How do CRNAs/SRNAs benefit anesthesiology residents? - page 3

I was searching for information on the Wake Forest CRNA program and happened upon this information on the Wake Forest anesthesiology program. Dr. Royster has an interesting view on how CRNA's/SRNAs... Read More

  1. by   loisane
    Quote from gotosleep
    This board has become a nightmare.

    Over half of the posts/threads have deteriorated into juvenile bickering. It is sad really, considering how good it was a year ago. This board has been taken over by knee-jerk zealots. The self-serving pontificating by first year SRNAs combined with radicalization of some the veteran CRNAs has become nauseating.

    Tenesma has consistently been one the better posters here (regardless of the fact that he is a MDA). I am sad to see him go.

    This board has become nothing but a source of negativity. I am embarrassed to be a member of it.

    This will be my last post as well.

    All internet groups evolve and change. And individuals wax and wane in their interest and desire to participate. I hope you both take a break, and return when you feel the desire and/or need. That is perfectly fine, and done all the time on these type of forums.

    For myself, I was getting a little tired of the same old "how do I get into school" threads, and have enjoyed something with a little substance. Yes, there is always some negativity. The ability to stay anonymous, and not really have to take responsiblity for one's comments breeds some of that. And some people are confrontational as a device to stimulate reactions. And I believe anytime you have people with varied backgrounds, all interacting together, there is more potential for volatility. But I have found it best to focus on the nuggets that are of interest, and just ignore whatever is offensive or of little interest.

    Just like I have learned to ignore the "how to get into school" topics (not that they are offensive). No need for me to fuss about them. They are important to somebody, and filling their needs. And I know how to skip over the posts that I'd rather not read. A good skill for all of us to practice.

    loisane crna
  2. by   TejasDoc
    Quote from deepz
    Not consumer info? Looks like it to me. Perhaps as a doc you don't like to read that half the MDAs in America are not board certified, but otherwise how is this anti-anesthesiologist? Page two of the site clearly informs the reader that one side of the page is straight consumer information (the majority of the page, looks like), the other side labeled editorial "CRNAs Speaking Out." The Orwell quote comes from the clearly labeled editorial side of gaspasser.com, I believe.

    deepz
    As for the site clearly stating that there is an editorial section, yes, that's true, as long as you get past the first page, which has no disclaimer about the information written there. Anyway, I think the site is full of misinformation, and even if I'm wrong, like I said before, I can't check any references. Example, training costs, "(Average $635,000 for a doc, $59,000 for a CRNA)" - where did this come from?

    And information that is just flat out wrong? "CRNAs and anesthesiologists are functional equivalents" - This isn't true, and you know it. I'm not saying ANYTHING about one being better than the other, just saying, they're not functional equivalents. We can duke this out, but I don't think it's worth either of our time.

    "In anesthesia training however, there exists little difference: both groups receive education that is essentially equivalent, often attending class and clinical side by side" Again, not really true. Sounds like it MIGHT be true, but isn't true. You'll probably want to debate this, let's see.

    "Today some 31,000 CRNAs provide two-thirds of the anesthetics in America." Yeah, I'm guessing this is probably true, but I can't tell where this statistic came from, but anyway, it's just misleading, it makes it seem like physicians are not involved at all in those anesthetics.

    "Anesthesia is unique, the only medical modality that does not aim to diagnose and cure; rather, our unique role is supportive care." Not true. Palliative care physicians and palliative medicine provide supportive care. In the rest of medicine, there are tons of examples of not being able to cure disease. Do internists always cure hypertension? What about ID docs and HIV? What about the cardiologist who treats A.fib? Are you going to tell me they're not practicing medicine because they couldn't cure the disease? Anesthesiologist/CRNAs diagnose and treat tons of perioperative conditions, whether that be postop nausea, or intraop arrythmia, preop anxiety, post op hypotension, and on, and on, and on. To say I don't diagnose and attempt to cure, even though I may only treat a condition, belittles what I do, and that's offensive.

