How do CRNAs/SRNAs benefit anesthesiology residents? - page 5

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 user69
    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.
    Many CRNAs in these type of positions do "voice their opinion with their feet" and leave such situations. They find a more agreeable ACT, or a CRNA only work situation. And sometimes they participate in cyber discussions, and are very vocal about their experiences.

    But not everyone can leave. My first job was in the only medical center in the area. CRNAs were hospital employed. The anesthesiology group was very anti-CRNA in philosophy, but apparantly had no problem with CRNAs creating revenue. CRNAs left regularly, which of course meant relocating your family to another community. But there were some who stayed, for whatever personal reasons. Perhaps spouse, or children who are unwilling to leave the area. Life is about compromises, sometimes you grin and bear it, to make your family happy.

    It takes guts to walk away from your home and start over. Most everyone says the good far out weighs the bad. But not everyone can do it. And I am of the mind to not judge anyone for their willingness or unwillingness to take the big leap.

    This is just my perspective. Maybe there are other explanations as well, because it does seem to be an all too common occurence.

    loisane crna
  2. by   deepz
    Quote from TejasDoc
    (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.
    Congressional committee testimony (under oath??) during his presidency of the ASA ... what? ... 4-5 years ago?
  3. by   georgia_aa
    Quote from loisane
    Many CRNAs in these type of positions do "voice their opinion with their feet" and leave such situations. They find a more agreeable ACT, or a CRNA only work situation. And sometimes they participate in cyber discussions, and are very vocal about their experiences.

    But not everyone can leave. My first job was in the only medical center in the area. CRNAs were hospital employed. The anesthesiology group was very anti-CRNA in philosophy, but apparantly had no problem with CRNAs creating revenue. CRNAs left regularly, which of course meant relocating your family to another community. But there were some who stayed, for whatever personal reasons. Perhaps spouse, or children who are unwilling to leave the area. Life is about compromises, sometimes you grin and bear it, to make your family happy.

    It takes guts to walk away from your home and start over. Most everyone says the good far out weighs the bad. But not everyone can do it. And I am of the mind to not judge anyone for their willingness or unwillingness to take the big leap.

    This is just my perspective. Maybe there are other explanations as well, because it does seem to be an all too common occurence.

    loisane crna
    My practice in the Atlanta area employs approximately 10 CRNAs and 20 AAs. We have VERY little turnover. Most of the CRNAs in this group have been with us for 10 years or more. We have an incredibly cohesive group and we are all great friends. We have a great group of MDAs who truely treat us as colleagues and not underlings. We work hard together and party together frequently. We do extremely difficult cases on very sick patients. We are all gratified professionally. If a CRNA is seeking professional challenge such as the opportunity to do hearts or big vascular cases then they will likely work in a physician supervised setting. If you want to do more bread and butter type cases then you might gravitate to a dual (MD/CRNA) or CRNA only setting. If the really big bucks is what motivates you then MD supervision is not going to be your choice. We make pretty good money as it is and we enjoy our work. No one complains about who bills for what.
    Last edit by georgia_aa on Jun 14, '04
  4. by   kmchugh
    To add to the debate in a (I hope) civil manner:

    I think there is a subtle but very significant difference between referring to us as "anesthesia nurses" versus "nurse anesthetists," a difference that on some level is not lost on the general public. "Anesthesia nurse" implies a nurse who assists the anesthesia doctor, and nothing more. He or she works in the anesthesia department, following the orders of the anesthesiologist. "Nurse anesthetist" recognizes the education and abilities of a person who has sought to be a nurse of higher degree and skill. In short, whether you intend it or not, by referring to us as "anesthesia nurses" you slight us by ignoring the experience and education we have.

    Considering the subtle difference in meaning, were I simply an "anesthesia nurse" I could not work at my present job. We have no MDA's, so there is no one who could direct me in the conduct of my anesthetic. In my small, rural hospital, and most other small rural hospitals, all surgery would have to cease. But, since I am a "nurse anesthetist," I safely and efficiently provide anesthesia care to all my patients. It may seem like a silly point, but I think if the radical members of the ASA had their way, all surgery would cease at places without anesthesiologists.

