CRNA independent states - page 2

Hi all. As a prospective SRNA, I was hoping someone could tell me which states nurse anesthetists are allowed to practice independently in. (Or which states they cannot, whichever is the shorter... Read More

  1. by   AWDC
    Quote from snakebitten
    Wrong--1% to 100% supervised means just that. The MD can come in and change your plan if he or she feels necessary. They will be there on induction, sometimes push your drugs (that they decide), start your lines etc.. and leave, then come back for emergence and extubation. (Try to do a locum job in Pennsylvania and you will see what I mean) To them you are a technician, uncapable of making a sound decision on your own. Why do CRNA's need to "collaborate"? Define collaborate.

    True autonomy is making your own SOLO decisions, depending only on yourself.
    Anyway,

    Gotta go do my next case--(All by myself on call 24 hours as it should be)

    Mike CRNA
    After reading this, I think I now know why MDAs would have an issue with CRNAs being independent practitioners. I'm in med school right now and all throughout med school, we are being trained as the providers that take the ultimate responsibility. That's the mentality. Physicians make the ultimate decisions and because of education, training, and scope of practice, we are given the right to overturn the decisions of other providers. Pretty much the only time you defer is to another physician specialist. Apparently, I guess it's not how it always works in anesthesia. So it just might seem inherently strange to MDs/DOs (and myself) how CRNAs can be a true "soloist." I'll even admit that I'm still trying wrap my finger around the concept of nurses being given the same rights and responsibilities as a physician. To me, it's just a very new/radical concept... Please share your thoughts.
  2. by   chattypattyCRNA2B
    Quote from AWDC
    After reading this, I think I now know why MDAs would have an issue with CRNAs being independent practitioners. I'm in med school right now and all throughout med school, we are being trained as the providers that take the ultimate responsibility. That's the mentality. Physicians make the ultimate decisions and because of education, training, and scope of practice, we are given the right to overturn the decisions of other providers. Pretty much the only time you defer is to another physician specialist. Apparently, I guess it's not how it always works in anesthesia. So it just might seem inherently strange to MDs/DOs (and myself) how CRNAs can be a true "soloist." I'll even admit that I'm still trying wrap my finger around the concept of nurses being given the same rights and responsibilities as a physician. To me, it's just a very new/radical concept... Please share your thoughts.
    Wrap your finger around this...

    http://www.aana.com/crna/history.asp

    CRNA's were the first group BEFORE PHYSICIANS, to perform anesthesia. It would be reasonable that they would be given the same rights and responsibilities as a physician in this particular area. If you do a little history on it maybe you would come to a better understanding and respect for the field.
  3. by   Sheri257
    Quote from yoga crna
    It is imperative that you remember that Opt-Out has only to do with Medicare reimbursement for Part A hospital payment. It does not apply to Part B, direct reimbursement. I am in private practice and receive Medicare reimbursement directly. Even though I practice in an non-opt-out state and have not seen an anesthesiologist in my operating room (except as patients) in over 20 years, there is no problem getting reimbursement. By the way, no one is having anesthesia complications, either.

    Yoga
    Thanks for that insight. I've often wondered how Medicare affected CRNA practice in non-opt out states. So, what you're saying is that it really doesn't affect CRNAs at all, as long as they bill direct? Interesting.

  4. by   deepz
    Quote from AWDC
    .......I'm in med school right now and all throughout med school, we are being trained as the providers that take the ultimate responsibility. ...... Apparently, I guess it's not how it always works in anesthesia. ......

    http://www.gaspasser.com/unique.html


    .
  5. by   lmdscd
    AWDC , just for the record we pratice under are own license that should give us right's to how we pratice anesthesia. M D sometimes want to push certian drugs and ways we think different. Something goes wrong you think md will stand up for me? My two cents in.
  6. by   yoga crna
    AWDC
    Welcome to America where the capitalistic system is alive and well. I compete with anesthesiologists and other CRNAs for business. The two areas of competition that are the mainstay of our country are: service and price. If I can provide a better service at a good price, I get the business. It is one of the major tenets of economics. Everything else is rhetoric.

