Certified Registered Nurse Anesthesiologist, Flo Schenke

[00:00] Michelle: Have you ever driven an expensive sports car? You know, one that goes from zero to 60 in 2.5 seconds? Well, you will have the same experience talking with Flo Shenke. She is fast and furious. She's also kind, compassionate, highly skilled, brilliantly intelligent, and funny as hell. In this interview, she talks about all things CRNA or Certified Registered Nurse Anesthesiologist, what she does, who she works with, her schooling, her business, and her legal challenges. And maybe the most important part of our conversation is how she treats people, gaining their trust and proving her trustworthiness with each patient. Flo, you can give me a cocktail any day. In the five-minute snippet, she tells us about a very expensive but tasty mistake she made involving wine. Cheers. Here is Flo Shenke. You're listening to the Conversing Nurse podcast. I'm Michelle, your host and this is where together, we explore the nursing profession, one conversation at a time. Well, good morning, Flo. Welcome to the show.
[01:24] Flo: Hi. Thank you. I'm glad to be here.
[01:26] Michelle: I'm so glad you're here as well because today we're going to talk about all things Certified Registered Nurse Anesthesiologists or CRNA. That's the short version. And you have lots of experience, so I was super happy when you told me, yes, I will come on your show and be your guest. So thanks again for being here.
[01:49] Flo: Absolutely. It's exciting. We love to talk about what we do and hopefully get new recruits out of it too.
[01:57] Michelle: There you go. There you go. Okay, well, so we're just going to start off by having you just talk a little bit about your background before you became a CRNA and kind of what led you down that road.
[02:11] Flo: Sure. So it doesn't say everything in my CV, but what got me into the medical field was I was actually the front desk person at St. Agnes. That's kind of falling off my resume because it was so many years ago, but they really kind of got me exposed to all the medical professions. And then quickly after that, I got into the nursing program at Fresno State, which was a great place where I met so many of my oldest friends there. And I actually started working at the Burn ICU at CRMC in Fresno, and that's really where I started to get the experience of critical care and dealing with real high acuity level patients. So that really kind of set me up for anesthesia. I didn't know it at the time because I did work in the Burn Center for almost five to six years and never had a plan to be a CRNA. I met them and knew what they did, but I really was passionate about burn nursing at that time. So during that time is when I met my husband and he was living in Visalia, working in Visalia. So I picked up a position in the PACU or Recovery at Kaweah Delta, and that was around 2009. And I met more serious, actually, I saw a transition there. I initially started in the PACU where there was only an anesthesiologist, MD anesthesiologist. And in that year I saw a new anesthesia group come into the facility and switch with a group that had both CRNAs and MD anesthesiologists. And so that was an interesting time and a huge shift for the facility that wasn't familiar with this type of provider. And it had some conflict, but they overcame it and they proved themselves to the community to be high-quality anesthesia providers. And they're the ones who really influenced me to go back to school and become CRNA. So that's kind of where it all started. Off to school. I was off to school.
[04:30] Michelle: I remember the period of time that you're referring to as I was working in the NICU at that time at Kaweah Health. And that was actually one of my questions, did you get pushback from either the community, the nursing community, or the physician community, when that whole thing came in? Because it was like MD anesthesiologists against nurse anesthesiologists. 
[05:05] Flo: Sure, I remember a lot of controversy around that.  I was an RN in recovery at the time that that switch occurred. And not only was there pushback but there were publications in the Visalia Times, which is the local newspaper with physicians and nurses both stating they would not want a nurse to pass their anesthesia, not really understanding their full background or even taking into any account of what kind of education they go into after they have been a nurse for a few years. And so it took a lot of education and actually I felt I was helping support them because the recovery nurses didn't want to recover their patients. And so there were a lot of awkward moments, you could say. But there was a phenomenal person and he actually was an MD anesthesiologist. And I like to say his name because honestly, he probably is one of the main people who made me go on this path,  he's Dr. Winston. He's the one who brought the group to Kaweah and it was Omni at the time. And he's the one who actually helped, he encouraged me to be a CRNA. He promoted CRNAs throughout the facility and showed what great work they did. And no matter what talk he heard, he did not shy down from a conversation to give them the background and the information they need to know that these are safe providers and they're going to take good care of you. So he always backed these CRNAs and him being a phenomenal anesthesiologist himself helped because that guy did amazing anesthesia and people knew it. And so when you have someone like that who can back a whole profession, it gives you a lot of credibility. And it took a couple of years, but I still work with some of these CRNAs who are the pioneers from that year on, and they went through a lot to get us where we are right now in this local community down here in Visalia.
