Awakened Anesthetist

LIVE Season 4 Finale @ AAAA 2025: PROCESS The AAAA Presidency and a Life by Design with Nicole Moore, CAA

• Mary Jeanne, Certified Anesthesiologist Assistant

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Nicole Moore, Certified Anesthesiologist Assistant and 2025 AAAA* President, shares her journey from discovering the CAA profession through a Google search to becoming a pivotal leader in CAA advocacy and education.

*American Academy of Anesthesiologist Assistants

In this LIVE Season 4 Finale recorded @ AAAA 2025 you will hear how Nicole:

  • Balances full-time clinical practice with AAAA presidency through an intentionally designed schedule
  • Discovered the CAA profession while questioning whether medical school aligned with her life goals
  • Led successful legislative efforts in Virginia resulting in CAA licensure after 8 years of advocacy
  • Emphasizes building relationships with physician anesthesiologists as key to legislative success
  • Shares a powerful story about a patient who experienced cardiac arrest during a C-section
  • Maintains balance through family support, planned downtime, and periodic digital disconnection
  • Views leadership as something that found her rather than a deliberate career plan

If you're navigating leadership as a CAA, want to continue growing professionally, or need a reminder about why you chose this profession, this conversation will ground you in what matters most.

Support Aaliyah Walker and her advocacy for PE Awareness and Black Maternal Health—work inspired after her OB emergency and the care she received from CAA and 2025 AAAA President, Nicole Moore. HERE and on TikTok @authentically.aaliyah


You can now text me! Questions/Suggestions

Support Aaliyah Walker, an OB patient whose care deeply impacted our 2025 AAAA President, Nicole Moore. Learn how you can aid Aaliyah’s recovery and amplify her impact.


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Speaker 1:

Welcome to the Awakened Anesthetist podcast, the first podcast to highlight the CAA experience. I'm your host, mary Jean, and I've been a certified anesthesiologist assistant for close to two decades. Throughout my journey and struggles, I've searched for guidance that includes my unique perspective as a CAA. At one of my lowest points, I decided to turn my passion for storytelling and my belief that the CAA profession is uniquely able to create a life by design into a podcast. If you are a practicing CAA, current AA student or someone who hopes to be one, I encourage you to stick around and experience the power of being in a community filled with voices who sound like yours, sharing experiences you never believed possible. I know you will find yourself here at the Awakened Anesthetist Podcast. Welcome in, welcome Awakened Anesthetist listeners to this special episode replay. This was previously recorded March of 2025, live at the Quad A 2025 in Charlotte, north Carolina. I'm really grateful to everyone who was able to join us in the room that day. Your presence really helped shape this conversation and if you didn't have a chance to be there live, I wanted to be sure you still got the opportunity to hear from our current Quade President, nicole Moore. So let me introduce Nicole a little bit and tell you some more about her in this timeout.

Speaker 1:

Nicole Moore, of course, is a certified anesthesiologist assistant. She graduated in 2017 from Case Western Reserve University's DCAA program and she currently practices full-time, still in Washington DC. Nicole has intentionally designed her schedule to support both her clinical work and her professional leadership work, which I think is really heroic. She works 40 hours a week work, which I think is really heroic. She works 40 hours a week, takes Wednesdays off to teach Sim Lab at Case DC and then she works a 24-hour in-house shift every other Thursday, which frees up every other Friday where she can focus on her advocacy and, of course, presidential work. In this conversation, nicole shares how she's expanded her professional impact through teaching, through advocacy, through leadership. She really shares the progression of her leadership roles, which I think is super expansive to hear how the Quad A president started in smaller roles, and she also shares some of her failures, which I'm so grateful for, because that is the truth and the reality, but also the part that oftentimes we don't get to hear.

Speaker 1:

I also want to point out that during this episode, nicole reflects on a really powerful clinical moment she had from fall of 2024.

Speaker 1:

Nicole was in a high-risk OB emergency case where she was caring for a parturient whose name is Aaliyah, and Nicole has since been given permission to share Aaliyah's story.

Speaker 1:

Aaliyah herself is trying to educate from her own platform about PEs and PEs in pregnancy, and you can go to the show notes if you want to learn more about the story that Nicole shares in this episode, learn more about the educational efforts that Aaliyah is making about PE awareness, and Nicole talks about how this experience really grounds her back into her, why for clinical work, and reminds her why she chose the path of being a CAA, which helps keep her motivated and grounded when she's doing all of the somewhat tedious jobs of presidency and legislative efforts, where sometimes it can feel like you are taking two steps forward, three steps back.

Speaker 1:

I'm so grateful I had the chance to interview Nicole live at this year's Quad A. If you are listening and navigating what it means to lead as a CAA, to continue growing, or you're wanting a reminder as to why we chose to become CAAs in the first place, why you chose to do what you do, then this episode's really going to land and impact you episode's really going to land and impact you and I hope you enjoy hearing from our current Quade president, mrs Nicole Moore.

