Here's what AAs really think of CRNAs - page 14
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
May 7, '04Quote from EmeraldNYL......What makes anesthesia so different that previous experience IS necessary?.....
May 7, '04Quote from srna04I would be interested in some honest input from your friend that changed to CRNA anesthesia. The A$A is always touting CRNA's that have become MDA's, posting quotes about how "undertrained" they were as CRNA's That's a matter of the school and desire, not the whle profession.I use to work with a AA at a ICU in Chicago. He originally got his AA degree from Georgia, and wanted to practice in Illinois and was not allowed to. He went back to school for his BSN then later went onto CRNA school at Rush. Now that is what I call dedication.
Does your friend feel the he/she is mpre prpared for anesthesia as a CRNA coming from an AA background.? Interesting situation.
May 8, '04Quote from nrskarenrnok, flowers or chocolates?i want a crna to provide my anesthesia care: at my side before , during and after surgery for i know from experience that in the majority of american hospitals, it's the nurses that keep the patient's safe and facilities functioning.
why choose a crna--a look at history reveals the depth of this profession:
a brief look at nurse anesthesia history-- a timeline of nurse anesthesia history
[size=2]start of nurse anesthesia
May 8, '04I 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
May 8, '04Quote from duckboy20This is exactly the way the MDA's want it, LEGISLATED control of anesthesia competitors. It is a matter of control. Right now, the autonomy of the CRNAs and the fact that NO states require supervision of a CRNA by an anesthesia MD , they do not have as much control as they desire. As bigger hospital staffs fill up with MDA's , they need to move into areas of the country that have had traditionally CRNA anesthesia. Most small hospitals are happy with CRNA only anesthesia. By requiring that there be an MDA to "supervise", it adds uneeded cost to the budget. Most CRNA's with these small hospitals have worked there for years, been a part of the community, and are very much appreciated.Georgia AA- This is where I see a problem with this statement. Apparently somebody sees a difference between AA's and CRNA's even if you don't. Otherwise you would be able to work independant of an anesthesiologist like CRNA's can. I don't personally know you or how your skills are. I have no reason to doubt you. But if you are as good as you say then why not get a license that enables you to work independantly without necessarily having to report to an MD?
May 8, '04I have watched this discussion with a great deal of interest and have wanted to respond numerous times, however held my comments for fear of offending those with different views or training than my own. However, here goes! WARNING! This will be a long one.
I am a registered nurse with a little more than one year of nursing experience in a Surgical Intensive Care Unit at a level one Trauma Center in Atlanta Georgia. Today I graduated with by BSN from the Medical College of Georgia and in June of this year will begin the CRNA program at Samford University in Birmingham, Alabama. The hospital at which I work employs AA's to a much greater extent than CRNA's. During , in addition to working as a nurse extern in the ER and the SICU, I worked as an anesthesia technician to gain insight into the differences between a CRNA and an AA. At one time, due to the lack of a CRNA program in Atlanta, I considered AA school as I did not want to uproot my family to attend CRNA school. It was for this reason that I tried to gain as much insight as possible into the difference between CRNA's and AA's. While I consider myself no expert in this matter I would like to share my observations.
First, it has always been my experience to show professional respect for those individuals with which you work, regardless of whether in healthcare or any other field. This applies to physicians, nurses, respiratory therapist's, nutritionist's, etc...... Part of this respect is recognizing someone's expertise and calling them by their respective title. A physician has worked diligently to earn the title of Dr. and I believe they deserve the right to be addressed as such. If they prefer to be called by their first name, let them indicate so. For me to assume they wish to be called by their first name, when introduced to me as Dr. .... I feel shows a lack of respect. In the SICU where I work you would be surprised at the number of physicians who feel slighted by nurses who will not address them as Dr. You may consider this childish, however to them it is disrespectful. Maybe I am just old school at 50. I do not feel this indicates subservience, just professional courtesy. I feel the same way about recognizing nurses. To call a CRNA an anesthesia nurse I feel is disrespectful to their hard work and the rigors they go through to become certified. I feel Anesthesiologist Assistant's deserve the same respect. They are not technicians. They go through a very vigorous training program as well.