[07:08] Michelle: Yeah, I remember at the time I was a charge nurse in the NICU, and so part of our job is to attend all the C-sections and the high-risk deliveries. And I remember you guys coming into the OR and just being so impressed with your professionalism. And I think the same thing happens with advanced practice nurses in terms of the community maybe not knowing what they do. So one thing that I can think of is nurse practitioners. We have a huge shortage of physicians in this area, as well as nurses. We're utilizing many nurse practitioners. And I found this true with my own parents. When they would go to the doctor and they're expecting to be seen by a doctor, and then the nurse comes in and they had no frame of reference and they weren't sure, and it took all of us kids who were nurses saying, it's okay, they're better because we had great experiences with nurse practitioners as patients ourselves. I will say that when I went through chemo, I had a nurse practitioner that worked in my oncologist's office, and I preferred to see her. Just the level of,  just the listening skills and the thoroughness of their assessment, and I was just really impressed. So thank God for physicians like Dr. Winston that can provide that segway for you guys to start your practice and be successful.
[09:00] Flo: Right? Very cool.
[09:03] Michelle: Yeah. You worked ICU,  PACU, and Burn. And how do you think working in those specialties prepared you for being a CRNA?
[09:17] Flo: I actually do still think my burn ICU background prepared me for more things than I could ever imagine. I still think that might be the hardest job that I've ever had. Just with the types of cases we saw and what we were expected to do at CRMC. I don't know if they still do it this way, but when I was there, we were the MICN for burn patients. We would come down to the ER.  We triaged our own patients from the moment they walked through the door. And _______, she was the director at the time. I still talk with her. She is still another person who just gives me so much wisdom. She was our director at the time and is now retired, but phenomenal lady as well. But she had us do every step of the way care, and when I mean every step of the way. We met them in the ER. We took them to ICU. We met with that family and explained what the process was going to happen. Many times with a 90% burn, this patient doesn't look like they're going to go through anything hugely traumatic. Oftentimes these secondary gray burns had to tell they still look normal at that time. No one truly understands the fluid shift unless you've seen every moment of it. So usually we had to talk this patient quickly through the patient and the family that you guys are not going to be able to talk with each other for the next six to twelve months. So we can say everything right now because the process here, we're going to be going through an intensive situation where we will be intubating your family member and it could be months. And so that's a very hard conversation as a new nurse, but they make you learn quickly. And so you take them through this ICU level of care. They go through multiple, multiple surgeries. We would go through the OR. We pre-opted them, we take them through the OR. We would post-op them. We did everything. So you got to see the CRNAs also managing, because CRMC, there's a phenomenal facility that has supported CRNAs for over 20 years, level one trauma. And they actually had a CRNA -owned group running their anesthesia for many, many years. They've kind of had some different groups come in and out, still working with _____, but the group Omni, a phenomenal anesthesia group really has shown the San Juaquin Valley, what nurse anesthesiologists can do in this community. It's a great group that I used to work for and also just can't say enough good things about them as well. But yeah, burn nursing, I would say that really helped me able to compose myself in emergency situations, and Michelle, stop me at any time because I can go off on a tangent forever. Bring me back to the center.
[12:17] Michelle: I hear your passion and your excitement for what you do. It's awesome. I know that our listeners are going to hear that and feel that too. Did you do any pediatric burns?
[12:33] Flo: Yes, and we were level one since we were the only level one burn ICU, even children, we would receive the children before Children's received, until they could get down to a step-down level. We would not transfer them to Children's. I was in my twenties and I didn't have kids and I would do it and of course, it touched me and I was like, oh my gosh, I can't believe this happens to a child. But now that I have kids, I don't know if I could do it anymore, to be honest. The stuff I saw, tears me and crunches me more than I think it did in my twenties of going to work and party after kind of situation. Again, the hardest situations where you're dealing with CPS, often, gang activity, things that.  I'll do one quick story just to give you an idea of how crazy things got. We had a person who was involved in drugs and got burned by meth production, and it involved I don't know if the cartel is the right word. It was just a lot of stuff where we had to keep our unit locked down, preventing people from coming into it. I mean, we were a lockdown unit anyway, but we had situations where we had to call officers because there were people at the door that could possibly be potentially hostile. So there was just so much dynamic there that I'm still impressed with everyone that still works there because I'm sure they're desensitized to those, we know what to do. I'd be like, oh my gosh, how do we deal with this? And I know we did it, and I did it back then, but again, I don't think I could do it anymore.
[14:21] Michelle: Pediatrics is different, and I had 18 years of pediatrics. We did see burn patients. They went straight from the emergency room to Valley Children's. But we are certainly familiar with all the dynamics, the CPS, and just all this stuff that brings with it the drama. Right. Part of your job involves obviously, inserting lines, noninvasive monitoring, invasive monitoring, central lines, arterial lines, and intubation. But did you do any of these things in the ICU as a nurse or how did you learn these skills? Was it all learned in school?
