From CRNA School to an AANA Journal Publication - The Power of Mentorship

Every nurse anesthesia resident will experience moments during their training that make them question themselves. A procedure doesn't go as planned. A patient doesn't respond the way you expected. You wonder if you made a mistake. But with the right mentor, these moments can become some of the most valuable learning experiences of your career. Today's guest shares how one unexpected clinical case guided by an exceptional mentor ultimately became a publication in the AANA Journal. Welcome back to the CRNA Mentor Podcast. I'm your host Tyler Anderson, and I'm joined today by Dr. Jillian Moyer. Jill recently graduated from the University of Scranton's nurse anesthesia program this past May. During her training, I had the opportunity to get to know her both in the classroom as well as in the clinical setting precepting her. And in today's episode, we're going to discuss her recently published case report in the AANA Journal titled Unilateral Spinal Anesthesia in a Repeat Cesarean Delivery: A Case Report. We'll talk about the rare clinical presentation itself, what it was like experiencing this as a nurse anesthesia resident, the mentorship that followed, and how an unexpected complication ultimately became a publication contributing to the field of nurse anesthesia literature. Welcome to the CRNA Mentor Podcast, Sarah Jill.

Thanks for having me.

You're welcome, and, and congratulations on graduating. Uh, congratulations on becoming a CRNA, and congratulations on this publication. It was something that was very unexpected on my end. I actually have the journal right here. Uh, so I, I got this in the mail, and I open it up, I'm starting to leaf through it, sitting on my island, and I'm like, wait, this is Jill, and this is Susie Newell. I'm like, one of my favorite students and an awesome, awesome leader in the ANA. So Shortly after that, I texted you, but congratulations on the publication. That's unexpected.

Thank you. Yes, I was really looking forward to it for a long time, so I'm happy it finally came out.

Did, uh, was it kind of under wraps from, from your end? Did any of your classmates know about it or anybody with at the school?

Um, I didn't really talk about it with many people. Uh, I did tell Zadok because he— we were keeping in touch about were being at Moses Taylor because he was after me. So we shared a lot back and forth about what would happen at clinical and everything. But other than that, I didn't really tell anybody, not until probably the end of my senior year because I presented the same topic for my DNP presentation. So then I kind of told people like, yeah, I'm actually gonna be publishing the same topic here soon. So, yeah.

Excellent. Yeah. There's a lot of pieces to this story that we'll get into here shortly, but one of the things that, that I do wanna mention as well on a personal note, 3 of my 4 children were born at Moses Taylor. So it's right down the road from me. And Susie Newell has really, you know, completely changed the delivery of anesthesia care at that facility. So it's such a great opportunity for all of our students here to go to that site and experience what it's like to be in a CRNA-led hospital that is purely obstetrics. I'm so excited for you to have this opportunity. And, and before we get into this, uh, Jill, let's, let's, um, talk a little bit about your background, kind of, uh, where you're currently at in your CRNA journey and, and where you came from with school.

Uh, yeah, so I'm originally from Pottsville, Pennsylvania. I went to Waynesburg University for nursing school, and then I worked as an ICU nurse at UPMC in Pittsburgh. And then I moved home, I went to University of Scranton for school, graduated this May, and now I'm waiting to start at Lancaster General Hospital, um, in August.

Excellent. Yeah, we're— I know we had talked about this, uh, in clinical, but, uh, you're moving back home for me, uh, at LGH and around that area. And, uh, so it's, it's super exciting to kind of see your journey. And I don't know if you've tuned into any of our other podcasts, we actually gave you a shout out a week or two ago with TD. We were talking about, uh, TD Carnahan, his, you know, intubation technique. And, and you're one of the, you know, people that are like I gotta try TD's, you know, nasal intubation. And, uh, you know, those, those are things that as, as a preceptor really stand out with me. I, I feel that, you know, from what I've seen in your journey, and, and obviously, you know, it's classroom as well as clinical, is you're very motivated. And, and that's something that for all of our aspiring CRNAs, uh, to, to, you know, try and, you know, put forth the effort, because we certainly notice it on our end as preceptors. Um, Jill, tell me, um, you know, when you were in anesthesia school and, and this case occurred, uh, what was your experience like in obstetric anesthesia at the time? Where were you at, I guess, in schooling when this happened?

