How do CRNAs/SRNAs benefit anesthesiology residents?

Specialties CRNA

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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 affect and benefit the anesthesiology residency program at Wake Forest.... " Another benefit of nurse anesthesia in a residency training program is the availability of nurses to relieve residents at the end of the day, so that residents can do their preoperative assignments and get home at a reasonable hour, have dinner with their family....." http://www1.wfubmc.edu/anesthesiology/Education/Residency/FAQ.htm

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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!"

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."

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.

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.

... 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

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."

:confused:

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

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.

Specializes in Anesthesia.
.....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

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?

It isn't that the ASA has used that phrase in print. It is terminology used in conversation, a spoken thing.

Well, hopefully you can understand my confusion. There have been posts on other threads as well where CRNA's have said the ASA refers to them as "anesthesia nurse." It could easily lead one to believe that the ASA, as an organization, frequently refers to CRNA's in this manner when, apparently, they have not (at least in an official capacity).

And, as you have pointed out, not all anesthesiologists have referred to you in this manner, instead using the proper title "nurse anesthetist." Is this, perhaps, a problem with some but not all MDA's?

:coollook:

Quick question for the CRNAs that are practicing now.

Does a MDA take offince to the term "Anesthesia Doctor"?

Actually, in the hospital I'm in, a few of the MDAs introduce themselves as just that. All introduce me as a nurse anesthetist if they happen to see the patient first. We all seem to have respect for each other. And, I make sure that they know we work as a team to provide a safe anesthetic, I also let the patient know that I will be sitting by their head keeping them asleep, as pain free as possible and safe (try telling your patients this, you will see a lot of worry and tension leave their faces). BTW, the supervising in my hospital is really just to start the case, they are moving on before the tube is taped. Little or no real direction as to how to run the case, just provide a safe anesthetic.

for user69,

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

I think all programs are Master's now. I am seeking a post-master's

certificate program...exact same science/clinical, but not repeating the nursing theory and thesis stuff. Truefully, another nursing theory class

would kill me!

The certificate is only for people who already hold the level of degree.

I do think that there are some NAs (as well as NPs) who have been

working long enough to have been though a cert-only program??

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

All current CRNA programs offer at least a Master's Degree. This is a relatively recent requirement for CRNA programs considering their 100 year history. I'm sure someone will correct my numbers if I'm wrong, but I think somewhere between 1/4 and 1/3 of currently practicing CRNA's hold no degree, unless they earned it after their anesthesia certification. There are a lot of CRNA's out there with a 2 year ADN or 3 year hospital nursing program diploma, and a two year nurse anesthesia program certificate.

I would like to respond to the whole concept of CRNAs/MDAs in the hospital. I just graduated with my BSN and my program obviously is very pro-nursing. I had a very similar conversation to this one with one of my professors, who is a MSN, DNS about how the CRNA program at our school handleded clinicals. The main hospital our CRNAs do clnicals in is a level one trauma/teaching hospital, which has CRNAs and MD residents. I did not want to go to clinical and feel inferior to docs in any way (by that I mean anything from attitudes of others to CRNAs getting the "lesser" OR cases). Her response to me, which I have though a lot on was "Do you want to be a junior doctor? or a senior nurse?" I CHOSE to be a nurse. I AM a nurse. When I go back to school I will become a CRNA, which means I will be an advanced practice nurse. Now, for all my rambling about pro-nursing, does that mean I don't respect MDAs or residents? No, it doesn't, it means I respect the fact that they chose to be doctors, and thier profession is EQUALLY as important as mine. I see doctors as no better than nurses, or vice versa. With regard to TDs posts, the question of why CRNAs want to be recognized as "nurse anesthetists" is because we do provide basically the same care as you (I know it's not identical, but we can compromise here a little). However, you as a MDA get to be recognized and respected as a doctor, while we are just seen as "anesthesia nurses" by some.

PS TD-I do enjoy reading your posts because as a young, new nurse I feel the bickering between professions needs to end, and the time is now. The new generation of coming nurses and doctors need to meet in the middle and respectfully defend their positions while hopefully enlightening the other side. In short, I think we have a lot to learn from you, but you can learn from us as well. I thinking you posting on this site is a great beginning and applaud you for being so open with us, as it does leave you open to be jumped on (for lack of a better word) by us.