[15:08] Flo: So in the ICU, obviously, you utilize these lines, you help assist the physician, place them when you're an ICU nurse. We were never allowed to place these things, but we know how they operate. We worked with them, we changed the dressings, things like that. In my profession now, yes, our program prepares us we have to have a certain amount of numbers through our program to be able to do these skills. And I will say CRNA school is probably the most intense thing as far as education I've ever been through. It's 110%. There is no vacation. When we say it's like three years or 27 months, it's every day, every week, every month. There is no vacation. You get Christmas off, you don't get the weeks around it off. There is no summer, there is no winter break. It's 100% get through it. And when I compare those kinds of hours to other master's degrees, I'm always like, man, I wish it was already labeled a doctorate because the hours we put in were doctorate level already. And now I've seen on your list here that it's switched to a DNP doctorate level program, which is good, because it only added two more months or three more months to the program, and now it's a doctorate. So I'm very happy for all these new grads that get to come out with that level of education because they deserve it. And you definitely earn your badge when you walk out of that campus. When I say you have a certain amount of numbers for these lines, art lines, central lines, intubations, all our skills, we go well above that by hundreds, sometimes certain types of skills. Thousands, really. We get so much hands-on. Another skill that's very valuable is our regional anesthesia with our nerve blocks. National University does a phenomenal job of getting us into independent CRNA groups where we get to perform all of these skills independently. It's really nice they do send us to groups where it's MD supervised, so we understand that that exists and that's an option in the CRNA anesthesia workforce. But most of us who go through that program stick with independent practice. Because once you learn that you can do this by yourself and you can be the one, not only, yes, you're responsible for everything you do and decide, but that you can make it the best that you want it to be, you have control of that quality. No one's going to tell you to do something that you feel uncomfortable with because you ultimately make the decision about what you feel is safe, appropriate, and best practice for that patient. And that's why I think people are serious in this area. We take our job very seriously. I know everyone does, but CRNAs have to be 110%. We have to do it better because even if we do it better, we're still questioned. MD is great, you know, and I met amazing anesthesiologists. I'm a big proponent of the idea that your label is your label. You prove yourself outside of that, you can have a phenomenal MD anesthesiologist, and you can have a phenomenal nurse anesthesiologist. And if they're both at that 30-year experience mark, they're both as good as they wanted to be in every single arena, depending on how they took their practice. And I feel that way amongst all specialties that have different types of professions doing skills for patients, it's based on that person and how seriously they take their role in the community. I'm sure every nurse practitioner, I feel very connected with them being our advanced practice and midwives as well. We all do what we do best and we make good decisions and all of us, we have to show 110%. Sorry, there's my dog. So sorry about that. I put them outside.
[19:35] Michelle: That's fine. So along those same lines, you were talking about midwives and advanced practice nurses. I interviewed in episode eleven, I interviewed Christine Daniel, and she's a charge nurse. Yeah. And she talked about working with the different professions, CRNAs,  midwives, and just really talked very highly of you guys. So I just wanted to get that in there and make sure you guys knew that.
[20:08] Flo: Christine is wonderful. We definitely appreciate her when she's up there with us. OB can be chaotic at times, and she helps us definitely orchestrate a well-run ship there. So we appreciate that. That's really nice to hear.
[20:27] Michelle: Yeah. Talk to me for a second about where CRNAs can work in different settings.
[20:38] Flo: Absolutely. If anesthesia can be done, we can be there. We work in OB anesthesia, we do epidural C-sections, and we do them all independently. We work in all the surgery centers, any type, to be honest. Just to say, going to that my group, we actually do run 90% of the surgery centers in Visalia and we all work independently. My partner Eric and I, and have actually six partners, but we all are the ones who develop the policies and how anesthesia is run at each of these surgery centers in Visalia. Same at Kaweah, it's an interesting dynamic there. They have two groups under an umbrella. They have an MD anesthesiologist group and a CRNA anesthesiologist group that work side by side and cover the same shifts. The difference between them is there's an MD anesthesiologist residency program, so that's the MDS run that program. That's really how that dynamic works there. There's education going on and CRNAs really do help support that because they have a lot of different specialties they have to get through and can't cover all the rooms. So it's a nice teamwork effort there that allows them to be able to, one, get all the procedures and shifts covered and still be able to educate these residents to one day be an anesthesiologist. So, yeah, CRNAs really can be in any type of department. The one department you won't see them in as much is cardiac anesthesia for like open heart procedures, and things like that. It's not that we can't often I think it's because we don't want to, but I do have some friends, who're not in this area, but who run the cardiac anesthesia in Arizona. And they are independent CRNAs that work with their cardiac surgeons, and they fully run the cardiac anesthesia department there. So, as I said, we can be in any department. It's just where the opportunity has opened up for us to manage it. I will say, as time has gone on, we've entered a lot of domains that we actually control the management, the billing, and everything that you would imagine an MD anesthesiologist doing. So it's really kind of nice that we've expanded in that way here in Visalia. But that is something I will say again. I want to talk about that group Omni. They have done that for years. There are lots of groups that have been around that are CRNA independent, that have managed it this way. And so it's just nice to be a part of that level of anesthesia, I guess, at this time for us, we're enjoying it.