    What you are really afraid of is that a nurse can do the same thing you will be someday able to do (after the same anesthesia education), do it well and get paid appropriately for the value of the service performed. I can assure you that if CRNAs were not clinically excellent, we would not be in practice long. We are not killing patients or do not have major complications, so get over it. Also, you have been misinformed by the arrogant physicians who teach you--nurses are responsible for our own progessional acts and the doctors are not legally, the "captain of the ship". I can show you many legal cases where nurses were held liable for the acts of the physician.

    I know I am coming off strong, but frankly I am tired of doctors thinking they have all of the answers. I can assure you that nurses will bail you out of trouble many times in your career and the good doctors know and respect that. The mediocre ones look for others to blame for their inadequacy.

    Yoga CRNA
  7. by   sonessrna
    Quote from yoga crna
    AWDC
    Welcome to America where the capitalistic system is alive and well. I compete with anesthesiologists and other CRNAs for business. The two areas of competition that are the mainstay of our country are: service and price. If I can provide a better service at a good price, I get the business. It is one of the major tenets of economics. Everything else is rhetoric.

    What you are really afraid of is that a nurse can do the same thing you will be someday able to do (after the same anesthesia education), do it well and get paid appropriately for the value of the service performed. I can assure you that if CRNAs were not clinically excellent, we would not be in practice long. We are not killing patients or do not have major complications, so get over it. Also, you have been misinformed by the arrogant physicians who teach you--nurses are responsible for our own progessional acts and the doctors are not legally, the "captain of the ship". I can show you many legal cases where nurses were held liable for the acts of the physician.

    I know I am coming off strong, but frankly I am tired of doctors thinking they have all of the answers. I can assure you that nurses will bail you out of trouble many times in your career and the good doctors know and respect that. The mediocre ones look for others to blame for their inadequacy.

    Yoga CRNA
    Well said.
  8. by   lmdscd
    Amen, Yoga. Well stated!!!
  9. by   jwk
    It will be interesting to see what happens when a state opts back IN.
  10. by   sandman1914
    Quote from jwk
    It will be interesting to see what happens when a state opts back IN.

    What gives you the indication that a state would "Opt back in?"
  11. by   gaspassah
    It will be interesting to see what happens when a state opts back IN.
    as it will be interesting when...
    AA's are deemed no longer a worthwhile option.
    md's leave the anesthesia arena
    iran becomes a democratic government
    north korea becomes a vacation hotspot.
    all states opt out... :Melody: :hatparty: :Melody:
    there goes jwk ruffling feathers again.
    d
  12. by   Tony35NYC
    The states won't opt back in. It doesn't make sense (logistically or financially) for them to do so. Why stretch their medicaid/medicare dollars to pay MDAs more when they've been paying CRNAs less to get the same job done for years. Besides, the states that opted out did so in the first place because most MDAs are not willing to relocate to practice in certain (especially rural) areas where they know they won't make a ton of money. The legislators would never have allowed opting out if they weren't convinced that it is a safe and advantageous thing for citizens of those states. This is one part of the battlefield where $$$ speaks louder than politics, and the physicians are not unaware of this.
  13. by   jwk
    Quote from Tony35NYC
    The states won't opt back in. It doesn't make sense (logistically or financially) for them to do so. Why stretch their medicaid/medicare dollars to pay MDAs more when they've been paying CRNAs less to get the same job done for years. Besides, the states that opted out did so in the first place because most MDAs are not willing to relocate to practice in certain (especially rural) areas where they know they won't make a ton of money. The legislators would never have allowed opting out if they weren't convinced that it is a safe and advantageous thing for citizens of those states. This is one part of the battlefield where $$$ speaks louder than politics, and the physicians are not unaware of this.
    MD's don't get the same financial incentives through Medicare for small hospitals that CRNA's do. If the hospital does less than 800 cases a year, some of the professional anesthesia services can be covered under Part A, allowing the hospitals to pass through their expenses and enabling them to utilize CRNA's. MD's on the other hand are only covered under Part B, period. They are paid the Medicare rate only. At $15-20 a unit, it wouldn't even cover the true costs of most anesthetists. But if you can add in additional money through Part A, it works out better. Of course that only applies to CRNA's, not MD's. That's why you see more CRNA's in rural hospitals. You actually get paid MORE than an MD would. So much for your CRNA's are cheaper argument.:chuckle

    As for opting IN, stay tuned, because it will happen...

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