Here's what AAs really think of CRNAs - page 13

And this comes from the PRESIDENT of the American Society of Anesthesiologist Assistants Again, assertions that AAs and CRNAs function at the same level -absolutely misleading. And, what's... Read More

  1. by   georgia_aa
    This will be my last post and then I'm going to turn in my super-secret allnurses.com decoder ring and get on with my life...

    I am willing to concede that on the day after graduation, the CRNA probably has an advantage over the new AA grad (unless that AA grad has prior healthcare experience like most of them do... but that continues to be ignored here). However, after 2 years you cannot tell them apart. Just like your claim that your nursing experience better prepared you for your work in the OR, an AAs experience in the OR is just as valuable as they continue to hone their skills. Then after, say, 5 years or so most AAs are exceptional clinicians (as are many CRNAs with 5 or more years). It's what I've been saying all along, if you have a superior intellect, and continue to learn and treat your job as an intellectual and academic pursuit then you can't help but succeed no matter what your prior background was.

    Now, this is for SWUMPGAS and DEEPZ. You asked me some questions now I've got some for you - how many times have you gotten a patient with an EF of 15% through a 5 vessel off-pump CABG. Have you ever even seen one?? How many times in the course of a week do you have to deal with a patient in the OR on a balloon pump?? When was the last time you did a AAA on a patient with end stage renal disease?? I know that you don't see this stuff as often as I do, because no hospital with CRNA only departments (no MDAs) sees this level of acuity. I do ... EVERYDAY FOR 14 YEARS!! Now you can puff up your chest all you want and talk about dodging bullets in IRAQ and so forth but telling me I can't do what you do?? - it's laughable really. You see, to me you are the most dangerous clinicians out there because you don't know your limitations. You think that you can go from being an ICU nurse (where you took orders from an MD) to being the equal of a board certified anesthesiologist after 2 years of CRNA school. You're the one whos gonna hurt someone someday, not me...

    To those of you (lizz, user69 and others) who actually contributed something meaningful to this discussion - thanks for the chance to give you a little insight into what I'm all about.
  2. by   London88
    [


    Georgia AA is the OR the first place where you got to take care of a balloon pump? Many of us did not have to go to the OR to take care of a patient on a balloon pump. As far as the EF of 15% and the other statements many of us did not have to go to anesthesia school to know the pathopysiology of an EF of 15% etc. There within lies the difference in the level of knowledge between the two different providers! Here is where the patient safety issue comes into play! I respected your posts up to the point of your last post. Do not try to impress anybody by bragging about the acuity of your patients as many of us were accustomed to taking care of patients on the brink of death before going to anesthesia school, and no the MD was not always there to hold our hands.
    Last edit by London88 on May 7, '04
  3. by   deepz
    Quote from lizz
    ....... These arguments are great if your audience is mostly CRNAs, other nurses and medical professionals.

    But, outside of that, your arguments aren't so great unless you can prove patient endangerment. .......
    Well, of course, we'll just agree to disagree on this particular issue, Lizz. But later, when you have paid your dues and become a nurse (if you do) come revisit this question with some clinical experience behind you and some medical expertise and then see if, as a nurse, your perspective hasn't changed. Until then, sorry, you're just speculating. And beating the proverbial dead horse on this thread. Unless you are actually a lobbyist for the AA and A$A cause, that is. 8^]

    Proof of endangerment? Please.

    Show me your arguments? Please. The AANA will show their cards at the appropriate time and in the appropriate place. Until then, they stay close to the vest.

    Meantime, rest assured that Atlanta anesthesia practices where AAs run loose will be closely monitored for billing fraud and adherence to the TEFRA 7.

    Cheers!

    deepz
  4. by   Sheri257
    Quote from deepz
    Well, of course, we'll just agree to disagree on this particular issue, Lizz. But later, when you have paid your dues and become a nurse (if you do) come revisit this question with some clinical experience behind you and some medical expertise and then see if, as a nurse, your perspective hasn't changed. Until then, sorry, you're just speculating. And beating the proverbial dead horse on this thread. Unless you are actually a lobbyist for the AA and A$A cause, that is. 8^]

    Proof of endangerment? Please.

    Show me your arguments? Please. The AANA will show their cards at the appropriate time and in the appropriate place. Until then, they stay close to the vest.

