AA vs. CRNA - Let's Discuss. - page 3

Let's have a discussion/debate (although it will probably be one sided) about AA vs. CRNA. These are just some topics I thought of off the top of my head. Any input or 'playing devil's advocate'... Read More

  1. by   Desert Rat
    I am not familiar with AAs. Work in a rural area where we have always used CRNAs and no anesthesiologists. This whole thing reminds me of several decades when docs were promoting nurse practitioners, then found out nurses could practice independantly and the docs couldn't control everything they did. Thus the PA programs were developed under medical auspices. Many members of the medical community still can't accept the fact that nurses can think and practice independantly. (Also a common misconception of the public in general)
  2. by   loisane
    Good observation Desert rat.

    New CCU Rn, who do you think is behind AAs? Who benefits?

    loisane crna
  3. by   loisane
    A good discussion so far. How about we break it down to the bottom line.

    When AA legislation is introduced in your state, how are you going to respond?

    Do you support it? (because you think it is a good idea for health care and consumers).

    Ignore it? (because you think it really won't have an impact on CRNA practice)

    Oppose it? (on what grounds? Turf protection isn't a good enough answer).

    Every CRNA/SRNA/wannabe needs to ponder this decision.

    loisane crna
  4. by   loisane
    AAs were a big topic at the recent Mid Year assembly in DC. Read nilepoc's blog today for a good summary.

    loisane crna
  5. by   Cosmid
    Hi everyone.

    I have been reading this site for months now -- I work in the IT field, because I've always had a nack with computers, and am pretty smart, and taught myself all of this networking stuff. Well, in case you didn't know, the IT field is dying, and not to mention, not having an IT degree hurts me in a lot of ways.

    So, I'm going back to what I went to college for in the fist place -- Health Care.

    I'm probably too old to be a doctor now (I'm 31 - it would be probably 2 years until I get in, then 7 years of working until I can start earning -- not to mention the incredible amount of student loans I'd have to pay back.)

    So, then I thought about nursing -- I really liked the idea of CRNA. But then again, I already have a BS, and why would I want to get another BS(N), then spend time in the ICU, then 3 more years of CRNA school... I really like the idea of AA. Although there are only 2 schools in the US at the moment, I think this has a great chance of catching on, just like PA's have.

    So, this is what I'm going to do -- it make more sense in my situation.

    -cosmid:chuckle
  6. by   loisane
    Cosmid,

    I have to agree, AA is a viable option for you. Be sure to check out if they are used where you want to work. They are not all that prevalent in all areas.

    For the CRNA route, you would not need another BS. You could get a 2 year nursing degree, work a year of ICU, and apply to one of the schools that offers a non nursing masters. But that would take at least 5 years, compared to 4 for AA. And I am sure you have read the comments about the pros and cons of basic bedside nursing, found elsewhere on this board.

    Good luck,

    loisane crna
  7. by   CRNA, DNSc
    You are the one that has to make that decision for yourself.

    Be very sure about the AA use in areas that you want to work and live for the rest of your life. Keep in mind that there are only two programs, they have been around for at least 15 years and there are only about 600 of them in the country. Compare that to CRNAs that have been in the United States since Sister Mary Bernard (the first documented nurse to engage in the practice of nurse anesthesia ----- in 1877), there are 86 programs in the US and Puerto Rico and there are over 29,000 practicing CRNAs in the country.

    Just food for thought!!! Good Luck!!
  8. by   u-r-sleeepy
    Let's discuss:

    I believe the A$A has figured out another method for increasing their CONTROL of the practice of anesthesia and how to increase their $$$ at the same time! Woohoo!! "I'm SHOCKED I tell you - absolutely SHOCKED!" 8^O

    Besides all the minutia and details presented here, try thinking about this for a moment:

    There are approximately 27-28,000 CRNAs currently working providing 67% (2/3) of all anesthetics while there are approximately 35-37,000 MDAs/DOAs doing 33% (1/3) of actual hands on cases??

    Does that ratio say anything to you about the supposed "shortage" of anesthesia providers? How about if say... 4-5,000 lounge-lizards (doctors "supervising") got up off their duffs, left the lounge (i.e. stopped reading the Wall Street Journal & buying gold on the internet) and actually started DOING THEIR OWN CASES?!? Maybe, just maybe, there wouldn't be a "shortage" anymore?

    What a thought -

    Frankly, I'm for INCREASING APNs' freedom to practice across the board which will include CRNAs. I think the economics alone will eventually dictate some of this trend. I'm very against anything smelling of "socialized medicine" but the camel's back (medical care) is about to break here in the USA and I believe the demands for care and availability will bring some of this change about.