[23:47] Michelle: Yeah, well, it's a hard one and you should enjoy it, for sure. So I did want to touch on your business here in Sierra Nurse Anesthesia, which you opened in 2015, is that right?
[24:02] Flo: Yeah. So we actually started contracting with just a couple of small surgery centers. One was my partner, Eric's dental, it's a dental surgery center in Exeter and we've worked with him for quite a few years now. And then another one was an eye center here in Visalia. And those were where we started. Both he and I started collaborating with a couple of CRNAs and we would still work at the hospital full-time. And people were hearing that we were managing these two places and often centers switch anesthesia groups. It's not uncommon. You always hope not to be the one that you get switched away from, but it's just how the business world works. But as we kept being talked about, we had more centers asking us to cover them. So we kind of really kept growing and growing. These specialties last three years and we were able to work in some of the bigger surgery centers here in town. So we actually now have six partners in our group. And then we do have contractors that help us staff all the rooms. And about Monday through Friday, we have anywhere between four to six or throughout the town that we're staffing. And so it can be hectic when it comes to scheduling, but we got a pretty good system now after a few years. It takes time, but I think we've got it down now.
[25:39] Michelle: Well, like I said before, that's no easy feat, and congratulations on that. So let's talk for a second about your patients. And I'm sure that your patients when you're counseling them for surgery or procedure, whatever you're going to do, I'm sure they express fears to you. And how do you address those fears? How do you reassure them?
[26:07] Flo: As you know, being a nurse yourself,  every patient requires a specific type of care. And it is no different with anesthesia when we sit with it. Oftentimes how it goes is the pre-op nurse warns us that a person has certain concerns or they're very stressed out, they almost passed out with the IV, sick little things that can happen with anyone who has anxiety or any issues, or if they're just angry people. Everyone's got their own agenda. We come in compared with a game plan, some of us, I'm kind of a joker amongst them.
[26:48] Michelle: No way.
[26:50] Flo: I usually bring humor into most situations, but people know I can get pretty direct. And if it's someone who requires a little bit of authority, I can put my mom voice on real quick too. But yeah, oftentimes am I going to remember something during the surgery or am I going to wake up? Those are the most common fears in the community. And I never want to tell someone that something's impossible because there is always a possibility of the most terrifying thing happening, of course. But I do tell them, I'm like, this is the most unlikely incident that could possibly happen with the types of monitors we have, the types of drugs we have. I told him, you're probably not going to remember the movie you watched this afternoon. That's usually how it goes. So whatever that patient needs, if you have to go slower with that patient and talk them through each step, we do that. Or sometimes they just want to get the drug right away and just get this over with. Sometimes that's what we do. Let's get you back there and get that cocktail in real quick. So everybody's just handled based on what it looks like they need. And we always reassure them that we're there every second. We don't just put them to sleep and walk out of the room. So we sit there and we stare at every beat that you create. We have head-to-toe monitoring every breath, every heartbeat. And so that usually makes them feel a little bit better, knowing that you're there, you're present, and I'll be there when you wake up. So that doesn't always work. Sometimes you still do. Sometimes I tell the nurse because there are some places we actually have them walk back so you can't have them having Versed and then walk back. So I'll tell the nurse and say, can we wheel them back in the chair? I'm going to give them drugs out here. This person needs this. Sometimes that helps. That's all we can do. We just do what we can with our pediatric patients. We do have a CRNA that's primarily pediatrics. And that's the difference. That one. We have to play them. Sometimes I give piggyback rides back to the or. We even let them play with the anesthesia machine and squeeze the balloon and let them pick out what flavor mask they have all these things. So just like whatever makes it fun for the patient, too. Like if they like drinking alcohol, usually that's when I get them to tell me the truth. I'm like, well, you need a cocktail. I normally drink a fifth of Jack. I'm like, oh, okay, I'll get more cocktails out.
[29:46] Michelle: I love that. Oh, my God. That brought to mind my daughter when she was 15, she had her wisdom teeth out and she had to go to Valley Children's and everything. And it was just a day surgery, but an anesthesiologist came in and he was very attractive,  an Asian guy, and she really loved Asian guys. I don't know why, but he was talking to her and he gave her the little cocktail as they were sitting there talking. And she looks into his eyes and she's just staring into his eyes. And I thought, oh, no, don't embarrass yourself. And she says, I love cats. And he looked at me, he goes, does she? I said, no, but I mean, I told her that when she woke up, but it was hilarious. Yeah. And that was totally my dad was like, give me the cocktail now. I want the cocktail now. I'm ready.