    If it is a silly point, and "nurse anesthetist" is just a title, then fine. Let's stop using "nurse anesthetist." Let's also stop using "anesthesiologist." From now on, we are all just "anesthesia providers." After all, "anesthesiologist" is just a title, and by ignoring the fact that you are an MD we mean no slight. And the term "anesthesia provider" is much more easily understood by the public. "I'm the person who is going to administer your anesthesia." It certainly removes the confusion. I suspect the ASA would raise the roof were we to actually start a movement to change the titles. How dare we presume to take the title "anesthesiologist," and all that implies, from MD's? By the same token, then, how dare the ASA take away the title nurse anesthetist, and all it implies, from us?

    Does that make it a bit clearer why CRNA's object to being called "anesthesia nurses?" It isn't that we are not nurses anymore, nor are we ashamed of being nurses. However, the title "nurse anesthetist" gives us credit for the education and experience we have, while the title "anesthesia nurse" tries to marginalize us.

    I said in my earlier post that anesthesia as a discipline faces a number of severe problems, which are not helped by this AANA vs ASA debate. To me, referring to CRNA's as "anesthesia nurses" is just another attempt by the ASA to continue this debate, to the detriment of solving the real problems that face all of us.

    Kevin McHugh
    Last edit by kmchugh on Jun 15, '04
  5. by   Sheri257
    Quote from kmchugh
    To me, referring to CRNA's as "anesthesia nurses" is just another attempt by the ASA to continue this debate, to the detriment of solving the real problems that face all of us.

    Kevin McHugh
    Does anybody know of a link where the ASA actually said this? I could not find anything on their website or with a google search where they referred to CRNA's as "anesthesia nurses," but perhaps I missed something.

    However, the ASA website does have tons of references where they do refer to CRNA's as "nurse anesthetists."

    Last edit by Sheri257 on Jun 15, '04
  6. by   user69
    Quick question for the CRNAs that are practicing now.

    Does a MDA take offince to the term "Anesthesia Doctor"?
  7. by   J.L.Seagal
    "I suspect the ASA would raise the roof were we to actually start a movement to change the titles. How dare we presume to take the title "anesthesiologist," and all that implies, from MD's? "--by Kevin M.


    I once shadowed a CRNA who was written up because she allowed her patient to call her an anesthesiologist. Actually the CRNA corrected the patient and explained her title to the patient, but the pt. continued to call her an anesthesiologist(while winking at the CRNA at the same time).

    Well, the situation was misinterpreted by an MDA resident who reported the incident to his superiors...who in turn hit the roof. Soon after, a memo was circulated to remind all providers that the title of "anesthesiologist" was the exclusive domain of MDAs, etc, etc....

    Apparently, this issue of titles is not new, nor do I believe that MDAs would give up their title of anesthesiologist for "anesthesia provider." Nice concept, though Kevin!
    Last edit by J.L.Seagal on Jun 15, '04
  8. by   kmchugh
    Understand that my point was not that we should stop using the honorific "anesthesiologist." Nor would I suggest that CRNA's be allowed to identify themselves in that manner. My point was that MDA's would bristle at the suggestion that we stop using the honorific in favor of a more general, less specifically identifying term. Why then is it so difficult to understand why many CRNA's might object to being referred to by the less specific term "anesthesia nurse" as opposed to the honorific "nurse anesthetist?"

    KM
  9. by   TejasDoc
    First, user69, in case you're wondering. I wouldn't care if someone wanted to refer to me as an anesthesia doctor. I think 'MDA' is a much goofier thing, just type out 'anesthesiologist'.

    J.L. Seagal, how is referring to an anesthesiologist as an 'anesthesia provider' a 'nice concept'? I just don't get it, what's nice about it? I feel like comments like that are only negative, "Let's see how they feel if they get called a provider. I bet they won't like it, will get mad, and then I'll get happy. Woohoo!"