So I just started my senior year of anesthesia school, uh, so I completed technically almost one whole year of clinical at this point, but most of it was doing um, more of the what you would call basic cases, I guess, that were junior level appropriate. Um, but I did have some OB experience from one of my clinical sites earlier that year, which I did maybe up to like 10 C-sections there. So I had a little taste of it, but, um, definitely not proficient yet in OB. And I had a few months since then before, uh, between doing OB cases. So Moses was kind of like a fresh start again.

Yeah, so, yeah, so, um, it's, it's interesting. And I always make this joke that when our nurse anesthesia residents are transitioning from junior to senior year, it's almost like they, they kind of whisper it. It's like, I'm a senior now, because, you know, they know the expectation is higher. They know that, you know, everybody in the room's like, oh, well, this is a senior student, so, you know, you should really, you should be running these cases. And, uh, you know, I, I think that that's great. But when you get into this opportunity, you have prior experience going into this. You go to Moses Taylor, and Moses Taylor in Scranton, Pennsylvania is the baby hospital. Like, if you're gonna have a baby, that's where you go to have that. And the care there that what Susie Newell has done has been tremendous. So let's get into this case report a little bit. Walk us through kind of from the beginning of the day. Was this your first case of the day, or how did this kind of play out for you?

Yeah, I think this was— this might have been our only scheduled section for that day, actually. Um, she was, uh, like a 32-year-old female. She was healthy, had a prior C-section with no issues before. Um, so, uh, the only other thing was that she— we did have a language barrier. She was mostly Spanish-speaking, which also makes a case more interesting, especially when you're having issues. Um, so, but we brought her back We had her sit up on the bed, all the usual things. Did the— I performed the spinal, went in perfect, easy, uh, no issues with that. Had good CSF, felt really good about it. Um, had her lay down. We, you know, had her on all the monitors, gave her all the usual medications, gave her some Neo to treat like the usual drop in blood pressure, raising in heart rate. Um, so for us, we're like, okay, good signs, good signs, everything's working. Um, they're starting to get the patient prepped and draped, and as per usual, they do the forceps pinch test. And that's when, um, she wasn't really speaking to us at all, but, um, we noticed that she like winced. And we were like, oh, interesting. We're like, does that hurt? And when they pinched the left side, there was no respon— like no response. And then when they would pinch the right side, she would wince. And we're like, oh, like something's not right here. So that's when we really started to deep dive, like having her try to move her legs and stuff. And that's when we were able to diagnose that she had a unilateral spinal. Wow.

And what, you know, what was kind of going through your mind when, when you're watching her face? And I guess I— when we spoke about this before, I didn't realize the language barrier was there. And that, that adds a whole other layer to this case, you know, 'cause this is one of the rare occasions when our patients are awake in anesthesia, right? And to have this inability to clearly articulate what is happening and this entire experience, especially some individuals, in my experience, they tend to just kind of not say anything and kind of, even if we have the language line there, even if we have the family members there that has signed off that they wanna translate, you know, oftentimes just kind of, this is what this experience is supposed to be. And, um, that certainly makes all of this, this more complex. Um, can you, for our listeners, um, can you kind of describe exactly what a unilateral spinal is?

Yeah, so unilateral spinal is when our anesthesia fails to provide, uh, like the sensory motor block on one side of the body, but it provides the complete sensory motor block on the other side. So they'll be able to move like one leg, they'll be able to feel what we're touching them on the one side of their belly, but then the other side's completely blocked.

And, uh, you know, several different differential diagnoses that go into this, but what did you guys come up with as, as what had likely happened in terms of what caused, um, this unilateral spinal?