[30:52] Flo: We make it happen. Whatever they need. Because patients really do, they wake up the way they go down if you sleep crying. And I always tell the PACU when we get there, they went to sleep crying. So they're probably going to wake up crying, sorry, ahead of time. And then with young men under 30, I don't know what young men under 30 dream about, but they like to wake up punching, oftentimes fighting right for that. And then I usually tell them and actually I notice just communicating with patients of expectations really helps because I'll tell the guys, I'm like, hey, man, I know you're going to want to wake up punching me for some strange deep down reason, but just think about not doing that and that we're your friends. And he's like, all these guys are like, oh, I would never. I'm like, okay, cool. Remember that sometimes it works. The brain is a weird thing when you give it different drugs to block certificate receptors or whatever. It's a funny thing. Real quick story of one guy actually said it to many people who just worry about going down under anesthesia. I had a guy very nervous. I said, where would you want to dream about? What's the one place I could take you there right now? Where do you want to go? And he said I want to go to a Dodger game. I'm like, all right, cool. Let's do that. So I'm like, all right, I'm going to give you your beer and your IV here. You don't even have to pay the $20. Your insurance company will do it. And then we get him to sleep. Surgery is pretty quick. Wake him up. I'm about ready to activate. Pull the tube. He puts his arm out and I'm thinking, oh, no, this guy is going to hit us. And I pull the two out and he goes, Kershaw. And we're like, why didn't you know at the time? Now I know. That's the picture. Everyone's like, that's the pitcher for the Dodgers. I'm like, is it? Wow, that's crazy. I always tell people, I'm like, think of that last place you want to dream about because that was probably where you're going to go. So think of a pleasant place. I don't make people count because then I'm like, now you're present with me, go be present somewhere else. That's nicer. Wow.
[33:02] Michelle: And I love your approach. You sound so much fun. And I know if you ever had to give me anesthesia, I would love it because you're so fun. And I'm really a highly anxious person. And I was one of those people who when I had my mastectomy, it was like my first surgery, a big surgery, and I was super anxious. And when I woke up, I was crying in the PACU and my sister Jennifer was there with me, even though she wasn't supposed to be, but the most wonderful Dr. Vassilev let her in. She's amazing, right?
[33:41] Flo: There's someone who's impressed on.
[33:43] Michelle: Yeah, Jenny was there and I woke up crying and the nurse was saying, are you in pain? And I wasn't. I said, no. I don't know why I'm crying. I just crying. I kept saying, maybe it's just maybe I'm happy because I woke up.
[34:06] Flo: Bless her heart. She taught me many things in anesthesia that you don't need, hardly. She's the MacGyver of anesthesia. She taught me how to intubate with things like if I was in the middle of the desert. She is a phenomenal lady, and she and I gosh with so many amazing cases together where patients were so sick, so close to death, and we got them out of it and off to ICU. She's amazing, that was an amazing MD anesthesiologist.
[34:41] Michelle: And just a beautiful person, too, for sure.
[34:43] Flo: Yes. So caring.
[34:45] Michelle: Well, let's talk for a second about this crazy California Assembly Bill, AB Five, which passed.
[34:57] Flo:  I remember, that was terrible.
[34:58] Michelle: Yeah. And so talk to me a little bit about just what it meant and then kind of what is the status of the bill right now?
[35:06] Flo: So, it's interesting. Initially, it was proposed for Uber drivers and all these people who drive food around, all those types of independent contractors, contractors, all these things in the interest of giving them health benefits. And I hate to be like, a negative Nelly on taxes, but I feel just so that there could be more tax dollars collected. But yeah, with AB Five to describe what a contractor needed to be, and it created exceptions. And the exceptions were not Uber drivers. All these people were fighting it so Uber drivers could be independent contractors. What AB Five did was actually, anyone who wasn't excluded from it could not claim to be an independent contractor per the law unless they met three criteria. I probably won't explain them correctly. I'm not as good as our CPA, but basically, you have to work for multiple people and prove that you have multiple clients and that no one dictates your schedule. And there was a third one where gosh, I'd have to look at it again. But basically, you had to meet these three criteria to prove and so it didn't say you were forbidden or couldn't be an independent contractor. It's just they would make you struggle more to prove that you are. But that still feared. Everyone fears hospitals, centers, and everybody, they don't want to be investigated. No one wants auditing. That's no fun for anyone. What a lot of lawyers did for all of our Anesthesia groups was they made us partnerships. So we all quickly changed. We all kept our escorts. Most of us have escorts. And instead of being independent contractors or LLCs, we have each our own corporation. I have Flo-right Nursing Anesthesia. My partner Eric has Dexmed anesthesia and with these S Corps, we created partnerships. And so my group, Sierra Nurse Anesthesia, is actually a partnership of S Corps. And it's probably so much gibberish to anyone who doesn't have to deal with this on a daily basis. And when taxes come, it is absolutely mind-boggling. But we have CPAs for that, so we found a way around it, and it works well. And actually, I think it made us all more cohesive with each other. I don't know if we all would have worked in tandem so closely in this area anyway if it wasn't for AB Five. While it initially seemed like it was going to block us from opportunities. I feel like it actually opened up opportunities in the sense that we collaborated together so closely and created these partnerships that we were able to achieve more because we did it as a team instead of as individuals, which always works better than you want.
