Anesthesia Deconstructed: From ICU to CRNA - How Social Media is Transforming Nursing Education의 전체 녹취록

into school much earlier than I anticipated. Joseph Rodriguez (05:25.579) Hmm. Chrissy Massaro (05:31.424) programs all had like three-year wait lists to get in and I happened by luck to start at UPenn a month after I sent out my first application. So I started at month 19 of nursing at the University of Pennsylvania. So I'm in CRNA school. We have this amazing professor, Dr. Libonati, who I feel like is a legend in this community. He's an amazing physio. Joseph Rodriguez (05:35.285) Right. Joseph Rodriguez (05:57.484) I know the name. Yep. Chrissy Massaro (05:59.214) He's brilliant. And every day that I'm sitting in his classes, I'm thinking to myself, if only I knew this as an ICU nurse, I could picture patients every day that I would have taken much better care of. And I thought to myself how unfair it was that this. information was withheld for me as a nurse when I would ask the question. People would say things like, you don't need to know that. And that there was no accessible way to learn about it online or really anywhere else in a way that was applicable to nursing. So that was kind of like the problem that I saw, right? I felt like there was a big gap between what nurses were expected to perform at and our level of education and that there was no real bridge for us there. Once I happened to start to develop an online platform, 2019, I downloaded TikTok. I did it so that I could make vegan cooking videos on the internet. I had no intention of talking about anesthesia at all. No, I'm like pescatarian, flexitarian, vegan-ish, 90 % vegan. cheat though. 90, 10. Joseph Rodriguez (06:50.756) my gosh. Are you vegan currently? Joseph Rodriguez (06:58.347) Okay, 90, yeah, got it. I'm sure if you were 100 % vegan, you would have started off the conversation by saying, just in FYI, I'm vegan. But okay, got it. ironically, we very rarely eat meat at home. somewhat similar. Anyway, I digress, continue. So you started your TikTok account on something not related to anesthesia and... Chrissy Massaro (07:13.57) There you go. Chrissy Massaro (07:23.02) not related at all. And there was like a silly musical trend going around that like reminded me of being a CRNA. And I just like made a silly TikTok and it went viral for me as a person who had like no followers, had like a couple hundred thousand views. And I was like, this is crazy. This is something I've never experienced before. I didn't even expect anyone to see it. Like I just, I was bored. I thought it was being funny. Joseph Rodriguez (07:39.413) Okay? Chrissy Massaro (07:48.334) So then I'm getting all these questions in the comments about being a CRNA. So I just start answering the questions and all of a sudden there's a platform. are people who are dying to know more about this profession. So I'm like, okay, okay, fine. We'll talk about being a CRNA. And that's how all the CRNAs are born. Fine, you guys don't want my recipes. We'll talk about anesthesia. But that kind of transitioned into seeing

Joseph Rodriguez (07:57.823) Hmm. Joseph Rodriguez (08:03.061) Yeah, yeah, we will not talk about vegan cooking. We'll talk about being a CRNA. Got it. Yeah. Chrissy Massaro (08:16.425) in the COVID-19 crisis, kind of like renewing my frustrations and understanding that gap again between what nurses are expected to do and what they're prepared to do. going back to the ICUs, helping the nurses as our hospitals were filling up, nurses who were never ICU nurses expected to do ICU level care, ICU nurses being stretched thinner than they've ever been before. And then now having this opportunity with an online presence made me really motivated to create the education that I always wished that I had access to. And I remembered Laura Gasparas making this content for the CCR. Joseph Rodriguez (08:49.834) Hmm. Mm-hmm, I remember Laura Gasparis. Yeah. Yeah. Chrissy Massaro (08:55.81) And I was like, why can't I just be like the next Laura Gasparis? Like, why can't I just do that? And so here we are. That's how Confident Care Academy was born. The goal is to bring graduate level pathophysiology and pharmacology to bedside nurses so that they can be more confident at their job. They can take better care of their patients. And if they do decide to move on to advanced practice or not, they will have a better foundation to do so and a smoother transition. Joseph Rodriguez (09:00.468) Yeah? Joseph Rodriguez (09:23.019) So it sounds like you're kind of living normal life, right? You get into the senior in a program, 2019, you start your TikTok account, you have this viral moment. It sounds like that's when you realize that you, and I want to make sure I'm getting it correctly, you realize that you could create this platform because influencers were not really a thing yet in the zeitgeist and the pop culture. Is that? Was it the viral moment where you realize you're like, I can be this next Lorin Gussow, this next well-known nurse educator, and this is how? Was that the moment? Chrissy Massaro (10:00.598) Yeah, I don't think it was like that first video, but I think it was like as all of a sudden the following started to grow, I started to hit 10,000 followers, 11,000 followers. I'm like, hmm. And then as the pandemic really started to heat up and I saw, I connected with other healthcare workers from across the country, ICU nurses on the internet talking about how much they were struggling and just seeing how all of us were building platforms at the same time. And then learning about Joseph Rodriguez (10:12.051) Yeah. Chrissy Massaro (10:29.75) you know, other online coaches talking about building educational products. I'm like, why can't I do that for nursing? Like if someone could sell a social media how-to course, how to be an influencer, why can't I create something for nurses? So, and that's how I met Anna Job, my business partner also. We met on TikTok and yeah. Joseph Rodriguez (10:41.353) Sure. Joseph Rodriguez (10:46.782) I was gonna, I was gonna mention.

