Anti-CRNA website= such B.S.!!!!

PMFB-RN, RN · Oct 20, 2011

right hand side of page

*** cool, thanks. i learned something. i had no idea.

no, not at all. i just hate the animosity between crnas and mds. i think we look quite sad when we say "we are just as well trained" and "we nurses know more" about medicine than md's. sometimes that is the case, but we are just as guilty of showing very little respect as they are.

*** most of my friends and buddies are crnas. i don't actually hear much about animosity between them until i come here. when it comes to the actual practice of bedside anesthesia crnas are just as capable i believe. i agree that physicians are better trained in many areas, including research.

not implying that you are saying that, but i hear it all too often and it sounds like we are the jealous little brother/sister.

*** i am most certainly not saying that.

nursing is different and as much as it pains me to say it (i am getting my phd) medicine has really been the forefront of education and research, and nursing is a distant second.

*** i took that for granted. it is obvious.

we just don't have the funding or the resources that medicine has. we have a minimum requirement of 2 years for a degree and then wonder why physicians don't take us seriously when we say we know just as much as them.

*** i don't really have much experience with physicians not taking me seriously, but then i never say i know just as much as them. obviously i know far more than physicians about some things, for example i understand the workings of our hospital and understand what we can do where. for example i know we can not start bi-pap or a nitro drip on certain floors, but we can on others, or how long it will take to get a chest ct preformed at 0200 the physicians depends on us (the rapid response nurses) to be experts in these areas. however i do not think, or say i know as much about medicine as they do. i don't hear other nurses say that either.

american physicians are the best trained physicians in the world.

*** i guess that is a debatable point. i don't totally agree with you on this. in some areas i do.

yes, some of them have a god complex and it is frustrating.

*** yes but we know how to deal with that and given a little time i can convince them otherwise.

but when we respect their education and intelligence, we will be able to focus on our own to make it better.

*** i think the lack of respect comes from the medical side, with the exception of a few vocal people on the internet. i agree nursing education needs improvement. my nursing education was a joke. nothing i experienced in nursing school, either in my adn or bsn programs came close to the quality of instruction i received in the army.

living in wisconsin i am sure you heard of aurora. there was a lot of animosity in a couple of the hospitals that had crna's (not baycare, the aurora in eastern wisconsin.) guess what? aurora no longer employs crna's. it is now a totally run physician group, as you know aurora is the number one employer in the state. i hate seeing when we can't come together that we are eliminated.

*** i didn't know aurora was the number on employer in the state. i am not the least concerned about the future of crnas. i know that for all their bluster mdas will consistently refuse to meet the demand for anesthesia services. not a chance the small and medium sized hospitals are going to stop doing cash cow surgeries and not a chance mdas are going to change their mind and provide care in these little communities. also supervising crnas are cash cows for mdas. they know that.

msn10 · Oct 20, 2011

My nursing education was a joke. Nothing I experienced in nursing school, either in my ADN or BSN programs came close to the quality of instruction i received in the army.

I love the way the armed services does their training. 2 of my nephews are doing PA and CRNA training respectively (the PA did medic training and now he is at UW doing the rest for PA since he is out of the military.) Anyway, they have great training. I really think nursing educators should not only look more to the military for education ideas, but also permit a lot more of their training to transfer into nursing. I find it crazy that some of my students can't transfer active duty time for credit - it is like clinical hours on steriods. I think it makes a few people who may have been interested in nursing to go into other fields.

Obviously I know far more than physicians about some things, for example I understand the workings of our hospital and understand what we can do where. For example I know we can not start bi-pap or a nitro drip on certain floors, but we can on others, or how long it will take to get a chest CT preformed at 0200 The physicians depends on us

I absolutely agree with you, and that is what I see as an essence of nursing. We do have our own scope of practice and we are much better co-workers with physicians when we are able to act as case managers, technological experts, etc.

Also, when I stated before that the one of the CRNA's that I knew "learned on the job" I should have corrected myself. He did do a program, but it was a hospital-based program a lot like your friend. He always tells me that he learned a great deal more on the job and he wished he had the education that the rest of the new grads are getting now. I am glad to see CRNA school getting to the DNP point. There is just too much to know.

msn10 · Oct 20, 2011

OP: Also don't worry about website. It is a joke. Not only was my post challenging their facts removed, but the guy who runs the site appears to be in need of work. It looks more like a marketing ad then an information site, especially when you look at the video. Pretty funny.

clintcron · Oct 24, 2011

Here is my two cents that I added to their blog. I'm just a lowly nurse getting set for CRNA school, but hopefully someone will read it before deciding to just believe the idiot that owns the site.