[38:29] Michelle: Well, I love how you turned it into a positive. When I was reading about it, I was dumbfounded that the CRNAs got under that umbrella, and I'm glad that you guys found a way to turn it into a positive experience.
[38:47] Flo: It took really some impressive lawyers to think around it and kind of think outside the box, but they did it and it's been great. It works well for us, and we're still able to have contractors. We make sure the contractors are two contractors that work for us, that they meet all three criteria and that we can check all the boxes if we were to ever be audited and things like that.
[39:16] Michelle: So that's great. It sounds like you have a great team.
[39:20] Flo: Yeah, we do.
[39:21] Michelle: Well, what keeps Flo going? Why does Flo keep coming back to being a CRNA? What inspires you? What motivates you?
[39:33] Flo: Honestly? People. I enjoy people. I love talking to people and I love having conversations with as many people as possible. I am absolutely an extrovert, and people always think, oh, I seem and anyone listening, I probably talk to you at SaveMart. It's interesting because before I went into here, I was like, why are you going to go into anesthesia? They're just going to be asleep. I'm like, yeah, but I get to talk to them before and after. It's a challenge to me, and I like this challenge of I have to get a person to trust me in less than five minutes and 100% with their life. And I take it incredibly seriously. On what avenue do I use jokes in this situation? Do I need to be a little more straight-faced? Do I need to just slow it down and get to know them, find something that what's valuable or what's important to them in a minute, and just use that to help them trust me? I don't know if everyone takes that part of anesthesia. Everyone has their own specialty in anesthesia. For me, it's talking. I love talking to each patient. I love talking to all the nurses. I love talking to the surgeon and just, you know, at the end of a hard case, I'm known for this, and a lot of surgeons, I'm sure, can attest to this. They successfully get through probably one of their tougher cases, and it was very difficult. But once it's all fixed and done and I'm about to wake the patient up, I always tell my man, that was easy. I felt like we didn't have to do much there. So I always try to lighten the mood when everyone is so serious. Only when I see the light at the end of the tunnel. If I don't see that light yet, I hold back. I just enjoy the community of it. I like being part of people's lives in OB. I don't do as much OB as I used to. I used to do so much OB. And I love being part of that special moment. And even when it was someone who thought they were just going to have a labor and epidural only and I have to take them back to a C-section being part of these critical moments, oftentimes I've had to also be the person that goes and talks to a family when someone's passed. While that's difficult, I don't want to say I enjoy that, but I definitely want to be a part of it with that person so that they know that we were there every minute of their family's critical moment and that we're still there for them. It doesn't just stop because their family member is not here anymore. There are so many moments that we deal with, whether it's the beginning of life or the end of life. Your average outpatient patient surgery is just building trust with everybody, and it goes outside of the OR. Because I see these people in the community, and it's just nice to know, like, all of us, that we were able to help you through a critical moment, no matter how small or big it was.
[42:47] Michelle: Yeah, I think nurses get a lot of satisfaction from that. I know as a NICU nurse for many years, seen the families of the babies that we cared for like you said in the grocery store. And, you know, nine times out of ten, I didn't remember that baby unless they were there for a very long time, but they remembered and they would tell me, I just really appreciate how you took care of my baby, and it feels really good. And that's definitely one of the things that keep us coming back. Right?
[43:21] Flo: Right, exactly.
[43:24] Michelle: So many of our audience members are nurses, and if I'm a nurse and this is the path I want to go down to be a CRNA, what can I do, like right now?
