MD referring to CRNA as 'support staff' - page 2

I know this is a sensitive topic to all. My question refers to how would all of you handle this situation that actually occurred in a pt's room preop. I am most interested in how NOT to overreact... Read More

  1. by   CRNA, DNSc
    Quote from athomas91
    Gotosleepy.....


    http://63.172.231.18/crna/ataglance.asp

    you may want to perhaps cite your opinions better - 29 states in the US have opted out...last time i did the math that was more than 50% of states .....of course i am tired - please feel free to work it out for me.

    As much as I would love it if 29 states had opted out, it is more important that we be accurate in the information posted. At this time 12 states have opted out of the supervision requirement under Medicare part B rules for hosptial participation. Also of note is that in the 2+ years of the opt-out no state has rescinded their opt-out.
  2. by   athomas91
    here is where my misunderstanding came into play - i thought the opt out for independant billing and the opt out of supervision were one in the same....i guess they are not...thank you.

    Certified Registered Nurse Anesthetist
    State/
    Territory
    Name Is the Benefit Offered? Populations Covered Copayment Requirement Prior Approval Requirement Coverage Limitations Reimbursement Methodology
    Alabama
    Yes
    CN



    Fee for service at 85% of physician fee

    Alaska
    No






    Arizona
    Yes
    CN



    Fee for service

    Arkansas
    Yes
    CN & MN



    Fee for service at 80% of physician fee

    California
    Yes
    CN & MN



    Fee for service

    Colorado
    Yes
    CN



    Fee for service

    Connecticut
    No






    Delaware
    No






    District of Columbia
    No






    Florida
    No






    Georgia
    No






    Hawaii
    No






    Idaho
    Yes
    CN



    Fee for service at 85% of physician fee

    Illinois
    No






    Indiana
    No






    Iowa
    Yes
    CN & MN



    Fee for service at 80% of physician fee if medical direction by surgeon or at 60% if medical direction by anesthesiologist

    Kansas
    Yes
    CN & MN



    Fee for service

    Kentucky
    Yes
    CN & MN



    Fee for service at 75% of physician fee

    Louisiana
    Yes
    CN & MN



    Fee for service

    Maine
    No






    Maryland
    Yes
    CN & MN



    Fee for service

    Massachusetts
    No






    Michigan
    Yes
    CN & MN



    Fee for service

    Minnesota
    Yes
    CN & MN



    Fee for service

    Mississippi
    No






    Missouri
    No






    Montana
    Yes
    CN & MN
    $4/episode of treatment


    Fee for service, some services reimbursed at 90% of physician fee

    Nebraska
    Yes
    CN & MN



    Fee for service

    Nevada
    No






    New Hampshire
    No






    New Jersey
    No






    New Mexico
    Yes
    CN



    Fee for service

    New York
    No






    North Carolina
    Yes
    CN & MN



    Fee for service at 90% of physician fee

    North Dakota
    No






    Ohio
    No






    Oklahoma
    Yes
    CN & MN
    $1/service


    Fee for service at 80% of physician fee

    Oregon
    Yes
    CN & MN



    Fee for service

    Pennsylvania
    No






    Rhode Island
    No






    South Carolina
    Yes
    CN



    Fee for service, at 50% of physician fee if teamed with anesthesiologist

    South Dakota
    Yes
    CN



    Fee for service

    Tennessee
    Yes
    A & B-
    See FN



    Fee for service at 44% of physician fee with physician direction or at 80% without physician direction

    Texas
    Yes
    CN & MN



    Fee for service at 85% of physician fee

    Utah
    No






    Vermont
    No






    Virginia
    No






    Washington
    No






    West Virginia
    No






    Wisconsin
    Yes
    CN & MN



    Fee for service

    Wyoming
    Yes
    CN
  3. by   Dixiedi
    Quote from catcolalex
    there are also situations in which CRNA's administer anesthetics without any supervision or direction from MDA's, but the MDA's are available for backup/support. Can we then refer to these MDA's as backup staff, or support staff? I realize that this is not a big deal, but it is a good example of how some MDA's take every opportunity to make sure that CRNA's are put in their place, at the bottom of the totem pole right? A little respect goes a long way.
    Also, to the people that suggested that the nurse just let the comment go and ignore it, thats fine, but it sounded like the MDA should have taken that advice as well. Its not the end of the world if somebody mistakes a CRNA for an MDA.
    Be proud of your advanced certifications. Be proud of the work you do, the pt care you provide. Don't get hung up on the little stuff. If it would not hurt for the CRNA to be referred to as a Doc, what does it hurt for the CNA to be referred to as support staff.

