Here's what AAs really think of CRNAs - page 20

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   Carolina SRNA
    Quote from makeup_nurse
    as someone is is considering becoming a crna, i found this thread very interesting!

    "in the 1960s, three anesthesiologists, joachim s. gravenstein, john e. steinhaus, and perry p. volpitto, were concerned with the shortage of anesthesiologists in the country. after studying the educational pathway for anesthesiologists and nurse anesthetists (nas), they created a new educational paradigm for a mid-level anesthesia practitioner that included a pre-med background in college. this person would perform the same job as the na but would be readily able to go on to medical school if appropriate. this new professional, the anesthesiologist assistant, or aa, thus had the potential to alleviate the shortage of anesthesiologists."

    (http://www.asahq.org/career/aa.htm#1)

    i have an undergraduate degree in biology from duke (pre-med), and a ms in molecular biology. why do people think a pre-med bs is much harder or "better" than a bsn?

    right now i am looking at entering an accelerated bsn course, and i don't find it easier by any means. different, but not easier.

    in fact, pre-med courses are great as a solid science base for medical school, but really have little practical application... the bsn seems to cover more practical applications of science. in my opinion, i think the bsn better prepares you for working in a clinical environment than a bs by many magnitudes!

    i am not on either side, it is just strange how the literature for aa programs, etc seem to emphasize that aas "are prepared to go to med school" (paraphrasing) at a moment's notice! to me, that doesn't mean that much, as i know i certainly wasn't prepared for anything after i got my bs degree (pre-med).

    now, the actual *training* aa receive in their program, and the *training* crnas receive in their program--that is what prepares both crnas and aas for their jobs.
    i'm not sure about the bs/bsn comment you mentioned but a bsn is a bachelor of science in nursing. upon graduation, you can sit for your state board of nursing to be licensed as a registered nurse.


    the bs, a bachelor of science degree, can cover any numerous majors in science, but yes, is great for applying to medical school. the bsn is required for crna school, as your bs,ms will most likely to let you walk into aa school as a competitive candidate.
    Last edit by Carolina SRNA on Oct 21, '04
  2. by   loisane
    Quote from Carolina SRNA
    We leave the roll as nurses and take on the responsibilties as physician trained anesthesia providers.....
    I have to take issue with this characterization of nurse anesthesia. While physicians may be involved in our EDUCATION, their participation is not the principle defining factor of who we are. Professionals are educated. Training is for assistants. Your choice of words speaks volumes. I challenge you to examine your own personal philosophy of nurse anesthesia, and your professional role. If you are a senior student, then this is part of the transitional process toward graduate.


    Personnally, after observing the criminal mindset of the general public and their quick way to make a dollar by lawsuits as I have thus far, I enjoy someone else having the ultimate liability while at the same time, I am under few restrictions to practice what I have been trained to do while existing under that liability.
    No, working with anesthesiologists does NOT place the ultimate liability for your actions on them. This is a myth, perpetuated by non-CRNA friendly 'ologists, in part to scare surgeons into insisting on 'ologist involvement in their cases.

    When you become a CRNA, the responsibility for your anesthetics lies with you. If you work with an 'ologist, they may share some of that responsibility, but it does not remove the responsibility from you. This is the difference between a professional and an assistant. What you say IS true of AAs, but not of CRNAs, even in anesthesia team care settings.

    My friend, I fear you have been the recipient of some less than completely accurate appraisal of our profession. Maybe this will be addressed in your program at a later date. The issues are complex, and many of our own colleagues are confused about much of this. And consider the fact that it varies state by state, and it gets even more intricate. But you are early in your career, this is a great time to tackle the complexities involved. The AANA journal has an article every issue on the legal ramifications of our profession. These issues are addressed regularly. Include this as part of your education. The April issue had a good discussion about the ASA team standard.