    Meantime, rest assured that Atlanta anesthesia practices where AAs run loose will be closely monitored for billing fraud and adherence to the TEFRA 7.

    Cheers!

    deepz
    Figured that was coming: The "you're just a student" thing. Fair enough, I suppose. I've probably beat the dead horse too much, but you've done the same with the insults and such.

    If the AANA had some other cards to play, I assume Florida would have been a good time for that. Afterall, a major state was on the line, and they lost.

    A lobbyist for the ASA? Uh ... OK. Yep, that's it. I'm drumming up votes for AA's in a CRNA forum. That really makes a lot of sense.

    Last edit by Sheri257 on May 7, '04
  5. by   Tenesma
    "many of us were accustomed to taking care of patients on the brink of death before going to anesthesia school, and no the MD was not always there to hold our hands."

    i was going to stay out of this (primarily because this 16!!! page argument over who is better is very similar to the CRNA vs MDA argument

    but the quote above is a bit silly.... I spend MOST of my time now in the SICU as an attending, and for some reason the nurses I work with (who, by the way, are easily the best/smartest/most independent nurses ever) would never say something like that.... where do some of you get this cockiness? all of a sudden a few years of ICU nursing is equivalent to being an Anesthesiologist/Critical Care Doc??? .... yeah, right...
  6. by   alansmith52
    but the quote above is a bit silly.... I spend MOST of my time now in the SICU as an attending, and for some reason the nurses I work with (who, by the way, are easily the best/smartest/most independent nurses ever) would never say something like that.... where do some of you get this cockiness?


    I don't think they would say it to you but I'll bet they think it, and know it.
    they've been trained not to say it. they've been trained that your their "boss" wich is silly. cuz you don't employee them. do you?
  7. by   Tenesma
    you are right alan... i don't employ them, and i never said they work under me or for me... I said they work WITH me, because we use a team approach in our ICU management of patients.... Do they think they can handle things without me... sure!!! Do they handle things without me? .. SURE!!! When somebody is near the "brink of death" all of a sudden my pager goes off.... I wonder why?

    in fact, i get paged also for when patients are not near the brink of death - so maybe they like having me around
  8. by   EmeraldNYL
    Quote from loisane

    I am also active in my state association. Do I use the same arguments in lobbying as I do here? Heck, no. Do I really think I am going to get anywhere with a legislator if I say "You should vote against AAs because nurses have the right to practice autonomously". He/she would laugh in my face. We have to tailor our arguments to the audience. As professionals develop in leadership, they learn how to do this. I am no expert, but I have witnessed experts in action.


    loisane crna
    Well then, maybe we should discuss just HOW exactly we would present this to legislators. I am completely pro CRNA, it's what I want to do more than anything else in the world, but I think we need to have a good strong argument to support our case.

    If I were a legislator or congresswoman, this is what I would say (just playing devil's advocate here):
    AAs really seem a lot like PA's. PA's have a bachelor's degree, ususally in a science pre-med curriculum, and go to a 2 year's masters degree program. PA's do not necessarily have previous medical experience before attending PA school, and they graduate and make fine health care providers who are safe and competent. In addition, there are many Nurse Practioner programs that now offer direct entry (for example, a direct entry MSN program for someone who has a bachelor's degree in another field). So, now people can graduate an NP program without ever having previous nursing experience. So how is this different than the NP vs. PA debate?

    We are so caught up on the importance of previous nursing experience that we forget that PA's and even some NP's don't have any previous experience. What makes anesthesia so different that previous experience IS necessary? More importantly, how can we prove that CRNA's are safer anesthesia providers than AA's??
  9. by   gaspassah
    SURE!!! When somebody is near the "brink of death" all of a sudden my pager goes off.... I wonder why?
    because if they didnt their a$$es would be handed to them for not notifying the physician in charge. not because they are scared and dont know what to do. they would probably lose their license and their source of income for them and their families.
    i will say.... there are plenty of times the icu nurse knows to start levo, neo, dopa, whatever the situation calls for, and may "start" it as they page the md to get an order to start the drug they already, were about to, was in the process of starting. but needed an order to do so. many nurses who develop a good working relationship with the md's on a day to day basis and earn trust do this often.
    i wouldnt do a cardiocentesis, does that mean i couldnt if i were trained? no.
    but that is not my or was not my focus when i was at the bedside.
    i still stand by the statement that working in an icu has "residency" qualities.