Let's begin by stating facts, shall we. While an MD (medical doctor) undergoes extensive didactic education and an in-depth clinical residency to become board certified, the CRNA undertakes very similar training. The CRNA gains a bachelor degree in the science of nursing. This not only covers the science courses required for most pre-med curriculum, but it also involves a more personal, holistic approach that is custom tailored to each patient. Recently, the bachelor if science in nursing was ranked nationwide as the most difficult bachelor's degree to obtain. While some schools require a minimum of one year in an adult intensive care unit prior to starting the CRNA program, the majority requires two years , with the average accepted student possessing 3-5 years prior to admission to the program. This is what is considered "residency" for nurses. This residency prepares the nurse for the nurse anesthesia practice by allowing the registered nurse the ability to take care of the most critically ill patients for 12-14 hours per day, 3-4 days per week. The MD is prepared through education, and then stopping by for approximately 15-20 minutes per day, 4-5 days per week.

Most CRNA educational tracts range from 2-3 years depending on the school, and whether the practitioner is pursuing a masters or a doctorate in the practice of nursing. That being said, educating the patient is everyone's responsibility. The CRNA is responsible for educating the patient in terms of the title that they possess.

Total time for an anesthesiologist: 14 years.

Total time for the CRNA: 10-12 years.

Now, one can consider that there is an option for the CRNA to sub-specialize in pain management. This is a post-masters/doctoral certification that requires another 15 months of additional training.

Please keep in mind that the nursing profession actually invented the practice if anesthesia. I am posting this information for educational purposes, as the author/owner of this site has not been completely honest it fair in the comparison of the qualifications pertaining to the nurse anesthetist. There has been many, published research projects conducted on the difference between anesthesiologist vs crna adminstered anesthetics. In terms of patient safety, mortality, and morbidity there are no differences. The most popular and talked about research project concerning these issues available today was conducted by another MD.

The concern expressed earlier in the blog is valid only as it pertains to the confusion of the patient. Misrepresentation occurs in every scope of practice, thus requiring the practitioner, whomever it may be, to educate the patient properly. Feel free to ask any questions, and please reference this site if you truly want the truth on all questions CRNA.

http://www.aana.com

Lastly, CRNA's are board certified by the state nursing board only after they take and pass the national examination for certification to practice as a CRNA.

msn10 · Oct 24, 2011

The MD is prepared through education, and then stopping by for approximately 15-20 minutes per day, 4-5 days per week.

Completely unfair and incorrect statement.

MD's get their 'education' in medical school. They do their residency (which is in house, in surgery training and patient rounds) in the hospital and it is anywhere from 60 to 80 hours a week, at least 5 days a week, but most are there 6. I understand one being upset by misinformation, but then we must be careful to give credit where credit is due. Apples to apples (PFMB-RN I am thinking of you) American anesthesiologist have more hours in sugery and do more surgeries than CRNA's when they are done with their training.

Recently, the bachelor if science in nursing was ranked nationwide as the most difficult bachelor's degree to obtain.

Interesting statistic, do you have a link for that?

Please keep in mind that the nursing profession actually invented the practice if anesthesia

However, CRNA's did not require a nurse to be master's prepared until 1997. Medicine saw anesthesia as advanced (required) practice much earlier. That is where medicine set the bar.

allnurses Guide · Oct 25, 2011

Completely unfair and incorrect statement.
MD's get their 'education' in medical school. They do their residency (which is in house, in surgery training and patient rounds) in the hospital and it is anywhere from 60 to 80 hours a week, at least 5 days a week, but most are there 6. I understand one being upset by misinformation, but then we must be careful to give credit where credit is due. Apples to apples (PFMB-RN I am thinking of you) American anesthesiologist have more hours in sugery and do more surgeries than CRNA's when they are done with their training.
Interesting statistic, do you have a link for that?
However, CRNA's did not require a nurse to be master's prepared until 1997. Medicine saw anesthesia as advanced (required) practice much earlier. That is where medicine set the bar.

No, MDAs don't necessarily do more hours in surgery or more anesthetics. Anesthesiology residents calculate their time differently than SRNAs. Residents count all cases and will often spend a lot their time bouncing from case to case and counting all of them. This is especially true on speciality rotations like trauma. Residents spend a lot of their time outside the OR doing regional, pain, and critical care rotations if you want to give them credit that is where they have the chance to excel above new grad CRNAs in their trainings.

