CRNA Debate from www.studentdoctor.net - page 4
hey guys, it's me again! this is a debate that is going on in the resident forum of www.studentdoctor.net . brett the poster is listed above his\her comment ... Read More
May 24, '02Sikofitall:
Point taken I withdraw my comments and apologise for assuming you have taken the contrary. :imbar
May 24, '02Posted this morning on the SDN:
I hope you all can take a few comments from "the other side." I am a CRNA, and there is another side to what you all have been ranting about. There seem to be a few common themes in your complaints, which I will try to address generally. First, the complaint that "nurses are practicing medicine, or encroaching on medical practice."
The first full time practitioners of anesthesia were nurses. There were a number of reasons for this, but the primary reason no physician wanted to be an "anesthetist" was that the anesthetist was considered to be under the direction of the surgeon. No physician wanted to walk into an operating theater and be "second banana" to another physician. Initially, medical students and residents were tried as anesthetists, but mortality rates were very high. So, nurses were trained in anesthesia, and did quite well. Mortality rates dropped substantially. And nurses were not just "trained monkeys" delivering what they were told to deliver. Some of the earliest published articles containing research data collected concerning anesthesia were published by a nurse anesthetist, Alice Magaw. CRNA's continue to perform and publish research on anesthesia and pain management. Under US law, the practice of anesthesia is considered to be a practice of both nursing and medicine. Courts have ruled this to be true in several cases.
Given these historical facts, a much stronger case could be made that physicians are encroaching on nursing territory, but that would be equally false. Each has a place in the practice of anesthesia, and for me, the best model I have found so far is a team approach, with both nurses and physicians working together to provide the best, safest care to the patients. Some CRNA's practice independently, which is also a valid model, but more on that later.
Many of you have complained that CRNA's are making too much money. From the tone of your posts, it seems to me that what you are saying is that no nurse, anywhere, should ever make as much money as even the lowest paid MD or DO, ever. Why is that? Because you attended medical school, and we didn't? By that logic, Bill Gates should not be making as much as any doctor, anywhere. By the same logic, no physician should make more than most clinical psychologists. They generally spend more time in school obtaining their Ph.D. than most physicians spend earning their MD. CRNA's perform the same functions as MDA's, and take the same attendant risks. In many places, they do so with no MDA supervision, and do so very safely. Apparently, you all would like to keep nurses of all stripes in lower income brackets. This, in spite of the fact that many RN's have obtained bachelor's degrees in nursing, and ALL advanced practice nurses have earned master's degrees in their discipline. Your attitude is a good example of why many young people are choosing professions other than nursing, and that harms MD's. If I had not planned, before ever starting my first nursing class, to become a CRNA, I would NEVER have come into nursing. Not because I'm not dedicated, and not because I am in this only for the money. I would never have sought out a position that required a four year degree that left me earning less than a dental hygenist, that required more knowledge and skill, that required me to work nights, weekends, and holidays, and required me to take abuse from prima donna physicians who would not stoop to doing the things I was required to do. Face facts. Patients are not in hospitals because they need "medical care." Patients are in hospitals because they need nursing and ancillary staff (physical, occupational therapy, etc) care. If all they needed was medical care, your rounds would involve stopping by each patient's home daily, or them stopping by your office daily. Like it or not, you WILL rely on nurses to care for and monitor your patients. So, why then is it unreasonable for nurses generally to want to be paid a reasonable salary? Why is it unreasonable for advanced practice nurses to want to be paid an equitable salary? And why should you be the arbiter of what is reasonable or equitable?
Some of you have said that the physician has more training, enabling them to better care for patients under anesthesia. Although I consider this statement to be a prime example of your inexperience, allow me to address that point. Yes, you have your four year undergraduate degree, and four years of medical school. If you measure only years in school, that gives you two more years of schooling than I have. Then, you begin your residency, in which you begin to administer anesthetics to patients. Prior to that time, how much time have you spent actually caring for patients? How much time have you spent in an operating room, or how much time have you spent studying the anesthesia machine? Before I ever attended my first class in my master's program, I spent three years in a surgical ICU, caring for all stripes of patients. I was fortunate to have a number of great physicians and nurses, all of whom taught me more than can be recounted here. Many of you have not, through hard experience, yet learned that there is no better teacher than hard experience. For example, you can study the pathophysiology of a code until you are blue in the face. None of that fully prepares you for your first real code. More than once, as both an RN and a CRNA, I have run a code, while residents and medical students stood at the foot of the bed, flipping through their "scut monkey" book, trying to figure out what to do next. Often, I have had the resident tell me "give drug X" as they flipped through their book, and I have had to tell them "gave it 30 seconds ago, but you keep swinging." Not that I was smarter or better than the resident. I simply had been there before. There is no better teacher than experience. Currently, I work for an anesthesia group that is comprised of both physicians and CRNA's, and we all get along quite well. The senior partner in the group is a physician of more than 30 years experience, who is considered to be one of the finest anesthesiologists in the city. He is also a staunch supporter of the ASA position on CRNA's (which, if you look into it does not want to do away with CRNA's, but simply wants to place them all under the supervision of MDA's). We also take residents for a CV rotation. I have occasionally been placed in a position of supervision over the residents. The group position on this is that whoever, MD or CRNA, supervises the resident, has the final say over matters of patient care. Not because we work for the group, but because we have more experience than the resident in caring for open heart patients. Ultimately, it is our butt on the line if anything goes wrong.