So we know like with spinal block, uh, failures, like there's, there's 3 main causes, which it can be anatomical, it can be from technique, or it can be from your dosing. But for this instance, since it was completely one-sided, um, we were think— it leans more towards anatomic, um, because your, uh, spinal canal is a tube. So if you're putting anything in there, it should spread evenly around. There's nothing that should be blocking it. So um, it's not like we had positioning where she was laying on one side and we're trying to make it one-sided. It wasn't anything like that. Um, she had the adequate elevation of the block to T4, so it wasn't the dose. Um, and like, we did have good CSF and everything, so we're like thinking like it probably wasn't a user problem, it wasn't a me problem, hopefully. Um, but, um, so yeah, we were pretty much like, this probably is an anatomic barrier, perhaps maybe the spinal before was a little bit traumatic, maybe from prior surgery, like there are some things formed in there. It's hard to tell like what happens, but yeah, that's one of the causes is anatomical changes.

And one of the things you mentioned there is it wasn't a me problem. And I, I do want to point out, and I will say, you know, in, in kind of putting this episode together, and quite honestly everything within CRNA Mentor and the CRNA Mentor podcast is always trying trying to look at it through the lens of our aspiring CRNAs, of our nurse anesthesia residents. And these failed spinals, you know, they often feel very personal, especially in school. Uh, what, what do you think, um, you know, what, what was your experience? You know, did you feel that, that it was like, oh, did I do something?

Yeah, so as soon as if I get a failed spinal, I immediately feel terrible. Like, my heart sinks and I'm just like, oh my gosh, like what did I do wrong, or what could I have done better to make this like work for the patient? And like, I've had it before with ortho cases, and a lot of times it's people like older populations, like their anatomy is all crazy from scoliosis and from, uh, prior back surgeries. And usually the CRNAs are like, it's fine, like they're all— we can just slip them under, put an LMA in, it's fine, don't worry about it, it happens, or their anatomy's messed up anyways, it's fine. But, um, I never had it happen with an OB patient. Um, I've had it like that maybe it wasn't adequate enough that we had to give a— or they just like couldn't stand what they were feeling even if it wasn't pain, and we had to give them a little bit of sedation to help them through it. But I never had like an actual failed spinal in OB. So for me, I was like Oh my gosh, like, are we gonna have to put them to sleep? And I never put a gen— like, I never put someone pregnant under general anesthesia. So for me, I was like, I know all the risks. And I was like, I, I will feel terrible if this is my fault.

Right. And I think that's something important to acknowledge. And I think as, you know, learners, it's very quick, not, not only for the CRNA in the room, but for the rest of the staff. To be like, oh, you know, this is the student's fault. And, and especially in, you know, an OB patient, because you and I know, and all of our, uh, you know, aspiring CRNAs will learn, you know, regional anesthesia, spinal anesthesia is the best for these patients, for the babies, for really every part of, of this procedure, uh, for the, the mother to have a good experience. And, and remember, you know, the baby being born, right? So there's a lot that rides on this, and it's something that when you have that feeling of like, I did something wrong, it really can kind of throw you for a tizzy here in school and be like, wow, what, what just happened? But, uh, one of the things in our conversation leading up to this episode that you pointed out, uh, you shared something that really stood out to me. You said that your preceptor, which— who was Susie Newell, she immediately assured you that this is not your fault. And can you kind of talk about, you know, what happened in this moment and why this made such an impact on you?

Yeah. So like you said, I— well, after we identified the failed spinal, everyone's looking at each other, like eyeing each other, like, oh, what do we do now? Like, we know this— something's wrong. And it's— for me, it feels like everybody's looking at me because I'm the one that did the spinal. And I'm like, oh no. Right. 'Cause a lot of times people don't like it, delays the case, and then obviously it's no be patient. So we don't want to put them under general anesthesia. But Susie literally grabbed me by the shoulders and looked me in the eyes and said, this is not your fault. And she's like, this is rare. It's kind of crazy that this is happening, but like, this is not your fault. And then she went around to the whole OR team and told them like, this is not Jill's fault. Like, this is super rare. This is like an anatomical issue. Um, she's like, this is so rare, it could get published. And that's like what she said to everybody. And I think everybody like listens to her, they trust her. So like, it was like the vibe in the room changed pretty quickly. Um, so then it turned into like, okay, like what do we do now? Um, and she like assured me like, we can fix this, like do not worry, everything's gonna be okay, we can fix this.