    Quote from kmchugh
    I think there is a subtle but very significant difference between referring to us as “anesthesia nurses” versus “nurse anesthetists,” a difference that on some level is not lost on the general public. “Anesthesia nurse” implies a nurse who assists the anesthesia doctor, and nothing more. He or she works in the anesthesia department, following the orders of the anesthesiologist. “Nurse anesthetist” recognizes the education and abilities of a person who has sought to be a nurse of higher degree and skill. In short, whether you intend it or not, by referring to us as “anesthesia nurses” you slight us by ignoring the experience and education we have.
    Kevin, good post by the way, but I think we can disagree on this in a civil manner. I totally agree with you that there is a subtle different in calling someone a 'nurse anesthetist' and an 'anesthesia nurse', but it's only subtle here, in these discussions about CRNAs and anesthesiologists, their differences and similaries, etc, etc. It is TOTALLY lost on the general public. I agree with you that if you say 'anesthesia nurse' people think that you are supervised and work under an anesthesiologist. But I don't think if you say 'nurse anesthetist' to someone in the general public, they automatically think, "Wow, first I thought you were a nurse who worked under a doctor. But now, since you said 'anesthetist', I know you're an advanced practice nurse with ICU experience and extra classroom and clinical education in the field of anesthesia."

    Quote from kmchugh
    If it is a silly point, and "nurse anesthetist" is just a title, then fine. Let’s stop using “nurse anesthetist.” Let’s also stop using “anesthesiologist.” From now on, we are all just “anesthesia providers.” After all, “anesthesiologist” is just a title, and by ignoring the fact that you are an MD we mean no slight. And the term “anesthesia provider” is much more easily understood by the public. “I’m the person who is going to administer your anesthesia.” It certainly removes the confusion. I suspect the ASA would raise the roof were we to actually start a movement to change the titles. How dare we presume to take the title “anesthesiologist,” and all that implies, from MD’s? By the same token, then, how dare the ASA take away the title nurse anesthetist, and all it implies, from us?
    Titles aren't a silly point, people work hard for them. If you want to be called a 'nurse anesthetist', by all means, I think you should use it. Professionally, it has a huge meaning, and within the confines of a hospital or the medical/nursing professions I think it says "I'm an advanced practice nurse with ICU experience and extra classroom and clinical education in the field of anesthesia." And I like 'anesthesiologist', it has both a professional and a 'general public' meaning, it means 'anesthesia doctor'. BUT, it's not my title, my title is 'Dr.'.

    Though, I would NEVER want to be an 'anesthesia provider'. I think being a 'provider' belittles all of us in health care. Insurance companies like to use the term 'provider'. But I'm a doctor, and there are patients, and when someone says "That's my doctor.' or 'He's my patient.', that implies a special relationship that we have. Why would I want to change out 'anesthesiologist' for that? I think the general public is just fine with the term 'anesthesiologist'.

    This discussion though just underlines a much bigger issue for the AANA and advanced practice nursing in general. The public thinks that care provided by a doctor is better than care provided by a nurse and that nurses answer to doctors, advanced practice nurse or not. Whether or not this is actually true, it doesn't matter. All the lobbying of Congress and state legislatures is not going to change that. The professional organizations could take out billboards and television ads, but it won't matter. No study saying our care is equal is going to matter.

    Quote from kmchugh
    Does that make it a bit clearer why CRNA’s object to being called “anesthesia nurses?” It isn’t that we are not nurses anymore, nor are we ashamed of being nurses. However, the title “nurse anesthetist” gives us credit for the education and experience we have, while the title “anesthesia nurse” tries to marginalize us.
    I don't think you're ashamed, and from reading most of the posts on this board, I think it's the exact opposite, I know you're proud of being nurses, your nursing background, and the history of nursing and nurse anesthesia in general. You should be.

