Here's what AAs really think of CRNAs - page 16

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   nurseunderwater
    we're on a road to nowhere... :chuckle:

    where are we going?
  2. by   Tenesma
    as far as ER/pulmonology/Interventional cardiology... they are far from being as good at managing a crumping patient than an anesthesia person... without a doubt... I freakin' have to fix their messes and save their asses on a daily basis... sigh

    deepz.... Coppola makes a great merlot for under $20

    london.... ACLS training dictates that you initiate your protocols and call for help... if they are asystolic then you pace, if they are asystolic because of pericardial tamponade, i will place the drainage catheter --- teamwork!
  3. by   athomas91
    Careful Swumpgas! People here are not quite as responsive to the "stream of consciousness" method of discussion, as you and I are used to in other areas of cyberspace ;-). Hehehe. Here, when things get "off track" (that is what they call it), somebody will start shouting to start another thread.
    LOL - that's what you get when you put 20 type A's in the same cyberroom...LOL (me included...)


    deepz.... Coppola makes a great merlot for under $20
    agreed...
  4. by   suzanne4
    Quote from swumpgas
    Let me divert the thread.. AMA is considering FMG (Foreign Medical Graduates) (IMG to be politically correct), that do not meet standards for an internsahip in the US to get licensure, for rolls in medicine. Possibly working as NURSES. in the US and Canada, due to the Nursing shortage. Lab techs, etc. Not sure what mechanism would be used to verify their skill levels, or even aptitude.

    But it is being talked about. These are DOCTORS in their own countries that will be stepped down in STATUS to the roll of nurse. Talk about attitide problems? skill deficits?

    Just something to think about and Look out for.
    http://www.asianlabour.org/archives/000813.html
    http://www.inq7.net/globalnation/sec.../feb/09-01.htm
    http://www.malaya.com.ph/mar05/edtorde.htm
    http://www.parl.gc.ca/committees/sim...06_blk101.html
    FMGs have to attend college for two years and have to sit for the same NCLEX exam. This doesn't get waived for them. Florida actually has several programs. The Philippines also offer an MD-RN program............The AMA doesn't control the ANA.
    Being a doctor in many other countries is equivalent to being a nurse in the US. In many other countries the nurses are not supposed to use their brains.
    Here in Thailand, the doctor is responsible for doing the assessment on the patient, not the nurse. The doctors on the medical units place the folet catheters, not the nurses. The doctors draw all of the blood cultures. Over here, schooling for a doctor is 6 years in a combination program after high school. A nurse with a MSN is also the same time. So they really aren't very different. The nurses here are all licensed midwives. They actually do almost all of the deliveries at the government hospitals, the doctors only do the problem patients or per request at the private hospitals. Government hospitals account for about 90% of the hospital beds.
  5. by   London88
    Tenesema,
    I believe we are in agreement!
  6. by   fergus51
    Quote from swumpgas
    Let me divert the thread.. AMA is considering FMG (Foreign Medical Graduates) (IMG to be politically correct), that do not meet standards for an internsahip in the US to get licensure, for rolls in medicine. Possibly working as NURSES. in the US and Canada, due to the Nursing shortage. Lab techs, etc. Not sure what mechanism would be used to verify their skill levels, or even aptitude.

    But it is being talked about. These are DOCTORS in their own countries that will be stepped down in STATUS to the roll of nurse. Talk about attitide problems? skill deficits?

    Just something to think about and Look out for.
    http://www.asianlabour.org/archives/000813.html
    http://www.inq7.net/globalnation/sec.../feb/09-01.htm
    http://www.malaya.com.ph/mar05/edtorde.htm
    http://www.parl.gc.ca/committees/sim...06_blk101.html
    Foreign docs will never be allowed to work as nurses in Canada without going through a nursing program. Foreign nurses have a hard enough time getting lisenced, so it isn't something I'll worry about any time soon.
  7. by   deepz
    Quote from London88
    Tenesema,
    I believe we are in agreement!