Pain man wrote "I for one think it would be great to monitor 2-3 CRNA's doing healthy cases while picking up 1 complex case a day. They can earn me as much as they want!" Better rethink that position. CRNA's do all cases, including the "complex" ones. I do anesthesia for bread and butter cases, as well as open heart, neuro, peds, and the sickest patients. On average, the group I work for does patients who are ASA III and IV more than any other group.
One other point I'd like to address was succinctly stated by Halothane, though many of you have made similar statements: "Nurses are dumb period. They probably have lesser GPA and stuff than people going into pure scineces, computers, humanities etc. let alone be in comparision with doctors , dentists and lawyers." Oh, really? My undergraduate GPA was a 3.975, and I took most of the same classes as the pre-med students. I took the Graduate Record Examination, and scored right at 2100. I completed my master's program with a 3.85 GPA. The master's program I took included a gross anatomy course, two semesters of pharmacology, advanced physiology, advanced pathophysiology, as well as principles of anesthesia. Many of my books were the same books you used in medical school. Many of you seem to think nurses are nurses because they were too dumb to get into medical school. Far from the truth. In fact, I, like many others specifically chose nursing over medicine, for reasons that are my own. You will in your career, be relying on those "dumb nurses." Don't think for a minute they won't figure out what your attitude is. And trust me, sooner or later, one of them will get tired of your nonsense, and will leave you hanging out to dry. If you are foolish enough to believe that you will never make a mistake for which you can be hung out to dry by a nurse, then I would guess you are far to arrogant to try to talk to. Life has some hard lessons in store for you, my friend. By the way, halothane is one of the oldest volatile agents still in use. It has some significant problems associated with its use, and has been surpassed by most of the newer volatile agents, that can do the same things it does with less possible physiologic cost. By most anesthesia providers, halothane is considered to be archaic. Given your expressed viewpoints, I'd say you have chosen the perfect name for yourself on this bulletin board.
Kevin McHugh, CRNA
May 24, '02Thank you Kevin,
You summed up many of the things I intended to say last night. But I was too busy explaining to one of the astute MD's in my ICU who has years of deep ranging education, how my patients high potassium was probably related to the use of atropine and succinolcholine in his resusitation and subsequent intubation. He wanted to give k-exalate for a K of 5.2. This without taking into account the patients huge amount of diuresis in the three hours after that lab was taken. Good thing I read my nursing recipe card on that one. BTW follow up K was 3.8.
I get the feeling that to spend time over there is just not worth it. I also get the impression that many of these uber doc's are in for some real suprises when they get spanked by that veteran ICU nurse from hell, who has trained many a resident in their career.
Anyway, I am formulating one or two last posts for them, and will then leave them alone.
CraigLast edit by nilepoc on May 24, '02
May 24, '02kevin,
Just wanted to say GREAT post this morning, Very well written and thought out.
May 24, '02Originally posted by meandragonbrett
I can freaking post anything I like, and if you don't want to read it you don't have to. Nobody's forcing you to read it.
May 24, '02Thanks for letting them have it Kev!! I was going to post something, but didnt have the words. What jerks!
May 24, '02Hey Kevin:
On behalf of "dumb nurses" and CRNAs everywhere, THANK YOU for your well thought out, very well-stated, factual response to the age-old debate currently going on at the student-doc BB.
Cheers to you for weighing in in such an intelligent fashion. You did the profession proud!
May 24, '02Excellent! Excellent and thorough reply, Kevin! One word describes all............"beautiful"!
May 24, '02Someone stop me before I post again! Actually, I did just post again. I'll probably hang around that bulletin board a while, just to see where the discussion goes.
May 24, '02Kevin: Are you going to take on this amazing question? ("amazing" because it seems to be asked with sincerity, "amazing" because these people don't KNOW the answer to that!)(actually, maybe that's more "scary" than "amazing!")
"Are you of the opinion that in a clinical environment, CRNAs can do everything that an MDA can do? Do you think there are circumstances when only an MDA should be allowed to run the anesthesia (i.e. very complex, serious cases) or do you think CRNAs can handle (on their own) absolutely anything that the hospital can dish out to them? I'm referring to the average CRNA vs the average MDA, with years of experience being roughly equal."