    In you education, never settle for "that's good enough for me, after all, I am always going to work with an anesthesiologist backing me up". Learn to practice as though you will be working solo. Then if you choose to always work ACT, fine you are just that much better at what you do. But if you decide later that you would like to "be a cowboy" (as you call it), you will not have closed a door and limited your options for your entire future, based on beliefs you hold right now.

    loisane crna
  3. by   Carolina SRNA
    Quote from loisane
    I have to take issue with this characterization of nurse anesthesia. While physicians may be involved in our EDUCATION, their participation is not the principle defining factor of who we are. Professionals are educated. Training is for assistants. Your choice of words speaks volumes. I challenge you to examine your own personal philosophy of nurse anesthesia, and your professional role. If you are a senior student, then this is part of the transitional process toward graduate.




    No, working with anesthesiologists does NOT place the ultimate liability for your actions on them. This is a myth, perpetuated by non-CRNA friendly 'ologists, in part to scare surgeons into insisting on 'ologist involvement in their cases.

    When you become a CRNA, the responsibility for your anesthetics lies with you. If you work with an 'ologist, they may share some of that responsibility, but it does not remove the responsibility from you. This is the difference between a professional and an assistant. What you say IS true of AAs, but not of CRNAs, even in anesthesia team care settings.

    My friend, I fear you have been the recipient of some less than completely accurate appraisal of our profession. Maybe this will be addressed in your program at a later date. The issues are complex, and many of our own colleagues are confused about much of this. And consider the fact that it varies state by state, and it gets even more intricate. But you are early in your career, this is a great time to tackle the complexities involved. The AANA journal has an article every issue on the legal ramifications of our profession. These issues are addressed regularly. Include this as part of your education. The April issue had a good discussion about the ASA team standard.

    In you education, never settle for "that's good enough for me, after all, I am always going to work with an anesthesiologist backing me up". Learn to practice as though you will be working solo. Then if you choose to always work ACT, fine you are just that much better at what you do. But if you decide later that you would like to "be a cowboy" (as you call it), you will not have closed a door and limited your options for your entire future, based on beliefs you hold right now.

    loisane crna
    As for you first comment, I am unsure of your point. I greatly value my chosen field and profession and have no interests in redefining my "philosophy" in part to your interpretation of an email; not a valid conversation or debate. My purpose in that statement was to say completely that a CRNA is educated including highly specialized training (strait off the AANA website definition). We no longer have the roll of "call the doc and get an order," but a responsibility of assess, interpret, and take the appropriate action. It in no way was meant to be a "characterization" of NAs with a negative connotation.

    For the second conundrum, I fully understand and accept the responsibilities of the profession I am studying as a professional. My clinical decisions will ultimately rest within the defined scope of practice set forth by the AANA and the State Board of Nursing and any variation of that set law falls on me, not my MD-A. My statement was in fact meant for the nurse anesthesia providers that continuously degrade AAs and ultimately feel flying "solo" is the only way to go and fear that AAs will strip them of their $$. In my home town, there is no MD-A. Both CRNAs have been fired recently d/t greed and being John Wayne as one poster put it. That's the direction my comment was manifested for. Don't ever think I would say a derogitory thing regarding my own chosen field. I am merely a realist. HOWEVER, this in fact is more based on a poor choice of wording in communication of my ideas rather than examples of inapt decision making by a student...I have revised my statements in the original posting.

    Thank you for you comments! I will gladly speak with you for your advice any time.
    Last edit by Carolina SRNA on Oct 21, '04
  4. by   apaisRN
    Quote from Carolina SRNA
    In my home town, there is no MD-A. Both CRNAs have been fired recently d/t greed and being John Wayne as one poster put it.
    I understand "John Wayne" type behavior, but how do you get fired due to greed? If your employer declines to meet your salary demands you can stay on at your current rate or you can leave, you don't get fired for asking (at least I hope not!). Unless there was bribery or some such dirtiness going on.
  5. by   makeup_nurse
    to Carolina SRNA:

    I know the difference between a BS and a BSN... What struck me after reading this thread and reading up about AA programs is that AA association really emphasizes that AAs have a BS, they they are "pre-med", that they have "taken all the courses required to get into med school", that they could "apply to med school", etc. Whereas CRNAs have various backgrounds, some BSN, some RN with other BA degrees, etc.