[43:39] Flo: So if you're a nurse right now, I would suggest finding an ICU to get ICU experience. If you're an ICU nurse already, you're already set. Now what you need to do is just look into what CRNA program you'd want to look into and make sure you have all the classes. Some people, obviously, have to have a BSN to enter CRNA school. There's also, certainly not every BSN has the same science curriculum, so you might need to take an extra biochemistry class or an extra Chem 1A or something like that. And I actually did, and I did that through one of these online programs that they have at Berkeley, which is a great online program that they have. And it's kind of pricey. They're like $300 for the class, but well worth it. Teachers are accessible. It's a great way to just quickly get the science class you need from a very reputable school. And if you're GPA, obviously you need to have a strong GPA. So one thing I used to help on the panel at National University to choose potential CRNA students, and one thing we would look at is, what have you done to want to drive your path this way? So you've done your ICU work. You have a 4.0, or maybe you didn't have a 4.0. This probably would be more helpful for people if you weren't one of those who just got A's on everything easily through nursing school. What we want to see is something you've done now to show us that you're going to be successful in this program. And that's, like I said, going and getting science classes right now and making sure you get an A in them to show them that you're going to be able to be successful through the didactic and academic portion of the program. It's rigorous. It's more than memorized. You have to memorize and understand and then execute everything you were taught. I have never had to know so many things about the body as I did in CRNA school, memorizing every nerve in the body and knowing what it innervates and what receptors it has and what drugs work on those receptors. And that's just one aspect of many things. They have us do it's rigorous, and the clinical sites are no less rigorous. And it's not to deter anyone, because I feel like if I can do it, anyone can. All you need is determination. If you want to do it, you can do it. Anyone can. At any age, any stage, you can do it. And I am definitely a believer. If this is what you want to do, right out of the nursing program, do it. Go straight into an ICU. ICUs need people. They'll train you, get your one, or two years in, and go straight into CRNA school. I didn't do it that way, but I am not against people doing it that way. And when I hear people say, don't you think they should have years and years of experience as a nurse? I'm like, it's not bad to have years and years of experience as a nurse. But do MD anesthesiologists have years and years of experience as a nurse? No, they don't. They go to med school. They become an anesthesiologist. If you know you want to do this, get to it as quick as possible and get good at it in your role. So I feel the same with nurse practitioners and midwives. I had many nursing instructors tell me how long I needed to be on a Med-Surg for. So, you know, what I did? Took the first position in the burn ICU. I was a CNA for a long time. I did do steps that got me the different steps in the medical field. I saw different avenues and different things. But if you really want to do something, there's no reason not to just get trained in it now. So I'm probably the opposite of many nurse philosophies, but I just have to think of all the different medical professions. Physical therapists never were a nurse first. Veterinarians never were a nurse first. They just learn their profession. And that's how I feel about CRNA. Don't be wrong. My experiences are the burners. My experiences that I had. Yeah, they molded me. You want to know what else molded me? Waitressing. Waitressing and anesthesia. Very similar when I got to that stage, all that stuff. Right.
[48:04] Michelle: Well, you're dealing with the people and yeah, those are great points that you make. I mean, I'm a big fan of what's happening in health care in the last, I don't know, maybe five years or so where managers are now starting to hire nurses into a specialty right out of school. Instead of that, you got to do your two years Med-Surg. It's like, really? I'm delaying what I want to do, what I'm passionate about. I'm being forced to make sure of that.
[48:40] Flo: You know that this person really wants to do them. I'm not just hiring new grads haphazardly. Make sure you have some kind of screening tool, questionnaire, or interview where you can somewhat make an assessment that this person is a good fit because that's number one in any unit, any CRNA program, as far as I'm concerned. When I hire someone or we look at someone we want in our group, don't get me wrong, they need to do good anesthesia. They need to be safe. But you can be a good anesthesiologist and be awesome. Let me put it this way. I'm trying to word this correctly. You can be the best anesthesiologist, the best anesthesia provider in the world. If you're a jerk, I don't want you.
[49:27] Michelle: Thank you, I love it.
[49:28] Flo: You could be average, you do a good job. Do they wake up right where we want them to, or do they sleep with their little sleeper longer so it delays our recovery time? Whatever. You're not always on point. You're not quick, but you do a good job and you're safe, but you keep the team together. We like you around. I'm going to invite you. I want you at our holiday party. I want that team together. Do you know what I mean?
[49:57] Michelle: Yeah.
[49:58] Flo: I can't have unsafe providers, but I can have good providers that can help you get better at anesthesia. There are tricks we can teach. There are processes you can learn. I cannot teach personality and humor. If you're dull, you're dull. I'm like, oh, God.
[50:18] Michelle: Oh, my God.
[50:20] Flo: As far as specialties departments, everyone, I'm sure, looks at things that way because you can ruin a group by only hiring the A-plus people.
[50:32] Michelle: Yes, so true.
[50:35] Flo: So interviewing is important in all those things. So while I say yes, specialty goes straightforward. The people who are hiring or the ones choosing those people should have a lot of discretion in who they pick. Of course, and I'm sure they do.
[50:52] Michelle: Well, you have given so much great advice and perspective and just humor. I have been laughing the whole time. I had a smile on my face this whole time. Thank you so much. All right, Flo, are you ready for the five-minute snippet?
[51:15] Flo: Yeah, let's do this.