Yeah. Um, so you know, that, that experience, looking back, how did this kind of shape your understanding of what it's like to have great mentorship?

Well, it definitely, it definitely inspires me to be more like her because I've been in situations where I was thrown under the bus, like where they're like, oh, the student did that, it's her fault. Or like an IV blows even though I didn't put the IV in, it's the student's fault because she didn't double check it. Like, so I'm pretty used to that and I'm used to just taking the blame even though it's not always my fault. Maybe I contribute, but, um, to have someone not only like look me in the eyes and like be like, this is not your fault, because she didn't want me to feel bad, but she like told all the staff too because she didn't want them to look at me like that. Especially because I feel like I was doing pretty good there, like I was on a roll with my cases and I was feeling good about my skills. So it kind of just helped me get over that bump, like okay, this happens. Anesthesia is extremely humbling, and this is one of those examples. Um, so she just kind of helped me get my— keep my head up and keep going and make sure my reputation stayed intact there.

Yeah, no, that, that's such an important part. And, and really, you know, I try my best throughout clinicals to try and ensure that people are having a good experience and trying to think about it from their perspective. But I do see you know, my colleagues, I do see, you know, surgeons tearing into, you know, some of our residents. I see anesthesiologists doing it and it's, it just creates a bad learning environment. And yeah, that's good that you got that great experience. Now let's talk a little bit about, you know, what happened after you realized, you know, this is not working. What did you do next? What did you kind of have in your planning to proceed with this case?

Yeah, so, um, for treating like the failed spinal, like, we weighed our different options. Um, for some cases, like, you can do a repeat spinal, but we ruled that out because she already had up to a T4 level on one side, and then you have the risk of making that a complete spinal, and then you're in trouble there. Or if there are true anatomical barriers, you might have the same result anyways. Um, and then obviously general anesthesia is always our backup plan, um, but we were trying to avoid that as well since she is a pregnant mom and has a lot more risks. Um, so then Susie was like, we can do an epidural, um, which I never, uh, would have like even thought of that like as a supplemental thing. So I was like, okay, like, yeah, let's do it. So That's when, uh, me and the OR nurse helped the patient like sit up, and, uh, Susie did the epidural record time, of course, and in like not the optimal position whatsoever, but she's amazing. So she put that in, and then we were able to like slowly titrate in, uh, lidocaine and fentanyl to help, uh, slowly bring that block up and to one side and try to do it safely so that we're not getting hooked complete block, um, and it ended up working perfectly.

That's great. Um, what was your biggest kind of clinical lesson or takeaway from this entire experience?

Um, I would say my biggest takeaway would be like knowing what my options are, um, and because I feel like we know the recipe for what we're supposed to do every day for these cases, but Um, when it— what we're really like paid to know and educated for is what to do when those things aren't working or when something's not going right. So like knowing what my options are for those rare situations, um, like for that case, and then sticking with what I think is the best for the patient. Because I know like many other places would've just switched right to general anesthesia. Yeah. Because they know how to do that and they know that that will work. Um, but I think it's important to know what's still best for the patient that you can do as long as time is allowing. Obviously sometimes that it's more urgent and you have to work quicker, but if you have the time, then we should be patient. And as long as the team is understanding, you can try different things like an epidural because it is better for the patient. So I think it's important just to be able to stand your ground and advocate for that.