    I disagree that having a BS (and having taken the pre-med requirements) makes someone more qualified than someone with a BSN. The AA association seems to think it does--sort of a funny thing to dwell on and emphasize over and over again in my opinion.

    I think it is "six of one, half dozen of the other" sort of situation... I don't think having a pre-med BS or a BSN will make you better or more qualified. AAs and CRNAs learn their profession while in AA school or CRNA school--that is what makes them highly skilled professionals.

    This thread has been very informative, and I wish both the AAs and CRNAs the best of luck!
  6. by   Carolina SRNA
    Quote from apaisRN
    I understand "John Wayne" type behavior, but how do you get fired due to greed? If your employer declines to meet your salary demands you can stay on at your current rate or you can leave, you don't get fired for asking (at least I hope not!). Unless there was bribery or some such dirtiness going on.
    Well, I don't know all the details but basically, two CRNAs were really pushing the system and getting raises about every quarter. Yet, they still complained about how poor their job satisfaction was...over $150,000 a year for about four hours of work a day must be real hard work...

    Anyway, that kind of thing doesn't work well in a small hospital with a four bed OR....they were released from their duties.

    To me...that is greed
  7. by   Carolina SRNA
    Thanks. Great conclusions!
  8. by   loisane
    Quote from Carolina SRNA
    ...and have no interests in redefining my "philosophy"
    Thanks for clarifying, and I understand that "choice of words" are just that, and may not have any "hidden meanings". But words are powerful, and we all can gain personal insight into ourselves through them. We all hold assumptions that may or may not be validated when brought to the light of day. My attempt is not to be confrontational, this is a process I reccommend for all of us, including myself.


    Quote from Carolina SRNA
    ...My statement was in fact meant for the nurse anesthesia providers that continuously degrade AAs and ultimately feel flying "solo" is the only way to go and fear that AAs will strip them of their $$.
    Of course there is much truth to the saying "follow the money", it is at the root of everything. So I believe we agree that money is a significant factor in this debate. We also agree that there is no need to "AA bash", and I have not participated in that myself (at least I certainly hope nothing I have said here would sound like that to anyone).

    But I believe it is counter productive to our profession to downgrade the contributions of the independents. Many CRNAs have expressed this attitude. They question our association's priorities, why do we even care about them when the numbers of ACT CRNAs are greater? And I thought I picked up a little of that in your post. It is an attitude I always try to address, especially in students who are just forming their professional attitudes.

    The independents are very important to our profession, no matter their numbers. I have never worked outside the ACT, but I understand that my work environment and future choices are better because the opportunity for independent practice exits. And that right is under constant attack, from many fronts. Many people even think that independent CRNA practice is something new, that we are trying to extend our scope of practice. Nothing could be farther from the truth.

    So the independents are often thick skinned, and abrasive. That is understandable when you realize they are on the front lines, fighting to protect all of our practice rights. I applaud them, and support them, as should all nurse anesthetists.

    Obviously, everyone is accountable for their actions, and nothing excuses illegal or unethical behavior. Sounds like your greed example might fit that category. In which case, I think we should make the distinction between providers who cross the line, and those who are standing their ground to practice in a way to which they are legally entitled, despite the fact that it ruffles the feathers of many powerful people.

    loisane crna
  9. by   Carolina SRNA
    Quote from loisane
    Thanks for clarifying, and I understand that "choice of words" are just that, and may not have any "hidden meanings". But words are powerful, and we all can gain personal insight into ourselves through them. We all hold assumptions that may or may not be validated when brought to the light of day. My attempt is not to be confrontational, this is a process I reccommend for all of us, including myself.




    Of course there is much truth to the saying "follow the money", it is at the root of everything. So I believe we agree that money is a significant factor in this debate. We also agree that there is no need to "AA bash", and I have not participated in that myself (at least I certainly hope nothing I have said here would sound like that to anyone).