    The Doc trusts your ability or you wuold not have been there, but fact still remains the CRNA is support staff taking on a different responsibility in the OR. However, the CRNA is still a nurse, not a Doctor and just as many RNs have problems with LPNs encroaching on their "turf", many Docs have the same problems with RNs encroaching on theirs. (Notice, I said many, not all)

    Nursing see support staff as dietary, maint., housekeeping, even lab techs and PT to name a few. Nurses are on the middle of the totem pole. When you are sitting higher on the totem pole (the Docs), the nurses also become support staff.

    Most Docs consider nurses as those who carry out their orders and if they didn't write those orders nothing would ever get done.

    Save energies for activism that supports nurses and nurses only. We will never cross the line into medicine, by definition, we are the Docs support, hopefully one day soon, professional support for the Docs.
  4. by   CoreyB
    Dixiedi-

    You're absolutely wrong. Nurses are not support staff. They are the reason patients come to the hospital - for nursing care. If the patient only needed medical or surgical treatment, they would go see the physician at the office or a same day surgery center.

    Your point about nothing being done unless it is written is also wrong. Yes many times nurses are making decisions based on standing orders or protocols, but that is not the same as having the doctor write out everything we're going to do. In fact I know for sure that the cardiothoracic surgeons, trauma surgeons and critical care doctors count on us knowing what we're doing and doing it (within the scope of our practice) without prompting from them. Because if we didn't it would mean either a delay in patient care or an unnecessary phone call to them (probably in the middle of the night). These generalizations maybe more specific to the ICU as that's where I work. However, as the majority of people posting either currently work there or have worked there in the past I think it is a little more relevant to the discussion than home health experience.

    CRNAs are not in the OR to support the anesthesiologist. They are there to care for the patient (manage respiratory/hemodynamic status and keep them as pain free as possible). Using your logic the anesthesiologist would be considered the surgeons support staff. I have a feeling many anesthesiologists would bristle at being labeled that way.

    As for crossing the line into medicine I have two points. First the courts have already determined that anesthesia provided by a CRNA is the practice of nursing. Second, as medical research and technology advance, as physicians' time gets stretched further and further, and as the quality of nursing education continues to improve nurses will continue to expand their scope of practice, not to enter into competition with doctors, but because the healthcare system (needs of patients and docs) demands it.
  5. by   yoga crna
    Dixie,
    Obviously, you are not a CRNA or in an anesthesia educational program. Anesthesia is different!!!. We practice independently, make our own decisions, there are no written orders, standardized procedures, guidelines or protocols. Anyone who works in the operating room, from the surgeons to the housekeeping personnel work as a member of a team, with the patient being our prime focus. I take great offense being called "support staff" and would take on anyone who called me that. We must be careful not to fall into traps that end up being negative to our image for years to come.

    As far as activism goes, CRNAs are the most politically active nurses group and we have done it by ourself. Years ago, organized nursing wouldn't help us, because they didn't think nurses should do anesthesia (or some stupid argument), so we got our own legislation defining our practice, got laws passed to receive direct reimbursement from Medicare and other health insurers and filed anti-trust suits for restraint of trade. Now organized nursing wants help from us--it's funny how time and economics change things. We have always been a strong and active group, have had the guts to fight and know the importance of politics. All the while, we have a history of being excellent clinicians, giving safe patient care and able to make our own decisions. I don't get involved in "little fights", because I simply put a stop to untruths as soon as they happen and take on anyone who distorts the facts. That includes nurses, anesthesiologists, surgeons, the press and anyone else who are uneducated on the facts.

    Yoga CRNA
  6. by   user69
    Could the remark have been meant just to put the patient and there family at ease and not as a major political statement to force CRNAs everywhere to be subservient?