Okay, got it. Was she also doing vegan recipes? Chrissy Massaro (10:52.716) No, no vegan recipes for her. But she was scramble nursing. We'll get at the top. Yeah. Joseph Rodriguez (10:55.145) I've met her. She doesn't... Yeah, okay. And is she in Sierra Nave School as well? Chrissy Massaro (11:01.74) She's about to graduate CRNA school, yep, in May. So I invited her to come join me because I wanted someone who at the time was a current ICU nurse to help me cover my blind spots because it had been a long time since I was at the bedside. And I thought to myself, if I'm making content for bedside nurses, I'm sure things have changed. I'm sure there's things I'm not thinking of. So I want someone who's like-minded, forward-thinking, and also very articulate to join me in this venture. And she was the first person who came to mind. She agreed to joined me and she helped me develop and unroll this vision and kind of create like a custom curriculum for people to go from day one of, you know, graduating nursing school through this transition into CRNA school. And now that she's gone through CRNA school herself, her education that she's able to provide the nurses has obviously really blossomed. And I think it makes it a really well-rounded program. Joseph Rodriguez (11:56.423) You know what's interesting to me about this is that you capitalize on the moment, right? In the sense of. If you had, if any of these pieces hadn't aligned, you know this burgeoning new media format, right? TikTok influencers, etc, etc. You probably maybe would have been an educator regardless, but. There's so many people where I don't know if the moment comes and goes, and you seem to have really been like it aligned with whatever was going on in your life as well, because you're pretty open on your TikTok channel, but. well, at least somewhat open. That's really fascinating to me. Is that what you feel like? Do you feel like, you know, the stars kind of aligned on that moment and you saw something you could hit or capitalize on and you did it? You felt like you were stepping into it? Chrissy Massaro (12:40.846) I don't think I knew what I was doing at the time. I don't think I saw it in that way. But I do know that in life, when I was much younger, I grew up in a very, I'm gonna be careful how I say this. I don't wanna offend anybody, but like I grew up extremely. Joseph Rodriguez (12:47.58) Okay? Joseph Rodriguez (12:59.122) Don't be too careful. Chrissy Massaro (13:00.942) I grew up very, very religious in like a very fundamentalist Christian community, even though I'm from Long Island and it's like not normal where I grew up at all. It was in a very extreme church where it was pretty anti-science and women were very much discouraged from pursuing education or if you were, it had to be like a mom friendly career. Not that there's anything wrong with that, but like I wasn't allowed to go to medical school because that was Joseph Rodriguez (13:11.879) Yeah. Chrissy Massaro (13:30.848) you know, not in line with our beliefs. And it was a man's career. Exactly. So it's kind of funny. Like I grew up in the nineties, but it's like a very integrated thing that I experienced. So I felt like I had given up opportunities that were meant for me when I was much younger. Being a CRNA was like not my plan. I didn't even know that this career existed. It's kind of something I stumbled into like after I entered nursing as a second degree. And I just Joseph Rodriguez (13:32.68) That was a man's career. That's... Yeah. Joseph Rodriguez (13:49.543) Mm-hmm. Chrissy Massaro (14:00.14) took that into my mid to late 20s thinking to myself, I really don't want to pass up opportunities again. I really learned my lesson. I felt like giving up on yourself and not. trying the hard thing or not giving yourself that opportunity really robs you of joy in life. Life is very short. That's one thing we learned very quickly as ICU nurses, right? So I saw an opportunity and I said, I don't really know where this is going to go, but I do know that if I don't do something about this, that I might regret it later. Joseph Rodriguez (14:35.196) I think it's not that specific experience, but the feeling of, know, well, I'll just relate to my own poor performance, I would call it, younger in life. I grew up in a very religious household as well. I didn't have the same exact experience, I think there's a lot for CRNAs, there's a lot of late bloomers, right? Comparatively late bloomers, right? As opposed to, it's not as common, I think, when You have somebody who knows they're going to be a CRNA from, you know, they're 10 years old and they know exactly what they're going to do. I didn't know what being a CRNA was going to be either. Do you mind if I ask, what was the name of the community or the name of the denomination that you were involved in? Chrissy Massaro (15:18.498) They identified as non-denominational, but honestly, it was like a hybrid of Pentecostal and Baptist. It was just a  church. Thankfully, everyone who's listening, my parents have left this community. They're still religious, but they are no longer of that level of belief. They're very supportive of me now. Joseph Rodriguez (15:26.159) Okay. Joseph Rodriguez (15:38.183) Okay. that's good. That's good. Chrissy Massaro (15:39.264) everything has like normalized and shaken out, everybody's good, everybody's happy. But that was like, you what was part of my decision making process at the time when I was 18 years old, for example. Joseph Rodriguez (15:49.52) Yeah, that's really fascinating. How old were you when you got out of that mindset, that framework of life where you were like, you know what, I do have options. I am going to start looking at things, exploring things. How old were you when you got out of that world? Chrissy Massaro (16:07.022) Um, I went, my parents asked me to kind of force me to go away to a Christian college. It said if I'm going to college, it has to be a Christian