Yeah, and that's something that you really kind of touched on in our conversation leading up to this podcast. And oftentimes we get so focused on the technical management of these cases and we don't really focus on the advocacy part as much. And as you mentioned, like this experience, and I think we need to think about the birth of this baby as an entire experience for this patient. How can we optimize it and how can we do something that is safe as well as the best outcome for her? And yeah, I think I think that's really important to key in on, especially as all of our aspiring CRNAs are going through this process, as our nurse anesthesia residents are having these experiences, uh, to kind of keep that in the forefront of your mind because it's so easy to get, you know, caught up in the technical side of things. Um, Jill, at what point did Susie kind of say we should publish this and, and what was your reaction to that?

So she like mentioned it like when we were kind of figuring out what was going on because of like she identified it right away, like this is rare. Like this isn't something that happens often, especially to this level. And then after we did the epidural and it worked beautifully, she's like, we should publish this. Like, because she kind of did another, um, reassurance for me after the case. Like, hey, let's talk about this quick. Like, this happened, it was like, we got through it, it was not your fault, but like, look at the outcome that we had. And then she's like, we should publish this because this is rare. There's not a lot of literature on it. And like, it's important for us to publish cases like this so that there can be literature on it in the future. And she's like, this way people might know what to do if they come across this as well. So at that point, she was like, let's do this. And I was like, all right, like, yeah, let's do it. So that kind of got the ball rolling. And then it— she like worked on it And we got through it like really fast actually, because she's done it before, so she knows what to do, which is really impressive to see. Yep.

That's why Susie was the Clinical Educator of the Year within the ANA. Oh, for sure. She's great. Can you walk us through this, the publication process, and what kind of surprised you along the way?

Yeah. So first biggest thing I guess is look, making sure you have like IRB approval if you need it and consent from the patient. Um, for this case, it's not— doesn't really, um, require much because it's just a case report. Um, but then it's more of just gathering all the, all the data and then, uh, the literature that you can find on it, which this, again, not a lot of literature to support it. Um, a lot of it's just, uh, like general information, and then we're trying to put in our two cents of what we discovered. Um, but then it was just making the manuscript, um, and then submitting that, and they make sure that it's appropriate for the journal. They make sure it's ethical and lines up with their, uh, their views and everything. And then if they like it, then they, um, will submit it for peer review, and then Um, the peer review part I thought was really interesting, um, because they literally will like label everything, this line for this paragraph, and like say, okay, like, this is what you said, this is what I think needs fixed. And then when you respond, you have to say exactly how you address each thing that they mention, which I was like, wow, that's like pretty intense. All right. Yeah, yeah. So, um, after you do all that and send that back, then you can— I think they send you like the revised copy or whatever. You— they like format it, they do their edits. You have to make sure everything's in AMA, which is completely different than I'm ever used to, AMA format. And then they'll send it to you for like a final review. Both authors will approve it and then and they will like say, okay, we are going to publish this in this month of the journal.

So all in the process about, was it about a year for you?

Yep, about a year because this happened in July and then it published in June.

Wow. How did you manage all of that? I mean, you are in your senior year, obviously you were done with your didactic portion, I think at that point, right? Yeah. But this is still a lot. I guess it was Susie kind of your resource throughout all this process?

Yeah, Susie was, uh, amazing. She, she took like the main toll of it. She's done everything before. She, um, she like was guiding me through it, keeping me updated with like the emails of everything. Um, because if I was doing this by myself, it would've probably took me a century to figure it all out and go through everything, especially with clinical and studying for the C exams and so on. I was, it would've felt like impossible. For me to do. But she, she was a rock star with that. And she just kind of was like, okay, this is what's next. This is what we have to do. I'm going to send this to them now. And then, and so on. So she was like a really good liaison with all of that.

That's excellent. It really sounds like, you know, publishing this article didn't just kind of give you a publication. It kind of changed the way that you thought clinically, right? You were talking in our phone call about doing looking into another research idea involving intrathecal fentanyl for C-sections. Uh, what kind of sparked your curiosity with that, and, and what did you learn from trying to pursue that project?