    I think about the "robber barrons" and how they monopolized the jobs, freedom to work in certain industries and especially the $$$ of the last century and before. I think the A$A is leaning the same direction - it's all about Control & GREED!

    No, I do not think the A$A is being altruistic with their talk of "patient safety" and thus the need for "Physician trained assistants" like the AAs. Currently, we are in an uphill battle with doctors able to outspend us on lobbying and it appears Bush & certainly Frist are on the physicians' side. The fight is on and I, for one, refuse to be silent about my sentiments.
  9. by   Tenesma
    just a quick note from a lounge lizard (i am an mda):

    i work 80hrs per week minimum - i get a total of 45 minutes to 50 minutes per day of free time (mainly for toilet/water/lunch breaks) --- i wish i had the opportunity to read the wall street journal and buy gold on the internet. Instead I am taking care of sick patients

    but u-r-sleepy: your numbers are a bit skewed regarding number of anesthetics provided.... the percentage of "65% of all anesthetics provided" is very misleading especially since that number has no references whatsoever in the CRNA literature and is a gross assumption, and is also very misleading as it implies that 65% of all anesthetics are performed independently by CRNAs which we know is not the case.... Currently based on Medicare reports there are 40 million cases of anesthesia per year and anesthesiologists are responsible for over 90% of those - Now the figure 65% may represent that CRNAs are involved in some way or another in 65% of all cases, but that is all you can really extrapolate about that

    I am also getting tired of the repetitive mantra that nurses have been providing anesthesia for a longer time - things evolve over time.... barbers used to do surgery, general surgeons used to do cardiac/thoracic/neurosurgery, general practictioners used to do high-risk obstetric deliveries....

    what blows me away about your backhanded comments about MDAs: "lounge-lizards (doctors "supervising") got up off their duffs, left the lounge (i.e. stopped reading the Wall Street Journal & buying gold on the internet) and actually started DOING THEIR OWN CASES?!? " for heavens sake, you are a STUDENT-RNA: how much realworld anesthesia did you experience for you to have such an opinion, or are you just repeating what you have heard from the disgruntled few?

    just curious
  10. by   keermie
    This is my first post; however, I have browsed this forum for about a year, as I start a program this week. One of the most disturbing issues to me is the fight between MDA's and CRNA's. I do not look forward to animosity in the clinical arena. In the words of Rodney King, "can't we all just get along?" I think both sides have valid arguments, but I have observed that most of the disagreement is based on misinfo, generalizations, assumptions, and paranoia. While I admit I'm green and that this is merely a subjective conversation post, I had been envisioning a more altruistic anesthesiasociety. Please don't critic this post, just take it for what it is: a roast of both PROFESSIONS.
  11. by   keermie
    loisane,
    In reply to your post when AA legislation is introduced in my state . . .

    Part of being a professional is being an active member in your organization. There is nothing wrong with debate, just how it is done ie misinfo, generalizations, paranoia . . .. ASA/AANA do well to their respective professions, so to ignore it is not an option as a participating member. I plan to participate.

    Now to support or oppose . . . ? I would oppose because:
    1) the shortage can be averted by increasing enrollment in est. SRNA/residency programs by a number of different options.
    2) although MDA's believe that CRNA's believe that AA's do not justify their practice with their educational backgrounds; the AA as I understand it has little health care experience at all. I have tremendous respect for those who complete medical school. I also respect nursing school and the tough critical care arenas where CRNA's gain exposure, experience, critical thinking, as well as encompassing all the aspects of health care.
    3) it adds a third providor that if there were not a shortage, would be a nonfactor
    4) AA is a valid alternative, albeit it were not more than a strategic lobbying effort which evades the real issue which is clear and defined roles for both providors implored in a variety of clinical settings.

    There is a middle ground, but I do not think it is AA's. If you allow AA's, it increases the rift between MDA's and CRNA's. AANA continues to push harder for expanded roles to offset shadowed roles by AA's. ASA cont to push harder to limit CRNA and promote AA's until the point where they are strong enough to establish their own professional organization: AAAEE (anesthesia assistants against everyone else). The misfocus of the debate will perpetuate and cloud the issue, until the only people who suffer are the ones like me who try to make sense of it all!

    Just my $0.02.
  12. by   CRNA, DNSc
    I would highly recommend that you buy or borrow a copy of "Watchful Care: A History of America's Nurse Anesthetists by Marianne Bankert and read it. You will see a century of physician attempts to control anesthesia practice by a number of different methods, legal, legislative, regulatory, accreditation, slander, etc. Then ask why CRNAs are leary of of the ASA's push of AAs!!!!!
  13. by   warzone
    A special thanks to Tenesma for the differing view point. I think it's very beneficial to have an MDAs persepective in this discussion...however unpopular it may be.

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