university. So I went to Eastern university, which is in St. David's, Pennsylvania, just outside of Philadelphia. And what was so funny about this school is that it's actually an anarchist Christian college. Day one, and I had no idea. Yeah, they're completely anarchist. It's hilarious. So day one of, uh, Joseph Rodriguez (16:15.0) Okay, what college? Joseph Rodriguez (16:22.714) Yep, I know it. Joseph Rodriguez (16:29.581) Okay. Really? Chrissy Massaro (16:36.91) You have to take all these courses when you're in a Christian university. So I had to take Bible 101, Bible 102, theology and faith, reason and justice. So it was really like all the core religious classes. So on day one of Bible 101, I felt like the rug got pulled out for me when all of a sudden we were looking at things in a very historical context and it's like, the Bible's not meant to be taken literally at all. And I was like, oh no. You know, this is all, you know. Joseph Rodriguez (17:01.636) It must have been... That kind of blew your mind. Chrissy Massaro (17:03.308) I was like, what? Completely, it was a totally different perspective and mindset shift and really looking at faith through a lens of... of justice and a broader social context and understanding like how things were written at the time and how they're interpreted by other religious communities really just opened up my mind and empowered me to just kind of spread my wings and say, hey, you know what, there's nothing anti-God about science. And even though I was a social work major at the time, that was my first major, I started, I missed my science classes. So I started taking chemistry and biology and I minored in biology so that I Joseph Rodriguez (17:38.97) Mm-hmm. Chrissy Massaro (17:44.448) could give myself the opportunity to potentially go to medical school. And then I ended up graduating with a psychology degree so that I could kind of bridge those interests. And doing a pre-med internship in Mexico, I studied abroad down there. So it was really that transformative process of deconstructing religion, not necessarily abandoning it. I still identified as a Christian at the time, but allowing myself to see that. these two things were not opposed. I didn't have to choose between like science and what I believed in at the time. Joseph Rodriguez (18:17.423) Yeah, I'm always interested in people's formative experiences and what, you this idea that you lost out on opportunities, you you went through life and now, you know, 2019 comes, pandemic comes and poof, here's an opportunity that evolved, you know, it sounds like over months and years, but yeah, it's just fascinating what drives people to make those decisions. So Confident Care Academy, how many people have gone through the academy as it were? Chrissy Massaro (18:44.174) we've probably had at least 2,500 members at this point. Joseph Rodriguez (18:48.344) Okay, and how long, just for those who are interested, I suppose, how long does one stay in the academy? Chrissy Massaro (18:57.198) you can stay as long as you like. So we have people who've been with us since the very beginning of since like June of 2022 and are still in the membership and they're in CRNA school now and they're using it as a supplement for their lectures currently. We also have a few anesthesiology lectures that we've started to kind of trickle out. So they stay around for that as well as the community aspect, right? So it's more than just a course. It's not just classes that you take. We also have discussion boards and meetups weekly. So they stay for the mentorship. Joseph Rodriguez (19:04.997) Mm-hmm. Joseph Rodriguez (19:08.581) Mm-hmm. Chrissy Massaro (19:27.252) they stay for the community and of course like whatever resources and just the access to pick like a mentor's brain as they need somebody. So some people are with us for years, some people use us to adapt from being a grad through orientation like their first year on the unit and then they leave. A lot of them come back again when it's time to apply for CRNA school they're like okay I want to brush up on my knowledge. We have some you Joseph Rodriguez (19:38.02) Mm-hmm. Joseph Rodriguez (19:50.308) Sure. Chrissy Massaro (19:51.936) Admissions like generic advice and strategy. We don't specialize in admissions. We don't like coach people, but we do, you know, provide resources and insights for people because so many of them do want to go to CRNA school. So a lot of them come back for that. people tend to be in and out throughout their ICU journey. Joseph Rodriguez (19:58.755) Mm-hmm. Joseph Rodriguez (20:10.828) Okay, interesting. about 2500 people, you're regularly posting on TikTok and other, is it primarily TikTok or is there other platforms as well? Chrissy Massaro (20:20.888) Confident Care Academy has its own online presence now. So now it has its own Instagram channel, its own TikTok and its own YouTube and Spotify. So I feel like that's where we've been putting most of our energy into, the education aspect on those podcasts and platforms. So that's kind of where it's taken on its new. Joseph Rodriguez (20:37.316) Sure. Okay. And then how much does it cost? Just out of curiosity. I'm not in the market for, I'm past that stage of my career, but yeah, for a brand new nurse, how much does member, is it an annual membership, something like that? Chrissy Massaro (20:42.956) So. No, it's fun. Yeah! You can pay annually, you can pay monthly. It's $49 a month if you pay monthly. If you do the annual plan, you get two months for free. And if you're currently in school or a military member, we always give people 50 % off. So if you're a senior year nursing student, if you're in a school, even if you're just taking classes part-time to kind of like boost up your CRNA application, we really want to encourage people to. get educated, right, however they do it. And there's a large financial burden associated with being back in school. So we try to make it as easy as possible