    Good Lord, this phenomenon is rampant!

    deepz
  8. by   AA2B
    from "athomas91": "(didn't know that - thanks for the education)"



    from "nilepoc": "how long did it take for you to feel comfortable caring for patients with multi system disease? i know that the time i spent in the icu prior to entering crna school really helped me attain this comfort level." perhaps this individual (like many others i will presume) is resentful because aa's do not require a year or more of icu experience or time expended really. moreover, not everybody will need 1 or 2 or 3 or etc., ect., ect years of experience to achieve this comfort level. for an example consider "athomas91" whom states; "the thing that bothers me is that i have to have a bsn in nursing, years of critical care experience, and another nearly 3 years of intense training". also consider "ether": "by way of the four-year bsn i am working towards and after some time in the icu, i feel i will be prepared to learn the scope of anesthesia.....however, i will be doing my time as an rn until i'm accepted - this goes for many other nursing students." i haven't seen anybody make the same argument towards physicians. they too do not have years of icu experience when they become residents and eventually anesthesiologists. or are most people here suggesting that the crna tract is the only way to train for proper administration of anesthesia? moreover nilepoc, athomas91 and ether how do you feel about np whom can enter directly into an anp program without years of training?



    from "deepz": "civil? when georgiaaa posts a veiled threat to invade my state? don't make me laugh. folks, there are merely a few hundred aas ... and 31,000 crnas. bring it on." yes, a few hundred aa's and 31,000 crna's but lets keep it in prospective won't we. crna's have been around since 1861 and aa's only from the early 1970's. naturally i would expect more members in an organization that is over a century old. aa's are a young virgining organization with vigor and full of promise. i love a challenge. check yourself again against in a few years.



    from "angel337": "crna's have to be competent or else they wouldn't be in the or." if we may, lets extend your logic to aa's. since aa's are in the or aswell then by your rules of logic aa's have to be competent.



    from "athomas91": "i am sorry to hear the practice of the crna's in georgia are so restricted...no subclavians etc...." when the crna profession was young they too had many restrictions. our profession is a young one and making progress by leaps and bounds, state by state. watch us grow.



    from "athlein1": "lbhot, i hope you clearly see that there is more difference than job outlook. but since you asked, the last time i checked www.gaswork.com, there were 1138 jobs posted for crnas (obviously, some may be repeats, agency, etc). there were 3 aa postings. aas are not pas. they can practice in a limited role in a minority of states in this country." keep in mind what your crna peers keep repeating--we've been around for over 100 years. i think this fact has more to do with it than with the number if job posting on gasworks.com. a more realistic appraisal of job outlook would include job offers of recent aa graduates. i'd guess 100% placement most with job offers before graduation. keep watching gasworks.com and watch the aa job posting grow exponentially.



    from "gregsto": ""an aa will do nothing unless he is directed to and a crna will do everything unless he is directed not to." (use she if you like) truely this can describe the practice situation i found myself in. this is not to slight aa's, this is simply the way their training is designed......extreme restriction of practice" also "deepz": says "so, as the saying goes: you want to be my equal?" this is the major point pro-crna's have been harping on. but by an large the arguments are mere semantics. for all practical purposes aa are supervised little more than crna's and the daily routine for both professions for all intents and purposes are alike.



    from "swumpgas": "surgeons have said for years tha monkeys can be trained to do anesthesia, maybe a bit of exaggeration, but just as the mda's tout a background in medicine is needed for anesthesia, it also applies to aa's with no background in medicine, or medical science. you are and will always be technicians, or "bag squeezers". serving at the whim of your overseer. doing their bidding. asking permission" this statement is wrong at so many levels but it reflects this persons "dumbness" for lack of a better word. this is what aa training is for, to gain experience not unlike medical students whom have to start somewhere. perhaps swumpgas is resentful (the common denominator amongst crna) because we can't, well to put it in his words "can you give an enema and not have the sheets all discolored?" lol. you know, it just occurred to me. i don't believe that one of the prerequisites for crna is to "give an enema and not have the sheets all discolored" or is it? i believe this hostile resentment is rooted in the fact that although aa's perform the same duties and get paid as well as crna's, aa's did necessary attend nursing school or are rn's . don't forget that a bachelors degree is required for admission to an aa program. correct me if i'm wrong but it wasn't too long ago when crna's only required certification beyond rn training. aa's school will also come into favor and will continue to evolve.



    from "athomos91": "and i bring that to the table prior to any anesthesia training...but some try to tell you that their english major plus their anesthesia training makes them my equal...wrong answer." do you think a nursing degree makes you better qualified to administer anesthesia? i don't think that all of your crna colleagues would agree because many have achieved an associate degree and rn certification only. in fact, most crna schools will accept merely rn certification and an english bachelors degree will do just as well as a bsn.