When investigating the program at Emory I found many of their students had a great deal of clinical experience. Many were former respiratory therapists as well as some who were critical care nurses with over 5 years of experience. These nurses often chose this program as they loved the job of a CRNA but did not want to leave Atlanta to attend CRNA school. They also had a number of students with no clinical experience; however their academic prerequisites were the same as those who attend medical school. Unlike many PA programs, some of which which are taught at the bachelor level, the Anesthesiologist Assistant program at Emory has always been a graduate trained program. Keep in mind it has only been in recent years that CRNA's have required programs to be taught at the master's level. I have run into CRNA's who went through certificate programs who did not have their bachelor degree. Also, the prerequisite for one year of critical care experience is also a recent addition to the preparation of a CRNA. CRNA's have sought improvements in their educational didadic training just as AA programs have sought to improve the clinical background of their applicant's.
I have had the opportunity to work with and observe many AA's at my hospital and have found them to be very skilled clinicians. To belittle them based on their experience prior to attending AA school ignores the fact that many SRNA's have only had one year of clinical care experience prior to CRNA school. Many SRNA's I have talked to have said you can forget most of what they were taught as nurses. Anesthesia school is a whole new ballgame. In fact, many program director's have told me that whether you had one year of critical care experience, or ten, they were going to teach you everything you needed to deliver safe anesthesia care. I have observed AA's with over 20 years experience and would gladly have them deliver my care in a team anesthesia model. I feel the same way about CRNA's, both independently and in a team. Would I choose an anesthesiologist independently? Yes. An AA independently? No, it is beyond their scope of practice. However to assume one is better than the other does not take into consideration either ones past experience as an anesthesia provider or the type of training they received. I recognize, AA's can not practice independently and will address that later in this post. Where I work it is obvious those who are new AA's because many appear a little overwhelmed when they come up to the SICU to pick up a patient who is on a rotorest with multiple drips and multiple pleurevacs. In fairness, I have also seen many second year residents somewhat overwhelmed as well. With time however, these observations disappear. I cannot comment on SRNA's or recently graduated CRNA's as I have not seen them at our hospital as the CRNA's we do employ are all very experienced. As for why they work here, with restrictions on their scope of practice I do not have the answer to that question.
On thing I feel that is missing in this discussion is a clear understanding of what the differences between these two providers are. For those SRNA's and CRNA's who have never worked with or observed AA's I would encourage you to do so to see first hand the care these people deliver. I think you would be impressed. Comments that these people deliver care outside of their scope of practice is unfair. I observed many AA's as well as CRNA's deliver anesthesia during 135 hours of clinical experience for one of my courses required for my BSN. For the induction I never observed either provider doing so without the attending present. They were not out playing golf or checking their stock portfolio. I am sure that this may happen at some hospitals however I never saw it here. The attendings were always present at the end of the case for extubations that I observed. However, I am certain that all of us, regardless of our clinical training at one time or another have exceeded our scope of practice. I do not feel that many of us do so on a regular basis, however to deny that we have done so is less than honest. To claim we are capable of doing so on a regular basis based upon our confidence and experience is reckless, however I think this is just bravado and beating one's chest which we all do from time to time demonstrating the passion we have for our profession and the skill which we deliver it. I have observed that ICU nurses and anesthesia