for them so they pay. Joseph Rodriguez (21:22.789) Sure, of course. It seems like a good investment. Especially because I can totally relate. mean, most people don't know this about me, I can absolutely relate. I was a bedside nurse first in 2005. Yeah, 2005. And yeah, I almost washed out. I didn't know anything. Anything. You know, I passed my boards on the first try. So I was, you know, modestly intelligent, intelligent at least. But yeah, this seems like. a big gap to fill. the people who are active, what percentage are ICU nurses, if you're comfortable sharing, feel free to share in broad strokes, like what percentage of the Confident Care Academy is geared towards ICU nurses right now? Chrissy Massaro (22:10.87) Like of the content or of the members, like how many members are ICU nurses or how much of the content is ICU nursing? I think that's hard to quantify content wise because so much of it applies to both, right? Like understanding the pathophysiology of the heart is applicable whether you're in CRNA school or whether you're a new grad ICU nurse. And we go quite deep. We go all the way into G protein coupled receptors if they want to go there. So, Joseph Rodriguez (22:14.503) both. Joseph Rodriguez (22:32.174) Mm-hmm. Chrissy Massaro (22:41.324) You know, all of it, 100 % of it is applicable to ICU nursing. Our anesthesia specific library, things like cardiac anesthesia, obstetric anesthesia, we just have a handful of lectures here and there. We're planning on developing a full curriculum starting this fall. Like we intend to have a lecture for every single topic that you'll cover in CRNA school eventually. So the goal is to support people all the way through that process. And most of our members, I'd say like, Joseph Rodriguez (22:59.661) Wow. Chrissy Massaro (23:11.456) of active members, like 90 % of them are still in the ICU, but we constantly have people getting into CRNA school. And again, not because I'm trying to force them to go there, it just happens to be the self-selecting population of people who are motivated to learn at that level of depth. They all are the same type of person who wants to go CRNA school. Joseph Rodriguez (23:28.365) Sure. Have you ever thought about opening a CRNA school? That seems like ConfidentCare Academy Vision Board 2030 or something. Chrissy Massaro (23:35.726) you It may be. Now, you know what though? I do guest lecture right now at Hunter College, which is opening a CRNA program here in New York City. The first class starts this May. So I will be guest lecturing there more frequently as that program opens up. Currently, I guest lecture for the nurse practitioner students there. And I will be kind of... track potentially to be faculty at some point there. I'm starting my PhD program soon, so looking to kind of dip my toe in a more formal education space. Yeah, I do have a vision of kind of creating an online library through Confident Care Academy that we could Joseph Rodriguez (24:10.252) Very cool. Chrissy Massaro (24:19.874) potentially give out to CRNA schools as a supplement. One thing I've noticed talking to students from across the country, a lot of programs might not have specialty lecturers for every single topic, right? So a lot of students are teaching each other obstetric anesthesia or cardiac anesthesia. I think that's a huge gap and a huge missed opportunity. So if we could create a really robust library, like in the way that many programs use the Nagelhaut lectures to supplement FARM, I would love to create a product where we could kind of give Joseph Rodriguez (24:35.628) Mm-hmm. Chrissy Massaro (24:49.848) this out to schools and say, like anything you're deficient in, this is a resource for your students. Right now, only real supplemental resource students have is Apex. And that's great, but you can't listen to Apex on the go in your car on the way to clinical, right? So I think this would be a good opportunity for. Right. Exactly. Joseph Rodriguez (24:54.252) Mm-hmm. Joseph Rodriguez (25:05.75) Right, because Apex is primarily test prep, correct? Okay, interesting. There's a lot of runway for your business, it appears. Chrissy Massaro (25:18.552) Got a lot of ideas. I just haven't figured out cloning technology yet, but we'll get there. Joseph Rodriguez (25:23.029) Yeah, yeah, it's a time aspect. That's very cool. just conversationally, there's this phrase called content is currency, right? And you're creating a lot of content and the way that people consume information has dramatically changed in the past five years. Are you like, do you think about these things? mean, are you like self-aware that you're on the vanguard of this media moment? I mean, Chrissy Massaro (25:48.3) all the time. Joseph Rodriguez (25:52.193) Joe Rogan got Donald Trump elected, right? Seemingly. So it's like, this is real. All these equations are changing. And yeah, please, I'd love your thoughts on that. Chrissy Massaro (26:01.302) Yeah. Chrissy Massaro (26:05.742) It's interesting because when I first got on TikTok, there was obviously mostly a negative response to it from fellow Sieranese, right? A lot of people thought it was silly or maybe unprofessional. And of course TikTok was different back then, right? There was mostly music and pointing to bubbles on screen or maybe dancing to like a popular trend and that would have an educational twist. And it was like very out there. Joseph Rodriguez (26:23.264) Right. Chrissy Massaro (26:30.968) So I understand why it was not popular at the time. People thought like, this is like making the profession look bad, childish, right? But I knew that there was something special to it because it felt so relatable. And that was something I never had access to growing up where I did. I've never had a... Joseph Rodriguez (26:31.115) Mm-hmm Joseph Rodriguez (26:49.953) Mm-hmm. Chrissy Massaro (26:52.596) a mentor in my life who was a CRNA. I never had a mentor in my life who was really a healthcare