Medicine didn't set the bar for anesthesia. MDAs have been slowing increasing the amount of formal education over the years just as nurse anesthetists have. Both professions used to train together, and one of the first formal anesthesia education courses was 3wks long with both nurses and physicians as students. MDA residency used to be just two years and now is three years. MDAs used to be considered fellowship trained with only 6mo of specialized training (which often used to be done in the last 6mo of residency) now it requires an extra 1yr of formalized training. MDAs quickly lose any numerical advantage in cases performed after they graduate if they go into ACT practice (where most MDAs work) where they will spend the majority of their time "supervising" and being out of the OR.

More education doesn't equate to better care or better outcomes if so then research would have shown that MDAs are better providers than CRNAs. We know from research (and personal experience) that as a group MDAs fair no better than CRNAs when it comes to providing patient care. If education was simply the answer than MD/PhD should be miles ahead of just plain MDs, and we know that isn't true.

msn10 · Oct 25, 2011

No, MDAs don't necessarily do more hours in surgery or more anesthetics. Anesthesiology residents calculate their time differently than SRNAs.

On average they do. We have both CRNA's and MD's in training at the trauma hospital. MD's do a great deal more. You can only supervise if you are a CA-3 (4h year).

The best way to compare is go to a school's website that does both types of training. Look at the Mayo website and compare the anesthesia programs. I only see 30 credits of clinical time as compared to 2 full time years for MD's with a 3rd year training, supervising, and doing advanced cases. About 5 CRNA's that work at our facility went to school there and admit the MD's saw more and did more.

More education doesn't equate to better care or better outcomes if so then research would have shown that MDAs are better providers than CRNAs. We know from research (and personal experience) that as a group MDAs fair no better than CRNAs when it comes to providing patient care.

I don't think we can say that across the board. It would be wonderful for the rest of medicine and surgery if all of the studies that are out there about patient safety in anesthesia weren't solely conducted by either the ASA or the AANA (or at least funded by them). Furthermore, research has barely touched the idea of comparing fellowship trained MD's vs CRNA care. You usually can't because in hospitals like Cleveland Clinic, St. Luke's Aurora, John Hopkins, or other hospitals who lead the pack supervise CRNA's and have fellowship trained MD's doing the advanced cases.

Anyway, I was not trying to get into another vs. argument but the last poster made a couple of mistakes yet accused others of misrepresenting the facts.

Last poster stated:

The CRNA gains a bachelor degree in the science of nursing.

Not necessarily, many programs only require a RN license. They could be an ADN with a BS in another science degree.

Also, you even have to admit that MD's don't only

stopping by for approximately 15-20 minutes per day, 4-5 days per week.

If that were true, and as you say there is no difference in patient safety between a CRNA and MD, then why should the CRNA's have a DNP? If you only need to have 20 minutes a day of training to be a anesthesia provider, lets just get monkeys to do anesthesia. It would cost a lot less and be more entertaining.

PMFB-RN, RN · Oct 25, 2011

Not necessarily, many programs only require a RN license. They could be an ADN with a BS in another science degree.

*** That's true. There is a CRNA I work with who's bachelors degree is in forestry. A friend who is in CRNA school right now has a degree in Dairy Science.

clintcron · Oct 25, 2011

Let me set the record straight for you. Very few programs will allow an outside bachelors degree and those that do, generally require it in a science related field. I.e. chemistry, biology, physiology, etc... Also, to clarify my statement, I was implying that the residents and attendings drop by to visit their patient for 15-20 minutes, not that their education was only preparing them for this. Both specialities are highly trained, and are compensated for what they can do if things go wrong, not what they routinely do in the OR. You cannot deny the fact that the majority of MDA's either spend no time actually supervising the CRNA or they stick their head in and say, "Yep, that looks good. Call me if you need me." I have the utmost respect for physicians, period. I just think that there is a political agenda, engulfed in greed, that refuses to see the facts, as they will lose money. Regardless, the CRNA profession will eventually win in this situation. Having an MDA on staff is actually a cost to the hospital. It is a necessary expense, but an expense still yet. CRNA's generate enough income for the hospital to at least pay for their total package. As this economy continues to decline, the nurse anesthetist will gain power, as it all ultimately stems back to the profitability of the non-profit hospital. The writing is on the wall. Surgeons, MDA's, RN's, and other o.r. staff have seen the CRNA practice independently for years now. The profession does not want equality in terms of titles, it wants equality in regards to respect. One last question. Why is the CRNA the only profession that really takes a beating over all if this? NP's usually do not. Everyone appears to be fine with the notion of optometry, chiropractirs, opthalmalogists, radiologists, etc... being called doctor. If you earn a doctorate, then you are recognized as a doctor in you field of expertise. Maybe medical doctors should implement a change in their initials. MP....Medical Physicians. I personally refer to my doc as my physician. This could fix a lot of arguing. Just saying. Lastly, education does not make the sole difference in patient care. Education is very important, but it is simply a generalized blueprint to gain a better understanding for the chosen career. Specialization comes into play, but the real difference maker is the clinical experience. Argue all that you want, but we all know that 4.0 will not necessarily help you in the operating room. Experience is the best teacher. Cheers!