I would like to respond to the whole concept of CRNAs/MDAs in the hospital. I just graduated with my BSN and my program obviously is very pro-nursing. I had a very similar conversation to this one with one of my professors, who is a MSN, DNS about how the CRNA program at our school handleded clinicals. The main hospital our CRNAs do clnicals in is a level one trauma/teaching hospital, which has CRNAs and MD residents. I did not want to go to clinical and feel inferior to docs in any way (by that I mean anything from attitudes of others to CRNAs getting the "lesser" OR cases). Her response to me, which I have though a lot on was "Do you want to be a junior doctor? or a senior nurse?" I CHOSE to be a nurse. I AM a nurse. When I go back to school I will become a CRNA, which means I will be an advanced practice nurse. Now, for all my rambling about pro-nursing, does that mean I don't respect MDAs or residents? No, it doesn't, it means I respect the fact that they chose to be doctors, and thier profession is EQUALLY as important as mine. I see doctors as no better than nurses, or vice versa. With regard to TDs posts, the question of why CRNAs want to be recognized as "nurse anesthetists" is because we do provide basically the same care as you (I know it's not identical, but we can compromise here a little). However, you as a MDA get to be recognized and respected as a doctor, while we are just seen as "anesthesia nurses" by some.

PS TD-I do enjoy reading your posts because as a young, new nurse I feel the bickering between professions needs to end, and the time is now. The new generation of coming nurses and doctors need to meet in the middle and respectfully defend their positions while hopefully enlightening the other side. In short, I think we have a lot to learn from you, but you can learn from us as well. I thinking you posting on this site is a great beginning and applaud you for being so open with us, as it does leave you open to be jumped on (for lack of a better word) by us.

TennRN2004, I want to congratulate you on finishing nursing school. And I agree with you totally, we have a lot to learn from each other, and I have no problem admitting that I can learn a lot from the experience of the CRNAs here and at work and I can learn a lot about anesthesia care from ya'll too.

As far as I'm concerned, the issue of 'anesthesia nurse' vs. 'nurse anesthetist' is answered for me. I understand ya'll's viewpoint on the issue, it is a reasonable request, and I have no problem making sure to address you and refer to you as nurse anesthetists.

I don't understand exactly what your professor meant ... junior doctor vs senior nurse. Did he/she mean junior doctor as in resident, or junior doctor as in someone who doesn't know very much? I don't know, you know the conversation, in its context. Anyway, please elaborate.

Now, I do want to address something, only if to make you think about something a little, if you haven't already, and maybe you have. You said you chose to be a nurse, you are a nurse, and you want to be a CRNA. I applaud you for your accomplishments and your dreams. You have conquered difficult training and you have plans for even more rigorous training in the future. I guess I'm interested, since you're so young (I'm young too, we're probably very close in age, I imagine), why chose being a CRNA over being an anesthesiologist? (I promise, I'm trying to ask this question in the least loaded way possible) Is it because you really want to be a CRNA, with everything that it means to be a CRNA now, or is it because you want to be in the anesthesia field, but don't want to spend 4 years in medical school and 4 years as a resident?

I guess what I'm saying is this. If you want to practice anesthesia with the rights, priviledges, respect and recognition of an anesthesiologist, go to medical school and finish a residency in anesthesiology. And if you want to be a CRNA, with all the rights, priviledges, respect and recognition of a CRNA, by all means, good luck, it's a worthly and impressive goal also. But to me, it seems wrong, if you train to be a CRNA and then try to legislate your way to being treated like an anesthesiologist.

Good luck, I look forward to hearing what you think about all this. And no worries, I knew coming into this that being 'jumped on' what part of the gig.

TD

P.S. Deepz ... D.O.A. huh? Doctor of anesthesia. Dream on buddy. I know what kind of fun you have with the whole 'A$A' thing, I can only imagine what you would do with DOA. Alas, your dream will never be a reality.

Specializes in Anesthesia.
..... to me, it seems wrong, if you train to be a CRNA and then try to legislate your way to being treated like an anesthesiologist.....

OMG. Can't change a leopard's spots. Can we really have a free and open conversation, grounded in the here and now, if your preconceptions keep getting in the way? Legislate our way into exactly what, doctor? CRNAs've been doing the heavy lifting for over a hundred years now already. We are not doctor wannabees, just anesthetists. It seems you don't distinguish between the two. Perhaps you still believe general anesthesia 'cures' asthma?

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