    Also I would think that anyone providing anesthesia (AA, CRNA, MDA) is part of the support staff for the surgery. The reason they are there is not to be put to sleep, but to have surgery. Everything else being done is support.
  7. by   deepz
    Quote from Dixiedi
    .....Most Docs consider nurses as those who carry out their orders and if they didn't write those orders nothing would ever get done.......

    Dixie, and those docs Dixie refers to, would seem to be stuck in the era about 1950 when medical care functioned like a wheel that revolved around the physician. Nowadays we put the emphasis where it belongs: with the patient at the center of it all. And all of us -- docs, CRNAs, other nurses and staff -- we are all among the patient's support staff.

    Still, such condescending putdowns directed at coworkers are uncalled for.

    deepz
    Last edit by deepz on Jul 8, '04
  8. by   Dixiedi
    Quote from stevierae
    You are absolutely wrong here, DixieDi. CRNAs are held to EXACTLY the same standards of care that anesthesiologists are held to.
    To the surgeon, the anestsiologists are support staff.
    I'm not arguing that the surgeon was right. Just that, very likely, from his point of view, he probably was right.

    I personally think both were wrong to even have "noticed" what the daughter said. It was not important in the situation and surely was not proessional for the Doc to have thrown in his 2 cents.
  9. by   gaspassah
    in my humble opinion i believe this discussion revolves around semantics and how the statements are presented in conversation.
    yes every single person is support staff if the patient is the center of attention as deepz mentioned.
    however if you reread the first post the doc was implying the crna was his/her support person for anesthesia
    SHortly later, daughter again referred to CRNA as 'doctor' (she was most likely not processing any info given due to the stress). Here the MD stepped in and corrected the daughter by stating he is not a doctor he is one of our support staff.(direct quote)
    the doctor stating he is one of OUR support staff. anesthesia support staff. clearly condecending.
    i for one would have been upset. every person providing services should be treated as a professional. i try to treat the techs, housekeeping circulators etc like professionals every day. it's not hard to do.
    the doc could have simply stated this person is a crna, i'm a doctor we will be working together to provide your dad with the best anesthesia care possible. that would be more a team approach than a hierarchial one.
    d
  10. by   alansmith52
    I think its all just classic.
    the doc said, did and acted as he was trained to do. (cant you hear them in your minds ear in class, "you are the one in charge, you take on the liablity, no one cares about the patient as much as you.. you... you.. you..)
    I also think we are all support staff to somebody including the (gasp) surgeon.
    some of our collegues simply choose to follow the father of medicines (lucifer) paradigm and choose to elevate themselves above their "brothers" I don't mean for this to be religous. really I don't. It shouldn't be.
    the most natural instict of a competitor is to raise himself above his "enemy" and thats what this guy did. and many before him have done.
    I like what was mentioned earlier.. "consider the source"
    one night on the unit we had an emergent reintubation. the MDA came in. I was excited I talked to him and tried glean perls of wisdom durring the short time I had with him. finally he broke down and said " you want to be a CRNA don't you" I said "yes". he said "oh, so your one of those guys that wants to be a doctor without going to medical school". durring a very formative time in my early nursing he helped me to form an opinoin of MDA's. He showed me the true nature of our field (health care) in general.
    the trick for all of us is to not let our natural insticts take over. this is very difficult for me but I recognize its value.
    Last edit by alansmith52 on Jul 8, '04 : Reason: so spelling fixation
  11. by   probable cause
    nurses are most certainly support staff. do hou have to feel like you're more important than that?
  12. by   gaspassah
    nurses are most certainly support staff. do hou have to feel like you're more important than that?
    yes, yes i do.
    d
  13. by   forane2001
    yes dixie di. if you are ever named in a lawsuit see where the buck stops!!! Crna's are delivering anesthesia. with or without an MDA around. I have a friend that works in a hospital with 3 crnas and 1 mda. each anesthesia provider runs his own room!!. So the idea that CRNA's cant' do anything without MDA is BS. So to all out there that believe CRNA's cant perform--get over yourself.

    Quote from stevierae
    You are absolutely wrong here, DixieDi. CRNAs are held to EXACTLY the same standards of care that anesthesiologists are held to.

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