Speaker 1:

She just got married. Okay, we good, awesome, well, welcome everyone to Awaken Anestis podcast. This is the second time I'm getting to interview the Quade president live. I actually interviewed three Quade presidents you're my third, but then Quade finally let me do this in person. So I'm grateful to be here and I'm really excited to get to know you, nicole, better. The point of Awaken Anestis podcast overall is just for CAAs to really become aware of what's possible for each of us, as opposed to thinking that we can only do what we immediately see around us. And so interviewing people like leadership and the Quad A president is really expansive. To know that if Nicole can do it, you know we can do it. So I really want to learn about the human behind the presidency. That's really what I'm interested in. So let's dive in with the rapid fire, which is my oh so favorite. I don't know that anyone else loves it as much as me, but I love asking little prying questions. So, nicole, are you a night owl or an early bird? Oh gosh.

Speaker 2:

Probably an early bird, not necessarily by choice, but definitely have turned into the early bird.

Speaker 1:

Yes.

Speaker 2:

What time do you get up? Work days, obviously like 5, 530. And two, unfortunately, the weekends is also like. I'm lucky if I sleep in past 630 and my husband wants to kill me all the time but yes we've learned to work with it yes, well, you mentioned your husband, so you're newly married, newly wed.

Speaker 1:

When was your wedding and where was it?

Speaker 2:

so it was January 18th um so just a couple months ago and we did it in Kent Island in Maryland, so just up the up the road from DC. So we actually just got all our wedding photos back, so I've been swiping through them all. It's been fun.

Speaker 1:

Yes, I've seen a few on Instagram. Thank you for sharing. Let's pick another good one. What's your guilty pleasure? Tv show or series?

Speaker 2:

Oh gosh, recently it's been a lot of Bravo. My friend got me into the whole Vanderpump scene Okay, that I had never, ever been at all involved with, and so I have successfully binged all of the Vanderpump rules and like one or two spinoffs at this point I don't know if I'm happy to admit that to the entire people that will listen to this.

Speaker 1:

We love it. We love that you're here Awesome, okay, last one, one word to describe what it feels like right now to be the Quad A president at Quad A 2025.

Speaker 2:

Oh gosh, I'm going to pick two, because I can't decide between the two Exciting and a little nerve-wracking. Yeah, that's real.

Speaker 1:

Totally Okay. Well, I love to jump in and hear how my process guests, which you are, found out about the CAA profession, and then what intrigued them most about being a CAA that drew you in.

Speaker 2:

So I actually found out about it on Google. I was really interested in medicine, specifically anesthesia, when I was an undergrad and I had every intention of going to medical school and residency and doing the whole road to becoming an anesthesiologist. And about three years into what was an engineering degree, I panicked and was like I don't know that I want to do all of medical school and residency. Looking at timeline of life, I don't know if I want that much more schooling in my future. And so I literally Googled jobs that involve the operating room, that don't involve medical school, and I got a list of a lot of different things and anesthesiologist assistant was one of them. And so when I kind of deep dived a little bit further into it, I found out more about it and started applying and decided that it was a good fit.

Speaker 2:

Did you have to go back to get actually was statistics, because I was already on a pre-medical track, I had already met most of the requirements or had them slated into my school schedule. But statistics, for whatever reason, was the one that sticks out and I mean it was fine. I didn't love having to go take it, but no we did it, we survived.

Speaker 2:

And where did you go? What AA school did you go to? I went to Case Western in DC Okay, graduated in 2017.

Speaker 1:

All right, and tell us about that application process. Were you thinking it was Case DC? Were you open to?

Speaker 2:

other schools pretty open. To be honest, there were back when I applied I think we only had six programs or so at the time, three of which were case programs Cleveland, houston and DC and I was in Columbus, ohio, for undergraduate at the time and so I really wanted to stay in Ohio, be close to family, and so I had applied to every AA program. To be honest, I was kind of like I'm going to take what I can get, because I just wanted to be in the school and do the career and I interviewed up at Case Cleveland and got kind of waitlisted for lack of a better term there, but I had ranked the other programs saying I was willing to go. I actually got a call from Shane on New Year or Christmas Eve.

Speaker 1:

Who's the program director for Case DC?

Speaker 2:

And he said I know you wanted to be in Cleveland, but we've got a spot for you in DC, if you're willing to come out here. And I was like you're going to give me a spot, I'm going to take it. So I went to DC and that's how I ended up there and I'm still there, amazing. So I went to DC and that's how I ended up there, and I'm still there.

Speaker 1:

Amazing. And you're working in the DC area still, yep, so I'm still in DC.

Speaker 2:

I've moved to a couple different hospitals over the years, but still in the district.

Speaker 1:

Wonderful, awesome. So you must have liked it.

Speaker 2:

I did Surprisingly. I thought I was going to hate it and not enjoy a big city and want to move back to the Midwest and go back home and I loved the city, all there was to do. It helped that a lot of my friends from class, a lot of my classmates, stayed that year in DC and so staying with the familiarity of classmates and friends that I had made through the program kind of solidified staying- I think it's interesting to be talking to someone who I know has a lot on their plate and then also thinking, oh, this person has to go to the OR nearly every day as well.

Speaker 1:

Can you tell us a little bit about your work schedule now, because you're still full time, correct Yep, still practicing full time as a clinical CAA, and then you're also volunteering every year? I want to say volunteering as the Quad A president. Every role in the Quad A is a volunteer position. And tell us how you're managing that just time-wise.

Speaker 2:

Yeah, so I still work a full-time job, so 40 hours a week, 80 hours, you know, every two weeks technically. So I actually switched my schedule a little bit. My work was gracious enough that it was kind of a mutually beneficial thing. So I now work a 24-hour shift every other week to get a big chunk of my time at clinical done, to really free up my afternoons and evenings so that I can take calls and do meetings and all of those things.