    from "smiling ru": "a nurse anesthesia student starts the program with a great deal of education and experience in the medical field. they all understand medical terminology, how to chart appropriately. various disease processes, their effects, and treatment. pharmacology, lab interpretation, ekg interpretaion, ventilator strategies, acls, pals, cpr, sterile technique, this list could go on and on." this point is shared by deepz and others i'm sure. in case all of you have forgotten, you are no longer is in the er, medsurg floor, icu, ccu, etc., ect., etc. by and large your daily routine consists of bread and butter cases, ortho, cardiac, well name your specialty. in any case, 98% of the surgeries are scheduled, sometimes weeks in advance. your job is to anesthetize a patient and keep him/her stable. you are no longer dressing wounds, administering meds., etc., etc., etc.. it is a very constrained and controlled situation. yes nursing will teach you a lot but how relevant is the proper turning of a patient to prevent bed sores, etc.. or consider this: when was the last time any crna or aa had to insert a catheter while the patient was undergoing surgery and under anesthesia? or when was the last time a crna or aa had to dress a wound while a patient is under anesthesia undergoing surgery? i could go on and on with examples. name your floor and i will give you scenario ofter scenario were procedures are not utilized in the or. although these are important skills they have little practical use in the or. as a crna, you have chosen to specialize. with that comes many new skills learned and many old skills less utilized or obsolete altogether. keep in mind that my assersions are generally true. there are exceptions i know this. i don't care to nor will respond to "your experience or training". i am not implying that crna's don't utilize their training as a nurse. far from that. i know that nursing skills are utilized. i do believe though, that to be profecient as an aa i don't need a lot of the nursing skills learned in nursing school. i will learn to be profecient in the or through the aa training curriculum.


    i believe it boils down to two things: competition for jobs (which effects salaries) and the sore subject that nursing school and "having paid my dues" isn't a requirement to do the same job (forgetting that aa school requires a 4 year degree to apply). we've paid our dues too and no you won't have the job vacancies to yourselves. face it, an aa is trained to be competent and proficient in or environment. anti-aa can talk all you want but you can't turn the tide. the aa profession will flourish. it is inevitable, in fact it is imminent. the confirmation is in the state statues that continue to come to fruition. this "i don't require supervision" stance is so elementary, ineffective and unappealing. i completed 6 years as a combat medic in the navy attached to a special forced unit. i'm not impressed with taking or giving orders. i want to do a job and do it well. there is a slight difference in the two titles (spelling) but the daily routine is the same. i don't feel inferior in any way because i will be "supervised" by an anesthesiologist. i hardly think "supervision" a burden. the job is challenging, the environment is stimulating and the pay is good. earlier on these posts i noticed some crna/srna individuals who suggested a get together of the pro crna and pro aa people get for a "discussion". i welcome that invitation. considering geography would prohibit a face to face discussion (at least for the time being), a chat over the telephone would be just as stimulating. if there are any takers, contact me via private email. i'm sure we can arrange, in a discrete method a time to talk and discuss these matters further so as to not disclose telephone numbers to the general public.
    Last edit by AA2B on May 17, '04
  9. by   athomas91
    they too do not have years of icu experience when they become residents and eventually anesthesiologists. or are most people here suggesting that the crna tract is the only way to train for proper administration of anesthesia? moreover nilepoc, athomas91 and ether how do you feel about np whom can enter directly into an anp program without years of training?
    noone is suggesting that crna training is the only route - just that it has better prepared practioners at the starting line - i don't agree w/ any advanced practice nurse that has obtained a degree w/o prior patient experience. if you are reasonable and logical in your thought process - it would occur that prior experience w/ patients, disease processes, medications, invasive lines and monitoring, reading and evaluating ekg's and lab work can only make you better. noone said (and if you would have posted my entire posts) that aa's aren't capable - but that they are limited as compared to a crna.

    when the crna profession was young they too had many restrictions. our profession is a young one and making progress by leaps and bounds, state by state. watch us grow.
    when the crna profession was young - what - 100 years ago?!?!?! you are remiss in your history of anesthesia if you fail to mention that nurses began the art of anesthesia and trained physicians....

    do you think a nursing degree makes you better qualified to administer anesthesia? i don't think that all of your crna colleagues would agree because many have achieved an associate degree and rn certification only. in fact, most crna schools will accept merely rn certification and an english bachelors degree will do just as well as a bsn.
    of course having nursing experience gives one an advantage - for 7 years i have been doing iv's - dealing w/ cardiac meds - treating patients.....all of which adds to ones knowledge base and prepares one to deal w/ emergencies when they arise. your statement makes no sense...an rn w/ an associates degree can have the same work experience a bsn prepared rn can have...that was not the point of the statement - if you bother to read it thouroughly you will see that the point was someone working as a nurse rather than an english teacher will have a better clinical grasp of anesthesia.


