinicals and in the OR, you will start thinking in a much more elevated manner and it will make a world of difference. I challenge you the next time a preceptor asks you a question, or a surgeon challenges your actions, to lift your head up, and with confidence in your voice answer them in an elevated manner, with language that befits your status in the Care Team. You will be pleasantly surprised with the results. I assure you that 9 times out of 10 that CRNA will stop badgering you and might not even ask you another question the whole day, and that surgeon will stop harassing you and will instead continue focusing on his part in the operating room, which is how
best to kill your patient, obviously.
So, start speaking the anesthesia language and you will begin to see results. Elevate your speak and be proud of your place in the OR. Sound like you know what you’re talking about and be confident of what you are doing. And for Goodness sake don’t say anything is a Beta Blocker anymore, that makes me cringe. It’s a non-selective Beta-adrenergic antagonist. Like, hello!!! Duh!!