So, um, yeah, after being at Moses Taylor, I kind of realized how much I love obstetrics, and I felt very passionate about it and like protecting that population because it is such a vulnerable population. And I feel like a lot of people don't like doing OB Yeah, and it probably depends on your— where you're at in the culture with it, but a lot of people don't like it. And so I was like, I like it and I would like to protect it. Um, and when I was at my next clinical site, um, I was— I would go up for the C-section. They didn't have it nearly as many, but I would go up every once in a while when I could. And I realized like they weren't putting any fentanyl into their spinals. It was pretty much only duramorph., and, uh, we were end up sedating most of our patients because they were in so much pain. Um, and I looked into like the literature on it. I knew what I did at Moses. I knew what I did at the other clinical site, and we always put fentanyl and duramorph in there. So I looked into the literature and it really supports like, yes, fentanyl is good. It helps with the onset of action and also helps with the depth of the block to cover the whole uterus because the duramorph obviously is more for post-op. It works later, um, and then the fentanyl works now and it really gets in there into the uterus. Because I feel like the local anesthetic works more superficially and it gets them through the cutting and through the initial birth, but then once we— they start suturing the uterus, it feels like it goes downhill from there. They can't handle it. They start screaming, crying., and then they're inconsolable. They can't enjoy being with their baby. So it really, like, I felt horrible every day and I don't really have a say because I'm a student. So I'm like, all right, like, here we go again. And then I'd make sure I had my Pressed X, Versed, ketamine, everything ready to go if I needed it because it was just seemed to be happening every single time. So I, um, started to look into like, maybe I can do a quality improvement project here. And do like a retrospective cohort study to show like, hey, look at this, like these few patients got fentanyl and duramorph and they did wonderfully. They didn't get sedation versus all these other patients that you only gave duramorph and they required all this extra stuff. Like it almost became normal for their anesthesia to just expect to give sedation. And I was like, that's not okay. Like that's not, that's not normal. That shouldn't be expected. So I really wanted to do that. Um, but then through the process, um, I got— it took me a while to get IRB approval from the hospital. Um, I didn't need IRB approval from the school, um, because they accepted the hospital one. And then I also got like a, a mentor for, um, from my school as a professor. And then I got the head anesthesiologist there to support me as well. Um, So then the hard part was getting access to the information. And I called so many people, I emailed so many people, and they were— it was a struggle for them to try to give me any access. Um, so in the long run, months, months, months later, I ended up never getting access.

Yeah, well, I mean, it's, it's impressive. Was that then after, um, this initial experience at Moses Taylor?

Yes. Yeah. Yeah.

So you're, you're plenty busy in your senior year, but looking for all these other opportunities.

Yeah.

Um, Jill, I, I want to kind of help, you know, provide some advice from other nurse anesthesia residents that, that are going down this path. And, and I think that many of them don't realize how many opportunities for growth exist, um, if they just simply pay attention to these opportunities. And, and I think, um, I, I kind of wanna talk about, you know, what, what advice would you give to nurse anesthesia residents or SRNAs who encounter these unusual or kind of unexpected clinical cases during training?

Um, I think it's important to look into them. Uh, we do like case studies every semester, and I feel like I learned how to find like these interesting cases where things were like different or went unexpected. Or things that I thought could change, and I would use that to deep dive into a literature review and come, like, find things and realize, like, what I probably will do in my practice in the future to help make that better for the patients, um, and have, like, better outcomes and everything. So I think it's important to stay up to date with literature, but, like, make sure you keep deep diving into it to, uh, explore things. Like, don't just be status quo, like this is how we always do things, because everything's always changing, medicine's changing, and there's always more literature coming out to support, uh, changes in practice. So, um, I think it's just important to do your own research and not just trust like the old ways or how everybody else does things, and then figure it out for yourself.

Yeah, no, that's good. And, and, uh, one of the things that I do want to mention real quick, um, in our phone call you were kind of brought up a story, and I, I think When, when people are listening to this episode, aspiring CRNAs, nurse anesthesia residents, and they're like, uh, you know, research is not quite for me, this whole process is intimidating, on the phone you're telling me about your experience when the school had brought in, you know, this IRB point person to talk to your class. What was going through your mind during that presentation, and when, when was that, I guess, that when that person with the IRB came in?