[51:17] Michelle: All right, so these questions came from my sister Jenny because she knows you really well. Do you have a favorite campfire meal or snack?
[51:29] Flo: Oh, my gosh. A campfire meal or snack. So it's edible. Okay, let's see here. Well, everyone would say normally donuts, because I bring donuts everywhere I go. Actually, if you go into the Scotties over there on Noble and Chinowith, my picture is up in there. I'm not even getting to the cash register. They have my picture there.
[51:54] Michelle: That's great. Do you have a favorite memory or experience of the mountains?
[52:01] Flo: Of the mountains. Let's see here. There are so many. We go skiing a lot, and my husband and I used to do ski patrol. Gosh. My favorite memory.
[52:12] Michelle: Well, I did have another question about the ski patrol. So do you have like the scariest heroic moment, like during ski patrol?
[52:25] Flo: Oh, yes, actually, we've had a few, but I'll go with this one. It was my husband's. I actually ski patrol a year longer or earlier before my husband started.
But his first year, we actually had a code, which was the hospital code blue on the hill, code blue on the hill. And I was on my snowboard patrolling and he was on his skis and I had to run, get up to what we call standby and get the Emergency pack and the AED and we had to go to the,  if anyone knows China Peak, I had to snowboard down and meet him there to get to the customer who was faced down in the snow. And that was actually the first time my husband and I coded somebody together on the side of a cliff, basically, and had to sled and get them down to the patrol house. That was kind of scary.
[53:25] Michelle: Yeah, no kidding. Okay. Speedboat or sailboat?
[53:30] Flo: Speedboat.
[53:33] Michelle: That's a huge surprise.
[53:35] Flo: Really? Fishermen hate me.
[53:43] Michelle: Do you have a favorite vineyard?
[53:46] Flo: Oh, gosh, I have so many. Let's see. I do belong to Justin. I used to say that they were my favorite. And I do like ______ and I still get six bottles of those every year. But actually, this new one, as I get older, I become a white wine person. I don't know, because I'm getting old and get headaches and gastric reflux. That Rombauer up in Napa. It's their chardonnay. Best Chardonnay. It's incredibly ridiculously priced at SaveMart at $40. But if you go to BevMo, it's $20 Rombauer. It's so good. Everybody should try it.
[54:21] Michelle: Love the tips. That's great. Along those lines, what's the most expensive wine that you've had?
[54:29] Flo: Yeah, because Jen gave me this party, so I had a bottle of wine that was $2,000. I had it for I know. This is so crazy. And we actually all just drank it just this past year because I had a party for it. This is actually I'll try to make this a long story about making well.
[54:46] Michelle: We have two minutes.
[54:48] Flo: Okay, two minutes. Here we go. It was my first year of being a CRNA. I was about to intubate a patient and this anesthesiologist goes, do you like wine? I'm like, I do. I get the tube and he goes, Harlem Ranch, you should try it. I'm like, oh, I'd love to. He gets me a bottle but doesn't tell me the price. Two weeks later, I get an invoice for these bottles. They were $900 each. So at that time they were $900. But apparently, they appreciate. Who knew this wine appreciates so fast? Anyway, my husband was pissed. I almost was murdered, but I made it. I sold a bottle back to that anesthesiologist anyway, had it for years, and talked about it for years. It was the bane of my whole marriage for a while until I had a party last year where I did a two-layered wine tasting with 80 people to pick out that bottle of wine. And I very strategically created the party. So the first tier was you had to pick out a $100 bottle of wine. The second tier, if you made the eight people that made it, could taste the expensive one. But everyone oh, wow. Everyone was very good. And actually, there was enough for everyone to taste the $2,000 bottle. That was a Harlem Ranch bottle. And so I won't recommend getting that because it's so expensive. Oh, my gosh, I'm going to forget the name. It's at Costco, though. It starts with a P. Oh, my gosh. It was really good. There were brothers $100 bottle people like that are at BevMo. And then this other one, oh, my gosh, I can't remember the name name. There was a lot of $40 bottle of red wines that people liked equally to the $2,000 bottle that are at Costco. Just goes to show, a $40 bottle of wine can replace a $2,000 bottle. Yeah.
[56:27] Michelle: Wow. Well, you certainly know your stuff. You know your wine. That's great. You know your practice and your profession. And it's just been such a joy to have you on. So thank you so much, Flo.
[56:44] Flo: Yeah, thank you for having me. This was fun.
[56:48] Michelle: Yeah. And we'll put some of those links there we go. And we'll put some of those links in the show notes and how people can get a hold of you if they have questions, all that stuff. So thank you again so much.
[57:03] Flo: Yeah, you're welcome. Awesome. Have a good one.
[57:06] Michelle: Thank you. You have a great day, too.
[57:08] Flo: All right. Bye.