Speaker 2:

If you ask any of my other quad A leadership, my response rate really depends on kind of my OR day. If it's a nice friendly OR day where I'm not bouncing between you know 100 endo cases I can respond to emails, you know, in our downtime while we're waiting for a surgeon or the room to be ready or whatnot. But there is a lot of that. Every moment is usually accounted for and then you have to try to fit to what you were talking about earlier your own well-being into all of that is a lot. But yeah, finding the right work schedule and having a supportive family, household at home to kind of let you do things when you're not at work is really helpful at home, to kind of let you do things when you're not at work is really helpful.

Speaker 1:

Yeah, and one of the other things I learned about the Quad A presidency is that it's a three-year commitment, and so the first year is help me with the language President-elect, president-elect. Now you're the president and then you're the past president. Correct, immediate past.

Speaker 1:

Immediate past president. So when you're signing up or putting your hat in the ring to be elected right, it's an elected position you know that it's going to be a three-year commitment. Correct and talk to me about how you knew that this was the right time in your life, knowing that you were still going to work full-time and have a wedding to plan and then perform and do. Why you picked right now.

Speaker 2:

So it was a lot of discussion with my now husband of you know I love being involved and I've loved what I've done with Quade and State Academies in the past and I knew I wanted to do it. And when we looked at kind of the timeline of what does life look like from our family side of things, it was we can do it now and, yes, we're going to plan a wedding or we can do it in 10 to 15 years from now, because really we want to start to settle down, hopefully have kids, things like that. And he is by far one of the most supportive people with the schedule and the calls and the emails. But he rightfully so was like when we have kids, I want, you know, especially a baby is something that you can't just be a million places all at once. So he was like we just really need to think about it. And so it was kind of like now or revisit in 10 to 15 years.

Speaker 2:

And I was already in the swing of things doing various legislative things, and so we said, all right, let's go ahead and do it. Do it now. And so, lucky for me, he was very supportive of the idea and we just kind of went for it now.

Speaker 1:

But I think that's very real, to hear that sometimes you have to say yes even though you're not quite sure exactly what it's going to hold, and that there is this, you know, and particularly with the presidency, there's people on both sides of you to help. But yeah, I just think to volunteer to lead our community, our profession, is such a huge undertaking that I just, I hope other people hearing how you're managing it allows them to think, OK, maybe I can do that too.

Speaker 1:

You know, I don't have to have ample you know I don't feel like I have all the time in the world to be able to still do this and still contribute.

Speaker 2:

I think I think that's a really fair point. I think it's very overwhelming when you look at it from the outside, but, even being so, we do these three year commitments right. As president, elect president, immediate past president. The two years now going on to the second, this year looks very different than it did last year, and it's somewhat nice because, depending on you know who that trio is that makes up those presidents.

Speaker 2:

We very much work as a threesome. It is really not a one person and then two kind of outsiders. We very much all three work together. Danny and Emily, who are immediate, past and incoming president or president-elect, are on almost every phone call. It's always kind of the three of us and so, based on whoever's clinical schedules, it can change right. So staff has been great. They work around whatever the schedule happens to be, and so for people that I think are reluctant to get involved because of things like that, it's nice to know that you can make any schedule work. You have to be flexible and be willing to give up. You know your own personal time and some hours you might not normally, but you can make any schedule work with the people you're doing it with, which is nice.

Speaker 1:

Yeah, that's encouraging. How different was. I love your story of being the legislative chair and how you got there.

Speaker 2:

I want you to tell that a little bit.

Speaker 1:

Some more details. And then also, how different is it being the legislative chair, which I assume is one of the biggest committee positions, versus being the quad A president? How well that prepared you to be the president now.

Speaker 2:

Yeah. So, like you said earlier, but obviously I guess our podcast listeners won't have been in your speech necessarily. So I actually ran for a board seat in what would have been like the fall of 2020 elections to kind of go into the 2021 year, 2020 elections to kind of go into the 2021 year. I ran for a board of directors seat because I had been involved in state academies with DC and just sort of Virginia and just had really liked it and I had become friends with some of the leadership and was like I think I really want to be involved and start to learn a little bit more. So I ran for a board seat, kind of honestly out of nowhere. To be completely honest, I just said why not? Let me put my name in the ring and see what happens? And I didn't get it, which is fine.

Speaker 2:

And Crystal Cam was actually, I believe, the president or president-elect at the time and she reached out to me and said you know you didn't get elected for the board seat, but we have a legislative committee chair opening because our chair just resigned from the position. Do you have any interest in that? You had said you know these committees interested you and I kind of hemmed and hawed and was like I don't know, that sounds like a big responsibility. But you know, if you guys are going to be there to support me, like, oh sure, I'll give it a try, not really knowing anything about legislative things I did not come from a legislative background it was a whole new thing to learn.

Speaker 2:

But they helped me with it and kind of guided me through it and I fell in love with it and so I did that for about three years for Quad A before I ran for president-elect. The difference between the two, I think, is just legislative committee chair is so much work and Brie Siekford, our current committee chair, is doing a phenomenal job with that. But it's in one realm and so you kind of get to focus on just that realm of things, which makes it, I think, a little bit more digestible. It's also, for the most part, timing it's busy in one section of the year and then kind of dies down. You always have your grassroots and things that you're doing to kind of prepare for the next legislative session, and that's just as important as the actual session itself.