    Quote from kmchugh
    ... but I think if the radical members of the ASA had their way, all surgery would cease at places without anesthesiologists ...
    I don't know if believing this makes you a radical. I think it sounds more radical though. There are many areas in this country that cannot get physician specialists to practice there. Neurosurgery is a good example. They designate trauma centers partially by there ability to attract a neurosurgeon to practice there. Level 2 if you have a neurosurgeon, level 3 is you don't. (there are other things that make a level 2 and 3 trauma center, but the difference between the 2 is the neurosurgeon) Does that mean that certain areas are not served by a neurosurgeon? Sure, I think it does. Does that mean that I think there should be a nurse neurosurgeon to serve these areas? No, I don't think that's a good idea. Anyway, this is just a long-winded way of saying I don't think it's necessarily a radical belief, but just not a widely held one. I think most anesthesiologists don't make a big deal about it because it does not affect their personal practice of anesthesia and many see rural CRNAs providing a useful service. I don't know yet how I feel about the issue, I'm going to let myself gain more experience before I decide.

    I imagine this last comment is going to be the one that most people comment about, but I hope not, and only because it was just a small point in a post of bigger points.

    TD
    Last edit by TejasDoc on Jun 15, '04
  10. by   loisane
    Quote from lizz
    Does anybody know of a link where the ASA actually said this? I could not find anything on their website or with a google search where they referred to CRNA's as "anesthesia nurses," but perhaps I missed something.

    However, the ASA website does have tons of references where they do refer to CRNA's as "nurse anesthetists."

    While I guess I should not speak for Kevin, I do think I know what he meant. It isn't that the ASA has used that phrase in print. It is terminology used in conversation, a spoken thing.

    As I described in my previous post on this, when an anesthesiologist refers to me in this way, it tells me what he thinks of my role function in the team. And that is the same definition that the ASA uses of the ACT. This is what I thought Kevin meant when I read his post.

    loisane crna
  11. by   Brenna's Dad
    Just to clarify things Tejadoc, although I'm sure everyone knows this, Nurse Anesthetists are not mearly, "an advanced practice nurse with ICU experience and extra classroom and clinical education in the field of anesthesia.". CRNAs hold Masters degrees in Anesthesia. I'm probably just being senstive again, but the statement makes it sound like we spend 2-3 weeks in class.

    The comment likening Nurse Anesthetists to Nurse Neurosurgeons is absurd. There is no relationship. Nurse Anesthesia is an established profession that has been providing anesthesia services for over 100 years.
    Last edit by Brenna's Dad on Jun 15, '04
  12. by   deepz
    Quote from TejasDoc
    .....I think 'MDA' is a much goofier thing, just type out 'anesthesiologist'........
    How about DOA? Would you accept that? 'Doctor Of Anesthesia'?

    Seriously, of course the MDA thing only started as shorthand, much as CRNA compresses the polysyllabic certifiedregisterednurseanesthetist. MDA = 3 syllables, anesthesiologist = 7 and five times the number of letters.

    So it now seems puzzling that you feel 'MDA' is goofy, yet 'anesthesia nurse' is only a 'subtle difference' from CRNA. See my point? I suggest such condescension from the ASA is not subtle, not in the contempuous context they employ it. Boils down to this: whose ox is being gored.

    Our profession names itself. So did yours; the word anesthesiologist first appeared back in 1937. For the ASA to recently presume to change our title to fit their view of our role in the world is simply unacceptable.

    deepz
  13. by   user69
    Quote from Brenna's Dad
    Just to clarify things Tejadoc, although I'm sure everyone knows this, Nurse Anesthetists are not mearly, "an advanced practice nurse with ICU experience and extra classroom and clinical education in the field of anesthesia.". CRNAs hold Masters degrees in Anesthesia. I'm probably just being senstive again, but the statement makes it sound like we spend 2-3 weeks in class.

    The comment likening Nurse Anesthetists to Nurse Neurosurgeons is absurd. There is no relationship. Nurse Anesthesia is an established profession that has been providing anesthesia services for over 100 years.

    Do all CRNAs hold Masters degrees? Or do some just hold a cert?

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