    the hours of hanging gtts, adjusting them to hemodynamics, bolusing fluids and documenting the results, observing and documenting patient responses to interventions, whether ordered by the md or interventions initiated by the nurses does have, will have and always has had an important impact on the learning curve in dealing with critically ill patients. to say the contrary would signify ignorance of what nurses really do.
    and doing all this on more than one patient at a time.
    do i know as much as an md about medicine? no
    does he know as much about nursing as i do? no
    we are trained differently, with different focus.
    does training from both backgrounds apply to anesthesia? you bet your a$$ it does.
    my concern about AA's is that most dont have that critical care background, yeah some may have been nurses or rt's or techs or paramedics.
    only the nurses sit at the bedside 12 hours at a time and deal with the drugs and the patients. yeah a rt can run a vent or intubate, they have little to no training didactically or clinically in the pharmacology drug administration and assessing the efficacy of those drugs. etc.

    lizz, i'm not real sure how to take most of your posts. i have read them on other threads also. i understand wanting to see proof. sometimes there is no way to effectively show what most people know inherently.
    it is sort of odd to see a future nurse take the side against nurses.
    how about an analogy.

    hospital administrators decide that to have more power over staffing and money they bring in techs to do the work of nurses.
    nurses take the stand that the techs are less adept, less educated and have less experience taking care of patients. thusly techs are less safe.
    the administrators say it is very safe to have 4 techs taking care of 24 patients (6 each) with one person (say an rn) overseeing. does this sound safe to you.
    but this is sort of what the a$a is doing. trying to replace qualified, well trained CRNA's with less experienced (sometimes not even healthcare workers of any sort) people to provide a service that demands knowledge of hemodynamics, pharmacology and pathophysiology.
    is there a way to do a randomized control trial to test its safety. not that i know of...but...inherently it sounds unsafe.
    david
  10. by   gaspassah
    emerald.
    i just got back from the student mentoring program in washington dc with the national aana.
    there are some things you cant say so as not to give away your plans to the opposition. they try to counter our movements as we try to counter theirs.
    do get involved with you local aana org. they do alot for us. more than i ever knew before going to washington. now i cant wait to graduate so i can run for committees etc.
    many congressmen in washington dont really care about your cause if you didnt "support" theirs, if you get the drift.
    but you have to write them, call them, and visit them to let them know...i'm in your district, and this legislation is important to me and this is why.
    david
  11. by   user69
    With the large number of nurses and the fact that most make a good salary, there should be a lot of votes and cash that can lobby on issues. How does nursing lobby stack up against the doctor's money and lobbying organization? I would think that just by sheer numbers the nurses should be able to outspend and out vote any medical push that is a problem.



    [font='Times New Roman']Anyone have any insight on this?
  12. by   Sheri257
    Quote from EmeraldNYL
    We are so caught up on the importance of previous nursing experience that we forget that PA's and even some NP's don't have any previous experience. What makes anesthesia so different that previous experience IS necessary? More importantly, how can we prove that CRNA's are safer anesthesia providers than AA's??
    Well, at least I'm not the only one. Maybe Emerald can take some heat for awhile since, maybe she's an ASA lobbyist too.

    Quote from gaspassah
    lizz, i'm not real sure how to take most of your posts. i have read them on other threads also. i understand wanting to see proof. sometimes there is no way to effectively show what most people know inherently. it is sort of odd to see a future nurse take the side against nurses.
    I'm not against nurses. That's ridiculous. I'm a pragmatist. I don't blindly embrace arguments just because it serves my own self interests. It probably stems from my journalism background, and reporting on legislative debate for 20 years. I am considering investing in a CRNA education, as well as other graduate programs but, particularly since I'm an older student, I'm not going to harbor delusions about the AA situation, or underestimate it. Quite frankly, I can't afford to.

    If an objective study is not possible, then I do think that's unfortunate.

    Last edit by Sheri257 on May 7, '04
  13. by   deepz
    Quote from Tenesma
    .......I spend MOST of my time now in the SICU as an attending, and for some reason the nurses I work with (who, by the way, are easily the best/smartest/most independent nurses ever) would never say something like that....

    Where did you get this omniscient ability to know the minds of others, Doctor? My bet is, you'd be very surprsied what the ICU nurses have to say about young tyro docs.

    Just MHO

    deepz

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