CRNA Threat - page 4
by samirish
20,989 Views | 70 Comments
I read the following post on a student doctor's forum: "Agreed. CRNA's and nurses in general aren't the smartest group of people out there. The CRNA backlash has already begun. In response to CRNA's push for autonomy,... Read More
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1Mar 2, '11 by Skip219I think you are missing the point: in rural settings CRNA do have complete autonomy. There are many places which are CRNA only practices. You would be surprised who does a majority of anesthesia in today's healthcare, its CRNAs. They don't have to go to medical school to practice independently, its just like CNM and FNP.
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3Mar 5, '11 by foranemanQuote from Skip219This is not limited to rural settings. One also has to define what one means by 'complete autonomy'. If complete autonomy means providing an anesthetic from start to finish without any material involvement by any physician (material involvement meaning a physician making the ultimate decision as to what technique will be used, what medications, or physical involvement in the delivery of the anesthetic, or 'checking up' at regular intervals that the anesthetic is being delivered as they would like) OR if complete autonomy means a CRNA is no required to practice in ANY setting with an anesthesiologist available by law, then complete autonomy exists in each and every state in every anesthetizing location.I think you are missing the point: in rural settings CRNA do have complete autonomy. There are many places which are CRNA only practices. You would be surprised who does a majority of anesthesia in today's healthcare, its CRNAs. They don't have to go to medical school to practice independently, its just like CNM and FNP.
Independent CRNA practice has existed for over 100 years. Only 12 states require by law that a physician (and it can be ANY physician) ‘supervise’ a CRNA’s practice of anesthesia. And here 'supervise' does not mean taking responsibility for or directing the anesthetic.
40 states do not have any physician “supervision” requirement for CRNAs in their nursing practice or medical practice laws or regulations. If one includes clinical “direction” requirements in addition to “supervision,” 32 states do not have a physician supervision or clinical direction requirement for CRNAs. Including state hospital licensing laws or regulations, 33 states do not require physician supervision. Including state hospital licensing laws or regulations, 24 states do not require physician supervision or direction.
No state requires a CRNA be supervised or clinically directed by an anesthesiologist.
In states which do require physician supervision, the supervising physician is not required to have any training in the practice of anesthesia or additional qualifications with the exception of New Jersey and Washington D.C. (exception applies in D.C. only when a general anesthesia is given). What constitutes ‘supervision’ or ‘direction’ is generally poorly defined or not defined at all. Usually the term hangs in the air without any reference as to what it should mean and mere availability suffices. The surgeon meets the definition of 'supervision' when he does the surgery and ignores the CRNA and the anesthesia.
- 0Mar 5, '11 by foranemanQuote from Skip219Drs like PA and AA because they are in control of them and can bill for their actions. Whereas, the CRNA is taking some of the money out of the MDAs pocket for each case. Do you know who does most anesthesia in the rural settings? Its CRNA where MDAs don't want to work. AA can"t work on their own in away of the opt-out states. In these states the AMA hasn't bought off the politicians with their PAC. There are 40-50,000 CRNAs and about 6000 AA. Its more cost effective for a hospital to employ CRNAs because they can work independently. MDAs stand there supervising inductions and emergences: then bill for it.
There are fewer than 2000 AAs practicing and they have been around for 20 years. Not a significant threat to CRNA practice. -
0Mar 8, '11 by msn10Samirish
It is unfortunate, but it is another case of class warfare in healthcare.
RN's won't do bed baths because it is the CNA's job.
CRNA's and PA's won't help lift or toilet because it is the RN's job.
MD's won't do ... because it is someone else's job.
These young medical students took their myopic view of medicine and applied it to an entire population. They were probably referring to first year CRNA students who, to be fair, are wet behind the ears as well.
The CRNA/MD debate has been going on for some time and it is unfortunate because both disciplines have a lot to bring to the table. CRNA's have great training and MD's do as well. MD's can also bring an extra value to the OR through there post doctoral training and board certification and some have post doctoral fellowships in cardiac, peds, pain, etc.
To me it is sad to have these competitions because there are good and not so talented people in all levels of service. - 0Mar 22, '11 by portland medicMy two cents; I have been a paramedic for 11 years in the Portland area. I'm not a nurse (yet) or a CRNA (but someday hope to be) but I think it's somewhat of an over-reaction to spell doom and gloom for the entire profession of CRNA's. Here in Portland, 1 hospital just this last year switched from the MDA-only Oregon Anesthesiology Group to anesthetix, a group based on the ACT model that incorporates CRNA's. I don't think it's likely that a whole career disappears when it has such a long history.
- 0Mar 10, '12 by ABCCRNThis whole debate regarding PA's vs. NP's funny. I'm a RN, going on 13 years. I've worked with many PA's and NP's in a varying capacities. Therefore, I believe I can make a pretty well informed opinion regarding the two. I believe that PA's are better prepared to practice compared to a NP. Their clinical experience while in school is much more intensive. There is no debate when you consider the minimum clinical requirement to graduate. The coursework is equally intensive and design to practice medicine, much like a doctor. NP school is a bit of a joke. (1) you can earn the degree online... Really? And, NP's wonder why they receive less respect. Personally, I think this is a slap in the face to physicians. (2) the coursework is quite similar to that of undergrad, just a bit more intensive. (3) too much time is spent on "nursing theories"! What a joke! Tell me, how is this going to save someone's life. How about eliminating all those stupid theories from the coursework and focus on more important topics.Just a few thoughts of mine.... I am pursuing a career as a CRNA because I believe it will provide me with happiness on many levels.
- 2Mar 11, '12 by nomadcrnaYou obviously have no clue. First because you are not a NP or PA. Second, because you are showing you have no knowledge about the school.
BTW, I am a CRNA AND FNP. So please, finish one and come back and discuss the difference between what you finished and PA/MD>diosadelsol and kids like this. -
1Mar 11, '12 by wtbcrna GuideQuote from ABCCRNSo, if NP training is so bad why are there several studies that show equal or greater care from NPs when compared to their physician counterparts.This whole debate regarding PA's vs. NP's funny. I'm a RN, going on 13 years. I've worked with many PA's and NP's in a varying capacities. Therefore, I believe I can make a pretty well informed opinion regarding the two. I believe that PA's are better prepared to practice compared to a NP. Their clinical experience while in school is much more intensive. There is no debate when you consider the minimum clinical requirement to graduate. The coursework is equally intensive and design to practice medicine, much like a doctor. NP school is a bit of a joke. (1) you can earn the degree online... Really? And, NP's wonder why they receive less respect. Personally, I think this is a slap in the face to physicians. (2) the coursework is quite similar to that of undergrad, just a bit more intensive. (3) too much time is spent on "nursing theories"! What a joke! Tell me, how is this going to save someone's life. How about eliminating all those stupid theories from the coursework and focus on more important topics.Just a few thoughts of mine.... I am pursuing a career as a CRNA because I believe it will provide me with happiness on many levels.
Unless you plan on going to a nurse anesthesia school that is not associated with a school of nursing you are going to take all those "nursing theories" again in nurse anesthesia school.diosadelsol likes this.