professional at all or in any sort of profession. I'm actually, sometimes I'm shocked to even went to college. So making a mysterious profession accessible and relatable to the average everyday person who's probably never heard of it was more important to me than the backlash. Joseph Rodriguez (27:04.917) Hmm. Chrissy Massaro (27:17.314) things changed very quickly once the pandemic hit and people were suddenly spending time on these apps and learning to integrate it into everyday life and seeing that quick shift. Joseph Rodriguez (27:23.423) Right. Chrissy Massaro (27:28.674) And the rise of podcasting, mentioned Joe Rogan getting Donald Trump elected as a perfect example. This is media that used to be very abstract and now it's something that's part of our daily lives. So getting to be in people's cars when they're on the way to work, getting to be in people's kitchens when they're cooking dinner and breaking down why it still makes sense to go to CRNA school, even though there's a lot of student loans involved in it, right? That makes it accessible to people like me who don't have a mentor who's explaining that to them. So that's kind of like. I guess my driving motivator. Joseph Rodriguez (28:01.45) Yeah, it's really cool. It's really cool, man. I'm glad you're out there mentoring these people even remotely. I think I, you know, I'm technically a millennial, right? So just barely. I'm an old millennial, but I had some similar experiences, but they were like, that phrase, seeing through a mirror dimly faded. I had a somewhat online experience. Do you know who said that? Do you know who said, I see now through a mirror dimly faded? Chrissy Massaro (28:23.596) Mm. Chrissy Massaro (28:30.702) It's familiar, but no, I don't know. Joseph Rodriguez (28:33.52) It's the Apostle Paul. So I figured what the religious references. Yes, yes. It's a great phrase. It's a great phrase. I use it all the time. Chrissy Massaro (28:35.476) I was gonna say, I was like, sounds biblical, but... I'm sure I knew that reference at one point in time. Joseph Rodriguez (28:44.992) Yeah, yeah, but you know it's different right? We were on forums. Yeah, he's probably like I should have taught my daughter better or something like that. But yeah, it's very cool and some of my you know, obviously Mike McKinnon started this podcast and he's about 10 years older than me and he was an early mentor for me. Cause I had no idea any of this was going on and then it was like even further within the recesses of the Internet. Like you had to dig really deep and now man. Yeah, you're. Chrissy Massaro (28:46.924) My dad is shaking his head. Joseph Rodriguez (29:12.513) You guys are out there. You and your cohort are much more out there. Who would you say... So you've been a senior in... You said since 2013? Chrissy Massaro (29:22.789) 2017. I was a nurse since 2013, I've a nurse since 2017. Joseph Rodriguez (29:23.68) Sorry, I'm getting my years mixed up. It's 2025. Oh my gosh. My sense of time is becoming so distorted. 2013 seems like five years ago for me. Anyway, so yes, 2017, got it. So who are your mentors now? Because you're in this new space. I'm sure you have some educational mentors in the more formal, traditional academic world. But yeah, who would you consider mentors either in this media world or in the CRNA world? Chrissy Massaro (29:30.542) I know. Chrissy Massaro (29:55.862) So media world, I'm sorry. I believe in seeking out mentors, but it's hard. It is hard to find a good mentor. You gotta like come people down and capture them like Pokemon. I would say my media mentor is Giselle Ugardi, if anyone's interested, U-G-A-R-T. She has been... Joseph Rodriguez (29:58.185) Are you mentor free? No go ahead, I was just kidding. Yeah, it is hard. Chrissy Massaro (30:21.878) all over different forms of media throughout her career. She's not in healthcare at all. But the first like thing that I learned about social media ever from was her. I followed her account back in the day and I bought her little mini master of TikTok course. And then we became friends in real life. And I feel like she's been really such a good source of encouragement and insight into the power of platforms and how to really put yourself out on social media and overcome those fears and just create content even if it's not Joseph Rodriguez (30:46.782) Mm-hmm. Chrissy Massaro (30:51.862) perfect even if it's messy so I feel like she was really a great mentor and friend in that space. In CRNA land I was very very fortunate to be assigned faculty mentors when I was a student at UPenn. So a lot of the faculty I'm still in touch with today, Dr. DiDonato, Laura DiDonato was like a huge mentor for me. She was my assigned mentor. Dr. Bent, who's the program director now, she was another just great resource. She's always been very encouraging to me. And Dr. Wiltsi Nicely, who was my director at the time. I was terrified of her because she was my program director, but she was always such a huge inspiration to me because she also, you know, Joseph Rodriguez (31:11.625) Mm-hmm. Joseph Rodriguez (31:25.311) Mm-hmm. Chrissy Massaro (31:37.58) just came from the same ICU unit I did and overcame so much as well in her life. So I've always modeled myself after kind of her. Yeah, she's like not, she's to be messed with. She's great. Joseph Rodriguez (31:43.935) That's Kelly, right? Joseph Rodriguez (31:47.785) Yeah, she was a... Yeah, she's awesome. She's awesome. If you're if she's listening. Yeah, yeah, she was. That's yeah, we have some common ground. She was I looked up to her quite a bit because I was a little baby srna when she was the president of the Pennsylvania Association. And yeah, just was the consummate professional. And she knew she was assertive, but respectful. And yeah, yeah, she's down in Georgia now, right? Chrissy Massaro (31:54.018) She's still such a role model today. Chrissy Massaro (32:08.078) Yeah. Chrissy Massaro (32:15.0) Totally. She is, she

