How do CRNAs/SRNAs benefit anesthesiology residents? - page 4

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 TejasDoc
    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.

    TD
    Actually, I encourage you to check it out. I started that thread, in an attempt to tell some history, and how it is still affecting all anesthesia practice (mostly nursing, but is bound to affect medical anesthesia also). I think it has alot to do with our discussion here.

    There is another thing here that physicians fail or choose not to see. The public and the media have dumped all of nursing into one big bag. As an example, is anybody else a Survivor junkie? Tina, who won one of the seasons, was always identified as a nurse. You know her real job title? She is a NURSES AIDE!

    So even RNs, and most especially APNs (advanced practice nurses, master-prepared CRNAs, midwives, clin nurse specialists, and nurse practitioners) have learned to be tenacious about hanging on to their titles, in order to not get lost in the mix. Seems like such a small thing to ask of our collegues in medicine, to get our titles right. Once they are educated to the issue, and still hang onto the "anesthesia nurse" phrase, it usually makes me questions their motives a bit.

    loisane crna
  2. by   Sheri257
    As a layperson, I'm a little confused by the title argument. I could understand the problem if people referred to CRNA's as just nurses. But I can also understand how people might say "anesthesia nurse" instead of "nurse anesthetist."

    The word "anesthetist" doesn't roll off the tongue that easily with all of those t's ... it's almost a tongue twister, of sorts. Are you sure it's meant to be insulting? Or, is it just easier to say "anesthesia nurse" in conversation?

    And why would it be insulting? I'm just trying to understand why CRNA's find this objectionable.

    Last edit by Sheri257 on Jun 14, '04
  3. by   loisane
    Quote from lizz
    And why would it be insulting? I'm just trying to understand why CRNA's find this objectionable.

    I believe there is a difference in the use of the phrase between a layperson and a health professional.

    I was talking about the use of the phrase among anesthesiologists. They are perfectly capable of pronouncing anesthetist.

    Whenever an anesthesiologist routinely and persistently refers to me as an "anesthesia nurse", I always wonder if there is a hidden agenda. Perhaps they are deliberately emphasizing the traditional hierarchial, controling relationship of physicians over nurses. It says to me, that this anesthesiologist does not view me as a collegue or a full team member. They expect to give orders, and expect me to follow them.

    I suppose it is possible that there may exist an anesthesiologist who uses that phrase, and does not mean it in that way. But I have yet to meet such a person.

    The anesthesiologist who I have worked with in positive, collegial team environments, do not refer to me as an "anesthesia nurse".

    loisane crna
  4. by   TejasDoc
    Quote from deepz
    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
    As for the practice of medicine, practice of nursing subject. We're never going to agree, I didn't expect we would, but I didn't want to ditch the question, since it would seem as though I am dodging it to save myself from an uncomfortable position. We can disagree on this one in a civil manner deepz. Though, I have to say that I think even the law agrees that anesthesia is the practice of nursing and medicinem, as far as I know. I think the ASA still thinks anesthesiology is the practice of medicine though, you should visit their website, the following page states it pretty clearly, but maybe it's out of date, if you could point me to a reference deepz, I'd appreciate it. I might be wrong, but you'll have to excuse me for not believing you, just because you said so.
    http://www.asahq.org/patientEducation.htm

    I don't play second fiddle in the OR deepz, I play a different fiddle, and I'm totally cool with that. If I had a sensitive ego, I wouldn't have gotten into anesthesiology. While in med school, I told an older surgeon, "I don't think young surgeons think much of anesthesiologists." He said to me, "Young surgeons don't think much of anyone but themselves." I laughed and it gave me a perspective on ego. And I'm sure you've saved your share of surgeons from hurting a patient. For now, I'm just going to concede your point on the "curative" role of anesthesia. I think Tenesma once posted all the things you can cure with anesthesia, it's out there if you want to look for it. But I can't concede that anesthesiology does not diagnose and treat with a very important critical care medicine component.

    The ASA and the "anesthesia nurse" comment, especially if being said in a derogatory manner, no, of course I cannot condone. But show it to me, show me where an official ASA document uses "anesthesia nurse" in a derogatory manner. It might be out there, who knows? BUT, I think the difference between an anesthetist and an anesthesiologist is lost on the VAST MAJORITY of the population. I'm just guessing, don't have any actual facts to support this, but I would bet that your average college educated American, if asked what an anesthetist was, would say "The doctor who puts me to sleep when I have surgery." They're not being rude, they just don't know. If you say "anesthetist" to a patient without "nurse" in front of it to exploit their ignorance, shame on you. Anesthesia nurse and anesthesia doctor are REALLY simple to understand, and if you use those terms to belittle those who work with you, again, shame on you. But if you use them to explain what might be a difficult concept to a less than savy patient so they can understand the members of their anesthesia care team better, no harm. But I'm going to always make it a point to say nurse anesthetist, now I know it's an issue, and I don't want it taken the wrong way, which it might. All honesty, I want to give you all the respect you deserve, and I think that saying 'nurse anesthetist' does give you credit for a lot of education and experience.