    On another note, Loisane, you're definitely right, I think there are many ways for an anesthesia care team to function, and I'm sure they are incredibly varied depending on the members and their chosen dynamic. Most of us only know how our small chunk of the pie works. Thanks for engaging me on this topic without getting ugly.

    Athlein, I think it's important to have different view points in any discussion group. Attacking Tenesma for being an active member here just makes it seem as though you don't want a differing opinion. The topics discussed by CRNAs affect anesthesiologists and vice versa, we should be writing in each others discussion groups.

    It's late, I'm tired, and I'm interested to see what people say.

    TD
    Last edit by TejasDoc on Jun 14, '04
  3. by   catcolalex
    Tejasdoc,
    can you elaborate a little more on why you feel that CRNA's need to be supervised?

    "I understand that you feel CRNAs do not need supervision, I disagree, but I think the definition of an anesthesia care team is pretty clear".
  4. by   Athlein1
    Tejas,
    Please edit your post to remove the portion that attempts to reveal personal information and the identity of one of our members. It should be left to each of us individually to decide whether we want to remain anonymous. It shouldn't be a punitive action on the part of another poster.

    As far as attacking goes, did you read my post to Tenesma, or are you assuming some of its content because of his reply? I did not reply with an attack due to a difference of an opinion, I merely called him on what I perceived to be a personal, derogatory remark about another poster.

    I, like gotosleep, am sad to so many threads deteriorate due to inflammatory remarks from all sides of the group. If we aren't more tactful, we won't have any members left!
  5. by   TejasDoc
    Quote from Athlein1
    Tejas,
    Please edit your post to remove the portion that attempts to reveal personal information and the identity of one of our members. It should be left to each of us individually to decide whether we want to remain anonymous. It shouldn't be a punitive action on the part of another poster.

    As far as attacking goes, did you read my post to Tenesma, or are you assuming some of its content because of his reply? I did not reply with an attack due to a difference of an opinion, I merely called him on what I perceived to be a personal, derogatory remark about another poster.

    I, like gotosleep, am sad to so many threads deteriorate due to inflammatory remarks from all sides of the group. If we aren't more tactful, we won't have any members left!
    Portion removed. Didn't mean to offend, and I definitely wasn't being punitive, wanted someone to come out and take some responsibility for saying certain things. People can draw their own conclusions as to who people might or might not be.

    I think we're actually confused about what happened with Tenesma. I thought you made a comment about him spending a lot of time on a CRNA board for an anesthesiologist? Maybe I don't remember, the post is gone. Sorry if I mixed that up. Though as for him making a "personal, derogatory remark about another poster", are you talking about the "insecurities" and "boring" thing? I think he was talking about the gaspasser.com author and website, not a poster on this board.

    TD
  6. by   Brenna's Dad
    Wow, interesting and heated debate.

    I'm very sorry to see that Tenesma has departed and left Tejasdoc to take all the heat. Tenesma was a valueable member and always had insightful posts.

    However, as a SRNA, I have to also disagree with you concerning the supervision issue. After I graduate, I will have no problem working side-by-side with MDAs. I value their input. However, as a physician and scientist, how can you argue with the research that consitently demonstrates that MDAs have equal outcomes with CRNAs?

    I must also admit that this statement,

    "The anesthesia care team, which involves an attending anesthesiologist supervising a nurse, provides the majority of anesthesia health care in this country,"

    just rubs me the wrong way. The intent of this statement is to demean the profession of Nurse Anesthesia. The anesthesiologist is given his full professional title and grouped with the words "attending" and "supervising." The CRNA in contrast, is purposely called a nurse, in an effort to marginalize the profession. I'm sorry, but this statement just reaks of disrespect.

    For example, imagine the statement was instead as follows:

    "The majority of anesthesia health care in this country is performed by the anesthesia care team, which involves the MDA sitting in the office getting rich, while the Masters-prepared, board Certified Registered Nurse Anesthetist, provides the anesthetic."