started the Emory program. So she really does it all. She also like was a new grad nurse in the same unit I was. She went back to CRNA school very quickly, just like I did. She managed to get on the cardiac anesthesia team when she was working at Penn Presbyterian. Like she had all these things that I was always told I couldn't. And so it was cool seeing somebody else who I felt like was similar to me kind of go down that. And then I feel like I followed in those footsteps. also ended up joining the cardiac team there and working at Penn for many years and like kind of accidentally I've been copycatting her. Right now, my current mentor is Dr. Majumdar, Jenny Majumdar. She is the... Joseph Rodriguez (32:53.362) Mm-hmm. Chrissy Massaro (33:03.008) Assistant Program Director at the New Hunter College Program. So she's starting that up right now. So she's been the one who's been bullying me into getting my PhD. So she's been a really great resource and source of insight onto that world. And we've been starting to work on research together. We're doing a meta analysis right now. So like this has been really fun to kind of learn about that world. Joseph Rodriguez (33:22.301) What are you setting? Chrissy Massaro (33:24.96) We are looking at anxiety for pre-op IVs. So we're getting nurses involved in this research study. It's really like a nursing focused study, but it's my first time really doing research. So I'm excited to kind of like learn the process. Joseph Rodriguez (33:42.781) You got to know this question's coming. know, PhDs, just generally speaking, PhDs generate research, right? Other standard entry to profession doctorates generally utilize research. I'm speaking very generally, of course. Why PhD versus what all the kids are getting now, their doctorate of nursing practice or DNAP? Chrissy Massaro (34:07.394) You nailed it, right? Generating research versus translating research. And it just aligns more with my interest just to be completely straightforward. I am very interested in my personal life and policy and how policy really shapes way we live, whether it be local policy and what the projects get funded, how people... get to our patients even, right? Whether you have health insurance or not affects whether you develop certain diseases or not because you have access to preventable care. All of these, know, safe nurse to patient ratios affects whether your patients go septic and fall or not, right? Joseph Rodriguez (34:47.965) Mm-hmm. Chrissy Massaro (34:48.108) Policy really determines everything and before policy comes research. So for me, I really see my eventual future not being so much really just girl bossing as an entrepreneur. I really do see myself studying research that could lead to policy and advocating for policy changes on things that I care about. So that is kind of why the PhD I think is going to be my like segue to marry all of these interests together. Joseph Rodriguez (35:17.361) How many years is it gonna take you to finish this PhD? Chrissy Massaro (35:21.454) Three to four years, it's a part-time PhD program. It's designed for working professionals. It's a PhD in nursing at Hunter College and two of the faculty members are CRNAs. So I'm lucky that I'll still get to study something applicable to anesthesia, but also potentially again, lay the groundwork down for maybe advocating for policy in the future. We'll see, see where it goes. Joseph Rodriguez (35:48.422) Sure. Yeah, Chrissy, you're cool, man. I have no idea how old you are. I'm not stupid enough to ask. But when I was in my late 20s, I enjoy policy quite a bit as well. I ended up not doing the research aspect because I'm not that smart. But I ended up getting involved in more Arizona state government policy. And it is, you are completely correct. You change a few small words of statute or regulation and you're impacting. thousands of people over the course of time. So I like that a lot about you. Okay, just because now we haven't talked about your clinical practice at all. And I'm also curious about that. Tell us a little bit about your clinical practice. You studied, you practiced at some giant hospital in New York doing cardiac and OB, right? I know there's more to it, but is that the main headline? Yeah. Chrissy Massaro (36:37.966) Exactly. Exactly. Like I said before, was at UPenn for many years. I worked at both Penn Presbyterian Medical Center and the Hospital of the University of Pennsylvania. So I did trauma there. I did cardiac, all the big cases, all the crazy stuff, lots of sick patients. Joseph Rodriguez (36:57.628) Mm-hmm. Chrissy Massaro (36:57.676) I was lucky to have some experience where we absorbed this little community hospital in deep West Philly. And then I got to have some like independent airway call, which kind of was like a surprise to me to have any like level of independent practice, like in Philadelphia. That was something I was told would never occur. Again, it was just like covering call for that. We weren't doing like cases, but just like even covering airways overnight was like my first tow in the water into that world. And then moving to New York City. Joseph Rodriguez (37:15.727) Mm-hmm. Joseph Rodriguez (37:24.239) Yeah, well that might be harder than actual independent, I mean, independent, yeah. But yes, continue by all means. Chrissy Massaro (37:27.79) It was scary. It was scary. Yeah, and just lots of great experience teaching call at Penn too. Like lots of difficult airways there, lots of sick patients, lots of learning. So when I moved to New York City, I was told that as a CRNA, I wouldn't get to do anything cool and that all my skills would erode and that never get to think a thought again. And it turns out that's not true. That's a rumor, everybody. We'll all bust the myth. There's definitely opportunities if you choose to carve it out for yourself, if you push. So... Joseph Rodriguez (37:53.989) Okay. Chrissy Massaro (38:00.174) I'm on the cardiac team.