    As a response to Kevin McHugh, REALLY well said. You had a really thought provoking post on the SDN before too right? We might not agree on everything, but I enjoy reading your opinions, and I think you really make some great points.

    Loisane, yep, I'm a new resident, and I'm trying to keep an open mind but to be honest, it's struck me as a fine idea to just find myself an all anesthesiologist practice when I'm done and not have to deal with a lot of this. The supervision thing is tough I imagine, if you're an anesthesiologist, and you respect the CRNAs you supervise (think they're well educated, capable, make good clinical decisions, have a wealth of knowledge and experience), you give them a lot of autonomy, then I see them coming to boards like this and saying you have donut breath and are getting rich and not doing anything. They never say anything to you, but theres an undertone of resentment that exists in that relationship. If you micro-manage, just the opposite, the CRNAs won't think you respect them, that you think their education and experience are worthless and that you need to hold their hands or they'll screw something up. Again, they're out on a message board saying how the anesthesiologists think they're incompetent technicians and the resentment, still there. Sometimes I think that if I can avoid it, I should. Oh well.

    TD
    Last edit by TejasDoc on Jun 14, '04
  5. by   Athlein1
    Tejas,
    Thank you for editing your post (not only the personal information part, but also the content about the MDA thing as well as the JUST NOT THE SAME remark). I think you realized that those portions were also inflammatory, and for that, you deserve recognition that you are trying to participate in a level-headed discussion in a tactful manner.

    I find it regrettable that Tenesma has decided to stop posting. I take responsibility for the part my post played in that decision. My response to his post had a comment that could be construed as personal, which is why I immediately removed it.

    I really do wonder what interest physicians and AAs have in this board, though I absolutely agree that their posts are often interesting and thought-provoking. At the same time, I believe they can also be inflammatory and condescending, whether intentional or not. It is naive to think that we would welcome statements describing anesthesia as the practice of medicine and espousing mandatory medical supervision for anesthetists on a pro-nursing, CRNA message board.

    If statements like these don't get our hackles raised, then how can we possibly hope to maintain the broad scope of anesthetic practice we enjoy today? Modern practice evolved as a direct result of the hard-earned efforts of nurse anesthetists who spent their entire careers working to receive recognition and fight for our rights to practice anesthesia. To acquiesce to efforts to define anesthesia as a practice of medicine or otherwise limit the scope of nurse anesthesia practice is a disservice to the profession - past, present, and future, even if such is undertaken with the aim of fostering improved relations between the two professions.
  6. by   loisane
    Quote from TejasDoc
    it's struck me as a fine idea to just find myself an all anesthesiologist practice when I'm done and not have to deal with a lot of this. TD
    Well, that is certainly one of your choices. But, I believe there is another as well.

    IMHO, the "donut breath" type comments are aimed at anesthesiologists who do not direct, and yet charge for it. CRNAs who work in these environments are capable of non-directed care. That is obvious, because that is how the care is being delivered. And yet, they are not respected for the level of that care.

    Another solution is to not charge for direction, if you do not give it. Charge as supervised, or non-directed (two other Medicare charge categories).

    If an anesthesiologist opinion on CRNAs is they "think they're well educated, capable, make good clinical decisions, have a wealth of knowledge and experience", they can practice in ACTs where CRNAs are not directed. The ASA wants you to believe that your only choice is direct CRNAs in a ACT or work in a MD only practice. You DO have other choices.

    These ACTs exist, and these non-ASA anesthesiologists exist. I wish they would become more active in their association. They are invisible in our current turf battles. Your job as a resident is to look for role models, and find the ones that fit your personal beliefs and values. It is my sincere hope that more and more anesthesiologist residents will come to question some of the traditional ASA mantras. Obviously, that is my pro-nursing postion. But I honestly believe that it is the best course for the care of our patients.

    I may not sway your opinion. But I challenge you to at least look at your choices critically.

    loisane crna
  7. by   Brenna's Dad
    Tejasdoc,

    I just wanted to emphasize that my comment, relating to the MDA sitting in the office getting rich, was ONLY intended to demonstrate the power of words and provide an example of a phase an anestheiologist might not appreciate.

    I thought I had made that clear, but my apologies if I did not.

    Believe me when I say that I have noting but the upmost respect for most of the anesthesiologists I work with and the anesthesiologist profession as a whole.
  8. by   deepz
    Quote from TejasDoc
    ......I think the ASA still thinks anesthesiology is the practice of medicine .......

    Undoubtedly. So do I. But to categorically deny that anesthesia is ALSO the practice of nursing flies in the face of reality. It is both. Of course the ASA does not represent all anesthesiologists, but for years the radical leadership of the ASA (Eg. Dr John [did 300,000 cases by myself] Neeld) not only insisted that anesthesia was solely and exclusively the practice of medicine, they also refused a dialog with the AANA unless and until the AANA acknowledged the primacy of that ASA policy.