allnurses Guide · Oct 25, 2011

On average they do. We have both CRNA's and MD's in training at the trauma hospital. MD's do a great deal more. You can only supervise if you are a CA-3 (4h year).
The best way to compare is go to a school's website that does both types of training. Look at the Mayo website and compare the anesthesia programs. I only see 30 credits of clinical time as compared to 2 full time years for MD's with a 3rd year training, supervising, and doing advanced cases. About 5 CRNA's that work at our facility went to school there and admit the MD's saw more and did more.
I don't think we can say that across the board. It would be wonderful for the rest of medicine and surgery if all of the studies that are out there about patient safety in anesthesia weren't solely conducted by either the ASA or the AANA (or at least funded by them). Furthermore, research has barely touched the idea of comparing fellowship trained MD's vs CRNA care. You usually can't because in hospitals like Cleveland Clinic, St. Luke's Aurora, John Hopkins, or other hospitals who lead the pack supervise CRNA's and have fellowship trained MD's doing the advanced cases.
Anyway, I was not trying to get into another vs. argument but the last poster made a couple of mistakes yet accused others of misrepresenting the facts.
Last poster stated:
Not necessarily, many programs only require a RN license. They could be an ADN with a BS in another science degree.
Also, you even have to admit that MD's don't only
If that were true, and as you say there is no difference in patient safety between a CRNA and MD, then why should the CRNA's have a DNP? If you only need to have 20 minutes a day of training to be a anesthesia provider, lets just get monkeys to do anesthesia. It would cost a lot less and be more entertaining.

If you are "supervising" then you aren't actually doing the case. That is not an accurate way to determine cases. You cannot look at credit hours and determine how much time is spent clinically.

You work at an ACT practice, which is pretty obvious from your statements, so yes I am pretty sure your CRNAs would say that the MDAs had more training. That doesn't mean all MDAs had more training than CRNAs. I graduated with classmates that did around 2000+ cases, and then others were in the low 1000 mark. Programs in anesthesia, physician and CRNA, are highly variable in what they teach beyond the prerequisite minimum.

The studies on CRNA safety were not all funded by the AANA. That is typical ASA bull. There are studies by state departments of health and the federal government showing the exact same outcomes between CRNAs and MDAs (unless you are suggesting that they in on some giant conspiracy also). Anyone that believes that ASA hasn't tried to prove that CRNAs are less safe MDAs is kidding themselves. There is no giant conspiracy theory that the ASA would have people believe where all the research studies are secretly controlled by the AANA.

I would welcome a study that compared fellowship trained MDAs versus CRNAs that had equivalent length of time in that speciality.

From the AACN:

"INTRODUCING THE DOCTOR OF NURSING PRACTICE

In many institutions, advanced practice registered nurses (APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Mid-Wives, and Certified Nurse Anesthetists, are prepared in master's-degree programs that often carry a credit load equivalent to doctoral degrees in the other health professions. AACN's position statement calls for educating APRNs and nurses seeking top systems/organizational roles in DNP programs.

DNP curricula build on traditional master's programs by providing education in evidence-based practice, quality improvement, and systems leadership, among other key areas.

The DNP is designed for nurses seeking a terminal degree in nursing practice and offers an alternative to research-focused doctoral programs. DNP-prepared nurses are well-equipped to fully implement the science developed by nurse researchers prepared in PhD, DNSc, and other research-focused nursing doctorates.

WHY MOVE TO THE DNP?