Speaker 2:

But it definitely becomes more of a manageable time commitment as the year kind of goes on, as opposed to the first couple months of the year where everyone's in session and hearing bills and all of this, whereas the president I think it's just consistently busy all throughout the year and you have those different silos of things. You have the meeting, you have practice, you have legislative, you have membership and you have kind of all of these different areas in the committees that are all great at what they're doing but ultimately come back to you and the board to ask guidance or approval and I think I kind of underestimated how much went to the presidents until I was involved in the doing of it I was like oh wow, yeah, we do a lot yeah.

Speaker 1:

I imagine so, because from the outside, I think the community is probably only recently starting to hear a lot more of the legislative efforts and maybe that social media that we're just seeing more of the work that it takes behind the scenes. And for you to say that you didn't know much about the state legislative process is so true, because the first time I learned about it I'm like, ok, let's break it down. It's like the Senate and then the representatives, and you feel so inadequate that you don't know. But it is this whole other world in language it is. Is this whole other world in language it is. And I would love to ask about how the legislative process in Virginia started, because you were the legislative chair when it started, correct?

Speaker 2:

I actually was still in school when it very first started. But, yes, I so they had efforts going all the way back. The first one that comes to mind is 2017. And I know they did some work before that, so I apologize to all the Virginia folks that did things before that.

Speaker 2:

But 2017 was one that I really remember because I was a second year student at KSDC and I was actually living in Virginia, right across the river at the time, and they had kind of pushed for it and they did a study that ended up not coming out in our favor and kind of derailed the efforts and fast forward to, you know, covid, and now we have all these work shortages and they pushed legislation again. I believe 2022 was the year and we actually heard from a hospital system that's pretty prominent in Northern Virginia that was like we're short people and we need to run our ORs, and so they were very much kind of the re-ignition of these bills to help with their staffing, and we legislated a little bit. It ultimately came to the decision that they were going to do a new study. To see, you know, now post-COVID, a lot of things have changed since the one that had were going to do a new study to see, you know, now, post-covid, a lot of things have changed since the one that had been done in 2017.

Speaker 1:

Can you say more about the study, because I think that is an interesting point in the legislative process that I don't know that people understand? Oh yeah, but I've heard that several times from other states.

Speaker 2:

Yeah. So some states every state's a little bit different. Some states do what's called like a sunrise review, where you fill out basically what is this career, how would it help the state, why does the state need it? And it's just kind of question and answers.

Speaker 2:

Other states do actual like workforce studies from either the Department of Health or the one in Virginia just recently was the Joint Commission did theirs, and they look at, you know, are there shortages? How would licensure of CAs affect the shortage? Would it actually help them? The other thing they looked into was CRNAs and kind of how would expanding their practice help or not help the workforce shortage, residency slots? So they looked at kind of all of these different options and see which one would actually be helpful. And so they had tabled our bill to do this joint commission study and it came out at the end of 2024, kind of fall into winter. They presented their findings and they found unanimously of the joint commission that they were short-staffed and that licensure of AAs would help with the shortage. And so it was a unanimous recommendation from the Joint Commission of Virginia that AAs be able to have licensure, and so that was really kind of what picked up the ball in 2025. We got really good support from it was actually the Virginia Society of Anesthesiologists the.

Speaker 2:

VSA reached out to the VAAA, the Academy of Anesthesiologist Assistants even I still stumble over all of our words and said you know, we have this study now and we have bill sponsors.

Speaker 2:

We really think it's a great time for you guys to put forth a lot of effort to this. We think we're setting ourselves up for a really good year. And so with that we talked to our legislative team and our director of government affairs, with McGuire Woods, and they kind of did their own little research and ultimately the decision came to hire our own lobbyists on the AA side of things. That worked phenomenally with the VSA lobbyists as well. And so the two of them worked together and we went down and we did testimonies and we wrote all of our letters that I'm sure lots of you saw me email and post about and just kind of trekked our way through the House and the Senate and to the governor's desk and he graciously signed it on Monday before we came here, which was the best surprise to the governor's desk.

Speaker 1:

And he graciously signed it on Monday before we came here, which was the best surprise in the world Very convenient, yeah. So like pre-2017-ish to 2025 is eight years plus of disappointments. Honestly, it sounds you know ups and downs, but I don't know that. That's a super unique story. Even I think probably some states are fighting that same battle. How did you, since you were involved in that on the legislative side, stay motivated through all those years of trying and trying and trying?

Speaker 2:

until you succeeded.

Speaker 2:

It's really, I think, looking at other states, honestly we in the last couple of years have successfully gotten a few states between Utah, nevada, washington, and so seeing those successes are reminders.

Speaker 2:

You know that it is possible Nevada had been in the works for years and years and years and just kind of waited for the right time to finally get it passed, and just kind of waited for the right time to finally get it passed, and so I think looking at all of those is just a reminder of it takes so much time and although it seems like we're not maybe doing anything or making any progress, it was really relying on the relationships that I had started to form and built, and so I actually don't know that a lot of people know this.