    Then last year a funny thing happened. The new leadership of the ASA opened the possibility that the two groups could dialog with *no* preconditions. That overture had to be approved by the ASA Delegates, I believe. And the two groups have now had a number of meetings. More info available at aana.com

    deepz
  9. by   Kiwi
    I regret that Tenesma, or any other MDA would cease posting here. AAs as well for that matter. There are few on this board who "scoff" their comments, but many of us who at least want to learn what they have to say. Undoubtably, there are veteran CRNAs who have experienced emotional torment, unkindness, and even humiliation from smug docs. Here, at least there is a safe harbor for learning and conversing and disagreeing - whatever. SRNAs can carry on the torch and hopefully reconciliation can be made step by step between MDAs and CRNAs.

    But I stop keeping an open mind if the poster is not pro-CRNA. And yes... MDAs, and AAs can be pro-CRNA.
  10. by   Kiwi
    Quote from TejasDoc
    If you say "anesthetist" to a patient without "nurse" in front of it to exploit their ignorance, shame on you.
    I disagree. Anesthetist carries the context of practitioner. Conversely, if I earned my doctorate (PhD) after becoming a CRNA (and could officially be called Dr. Kaufman), it would probably imply to the pt that I was an M.D.
    In that case, it may be innappropriate. Is "CRNA DNSc" out there to answer this one?
  11. by   TejasDoc
    Quote from deepz
    Then last year a funny thing happened. The new leadership of the ASA opened the possibility that the two groups could dialog with *no* preconditions. That overture had to be approved by the ASA Delegates, I believe. And the two groups have now had a number of meetings. More info available at aana.com
    deepz
    Yeah, I've seen some of the information about these meetings, I just get my info from a different website.
    :chuckle

    Thanks for the heads up.

    Quote from Athlein1
    I really do wonder what interest physicians and AAs have in this board
    I think the subject matter is interesting, people get pretty heated in their discussions, especially with anesthesiologists involved, I like to argue, great instant feedback about my opinion. I'd rather not have these discussions with people I work with. There's my interest. And honestly, I originally posted here because I thought the comment about the CRNA's at Wake Forest needed some clarification.

    Quote from deepz
    Eg. Dr John [did 300,000 cases by myself] Neeld
    I tried to hunt this little piece of information down, where did this come from? I'm dying here Deepz, my need for references is just killin' me.

    Quote from ether
    ... it would probably imply to the pt that I was an M.D. ...
    I agree Ether, I think it would imply to the patient that you were an anesthesiologist. This happens all the time in medical school, lots of students get their Ph.D. before completing their M.D., I think it's suspect for them to call themselves 'doctor' in the hospital setting.

    Quote from loisane
    I may not sway your opinion. But I challenge you to at least look at your choices critically.
    You may be surprised, my opinion can still be swayed. It's too early for me to have developed all my opinions just yet. And another problem with my view of the anesthesia care team is that i've only ever seen it done one way, anesthesiologist supervising CRNAs. I'm positive there are other ways out there to make it all work.

    TD
  12. by   CRNA, DNSc
    Quote from ether
    I disagree. Anesthetist carries the context of practitioner. Conversely, if I earned my doctorate (PhD) after becoming a CRNA (and could officially be called Dr. Kaufman), it would probably imply to the pt that I was an M.D.
    In that case, it may be innappropriate. Is "CRNA DNSc" out there to answer this one?
    Yes I am out here. As one of the few (<1%) doctorally prepared CRNA in the US today this is a situation that I deal with in the following ways. To my students I am Dr. -----, to my fellow CRNAs I am --(first name)-- or Dr. ---- which ever they are more comfortable with, likewise the MDs, to others in the hospital I am Dr. ----- but to my patients I am "your Certified Registered Nurse Anesthetist, Dr (first Name) ------ and today I will be administering your anesthesia and working with Dr.----- your physician anesthesiologist". I also take this opportunity to educate patients and family members about CRNAs and the anesthesia care team model so they know who is taking care of them and how.
  13. by   user69
    Quote from loisane
    IMHO, the "donut breath" type comments are aimed at anesthesiologists who do not direct, and yet charge for it. CRNAs who work in these environments are capable of non-directed care. That is obvious, because that is how the care is being delivered. And yet, they are not respected for the level of that care.
    I am still confused on why a CRNA would work for any MDA, much less one that does not have proper respect for a fellow professional. I understand that an AA has to be supervised, so it makes since on why they work for a MDA. But from my understanding is that a CRNA can work and bill independently in all 50 states without any involvement of a MDA. There must be some reason that I am missing on why a CRNA is willing to work for a smaller piece of the pie.

    Can someone break this down for me please.

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