    I imagine this might rub you the wrong way as well. CRNAs are no different than Anesthesiologists. Both professions deserve respect. The above statement does not acheive this end.
  7. by   catcolalex
    well put brenna's dad
  8. by   TejasDoc
    Quote from catcolalex
    Tejasdoc,
    can you elaborate a little more on why you feel that CRNA's need to be supervised?

    "I understand that you feel CRNAs do not need supervision, I disagree, but I think the definition of an anesthesia care team is pretty clear".
    You know Catcolalex, are we opening a nasty can of worms with this discussion? :angryfire

    The simplest answer I can give is that I think anesthesiology is the practice of perioperative medicine and medicine is practiced by physicians.

    Probably not the answer you're looking for, but, hey, what am I going to do?

    Quote from Brenna's Dad
    "The anesthesia care team, which involves an attending anesthesiologist supervising a nurse, provides the majority of anesthesia health care in this country,"

    just rubs me the wrong way. The intent of this statement is to demean the profession of Nurse Anesthesia. The anesthesiologist is given his full professional title and grouped with the words "attending" and "supervising." The CRNA in contrast, is purposely called a nurse, in an effort to marginalize the profession. I'm sorry, but this statement just reaks of disrespect.

    For example, imagine the statement was instead as follows:

    "The majority of anesthesia health care in this country is performed by the anesthesia care team, which involves the MDA sitting in the office getting rich, while the Masters-prepared, board Certified Registered Nurse Anesthetist, provides the anesthetic."

    I imagine this might rub you the wrong way as well. CRNAs are no different than Anesthesiologists. Both professions deserve respect. The above statement does not acheive this end.
    Hey Brenna's Dad, thanks for the comment. I find myself responding to a lot on this board and I just got started. Initiation by fire right?

    "The anesthesia care team, which involves an attending anesthesiologist supervising a nurse, provides the majority of anesthesia health care in this country"

    How about this? "The anesthesia care team, which involves an anesthesiologist supervising a certified registered nurse anesthetist, provides the majority of anesthesia health care in this country" Is that better? Removed the "attending", added your FULL professional title, leaving off whether or not the anesthesiologist is board certified or not, whatever. Supervising, I just don't think you get to take that one off, unless it's not actually true, and that you've got to prove.

    I don't know how referring to you as a nurse marginalizes you, you're a nurse.
    I think there's a discussion about this right now, something to the respect of "Are CRNA's ashamed of being nurses?" Probably interesting, haven't gotten too into it, don't think I have anything to offer that discussion.

    "The majority of anesthesia health care in this country is performed by the anesthesia care team, which involves the MDA sitting in the office getting rich, while the Masters-prepared, board Certified Registered Nurse Anesthetist, provides the anesthetic."

    This is like the donut comment from earlier. Like I said before, I'm sure a lot of this sentiment comes from anesthesiologists who haven't held up their end of the deal and supervised as they should. That's a lot of negativity to already have as a nurse anesthesia student though.

    I really have to finish this message by saying a couple of things, because I want people to know how I feel. I respect CRNAs, and I think nurses provide an INVALUABLE service to the hospital and to our patients. I don't want anyone to think I don't respect what nurses and CRNAs do, the education they have, or their commitment to patient care. We've got our differences, hopefully we can discuss them here respectfully. I know some of the Student Doctor Network discussions have become ... not so civilized, and I don't want to be 'that guy', so to speak.

    Good night,

    TD
    Last edit by TejasDoc on Jun 14, '04
  9. by   kmchugh
    I'm going to try to be the voice of reason, here, and will play both sides of the fence.

    I think the ASA is working to prevent the marginalization of anesthesiologists. They are afraid of the public perceiving that CRNA's doing everything MDA's do, so essentially, the MDA has "stepped down" to the level of nursing. We all know that isn't true, but perhaps in their attempt to prevent this, the ASA has taken the "lower road." Rather than painting MDA's as highly skilled and professional anesthesia providers (which most MDA's I have had the pleasure of knowing were), they have chosen to paint the CRNA as unsafe unless under the direct supervision, if not observation, of an MDA. That is a false construct. The AANA, on the other hand, wants to convince the public that we are equally safe providers of anesthesia, and do not need our hands held while we administer general anesthesia. There is merit to both arguments.