Speaker 2:

I went to so many different VSA meetings. They were gracious enough to invite us to send a representative and talk about who AAs are and educate their residents and their membership, and it was really cultivating those that then kept their interest in it and their support. That way when they needed something they knew who to come to. And so then we were involved when the time came, and so it was really leaning, I think, in fostering those and then hearing their support. Even though we weren't making progress in the legislative chambers per se, we kept getting invited to these things and it was like there is support in the state from the physicians and from different people.

Speaker 2:

So it will come. It's just when is the right time that it will all fall into place.

Speaker 1:

Yes, legislation sounds a lot like finding the right time. Correct. It doesn't A hundred percent, it's almost like it doesn't matter what you're fighting for. You just have to have the right synergy of parts to put in that finally gets you the outcome you want.

Speaker 2:

Yeah, exactly, it's a lot of timing. A lot of timing Interesting.

Speaker 1:

Well, I want to switch gears a little bit. Oh, we are so good on time. You told me in our discovery call so how these process episodes work is that I find people who are interesting and are doing something different or something that oftentimes these are things that I want to do Like, oh, that's kind of interesting to me. What would you know? How did they get? There is sort of how these start and I have a discovery call with them and then we I create a little storyboard and then we do the podcast off of those storyboards. And when I first met Nicole, she was talking about how you wanted your legacy as Quade president to be. That the Quad A members felt like Quad A gave them something like gave them more, or they could really reach out and be like okay, this is what Quad A is doing for me. Can you describe that a little bit more? Or maybe what your hopes are for this year?

Speaker 2:

Yeah. So I feel like we're in a really unique and almost tough position, but it's a great one in that we're growing so fast that it's almost hard to kind of keep up with how things are changing, in the sense that, you know, 10, 15 years ago it was such a small group of people that it was really easy to know everyone and know exactly what was going on. And you know if a state was going through things, it was really easy to kind of manage, know exactly what was going on and you know if a state was going through things, it was really easy to kind of manage all of those things. Fast forward to now we have, you know, double digit states that are trying to submit bills for licensure and you have to keep track of them all. And we're bigger, we have more people, we have so many students, which is phenomenal and it's kind of how do you really take all of those people and really give them the benefit of being a member right? And how do you keep people wanting to come to what's now this just growing thing outside of just? You know you should do it to support the profession. What can we really offer? And so you think of obvious things like CMEs and things like that at the annual conference that everyone needs to get their recertification.

Speaker 2:

But I think what we're really trying to do this year and my hope is that we can really kind of dive into what do members want from the quality that we can realistically give them.

Speaker 2:

And so, whether that's support in their workplace when they run into you know a problem of you know my workplace is doing this and it seems a little off, or they're having problems billing for us, or things like that, that the members really feel empowered to come to the committee chairs or leadership and say, hey, what have we done for this in other states?

Speaker 2:

Because those are resources that we can really give out if we know about it but that we don't necessarily always know about. And so it's things like that or things like the mentorship program that I'm actually really excited to see where it goes and kind of channel all of these new bodies that are coming into the profession and really give them a chance to grow and learn what the profession's about and rely on more experienced AAs. And so this year I think we have 12 pairings, which I'm excited to start. It'll be a nice small group for us to really kind of see what people want out of it and how it goes, and so I'm really excited to give that to members and try to channel what they want and how they could see membership from Quad A benefiting them and just really dive into that. Now that we've got more people, we're growing the conference, we're doing all these things, what can we really set up?

Speaker 2:

for them to want to come and be a part of it, outside of just this space for these four days, yeah.

Speaker 1:

I have a hard question. Oh boy, that I did not tell you about I have a hard question that I did not tell you about, but I was thinking like as a CAA and you had said what the Quad A can realistically do. What are keeps the quad A from being able to do things Like what are the constraints? Is it money? Is it that everyone's a volunteer? Is it time?

Speaker 2:

Yeah, it's a combination of everything that you just mentioned, right. So money is obviously a big factor in a lot of things. Everything that we want to grow into and do costs some form of money to get it done, and so it's kind of balancing out when is the right time to do all those things. Our new membership portal was a big one, right. We had talked for a little while about how we didn't love the membership portal we were on, but it's going to be this big endeavor of money and time and staff needs to learn how to use it and all of these different things, and it's kind of you have to gear up to be able to make those changes that, in the long run, are going to be worth it. But it's really going to be a struggle in that transition period, which, thank you to everyone listening that dealt with all of the emails that we sent out about Fonteva and our transitions, but in the end it makes it work.

Speaker 2:

It's better for a member to be able to go in and do their own things and manage it themselves. So it's a lot of that and it's a lot of just navigating places we haven't been before, because we've been a really small group of people able to either attend things or do things or have experience outside of the anesthesia world that they can bring in. I think that's really where we're going to be able to experience more growth and benefits, just because now we have more possibilities where we didn't have that before. And it's really navigating. How do we take all these ideas and put them into something that is a good product for people? We don't want to throw something out there, that's. We want it, but it's not done right.

Speaker 1:

Yeah.

Speaker 2:

So yeah.

Speaker 1:

Yeah, and I think it's interesting too that we can look you know, we're almost in a great spot because we're small and nimble and we can maybe make easier changes than we can look to the ASA, and we can look to the ANA and see what they've done and sort of improve upon it or, you know, find our own way that serves our community and not have to, you know, maybe do as many hoops as they had to do.