Um, they usually— this— she came, I feel like I heard her twice. So it was during like our M&M thing, so it would have been, um, either the end of our freshman year or like our— in our second year, um, she came through. But like, she was just like the IRB lady, like, yeah, the IRB lady's coming from the school to talk to us, and We'd all be like, oh, this, we have to do this again. But yeah, running through my mind, I'm like, yeah, I'm never gonna do this. I have no interest in research. I don't want any part of this, so I don't really need to pay attention. And then as soon as like we, I did this with Susie, I was like, this is actually really cool. Like I felt like I learned a lot. I feel like this could help others and can express like what I'm passionate about. So I was like, huh, maybe I should have paid attention. And then when I was thinking about doing that other research, I was like, Tracy, what's that IRB lady's name again? Like, I need to reach out. But yeah, so I definitely changed my point of view going through school and now I'm like, okay, I definitely would be interested in doing this again. Um, if like the proper opportunity came up.

Yeah, that, that's, and, and that's really probably one of the biggest takeaways for everyone listening to this episode is the more receptive you can be to these opportunities, um, there's going to be multiple doors that are going to open for you. There's going to be individuals, um, like Susie at your clinical sites that are going to be like, come on, I'm going to show you the way. It's going to be more work. Don't, don't get me wrong about that, but it can be an amazing opportunity that can completely change your mindset as you navigate this path to CRNA school and, and becoming a CRNA. And, um, you know, props to you for, for, you know, jumping at this opportunity, uh, and props to Susie for help— helping kind of facilitate that. But, but don't shy away from these experiences even if they are more work. I think that's probably one of the biggest takeaways from this episode. Um, you know, as we wrap this up, Jill, I want to zoom out a little bit and, and just away from this one case and kind of look at the bigger picture. As you begin your career as a CRNA, uh, what lessons from this experience do you think you'll carry with you throughout your career?

Um, I think that I will carry with me, uh, like I said before, like advocacy, like not being afraid to do what I think is right for the patient and what's best. I feel like it— this experience gave me more of a backbone, um, for advocating for patients. Especially in the OB population. Like, sure, if I'm in a robotic laparoscopy and I want to give them Presidex or something and the anesthesiologist is like, no, I don't like that, I can probably like let that battle go. But when it comes to OB and like, you know, if I think they need fentanyl in their spinal or if I want to try an epidural to supplement like the failed spinal, I feel very comfortable like pushing for that now because I've seen all the research on it. Um, so I think I'm going to be much better at, um, speaking up for that.

That's, that's great. Um, Jill, congratulations again on graduating from the University of Scranton, on becoming a CRNA, and publishing your work in the ANA journal. Um, also a little plug, uh, thank you for— you helped represent, uh, University of Scranton at the College Bowl at Pana, right? And this is our second, uh, win here in the history of the school of winning College Bowls. So thank you for being a part of that and making all of us alumni proud. Um, but, um, you know, these, these are really incredible accomplishments, and, and I really appreciate you taking the time to share the story with us today. You know, what one of the biggest takeaways from this episode in this conversation is that your journey through CRNA school is much more than, than learning about how to perform anesthetics. It's about how to think through these unpredictable and unexpected situations, about advocating for your patients, and, and really growing from these challenges and seeking out these mentors who, who help make you the best provider that you can be. So for all those listening today who are aspiring CRNAs, who are nurse anesthesia residents, the patient that you're caring for today, the case that doesn't go according to plan, or the mentor that's investing in your development may end up shaping your career in ways that you never expected. So thank you for, for joining me today. If you guys found this episode helpful, I really appreciate if you share with somebody who needs to hear it, who is another aspiring CRNA, and Jill, thank you again for joining us and, and for being part of the CRNA Mentor platform and just sharing your wisdom. And good luck moving forward here.

Thank you.

All right, take care, Jill.

You too.