providers are typical type A personalities and tend to be drawn to the challenges that these areas provide. I also would encourage AA's to witness first hand the care CRNA's deliver in areas that do not provide a team approach, but where the CRNA are the sole provider. I cannot speak from experience as I have not had the opportunity to do so. AA's do not witness this in their training or in their everyday work. CRNA's can practice independently if they choose to do so. And although I have read comments from AA's in this forum, as well as heard them during clinicals compare themselves as equals to CRNA's and the job they do, I do not feel this is justifiable as AA's cannot by law practice independently of anesthesiologists. I agree this is comparing apples to oranges. To claim they are equals when they have no basis for comparison is inaccurate. They have never functioned in this arena, and never will based upon their training or their scope of practice. To claim they have done so at times when the attending anesthesiologist is not in the same room, or because they make some independent decisions on the delivery of care negates the fact that the anesthesiologists are always available for supervision and consultation. The fact that their scope of practice is the same as CRNA's that they work with in hospitals that practice team anesthesia is not recognizing the scope of practice that the bulk of CRNA in this country deliver in those markets without anesthesiologists. Are they capable of doing so? I am sure that many of them would like to do so and may have the ability. If they are so inclined then I suggest they go on to medical school and become anesthesiologists, as 10% of Emory's AA's do. Or they could go to CRNA School which is less likely. In their present scope of practice they will never be able to do so and I think this creates some resentment on their part towards CRNA's. I also feel that CRNA' who compare themselves as equals to MDA's are inaccurate for CRNA's scope of practice is different than MDA's. Although clinically we can deliver the same level of care as an anesthesiologist we cannot supervise multiple cases. MDA's can supervise up to four cases at one time, whether delivered by AA's or CRNA's and can be compensated for doing so. AA's nor CRNA's can do so. If CRNA's wish to do so they should go to medical school, which some have done.
For me, I decided to become a CRNA as I wanted the freedom to practice independently. I know I would always regret my decision if I went the AA route. My wife and I decided it is better to relocate and give myself the opportunity for an autonomous career as opposed to being restricted to being an assistant. Is this my ego talking? I suppose it is. Is this because of my desire to have the opportunity to earn more income? Most definitely. I make no apologies for this. I expect a return on my investment as any of us do for the money we spent on our education. Will I ever participate in team anesthesia? Without a doubt. Will I do so for my entire career? I doubt it. One thing I do recognize is that all of us regardless of our backgrounds need to have respect for each other and the contributions we will bring to the delivery of anesthesia. I will always believe that two heads are better than one as each individual has something to contribute no matter what the profession. In my previous career as a pilot, I valued having two pilots in the cockpit, however I recognized that there were times that two pilots would be overkill and a waste of a valuable resource. The delivery of any type of healthcare is not delivered in a vacuum but the result of collaboration from multiple disciplines. However, through teamwork it can always be improved. That is what continuous improvement is all about. I chose Samford's CRNA program because I wanted the opportunity to attend anesthesia school where I was not competing with anesthesia residents for cases as well as the opportunity to be trained by CRNA's in rural areas where they are the sole provider's of anesthesia. I will not get this training from an anesthesiologist, nor will an AA. I will miss some of the opportunities to work in large trauma centers on complex cases as a SRNA in my program, however I can get this training after CRNA school by returning to my hospital which I plan on doing to get this experience as well as working in a team environment which I feel is a very valuable part of my training.