Speaker 2:

Definitely definitely. We definitely look at things that the ASA does that we're like, oh, that's great, we would love to come up with something like that, or I mean even the AA&A. As much as you know, there are some things we disagree on. There are things that they do that we're like, okay, maybe we can channel that into our own way and think of a you know way to do something. And so, yeah, we take the PAs we've kind of looked at, and so it's all of these different things that we'll look at and see how are these organizations that are bigger than us right now? How do they do it? Can we kind of look to them to form how we handle this as we grow and get bigger?

Speaker 1:

Well, speaking of the AANA, I'm wondering, as the Quad A president and because you did the legislative effort in Virginia, I'm assuming you heard you know the rebuttal against AAs what would you want CRNAs to hear the Quad A president say? Like, what do you want to say about CAAs to the CRNAs?

Speaker 2:

I think the biggest thing that I personally feel like I always want to say in those harder moments is like we're just people too right. We're just people too right. And when you break down, anybody that's in any sort of workplace, they go home to a family, they go home to a life outside of work and they're just people. And so all of us are people that got into a profession just to help patients.

Speaker 2:

For the most part, I would say, if you ask 95% probably of all of the students that are out there the A's that are out there of why did you get into the profession? It's somehow going to boil down to I wanted to help patients and I wanted to do patient care. And I think that's where sometimes in these legislative efforts and this back and forth, we get somewhat lost, in that all we're really trying to do is improve patient care and offer patient care, and so I really would love to sometimes just be like we're just these people that just want to go in and do our jobs. We want to work with you Like we want to be colleagues Some of my best friends are CRNAs and we just want to be a friendly face at work that does a job, does it well and, you know, provides good patient care, and sometimes I think that starts to get a little lost in the heat of legislature.

Speaker 1:

Yeah, and I can imagine that when you are so focused on the legislative effort that you lose sight, like you lose that touch point of oh why did I, the CNA or I, the CAA, go into this? How do you stay connected to why you want CAAs in every state, why you wanted the Virginia license to pass, like how does that? How do you stay grounded in that?

Speaker 2:

Yeah, so it's definitely little moments with the patients.

Speaker 2:

I think sometimes you forget you know, in the grand scheme of things, why you wanted to do the job and you kind of get in the day in and the day out. So you know you go to the OR you go home, you go to the OR you go home, and it's a couple of little moments where you know they say thank you so much and they're really nervous in the pre-op bay or you take those extra couple of minutes to make them feel a little better and you're like that's why, why I came into, what I came into was to be the comforting face and be somebody that, in an otherwise scary time, can be, you know, a little bit of a relief for them on that day, and some patients just will stick with you for a while. I think we all have our situations where you know we really bonded with a patient for whatever reason, and I actually just recently had one this past fall who was up in labor and delivery with me. She was an add-on C-section that we were doing. I was working, you know, one of my 24-hour shifts and she was getting put on for I can't even remember what, to be honest. But she had twins and I will say with everyone I have talked to her since and she's okay with me kind of telling her story. So she came in, we started her C-section somewhere around 1030, 11 o'clock at night and your usual uneventful, you know, spinal. They were so excited, talking about the baby names and kind of disagreeing on them and deciding how they were going to do.

Speaker 2:

And after babies were born they were closing and she actually threw a PE and cardiac arrest on the table, me in my own OR, and I was terrified for her. I mean, we did ACLS, we got her back, we took her down to CT and you know she was managed very well at our hospital and the hospital she went to subsequently was in the ICU and intubated for days and ended up extubated, spent lots of time in the hospital. But I had never chart checked someone so frequently after and just kind of remembered everything about her because she was saying, you know she was so nervous but so excited and I thought about her a lot. But it was really the moment when she came back to the hospital randomly when I was on another night shift just to visit they had been at a pediatrician appointment down the road and decided that they were going to come visit. And she doesn't remember anything, so she has no idea who I am, but it was still the just like thankfulness in her eyes to someone that took care of her in such a big moment when she really had no recollection of me. We had conversations that I told her about and she was like I don't remember you know, telling you what I was going to take my babies. I don't remember any of this, but her husband since it was a C-section was obviously in the room too and he remembered and was so thankful. But she sticks with me a lot and she is somebody that now I'm like when I need those reminders I go. She's why, you know, I do it.

Speaker 2:

And I actually connected with her outside of this.

Speaker 2:

On social media. She got a lot of news attention because she's been spreading awareness about PEs and pregnancy, and so I connected with her and have gotten to talk to her and kind of follow her life after, which is something we don't usually get to do. As anesthesia providers, we usually see our patients, so we see them in the recovery room, maybe a couple of days later if they're still in the hospital, but we really don't get to see what happens to them after. And so getting to kind of see her now and kind of follow along in her journey and watch what she's been doing to educate people is really a big grounding piece for me. Of you know, I got to help her in that moment where if it had been any other moment it may not have turned out like that, and so I think that's really a big thing that kind of keeps me motivated and reminds me of why I work so hard and why we do. What we do when we go through the training we go through is just to kind of have those moments and be present for those things when people need us.

Speaker 2:

The most.

Speaker 1:

That's incredible and I appreciate you sharing that story. And, yeah, let me know if we can support her in any way. Maybe we could link to something in the show notes, but we'll talk after about that, oh yeah.

