CRNA this is terrible

  1. Did you guys know that in the state of missouri the house has recently passed a bill that would allow anesthesia assistants to obtain certification. This means that CRNA's will be out of a job because the anesthesia assistants are cheaper, almost 50,000 cheaper. An AA does not have to have a degree involving medicine, nursing, etc. they're not even required to have ICU experience. This is terrible news. This plan has been proposed by anesthesiologists in Missouri. This bill is going to be voted on in the senate very soon. If any of you are from Missouri please email or notify your senate representative to vote no on bill 300. I think this is terrible for nursing!!!!!!!!!!!!!!!!!!!!!!!!!!! I am a nursing student aspiring to one day become a CRNA it is terrible that anesthesiologists want to do this. What do you guys think?
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  2. 33 Comments

  3. by   ctbsurf
    georgia, alabama, south carolina, ohio, new mexico already allow AAs to work in these states. texas and missouri are next in line. there are ~30,000 crna in usa and only ~1000 AAs (~48 schools compared to only 2) so the threat is not immediate to our job security but possibly more long term. the more immediate threat is to the patients who are under the care of the AAs. that's the angle that needs to be used in order to fight this. i'm from florida and the -ologist spent a lot $$$$ to push for AAs last year, fortunately FANA fought tooth and nail and the bill never made it to committee. but it starts all over again this year.
  4. by   dcc43210
    "the more immediate threat is to the patients who are under the care of the AAs.
    ---------------------------------------------------------------------------------

    Same argument that MDA's make about CRNA's.
  5. by   Cosmid
    Fact Sheet for Legislators on Anesthesiologist Assistants (AA)

    http://www.moana.org/html/aa.html


    Looks like MOANA is fighting this very hard!
  6. by   dianacs
    I have a couple of thoughts on this, not just relating to MO but wherever AAs are currently practicing. One, what does supervision by an MDA actually mean? Is the MDA physically present--and if so, does that mean in the OR or elsewhere in the hospital? Or can the MDA be offsite but available over the phone? This seems like a big gray area--how specific are the laws on this? Two, if AAs do require actual physical supervision by an MDA, then how will this benefit rural communities that don't have MDAs anyway? I guess I can see where AAs might be used in cities where there are MDAs. Lastly, while some of the arguments against AAs have been (shallowly) applied against CRNAs, there is a big difference between AAs and CRNAs/MDAs. The latter already have developed assessment, evaluation, implementation, etc. skills via education and experience BEFORE entering anesthesia. They can build and expand on this ESSENTIAL foundation. I think this makes a huge difference.
  7. by   VaMedic
    All goes back to "you can teach a monkey to do anything." Anyone can be taught the technical skills required, but that critical thinking and decision making is not there. With my current job in EMS I can see some of the same situation. We have a Cardiac Tech certification that is a step under a Paramedic. They are taught the skills, but are not required to take the extra A & P, Pathophys., Pharmacology, and Pediatrics. The Fire Departments only pay for them to get their Cardiac Tech and not Paramedic as it is cheaper labor for the fire department. Fortunatly medicare is jumping in a refusing to pay the high rates unless there is a Paramedic on board. Alot of the same situation - Less training, cheaper labor, greater restriction. I fear for the patients with the AA that can not get in touch with the MDA when they need to. The supervision question is very good. I know my MD uses a PA in his practice and as long as the MD is reachable by some means (phone,pager), then he can act like the MD with prescriptive authorithy. Fortunatly that PA is very smart and has alot of experience and can be well trusted, but what about the AA with no clinical background whatsoever.
  8. by   Qwiigley
    This proves that no matter how much you may dislike politics, as an informed adult, you must be active in politics. Your career depends on it as well as your patient's lives. GET ACTIVE IN YOUR LOCAL PAC!!!!!
  9. by   dcc43210
    Not to sound like a broken record, but the patient safety issues you raise with respect to AA's are the very same ones raised by MDA's when they bash CRNA's. In reality, it's all about protecting your "turf."
  10. by   New CCU RN
    dcc43210,


    You make a point, indeed. But these AA's have no clinical background. They have never practiced and now they are going to be out there administering anesthesia. Would you go to one?
  11. by   London88
    dcc43210,

    I understand the point you are making, however CRNAs have been administering anesthesia for 100 years. They were administering it before it became a physicians specialty. I have no gripe with MDAs, but it cannot be that now that we have MDAs the CRNAs are putting patients at risk. AAs are a new breed with no clinical background. There is definitely a patient safety issue, and if this is what MDAs are saying about CRNAs then they definitely should feel that way even more so about AAs unless of course they plan on being with them throughout the procedure being performed. That being the case, why are they needed?
  12. by   lpnga
    What is an AA's and how long does it take to go to school for this...I live in Georgia and read a post ahead and I am one day wanting to be a CRNA.....I don't want to get cut short...
  13. by   Tenesma
    hi guys,

    first to answer MDA supervision question:
    It is a legal requirement for an AA to be certified at a hospital to assist in Anesthesia Care that the following must occur: 1) the MDA has to be either in the room with the AA, in the hallway right outside the door of that room, or in the room adjacent to the AA (for example, if the MDA needs a bathroom break he needs another MDA to step in to continue supervision)... so the AA is technically always in the vicinity of the MDA. 2) the patients whole anesthetic management is based on the MDA's plan without any deviation alowed unless the MDA changes the plan 3) the MDA has to be present in the room for intubation/emergence and any other critical period.... (the above is based on a summary of the legislative rights attributed to AAs)

    So you can see that the AA fills the role of the anesthesia extender and allows the MDA to run 2 rooms for the price of one MDA - and also allows for higher turnover.... I agree that this will not help rural america as rural america is underserved by MDAs right now, but what this will do is free-up more CRNAs to go to those rural areas where they can provide independent care.

    Basically AAs are the equivalent to Anesthesia as PAs are to Medicine/Surgery/Pediatrics/Psychiatry
    Family Medicine/OB-Gyn... same amount of training, etc... same backgrounds (most AAs that I have met were respiratory therapists - who are relatively comfortable with the basics of airway management.) In fact, in Canada where they have a similar system set-up mainly to CUT costs - requirements for acceptance are a medical background with a bachelors (ie: respiratory/Paramedic/Nursing).

    AAs will never take jobs away from CRNAs - seeing as they need to be very closely supervised as opposed to CRNAs who can practice independently. Not to mention the ridiculous shortage of anesthesia providers out there... or the fact that there are only 900AAs and 30,000 CRNAs

    and I agree with the previous statement: "you can teach a monkey to do anything" ... AAs will never make anesthetic decisions on their own that may affect patient care... but over time/experience they will become very adept at maintaining airways and at recognizing the early signals of danger.

    my 2 cents,

    Tenesma
    Last edit by Tenesma on Mar 4, '03
  14. by   K38s
    London88

    I second what you said, and would like to add that CRNA's have been the subject of research study after research study trying to determine wheather CRNA's are capable of providing safe, competent anesthesia. CRNA's have passed this "litmus test" with flying colors on every occasion. I would be comfortable with CRNA's providing my anesthesia because, as a group, they have a "PROVEN TRACK RECORD". It may be that AA's are competant and safe, then again maybe not.
    The thing I find interesting is that the ASA is so quick to embrace AA's. As London88 said, if the ASA believes that CRNA's are unsafe, despite over 100 years of practice and research proving otherwise, then that can only lead to one conclusion about AA's...
    Last edit by K38s on Mar 4, '03

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