    I have worked in an environment where I was under the medical direction of and MDA, and now work in a hospital with no MDA's. I have seen it both ways, and frankly, I see advantages on both sides of the fence. When working without MDA's, I can run my anesthetic as I see fit. I don't have to wait around for an MDA to start induction, and I set the pace. More than once in my prior job, I have rushed a patient to the recovery room, then run to my next room to find my next patient (whom I haven't even seen) asleep and intubated. It's what we had to do to make the surgeons happy, but I like to know a bit more about my patient than simply what the chart tells me.

    By the same token, when working with an MDA I have a comfort level knowing that there is almost always another pair of hands available if things go down the tubes. It isn't that I don't know what to do, but we have all been in the place where one pair of eyes, one pair of hands were not enough.

    Don't get me wrong, I can take good care of my patients and myself. But in my present position, there has been a time or two when it would have been nice to have a good MDA around to back the surgeon down. In their dealings with me, it is always obvious that the physicians have in the back of their minds "this guy is just a nurse, so ultimately, he's going to do whatever I tell him." Of course, it isn't true, but this mindset often prolongs the discussion. For example, the surgeon who wants a general anesthetic performed on a pregnant woman in her second trimester to repair a 1 cm umbilical hernia, for obvious cosmetic reasons. Or the surgeon who calls from across town saying "I will be there at X time, I want to walk in and cut. So I expect the patient to be asleep and ready for surgery when I arrive at the hospital." In other words, start the anesthetic without me. (Yes, that happened.) It would be nice to refer the surgeon to the MDA, who could tell the surgeon that they are out of their mind, MD to MD. All of us have seen that we can tell the surgeon something, only to have a fight on our hands. Yet let exactly the same words come from an MD, and there is sudden acceptance.

    So, what's the short version? Our organizations (the ASA and the AANA) are in a huge fight. Threads like this contribute to that fight. The fight is counterproductive. Statements like "CRNA's are unsafe without MDA supervision" and "MDA's are only glorified CRNA's" are not true, and only serve to add fuel to the fire. The number of anesthesia providers is falling across the board. At the same time, the number of surgeries is rising. Do the math. Part of the reason that I left my last position was that we were working 60 hour weeks commonly, and 70-80 hour weeks were not rare. We (anesthesia providers) cannot continue that pace forever. We, and our organizations, need to put aside the petty quarrels, and start working as partners, rather than bitter enemies. We need to address the common problems that all anesthesia providers face before we are overwhelmed by those problems.

    To the SRNA's on this board: I must admit to being a bit ticked off. We have an MDA who posts to this board, and often has valuable contributions to make. There is one area where there is a minor disagreement, so you turn on him. He decides it isn't worth the stomach acid to continue, and leaves the board. Nicely done. In short, KNOCK IT OFF. The practice of anesthesia is facing some real challenges. We have to deal with those challenges. You are not helping, you are merely heating the fire of a debate that is ultimately moot. It isn't that we cannot continue to debate the issue, but take a page from Loisann. The debate can be civil and professional. Just because our professional organizations choose to act like children does not mean that we have to do the same thing.