Speaker 2:

Her name's Aaliyah Walker. Again, she let me you know. I asked her. I said if I you know, they'll talk to me a little bit. Am I allowed to share with you? Know people that ask? And she said yes, by all means share the story. She's been a big advocate and really trying to just get the word out there for people that otherwise wouldn't know. So we'll talk after and get you some information to put in there so that people can follow along with her.

Speaker 1:

Great, you know this is what it's about. Like a human to human experience. Like you are trained to help people in this very specialized way and if you weren't there, you know she wouldn't have got this level of care, and just that. At the end of the day, it doesn't matter if you're the anesthesiologist, the CRNA or the CAA, like we're working together to do this thing. Like she doesn't care who you are, she just wants you to give her the best care possible.

Speaker 2:

Like everybody talks about. I feel like how they have like one patient that sticks with them and they can always tell the story and I think for the rest of my life she will be the person that I like can vividly remember and look back on and be like okay, this is. It was crazy. We were like if we hadn't, you know cause, everybody, even the OB, and everybody was like should we have taken her earlier? Cause we waited, cause she had eaten, and so we're like we kept her NPO. And everybody was like should we have gone earlier? Like would this not have happened? And like, after the fact, where you were all talking and we were like, no, it's like it honestly happened in the best way that it possibly could have happened, because that clot was there, it would have moved at some point. It was like if it had moved after the C-section, when she was in a recovery room, like we would have been there fast enough. So it was just wild. It's like wild to think back on, but anyways.

Speaker 1:

Wow I bet you know everything there is to know about PEs and embolisms.

Speaker 2:

I'm like, oh, I'm like, do I need to go get an ultrasound scan of my own legs?

Speaker 1:

Yeah, I mean it is. It's an interesting way to learn too, because, as you said, you had never done, or you maybe had you never seen a cardiac arrest, or you had never seen a PE to cardiac arrest in the OR before.

Speaker 2:

I had never had my own. So I responded to codes in the OR and, obviously, like, I teach them lab and we go through it all the time and but it was the first time that I had ever actually had to call a code on my own patient, which was one of those kind of like oh my God, is it? Like is this really happening? Is what I think I'm having. Like, um, so there was definitely that moment of like oh my God, no, this is actually happening.

Speaker 1:

Yeah, I think that's really um, what I was going to say is that in our training you know, when you go to AA school they can't guarantee that you're going to see a cardiac arrest in OB, like that's not. Like, oh, check mark, great, we learned that. And so of course that's when Sim Lab comes in to help fill in some of those like sentinel events that you may or may not get to see. But it's interesting how you know the training that you do up to that point with all the other patients. And then of course, acls training like does come together in the moments that you need it and it's wonderful to know that. I'm sure one of your first calls was like let's get the anesthesiologist in here, let's get more anesthesia help in here that we don't have to do it alone, like that's such a beautiful you know exercise in the anesthesia care team model really.

Speaker 2:

Yeah, it was, because I mean, we were you know, it was nighttime and OB I think my attending was either had gone to do epidurals or maybe try to lay down in between, you know, a busy night. Everything had been going great and it was the first thing I told my nurse, when I thought things were starting to go downhill and she didn't look great, was I need you to call. You know, I named my attending right now and she came in the room within a matter of minutes and then it was.

Speaker 2:

Yeah, you just fall back on what you go through in those sim labs, which is crazy, because it's things that in training you're like why are you know? Why are we doing this so much? Why are we doing this so much? But it's because you don't see it all the time. It took me what? Eight years to have it kind of fall right in front of my face, and for some people it takes longer. And so you just have to kind of rely on what is ingrained in the back of your head from all of that training and it just naturally comes out and it, you know, and that's what you rely on.

Speaker 1:

Yes, yeah, there's. There's a lot more we could say there, but I just love that you have that as your or one of your grounding moments, because that's what we're doing, that's why we're here, that's why we're fighting for legislation, that's why patients deserve physician-led anesthesia care, like that is because when these things happen, you need an expert team. You know there to make it seem like oh yeah, we just took care of you, no big deal, like she remembers you know nothing like A president, stuff on your breaks and everything. How do you recharge or touch back into who Nicole is, outside of being a CAA, outside of being the president?

Speaker 2:

Yeah, it really is my husband, ryan and our dogs.

Speaker 2:

It's kind of putting down and I would argue Danny and Emily will completely disagree with me because they say I don't do it putting my phone down, not answering a text or an email and just kind of spending time, whether it's, you know, watching a show that we watch every week, like we do Survivor, we do Amazing Race, we do these things.

Speaker 2:

You know that kind of air every week and so whether it's sitting down and just doing that and not thinking about it for a minute, or going for a walk is a really big one. I love to go out and just kind of walk and I find it to be very grounding. I also get a lot of thinking inevitably done about whatever I was trying to walk away from, but it's at least my own thoughts and kind of gives me a chance to organize them a little bit. But yeah, it's really leaning on, I think my home support system and you know, the dogs again always have that second sense of they're like I need to go like look at mom, real cute and cuddle, so that she forgets about whatever she's doing.

Speaker 2:

But yeah, they're huge and kind of unwinding and coming back to reality. Yeah, totally.

Speaker 1:

Let me see I have a final question, but I have a couple fun ones. So let me ask you what would surprise someone if they knew about you?