I was told CRNAs would never do cardiac at NYP, but we do. We absolutely do. So it's been a really nice opportunity. Joseph Rodriguez (38:09.987) Okay, were you one of the first crop of people to do it? Chrissy Massaro (38:14.306) Yup. Joseph Rodriguez (38:16.217) Okay, how many CRNAs? This is interesting. Yeah, you started the cardiac team? Chrissy Massaro (38:17.048) Starting a cardiac team. Yeah. Yeah, it's me and another CRNA who also came with cardiac experience from another institution. So we are a two man team currently. We had our first nurse anesthesia resident in cardiac recently. So that was a success. And we hope to grow the team over the next year or two, depending on what happens with our volume. Of course, like we have a large physician residency. There's only so many cases to go around. But we do plan to have nurse anesthesia residents in the cardiac rooms and we do plan to continue to have a presence there. So we're very excited about that. Joseph Rodriguez (38:47.237) Sure. Joseph Rodriguez (38:55.914) This is New York Press-Baterian, correct? Chrissy Massaro (38:58.359) Mm-hmm. Joseph Rodriguez (39:00.027) Prior to your, just double clicking to use the cliche on this, prior to your engagement in those services, was this a physician only service? Was this physician anesthesiologist only? Chrissy Massaro (39:11.246) Cardiac? Mm-hmm. Yeah, there were CRNAs at my hospital who had done cardiac from time to time, but it wasn't a consistent team. you know, it was just like not enough volume to keep them there regularly. So there's like one or two CRNAs who did it like a few times a year. And then they kind of stopped doing it because the consistency wasn't there to really keep people competent and comfortable in the skill. So most people just stepped away from it and said, I really don't want to do this unless it's something that's going to be routine. So I volunteered to be the guinea pig. I said, well, I'm already comfortable. Joseph Rodriguez (39:42.96) Of Chrissy Massaro (39:48.94) just put me in and let's just see where it goes from there. And it went well. And then my colleague joined our group and he had a PEDS cardiac experience from UCLA. So we're like, let's try it again. And between the two of us, we've been there consistently and we've really enjoyed everyone that we've been working with. The cardiac team has been really, really welcoming and. Joseph Rodriguez (40:03.93) Mm-hmm. Chrissy Massaro (40:13.888) warm and receptive to having serinase and that's been a really awesome thing to see. Joseph Rodriguez (40:19.418) Are they, this is interesting, one of my good buddies is a cardiac anesthesiologist. just, so for the listeners, I'm gonna be very broad, but west of the Mississippi, at least in my experience, cardiac is exceedingly rare for CRNAs to be involved in. I think in the city of Phoenix, I know of like two CRNAs, like total, that do any kind of cardiac, and generally it's an MD only specialty. And that's kind of how the west has evolved. Differently, there's a lot more independent practice, but. There are certain segments that are MD only. When you're doing this, is it two to one in a medical direction as a predominant model on the Eastern seaboard, especially kind of mid? Yep, yep, yep, yep. But are they doing, are you, you're doing the case and someone else is doing the case and there's a medically directing physician covering you with, or covering the cases with you? With both of you, I should say? Chrissy Massaro (40:55.938) Yeah, totally medical direction. Master. Chrissy Massaro (41:08.748) When I was at UPenn, yeah, when I was at UPenn, that's how we did it. We were two to one. It would be me in one room and like a physician resident in another room. And then the attending would just kind of bounce back and forth. And then they loved having CRNAs because they could kind of like ignore us if they needed to, right? They'd come in. We had fellows around. Yeah, they had fellows to do the TEE. So, you know, they would be like doing their exam. They were another set of hands. And that's kind of how things shook out there. At my current job, our Joseph Rodriguez (41:24.728) Yeah, you're an experienced professional, you're not... Yeah. Chrissy Massaro (41:38.574) our head of cardiac surgery wants every single physician to be one-to-one with their resident. So there's no one-to-two at all cardiac where I work currently. And because the residents can't be more than one-to-one, we are also one-to-one. So it ends up being a little redundant, like having that many bodies in the room truthfully, but I'll say this. Joseph Rodriguez (42:00.537) Sure. Chrissy Massaro (42:02.174) Normally the attendings don't feel comfortable stepping out when they're with the residents. They don't really get a break all day. And now that we're there, they can get to step away. And it's been like a good dynamic for everyone. They've been really open to having us do all of our skills. do all my own lines. There's been no limitations there. They've been teaching me the TEE so that I could feel comfortable like dropping a probe in OB. If we have a code, for example, like everyone's been very proactive in helping me develop that skill set. Joseph Rodriguez (42:08.632) Mm-hmm. Joseph Rodriguez (42:29.273) Sure. Chrissy Massaro (42:32.138) So even though it's one-to-one and it's certainly not like autonomous practice, it's been a great learning experience and I've been really excited to again get to develop those skills. Joseph Rodriguez (42:44.206) Yeah, that is very cool. That is very cool. I think there's this demarcating line, you know, there's this divide between either you're independent or you're not in our profession. And I think it just doesn't align with reality in the sense of. Yeah, if we stop thinking about who, which profession is best and we start thinking about almost like pilots. So in pilot world, you get a license for a specific skill or for a specific plane rather.

And I tend to think about anesthesia more in those terms than ultra broad generalizations. You are independent or you're not, or you are medically directing or you're doing your own cases. Because yeah, I've to tell you, I've practiced so-called independently or autonomously for basically my whole career and I would never do those cases. Never, ever. No, if somebody wanted me involved in those cases, I would be like... Chrissy Massaro (43:23.918) Totally. Joseph Rodriguez (43:42.765) Yeah, you better get your butt in here. Anybody! Anybody knows what they're doing. So yeah, that's cool, man. That's very cool. Chrissy Massaro (43:48.94) Yeah, it's all a spectrum for sure. Pros and cons. Joseph Rodriguez (43:52.313) So, one follow-up question there, I want to flip back to CCNA. So, what's the vision for the department there at your place of work? Is it to expand that service where CRNA professionals are more engaged in cardiac world? Or is it more like it's just you two, you and your partner there, and that's kind of where it's going to stay for now? Chrissy Massaro (44:14.734) If you want a small pool, I think the goal of the department, we've