    unfortunately you have failed to read the good comments in many of our posts - but that is your issue - not ours...do not expect to come to a nursing discussion and for us not to be very pro-nursing....it only takes a small use of the noodle to figure that one out. it doesn't boil down to job security - because i can practice in places where you cannot (like in the military overseas as a single practitioner)...it boils down to the asa wanting to keep control of the money flow ... i have no problem w/ aa's who function w/in the guidelines set...but frequently those guidelines are too loosely followed - but you won't have to worry - you won't be held legally responsible - the mda will. if you want to talk money - lets....why pay for 8 aa's and at least 2 mda's...when you could hire 4mda's and 4crna's - monetarily speaking that would be the most fiscally responsible hiring ratio...or even 2 mda's and 6 crna's ....still 2 less employees...if you think all we do are bread and butter jobs..you should rethink ...i am sure that most aa's are very competent and skilled practitioners...but there is no way a provider w/ patient experience cannot be superior at the get go - f you argue that (which even georgia aa conceded to) then you are just being dull. and if you were in the military...and had all this training - they of course encourage the nurse and crna route...couldn't you get in??
  10. by   ken-pin
    What a refreshing post....a joy to read!
    As a future CRNA, hopefully anyways, thanks so much for your keen and sometimes funny insight. It has that beautiful ring of truth to it.
    -ken

    Quote from swumpgas
    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    This is bound to make a lot of eyeballs roll back in a lot of heads, but ya gota understand the history of Nurses in anesthesia and MD's in anesthesia.

    I'm sure anyone knows that early anesthesia was traditionally done by Nurses.. They were more "Vigilant" (attentive) than the residents and interns , then came the surplus MD situation.

    It's a matter of control. CRNA's on a day to day basis "witness" the clinical skills of Anesthesiologists, (from now on MD-A for short)

    These are the guys that are supposed to be our superiors.. and in many cases, they are good.. not superior, but at least equal.. Then there historically has been the Foreign Trained MD that chose Anesthesia, because they could not speak enough English to enter private practice. Their skill level might have been good, but their other skills lacked.

    For years MD-A's were looked down upon by their surgeon colleagues for some of those reasons.

    And at the other extreme is the MD that is not trained in anesthesia at all, possibly taking a rotation in anesthesia for a few months, then calling themselves an Anesthesiologist. They are still out there, maybe as a GP doing anesthesia ,to a lesser degree, but still mucking about. Then there are the ones that cannot pass their boards in anesthesia, but call themselves "board Eligible" and work as MD-A's.

    Now this fussin has been going on for at least 40 years that I have been passing gas and longer between CRNA's , that usually come from the tops of their classes, are somewhat over achievers, and clinically excellent, in comparison with some of the older so called MD-A's that just squeezed through med school.

    The issue now is about control of anesthesia provision and competition, by the MD-A's, that by law, and standard practice have no real control over CRNA practice. CRNA's are technically supervised by a surgeon, as part of a team effort in most states, but Surgeons do not know a lot about modern anesthesia . It's about all they can do to stay on top of their own Board requirements.

    So the CRNA-AA fuss stems from the CRNA / MD-A control issue. They have been unsuccessful in legislating control over CRNA's, so they have created their own Newtech Anesthesia provider.. The Anesthesia Assistant. And these folks have put down their sliderules from engineering, Botany, Chemistry , etc degrees, and come into a patient care field without any background in human science (eg Nursing background-- remember all the hoops you all had to go through, taking care of patients? Enemas till clear. talking to the family of a child that just died, Psych and OB training, etc,wrestling with the drunk in ER, and worse as part of your nursing backgrounds? )

    This is not a put down of Anesthesia assistants, they have just been sucked into the CRNA MD-A turf Battle... All proposed legislation to permit Anesthesia Assistants to work has required that they be SUPERVISED by an MD-A--- talk about built in control..

    there is NO requirement in ANY state that a CRNA must be supervised by an MD-A , but MD-A's would love this requirement, and control.

    There is an old saying among CRNA's , that we all get smarter at 3:30, when the MD-A's go home, and we are left there by ourselves, finishing the schedule, or being on call the rest of the night, with no supervision..

    The Anesthesia Programs at Emory and other places, were started as a direct attempt by MD-As to gain control over anesthesia. Note, it was not mentioned that the MD-A's actually do the cases, Lord no.. that would make it difficult to sit in the lounge and watch the stock ticker and eat donuts..

    I do not really have a problem with AA's, but again I do not personally know any. They may be the greatest people in the world, I don't know. I do know, that by law, their wings are Clipped,, they may not make independent decisions , insert invasive cardiovascular lines, do regional anesthesia in most situations (another facet of "Control")

    God forbid the MD-A should be stuck in the bathroom or have an MI and they had to make a clinical judgments, that is not in their armamentarium.