In closing I do want to address some of the tone of the discussion on this board as I feel it reflects some of the underlying attitudes that exist in the anesthesia community. While for the most part I have witnessed a very cordial working relationship between anesthesiologists, CRNA's and AA's I believe that the tone of the discussion on this board reflects the underlying tension and mistrust that exists between anesthesiologists, AA's and CRNA's. CRNA's who practice independently do compete with anesthesiologists and the anesthesia team delivery of care that can involve CRNA's and AA's. Because of this competition it should be no surprise to anyone with reasonable intelligence, which I believe is a valid assumption based upon the education of those in this discussion, that this is a turf war, based upon control and compensation. Do I fault MDA's for wanting to protect their turf, compensation and return on their investment? Absolutely not. Do I fault them for wanting to restrict my practice as a future CRNA? You better believe I do and I will do all I can do to make sure this does not happen. I would strongly recommend each and every CRNA and SRNA to become politically informed and involved and when it comes to financially supporting our profession we all should be happy to do our part. It is necessary to protect our profession and to continue the work of those who came before us. I also feel, in fairness to anesthesiologists, we do ourselves a great disservice when we talk about eliminating anesthesiologists from the delivery of anesthesia. Do any of us, regardless of nurse's history in the delivery of anesthesia, feel the profession is not better off based upon the contribution of MDA's? And how can we justify the restriction of AA's when supervised by anesthesiologist's in a team anesthesia setting. We cannot claim that AA's are unsafe based upon our intuition. I do not think research will bear us out on this one. I must say I agree with Lizz, that to argue AA's are unsafe based upon our feelings appears we are only trying to protect our own self interests and is not consistent with trying to improve availability of care to those who need this care. I also want to applaud those anesthesiologists as well as AA's who have the courage to come on this board and defend their contributions as well as try and intelligently discuss their experience. I do not understand, nor feel it is appropriate to bash them or invite them to leave this forum. I also feel it is not appropriate to have them come on this board and bash us as well. In the final analysis we all have more to gain by working together to insure the best delivery of care and the availability of this care, while insuring we all protect our own self interests. Will this ever happen? I certainly hope so. The ASA and the AANA are obviously trying to do so and it is my hope that these talks will continue and that they will bear fruit. For those who caution us about the past, we must listen and heed their advice. But we must not let the past tensions between these professions prejudice us so as to prevent a better working relationship between us. As from the rhetoric from both professional associations, we are all guilty of presenting biased arguments to support our positions. It is the American way and is part of our democratic process. It is from these differences that we work towards compromises that we can all live with. That is the nature of the political process. Sit on the sidelines and you will lose. I apologize for this long post and I will now return to my lurking.
May 8, '04First of all, Swumpgas and deepz; I LOVE YOU MAN........ ok, enough of my tears.
There are some things that are self evident here. The ASA is doing what they do, out of self interest. Heck, they have been blatantly coming after CRNA's since the 1920's or so. As for the creation of AA's, I believe this was a stroke of genius. Yes the AA's started 30 years ago and their numbers are still small but, the ASA appears to be gaining ground. The ASA is a powerful bunch and they have all the time in the world. They also have ample medical to train their assistants. Realistically, I believe you can slow them down but, I doubt you can stop them completely. So, what can we do?
I suggest it is time to get involved! This is not a time to assume everything will be ok. Believe me, the ASA has a battle plan and they have Juice. Support your state and national nurse anesthetist organizations and donate to their political action committees. I donate and I am a CRNA wannabe.
As for the rest of my ideas on this matter, I'll wait until I can speak confidentially as a member of my state and national nurse anesthetist organizations.
May 8, '04I have actually spoken to my friend about this issue, comparing AA school to CRNA school. He felt his CRNA program was a more comprehensive program and more difficult to get through. Obviously, he had a easier time in school because of his previous experience as a practicing AA. In addition to 2 years as a critical care nurse. I think a key element of CRNA programs is that you are required to have a certain number of years of critical care experience. Sure, some AA may have been respiratory therapist or even nurses prior to school, but clinical experience taking care of critically ill patients is not required to my knowledge. I believe the same is true when comaring nurse practicioners to physician assistants.
May 8, '04Trauma Tom - phenomenal post....
but noone (well most) aren't saying AA's are incompetent. If you read the very first post - you will see where the hostility origionated from - and all we have done is attempted to dispell some myths....unfortunately - AA's aren't equal due to legal constrictions - that is not to say that they aren't good practitioners - but that they cannot function on their own - yet are being allowed to in many situations...what does this say for the patient? when one has no superceding responsibility...it has to ultimately affect patient care...however - when it comes down to the meat of it...$$$
why employ 2 MDA's and 8 AA's - when you could have 8 CRNA's - or 4MDA's and 4CRNA's....they are utilizing more people for the same amount of work - now tell me - how is that financially wise? the answer is - it ISN'T....so then you must ask yourself..why the ASA is so gung-ho?? the questions all answer themselves...