    But I believe it is counter productive to our profession to downgrade the contributions of the independents. Many CRNAs have expressed this attitude. They question our association's priorities, why do we even care about them when the numbers of ACT CRNAs are greater? And I thought I picked up a little of that in your post. It is an attitude I always try to address, especially in students who are just forming their professional attitudes.

    The independents are very important to our profession, no matter their numbers. I have never worked outside the ACT, but I understand that my work environment and future choices are better because the opportunity for independent practice exits. And that right is under constant attack, from many fronts. Many people even think that independent CRNA practice is something new, that we are trying to extend our scope of practice. Nothing could be farther from the truth.

    So the independents are often thick skinned, and abrasive. That is understandable when you realize they are on the front lines, fighting to protect all of our practice rights. I applaud them, and support them, as should all nurse anesthetists.

    Obviously, everyone is accountable for their actions, and nothing excuses illegal or unethical behavior. Sounds like your greed example might fit that category. In which case, I think we should make the distinction between providers who cross the line, and those who are standing their ground to practice in a way to which they are legally entitled, despite the fact that it ruffles the feathers of many powerful people.

    loisane crna
    Well said. It is obvious there are things I will develop as I grow professionally in this awesome arena of medicine. I know I will mature and nuture my skills and most likely, might be a private practice provider at some point. The majority of my comments only arrive from a handful of postings on the site and as mentioned, a few personal contacts that has left a bad taste in everyone's mouth. It is not a global attitude I have developed. I support the front line as you mentioned....might not agree with them always, but support them. I believe it is always a true display of character when those can interact on such a diverse topic yet stay professional....no feelings of confrontation felt. Again, thanks.
    Last edit by Carolina SRNA on Oct 22, '04
  10. by   kmrmom42
    Swumpgas, not only was I not yawning I was interested in every word of your cogent post.This has been an utterly fascinating thread and I have learned much by reading your post as well as many of the others. As I was reading I was thinking that the crux of the issue between AA's and CRNA's seems to be the old "medicine vs nursing" conflict. Medicine seeks to retain control and nursing wants to achieve it's own place in history. You have done a wonderful job of explaining what was an emerging kernel of thought for me. I have thought much about this in terms of PA's as compared with APRN's and now I realize that nursing is being threatened on another front, one I was not aware of until today. That AMA is a powerful force to be reckoned with isn't it?!
    Personally, I have worked in L&D and in the OR with both CRNA's and MD-A's (never heard of AA's until today) and although there are some wonderful MD-A's I would personally prefer the care of a CRNA under most if not all circumstances.
  11. by   santhony44
    I am an NP and had never heard of AA's either.

    My personal experiences with CRNA's have been good. I have been slept by one and didn't even have a scratchy throat later. Even the ones I've known that were not pleasant to work with from the nurses' point of view were very good with their patients and good at their jobs. I now live in the Panhandle/South Plains area of West Texas and know that a lot of smaller rural hospitals would not be able to do even the limited surgeries they do if not for the CRNA's.

    Do AA's compare with PA's? Most physician's assistants have bachelor's degrees, are trained in schools of medicine, and work under the physician's license.

    When I started graduate school, I took core curriculum classes with CRNA students. I remember that they had at least 6 months longer in school than the NP's and CNS's did, and had an ungodly number of clinical hours to complete before they could graduate. They graduated with Masters' degrees. I would hardly call them inexperienced! (All had a number of years' nursing experience, as well, in areas like OR, ICU, ER, etc).

    Also, just for my information, what kind of certification exam do CRNA's take? Who are they certified by? I have actually never thought to wonder before!
  12. by   deepz
    Quote from santhony44
    ....Also, just for my information, what kind of certification exam do CRNA's take? Who are they certified by? I have actually never thought to wonder before!

    http://www.aana.com

    http://www.aana.com/council/default1.asp

    Wonder no more.

    deepz
  13. by   Nitecap
    Isn't this thread like 4-5 months old. Please quit bumping this thread back up. The debate between the 4-5 original peeps is over, quit trying to start a fire on the forum with ancient threads. Visit the forum more often if you want in on these types of threads.


    Quote from deepz

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