    Kevin McHugh
  10. by   catcolalex
    tejasdoc,
    thanks for your comments, i think that we can all agree that CRNA's and MDA's can work together respectfully. i have a great deal of respect for you and any other physician who puts in the time and effort to go through school and residency and ultimately practice in your fields. I also feel that CRNA's deserve to be adressed as either anesthetists or nurse anesthetists because of the time and effort and schooling that they have undertaken. I am not ashamed of being a nurse, and i dont think that any CRNA is. But i also feel that all CRNA's are proud of being CRNA's and would like to be adressed as such. being referred to as a nurse means "RN" in my eyes. by adressing them as nurses, you take away the extra education, and training and hard work that they have done. Im not saying that you were trying to do that, but i am just explaining how we feel on this side of the fence. the only thing CRNA's would like is to be recognized as what they are. just as being an MDA is something to be very proud of. its not that we don't like being nurses, its that anesthesia provider implication of "anesthetist" that I think CRNA's want to be recognized for.
  11. by   BigDave
    Great post Kevin. I need to buy you a few beers some day for working hard to keep this forum grounded. I am new around here, and not a CRNA/SRNA (yet?), but I do enjoy hearing valuable comments from other anesthesia providers, namely tenesma, georgia aa, and tejasdoc. Yes, it looks as though there is a lot of misinformation, bias, and maybe fear of erosion of professional position. Similar to what you said, we are all going to have to work together and find a solution to the increases in demand or just start living in the OR...

    I have limited personal knowledge of the MDA/CRNA friction. I always thought it was the surgeons that created all the stress. That is the reason that I went to NP school rather than CRNA school...big mistake, and thanks Dr. C---(you jerk!).

    It is good to know that there are all these "issues" between MDAs and CRNAs, or more correctly, the ASA and AANA. Better than being blindsided?

    Am I wrong, or do the practicing CRNAs on this forum seem to have the least negative things to say about MDAs?? Are they just being civil, or did they find a practice setting that provides harmony, rather than strife?

    thanks,
    Dave
    Last edit by NRSKarenRN on Jun 14, '04 : Reason: PEr TOS, removed name
  12. by   deepz
    Quote from TejasDoc
    "Anesthesia is unique ... our unique role is supportive care." Not true.

    .....To say I don't diagnose and attempt to cure, even though I may only treat a condition, belittles what I do, and that's offensive.
    It appears from other posts that TD does NOT accept anesthesia as ALSO a practice of nursing, and therefore insists it to be exclusively the practice of medicine, even though the ASA itself has recently amended their official party line to recognize anesthesia as ALSO the practice of nursing. Not much to discuss there. As is said, "We don't need no stinking badges."

    Regarding the unique nature of surgical anesthesia, I simply cannot comprehend how TD can categorically deny that anesthesia is supportive, not curative. That TD, as a perioperative specialist, may also have other duties outside the OR, beyond surgical anesthesia, duties which mean TD attempts to cure a patient's problem, that's a separate issue. Surgical anesthesia itself cures nothing, seems to me; I'm just getting them through their procedure and out to PACU best as I can. Anesthesia facilitates the efforts of others in their attempts to cure. Yes, it is a secondary role, and it always will be. No problem there for me. Sorry if that offends TD, or if TD finds it belittling to play second fiddle.

    OTOH, does TD repudiate the ASA habit of invariably using the put-down term "anesthesia nurse" to belittle CRNAs?

    deepz
  13. by   loisane
    Quote from TejasDoc
    The simplest answer I can give is that I think anesthesiology is the practice of perioperative medicine and medicine is practiced by physicians.TD

    Sigh, yes this is it in a nutshell. IMHO, all of our professional disagreements can be distilled down to our divergent opinions of the ACT. Organized anesthesiology has defined all anesthesia as the practice of medicine. So their definition of nurse anesthesia is that CRNAs practice delegated medical acts. Of course, nurse anesthesia disagrees.

    It might interest you to know that all the court cases, and legal precedents have favored the nurse anesthesia definition. And to know that not ALL anesthesiologists agree with the ASA party line. Obviously, if some anesthesiologists are working with CRNAs in ACTs where they accept the CRNA as a full participitory member of the team, they have rejected the ASA definition, at least on some level.

    I know you disagree with all of that. But if I remember, you said you are early in your anesthesia career, a new resident? You will be forming your own values and opinions over the coming years. The very fact that you are here indicates to me a willingness to keep an open mind. I encourage you to always try to see the big picture, and decide for yourself.


    loisane crna

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