May 8, '04Quote from Trauma Tom......Where I work it is obvious those who are new AA's because many appear a little overwhelmed when they come up to the SICU to pick up a patient who is on a rotorest with multiple drips and multiple pleurevacs. In fairness, I have also seen many second year residents somewhat overwhelmed as well. With time however, these observations disappear.......
I've heard it said that anyone who doesn't at times feel overwhelmed just isn't paying attention. Some folks don't pay attention. Which brings me to the point of replying to your cogent and comprehensive post, T-Tom. (Must be your maturity showing. BTW post more and lurk less, your posts won't need to be as comprehensive.)
Among those CRNAs who have been involved in training programs for both SRNAs and anesthesiology residents, as I have, it has long been a general point of agreement that the first two years of a physician's training are spent trying to teach doctors to behave like nurses.
Teaching docs to behave like nurses?
Now before tenesma has a stroke, let me elaborate: these are examples of a few nurses' behaviors vital to the practice of anesthesia ---
-- monitor the patient; monitoring only the monitors will lead you astray. A classic voice recording from the aviation industry shows a cockpit crew fixated on why the landing gear light will not illuminate. For twelve minutes they all tap it and talk and speculate ... while no one notices that the Automatic Pilot has somehow become disengaged ... and the airliner slowly loses altitude and *crashes* into the ground. Pay attention. Open your scope of awareness. Monitor the patient, not the monitors.
-- confirm a reading before acting on it; artifacts do happen
-- read the label. Read the label when you pick the vial up, when you draw the drug up, when you set it back down. And did I mention?--read the label.
-- multi-task like one-armed wallpaper hanger. Hard to explain this one. ICU nurses know very well what I mean, from caring for multiple patients hands-on.
-- project yourself into the patient's place. In other words, big time empathy. i.e.: get over yourself already!
-- what else ...? Others can surely suggest essential nursing behaviors as further examples.
Of course no nurse or nurse anesthetist holds proprietary rights to these behaviors. These are only generalizations gleaned from long observation. And only MHO.
May 8, '04Quote from LaserHistorical point, the A$A was not incorporated until 1937, even though they like to claim 1905, when the Long Island Journal Club, or some such local entity was founded. Typical exaggeration from the OneUpManship mentality of the A$A leadership......ASA is doing what they do, out of self interest. Heck, they have been blatantly coming after CRNA's since the 1920's or so. .....
May 8, '04Quote from teeituptomteeituptom also replied to another thread, entitled: "OR Nurses Giving Conscious Sedation--WHY SHOULD WE?" And in this one, he said...Im a nurse with 3 decades in service
If Im having surgery I want an AA, not an CRNA.
and also for my family
"But we do it (conscious sedeation) all the time in ER for all sorts of procedures, we have guidelines we follow them, been doing it for years. No Biggie. I dont understand your concerns."
How crooked. Oh wait, he's from Texas.
May 8, '04Quote from Trauma TomThank you.CRNA's who practice independently do compete with anesthesiologists and the anesthesia team delivery of care that can involve CRNA's and AA's. Because of this competition it should be no surprise to anyone with reasonable intelligence, which I believe is a valid assumption based upon the education of those in this discussion, that this is a turf war, based upon control and compensation ....
And how can we justify the restriction of AA's when supervised by anesthesiologist's in a team anesthesia setting. We cannot claim that AA's are unsafe based upon our intuition. I do not think research will bear us out on this one. I must say I agree with Lizz, that to argue AA's are unsafe based upon our feelings appears we are only trying to protect our own self interests and is not consistent with trying to improve availability of care to those who need this care.
:spin:Last edit by Sheri257 on May 8, '04