Clinical Education

Our School of Nurse Anesthesia enjoys enthusiastic support from Truman Medical Center Hospital Hill and the University of Missouri-Kansas City School of Nursing and Health Studies and our local clinical affiliate hospitals:

Students are introduced into the clinical area in the third semester of the program. Initially, students are assigned to elective surgery patients who are relatively free of significant pathology. As the students’ clinical skills progress, they are assigned to cases of increasing complexity requiring emergency, obstetrical and pediatric procedures, or to patients with significant pathological conditions.

Our students participate in anesthesia care for all surgical specialties, including general surgery, plastic surgery, ophthalmology, obstetrics and gynecology, urology, oral and maxillofacial surgery, ENT, orthopedics, podiatry, thoracic and vascular surgery, and neurosurgery. In addition, our students participate in specialty anesthesia and outpatient clinics including gastroenterology, cardiovascular, and radiology procedures outside of the operating rooms.

Due to the very active oral and maxillofacial surgery and head and neck surgical services, students have the opportunity to manage difficult airway problems in patients with conditions such as facial abscess, Ludwig’s angina, facial-skeletal deformities, and post-operative/post-radiation airway pathologies. Students also participate in the management of emergent cervical spine fractures and head trauma.

In addition to general anesthesia using mask, laryngeal mask airway, or tracheal intubation techniques, students perform and manage subarachnoid (spinal), epidural, and upper and lower extremity nerve blocks. Students gain experience in central venous, pulmonary artery, and radial artery catheterization during open heart surgical procedures and trauma cases. Senior students provide 24-hour, supervised coverage of Truman’s high-risk labor and delivery unit.

The importance of nurse anesthesia care throughout the entire perioperative period is emphasized during the program. Students learn and perform pre-anesthetic history and advanced physical health assessment which includes review and interpretation of relevant lab data, and radiologic and cardiovascular diagnostic testing. Students develop and apply anesthetic care plans for each patient in consultation with anesthesia clinical faculty. Students also gain experience in post-anesthesia outcome documentation and assessment.

The relationship between the student and the clinical instructor is dynamic. At first, the student is a dependent learner, while the instructor provides information, guidance and support to the student. Gradually, this relationship changes as the student’s knowledge base and clinical skills grow, and the instructor allows the student to make increasingly complex decisions while continuing to provide a source of support and guidance. Evaluation of student clinical performance is a tool that helps the student identify his or her strengths and limitations, and provides a basis on which to plan for continued growth of clinical skills. Ultimately, the student attains the level of skills expected of a novice nurse anesthetist with the instructor acting as a consultant.

Clinical experiences available to students are rich and diverse – over 4,000 procedures are performed annually in TMC’s operating rooms, providing generous geriatric experience, emergencies and trauma. More than 26% of the procedures are performed on ASA Class III or above patients. As a High-Risk Pregnancy Center, the obstetrics department handles approximately 2,500 deliveries each year.

Level I Trauma Center designation at TMC allows students the opportunity to become skilled in the management of anesthesia for trauma surgery. Complex, multiple-trauma cases facilitate a “team” approach to anesthesia management. Together, the emergency department, surgery, and anesthesia personnel integrate their specialties to provide continuity of care from the moment the patient arrives, through surgery and stabilization in the intensive care unit.

Regional anesthesia education begins in the classroom, progresses in simulation, and culminates in the clinical practicums. Students receive extensive experience in the administration of spinal, epidural, upper and lower conduction nerve blocks, and intravenous techniques. Intraoperative management and the use of ultrasound are included in the curriculum.

Pediatric anesthesia experience at Children’s Mercy Hospital provides nurse anesthesia students with one of the most extensive pediatric experiences in the country. Experiences include cases in all surgical specialties including ENT, ophthalmology, general surgery, orthopedics and neurosurgery.

Cardiovascular anesthesia experience at Harry S. Truman VA Hospital, Centerpoint Medical Center and Lake Regional Medical Center allows students to acquire the knowledge and hands-on skills necessary for placement and management of arterial lines, CVP lines, and pulmonary artery catheters as well as the anesthetic management of open heart and vascular/thoracic procedures.

Call Experience: Students participate in (in-hospital) call experiences along with other clinical faculty 3 to 4 times per month throughout the clinical portion of the program. Students engage in anesthesia care for emergency surgical and obstetrical patients under the direct supervision of CRNAs and other clinical faculty. Students also function as members of the code blue and emergency airway team. These experiences include awake fiberoptic, nasal and oral intubations on patients throughout the hospital.

Housing & Travel

Students may be required to travel to clinical sites outside of the Kansas City area. If drive distance to a clinical site exceeds 60 miles from Truman Medical Center Hospital Hill, housing will be provided at that site. Currently, there is no cost to the student for housing at distant educational sites.

Typical case numbers upon graduation from
TMC School of Nurse Anesthesia (2013)

Total Cases: 850-950  
Total Anesthesia Hours: 1400 – 1600
Physical Status Class 3, 4, or 5: 350
   
Regional Anesthesia  
Spinal 40
Epidural 70
Peripheral Nerve Blocks 12
   
Invasive Lines  
Arterial 25
CVP 10
PA Catheter 10
   
Other Anesthetics  
Fiberoptic Intubation 10
Caesarean Section 40
Geriatric 100
Pediatric 80
Mask Anesthetic 35
Cardio-thoracic 25