The changing demands of this nation's complex healthcare environment require the highest level of scientific knowledge and practice expertise to assure quality patient outcomes. The Institute of Medicine, Joint Commission, Robert Wood Johnson Foundation, and other authorities have called for reconceptualizing educational programs that prepare today's health professionals.

Some of the many factors building momentum for change in nursing education at the graduate level include: the rapid expansion of knowledge underlying practice; increased complexity of patient care; national concerns about the quality of care and patient safety; shortages of nursing personnel which demands a higher level of preparation for leaders who can design and assess care; shortages of doctorally-prepared nursing faculty; and increasing educational expectations for the preparation of other members of the healthcare team.

In a 2005 report titled Advancing the Nation's Health Needs: NIH Research Training Programs, the National Academy of Sciences called for nursing to develop a non-research clinical doctorate to prepare expert practitioners who can also serve as clinical faculty. AACN's work to advance the DNP is consistent with this call to action.

Nursing is moving in the direction of other health professions in the transition to the DNP. Medicine (MD), Dentistry (DDS), Pharmacy (PharmD), Psychology (PsyD), Physical Therapy (DPT), and Audiology (AudD) all offer practice doctorates."

http://www.aacn.nche.edu/media-relations/fact-sheets/dnp

It is funny that the AMA/ASA had no problem with all these other professions moving to doctoral degrees, but when nurses do essentially the same thing it now an unnecessary crisis that threatens all of healthcare.

allnurses Guide · Oct 25, 2011

*** That's true. There is a CRNA I work with who's bachelors degree is in forestry. A friend who is in CRNA school right now has a degree in Dairy Science.

That is funny, but to be fair you would have compare their entire transcript not just degrees held. Which I am sure is what the school did when they admitted to school.

msn10 · Oct 25, 2011

wtbcrna

No, I don't work in a ACT hospital, I teach the CRNA's in a trauma/teaching hospital. We have 8 hospitals in the area that I work and teach. I get to see more than one model, I get to teach in more than one model.

It is obvious that you are pro-CRNA, you are one. But again, the MD's don't have anymore problem with CRNA's than CRNA's like you have with MD's. This is why I was talking about chips on shoulders. I don't think I have read any thread on this site where you give MD's credit. That either means you haven't worked with enough since you are a newer graduate or you really can't give them credit because they are a threat to you as well. Regardless, your feet are dug in the sand.

I would welcome a study that compared fellowship trained MDAs versus CRNAs that had equivalent length of time in that speciality.

I would too, but fellowship trained MD's are going to do the hardest and most complicated cases and because of them, hospitals can increase their scope of cases they take on. The CRNA won't do the triple re-do bypass with multiple co-morbidities when a fellow is on staff. Most physician practices and hospitals hire these people to advance surgical practice as well as anesthesia. Furthermore, in my experience, fellows actually prefer to work with CRNA's over AA's. Our medical college in town has one of the top rated anesthesia programs in the country. Some of the administrators started buzzing about starting an AA program. The staff physicians at the local hospitals (who were trained as fellows at the college) said they had no desire to work with AA's. They felt that the CRNA's had the proper training AND they valued their experience as nurses in critical care and felt more confident with the CRNA's. One of the cardiac fellows said he would never work with an AA and would leave town if he had to supervise them which is saying a lot since he only supervises when there are no cardiac cases to do which is about 15% of the time for him. The MD's do respect most of the CRNA's here and visa versa so maybe this is just a regional thing and I shouldn't even argue.

You also mentioned in a previous post that anesthesia is a 'nursing practice' performed by doctors. If that is true, then why can't I ever find a nurse anesthetist in the hospital? I have yet to hear the CRNA's introduce themselves as such. They introduce themselves to the patient by saying "I will be your anesthesia provider today" or "I am the anesthetist." If the CRNA profession truly believes that they are the inventors of the anesthesia then they should be proud that they are nurses. CRNA's should say "I am your nurse anesthetist. Most CRNA's tell me that they no longer practice 'nursing' they practice anesthesia. NP's don't say "I am your internal medicine/family practice provider.

I have a great deal of respect for CRNA's and call many of them friends. But I am also tired of the doctor bashing on any level. Yes, some docs are frustrating and lazy, but so are some CRNA's. Sometimes getting some of them out of the lounge to do a case is like pulling teeth while the regular RN's see their behavior and feel the same way about them that the CRNA's feel about the MD's.

INTRODUCING THE DOCTOR OF NURSING PRACTICE

Our university has 6 DNP programs, not sure why you referenced this for me, I do understand the program.