had many conversations about this, they would like a few more siren aids to be in the regular pool eventually. That way, like any day that they need to pull someone there, there's someone available, right? If it's just me and one other guy and one of us is on vacation, then they're short-staffed and cardiac that day and then nobody's happy. So I think they'd ideally like a group of like up to like five of us over the next few years. Joseph Rodriguez (44:32.888) Right. Joseph Rodriguez (44:39.769) Mm-hmm. Mm-hmm. Chrissy Massaro (44:40.588) It's obviously something that we're slowly developing over time. As the Hunter College program opens up, we're going to have to give those students their experiences too and their numbers, the nurse anesthesia residents. So kind of integrating them into the team will be, again, another ongoing process. So it's underdeveloped, I guess I'll say. Joseph Rodriguez (45:01.697) Yeah, you guys are all employed by the hospital, correct? Chrissy Massaro (45:04.931) We are. Joseph Rodriguez (45:06.583) Okay, that's interesting. Only because, generally speaking, the rule of thumb, again, market forces being what they are, you don't really get economies of scale with CRNAs and MDs practicing together until you're like at four to one, at least. Anything, at least in the Arizona market and to, I'd say also in Texas, and as far as I know, like one to two, one to three, it's generally more cost efficient just to have the physician doing their case. But... Chrissy Massaro (45:21.891) Great. Joseph Rodriguez (45:35.723) When you're all employed by the hospital and your anesthesia costs are one little line amongst the, you know, $7 billion hospital, doesn't really matter, you know. least, yeah, do you guys get into those conversations at all? Chrissy Massaro (45:43.862) Well, and I think where it comes out ahead is allowing... Sorry, can you repeat that? Joseph Rodriguez (45:51.555) Do you guys, there must be a delay, I apologize. Do you guys talk about the financial impact of those things at all? Is anyone in the department aware of those? It's been a long time since I've been in academics, so I'm just curious. Chrissy Massaro (46:05.966) don't think the CRNAs are specifically at the forefront of those conversations necessarily, I think, but of course budget is like part of the decision making process before you bring CRNAs in. That pulled us out of the main OR numbers, right? Like it makes more, or for a long time, it made more financial sense for the department to have me in, you're right, in wider ratios, exactly. And like being able to be more productive and like OB or even the surgery center or whatever place you name. But. Joseph Rodriguez (46:34.145) Mm-hmm. Chrissy Massaro (46:35.178) It also allows us to have more cardiac volume. And ultimately that is a big moneymaker for hospitals, right? Cardiac surgery. So, you know, as long as the hospital feels that they have the budget to accommodate one-to-one and that is a fraction of expense compared to what they're making on cardiac surgery that allows them to have more surgery volume, it's still an overall net advantage. Joseph Rodriguez (46:39.329) Hmm. Sure. Joseph Rodriguez (46:55.275) Right. Yep. Chrissy Massaro (46:59.734) And that is the difference between when you're employed by a hospital versus a group. Like those numbers, you can kind of look at the global balance as opposed to just the anesthesia costs. Joseph Rodriguez (47:06.249) Indeed. And yeah, yeah, I think you're the juice has to be worth the squeeze. It's I'm not sure if it's easier or not when it's all in one budget, so to speak. I think anesthesia groups are just generally more scrutinized. I always tell hospital executives when when they want to internalize like you'll you went on control, which is what you guys have. Generally, you lose on cost because of this. But you know, as long as you're earning it somewhere else, it really doesn't matter. Anyway, that's a good segue. So back to Conflict Care Academy. Where do you see this going? Where would you like to see it in three and five years? And then I'll let you have any closing thoughts as we wrap up. Chrissy Massaro (47:50.508) love to eventually create an app that bedside nurses can use that is a ongoing, easy to use, easy to understand clinical resource. Joseph Rodriguez (48:02.548) Mm-hmm. Chrissy Massaro (48:02.958) The video library, think, will always live on. I do want people to always have access to in-depth education where they can listen to an hour-long lecture on G protein couple receptors and how vasopressors work and how liver failure works. I want them to always have that, but the reality is in our day-to-day life, we're not always gonna pull up an hour-long lecture, right? So I want them to have a app where they can have access to the need to know on the go as well. Joseph Rodriguez (48:23.326) Mm-hmm. Chrissy Massaro (48:30.486) That will probably be the next iteration of CCA. So as we're developing the rest of our anesthesia library, we're also going to start slowly developing a custom app in the background. And I'm sure those two projects will few years. After that, I don't know, I'll probably let it kind of go on autopilot. We're developing a mentor network within CCI. We're hiring peer mentors to be able to kind of offload the amount of time I spend there and give people access to more diverse opinions, other mentors besides just myself and Anna. So I imagine that mentor network will expand and I will be less and less involved at some point in time. Joseph Rodriguez (49:00.789) Mm-hmm. Chrissy Massaro (49:11.758) And that's it. I'll be hopefully pivoting to policy and more formal education, I think. One day. We'll see. Joseph Rodriguez (49:17.637) Could you ever see yourself running for office? Chrissy Massaro (49:21.4) Totally. Not like president, but like city council, congress, yeah, absolutely. Joseph Rodriguez (49:23.445) Yeah. Mm-hmm. Yeah, that's cool, man. That's very cool. Unfortunately, yeah. Well, you're squaring up, to use the baseball term. That's what you're squaring up for. As an outsider looking in, you're an above-average communicator, and that's just at first glance. We're just kind of getting to know each other. You're clearly ambitious. Chrissy Massaro (49:31.554) Maybe in my 40s, like next decade. Joseph Rodriguez (49:53.857) And you're developing a business and now you're starting to work on policy, right? Like. That has the resume of the I know I mean this is good. This is what we want in our elected officials. People who actually know stuff right and you're your media savvy too, right? You're you which can be a good thing and a bad thing, but you're definitely using it for good. So I love it man. Christie, thank you so much for being on. This was really cool. I enjoyed getting to know you a little more. Chrissy Massaro (50:19.832) Thanks for having me. This was a great episode. I hope everybody got a lot out of it. Please feel free to reach out to me at any time if you guys have questions. Always happy to answer, always happy to help. Joseph Rodriguez (50:31.027) I love it.