    When I have my next surgery, I want my anesthesia done by someone that can give me an emergency enema if needed, without calling an MD-A for advice.

    Oh yea, someone made the comment about the US being the only place that uses CRNA's... Untrue, and it is being experimented with in England, Australia, Canada, and many other places that have traditionally had only MD-s Doing anesthesia.. they are beginning to see the light..

    Many Anesthesia Assistants are trying to pass themselves off as Physician's Assistants. The Nation Physician Assistant Assn, states in no uncertain terms, that Anesthesia Assistants are NOT the equivalent of Physicians Assistants.
    http://www.aapa.org/gandp/aas2.html

    You can see Emory's evaluation of the 2 on their own web site
    http://anesthesiology.emory.edu/PA_Program/whatis.html

    As nurses you have seen the good and bad Physicians. And the control issues. This is what I all comes down to. Control and MONEY..

    I'm done ....you can wake up now..
  11. by   Athlein1
    AA2B,
    Your arguments are too weak to merit much of a response. It's interesting that the only part of my viewpoint you care to address is the number of postings on gaswork.com.

    Seems no one from the AA camp wishes to dispute the facts that have already been presented in this discussion. I will give a quick re-cap for the sake of clarity:

    1. AAs and CRNAs are not interchangeable, as CRNAs are able to practice independently by virtue of their training.
    2. CRNAs have the distinct advantage of prior training in nursing and patient care, at least initially, and arguably for the remainder of their careers.
    3. CRNA and AA salaries are comparable in some markets with the anesthesia care team model, but this is an absolutely untrue generalization. I know many CRNAs whose salaries are double, even triple, that of an AA or CRNA in a team setting. AAs will not be able to raise their salaries to that level because AAs cannot bill, nor can they work independently.
    4. AAs are not the solution to this country's "anesthesia provider shortage", as your national organizations assert, because AAs must have a physician supervisor. Physicians do not want to work in the settings with the greatest need for anesthesia providers, such as rural areas, communities with poverty, and disadvantaged minorities. Therefore, AAs cannot be the solution to this situation.
    5. AA practice has recently been significantly restricted in one of the states with an AA program. CRNAs practicing in that state were not similarly restricted.

    And, as a side note:
    AA's are a young virgining organization with vigor and full of promise
    "Virgining"? What the heck is that? I don't mean to be a snot, but if you're going to practice those GRE words, try to use them correctly. Might you mean burgeoning?
    Last edit by Athlein1 on May 16, '04
  12. by   nurseunderwater
    Quote from Athlein1
    AA2B,
    And, as a side note:
    "Virgining"? What the heck is that? I don't mean to be a snot, but if you're going to practice those GRE words, try to use them correctly. Might you mean burgeoning?


    omg.... :chuckle
  13. by   AA2B
    and, as a side note:
    "virgining"? what the heck is that? i don't mean to be a snot, but if you're going to practice those gre words, try to use them correctly. might you mean burgeoning?[/quote]


    athlein1 it is your argument that is weak. i addressed your point of view regarding gasworks.com only because your other points had already been expressed by your fellow crna's, which i responded to. you and your fellow crna's ask redundant questions. the anti-aa questions and statements are addressed by others and myself with relevant and valid information but the anti-aa continue just as if they hear nothing; thus the redundant questions. you can expect more redundant questions in future posts. i suppose purposeful ignorance will provide temporary comfort and security but sooner or later you will have to face reality. so consider my other points, they will apply to you as well. moreover, your reasoning consists of nothing more than finding excuses or exceptions to go on believing as you already do (the lot of you anti-aa's). your itemized statements (1-5) are mere assertions not accepted practices. regardless, i did say in my last post that there were exceptions to my statements but for the most part there is little if any difference in the daily routine of a crna and an aa. i think you would serve yourself well if you studied my post. if you would like to discuss any point with substance my offer stands, contact me via private email. we can arrange for an amicable discussion. but if you want to squabble over trivial differences in point of view, don't waste your time. like i've said, this is petty and i don't have the time or the inclination to address everybody's unique "experience". and for your information i did mean virgining! it was a metaphor but you need it spelled out, don't you? well, at the risk of sounding sexist here goes. the metaphor was between the crna profession and the aa profession in that although age can have significant benefits, so can youth. a prime example would be a spouse or significant other. would you prefer your spouse to be 143 years old or would you prefer your spouse to be in her/his prime 30's? now, i know my point of view is not popular here or will even fall into favor but i won't respond to anymore discord. best regards and enjoy!
    Last edit by AA2B on May 16, '04

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