Speaker 2:

Let's see, I think actually a lot of people are always surprised to learn I have quite a large bourbon collection, which always surprises people when we talk about it. I grew up mostly in Cincinnati and so my dad ended up into bourbon and so we had it around the house a little bit as I started to, you know, get older and come home from college and whatnot, and then did the bourbon trail down in Kentucky and have just slowly started collecting bourbon and that's always very surprising to people.

Speaker 1:

They're like you have a lot of bourbon.

Speaker 2:

Or they come over to the house and they're like oh my gosh. And I'm like oh okay, maybe not the best thing, but I'm painting a certain picture. Most of the bottles are full. I promise painting a certain picture.

Speaker 1:

Yeah, most of the bottles are full, I promise. I think this is interesting.

Speaker 2:

What do you think you would be doing if you weren't a CAA? Oh gosh, so I actually my degree from undergrad is engineering. Both of my parents are engineers, and so I actually really enjoyed learning engineering when I was in undergrad, and so I think I probably would have stuck with it and done some sort of project management for engineering. I don't think I could ever be a like nine to five desk job, as much as I envy it sometimes when we're at work on the holidays and I'm like why did I not do?

Speaker 1:

some sort of office job where I would be off work right now.

Speaker 2:

So probably some sort of like engineering related project management thing.

Speaker 1:

Do you have big plans for next year, when you're done with this presidency? Reign 2027, I guess.

Speaker 2:

I don't. Hopefully we're in Virginia and hopefully we can like settle down and kind of figure out what that next phase of life is. I always joke that who knows what I'll be doing, because I have a hard time not doing more than my like 40 hour work week.

Speaker 1:

You like to be busy? Yeah, exactly.

Speaker 2:

Can't have too much free time. I'm like, what do I do with myself? Can't have too much free time. I'm like what do I do with myself. But I'm really actually hoping to take a step back, at least for a couple years, and just really kind of enjoy life and not be worried about what's going on or troubleshooting things or answering an email, and just kind of have a couple years before I inevitably, I'm sure, jump back into something somewhere yeah. And just kind of enjoy what life brings.

Speaker 1:

Yeah Well, I'm looking forward to seeing that. My last question is the ethos of this podcast, which is to help CAAs realize that they already have everything they need to create their life by design, to create their dream life, whatever that means for them. And I'm just always curious if you, if my guest, if you would agree with that, do you feel like that resonates with you and, if so, how do you feel like that's played out in your life?

Speaker 2:

You know what I do think I agree with you in that sentiment. I don't think you know it, I think a lot of us don't think that and I think if you asked me a couple years ago I wouldn't agree with it. Just by kind of looking at random things. And if you had told me five years ago that this is the position I'd be in and I had all the tools to do it, I would be like you're crazy, there's absolutely no way. But I think it kind of goes back to what you had said earlier of you just have to be open to what happens and be curious about it.

Speaker 2:

Never in my CAA schooling would I have thought that I would ever be Quad A resident or have any desire to do it. Yeah, to be completely honest, when I was in school and kind of going through everything, I was like I'm so excited to get to a place in my life where, like I can go to work and I can come home and I can not do anything. And then it just kind of took random people in my life that had been involved to be like, hey, you know, we need some help. Do you have any interest in it? Would you be willing to do it and, being somewhat of a people pleaser that I am, I was like, oh sure, and it just kind of worked out that it taught me that I really liked that and I had all of these skills to go about and do a job that I otherwise really had no intention or thought would ever be kind of in my realm of things to do.

Speaker 1:

Yeah, I mean, how many people think they're going to be the Quade president? I don't know, not many.

Speaker 2:

Hopefully somebody out there, thinks they will be.

Speaker 1:

Yes, exactly Wait a minute, wonderful. Well, I am so grateful that you said yes to this live interview and thank you all so much for coming, yay.

Speaker 2:

Thank you, you, this was fun all right, everyone.

Speaker 1:

That's a wrap on season four of the Awakened Anestis podcast. Woohoo, we did it. Thank you so much for listening and an extra special thank you to everyone who joined me live at the Quad A 2025. It's been such an honor to share these CAA stories with you this season. I'll be taking a break for the summer, but I will be back in fall of 2025 with all new conversations, all new process episodes, some new CAA miniseries episodes and just some more fun for season five. In the meantime, I invite you to catch up on any of the episodes you've missed and if one of them moves you and you really love it, I encourage you to share it with a fellow CAA, aa student or someone who is CAA curious. These stories are meant to ripple through our community, to connect us and impact for years and years to come, I hope, as long as the podcast is up and in the airwaves. You can also stay connected by joining my mailing list. By using the link in the show notes. You'll be the first to know when I decide on the season five premiere date.

Speaker 1:

You can also follow me on Instagram at AwakendAnesthetist. I'm on there somewhat frequently sharing some behind the scenes and just some life updates of me going about living my life by design, and let's see what else. I'm always approachable on email at awakenedanesthetist, at gmailcom, but if you want to get a really fast response, you can DM me, and I love to leave a little voice note. Those are super easy and approachable for me, so I really encourage you to follow me on Instagram at awakenedened Anesthetist. It's easy for us to chat questions over there, and I think that's it. So until next time, let me leave you with this question what would it look like to live your life by design, not by default? All right, everyone, stay curious, stay awake and we'll talk soon.

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Mary Jeanne Roberts, CAA

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