MD referring to CRNA as 'support staff'

  1. 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 but to correct the impression left on the pt and family by the MD. What happened:

    Pt being prepped somewhat 'emergently electively'. Pt and family present. OR crew, CRNA providing anesthesia for pt and MDA in room all together reviewing procedure, prepping to roll to OR. pt daughter (distressed and acting inappropriate by flirting with all males present in room) at one point made the mistake of referring to the CRNA as 'Doctor'. CRNA politely corrected pt daughter by giving a short explanation of his role/title to daughter.I dont remember exactly what he said but it was basically 'I'm a nurse anesthetist and I'll be giving your dad the anesthesia to get him to sleep for surgery'. 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 (direct quote)

    Oh, he is not the doctor, he is just one of our support staff.

    The CRNA did not say anything about this. I was a lot annoyed and began wondering if the CRNA is 'support staff' how does she (the MDA) view nurses etc she works with??How would all of you have responded to assert your role and also not ruffle the MD's feathers?? Not trying to be inflammatory just want diplomatic responses!
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  2. 29 Comments

  3. by   athomas91
    it definately would have ruffled my feathers......
    i have already on numerous occassions educated patients as to what a CRNA is, what they do, and that they can and do function independantly of physicians ..in addition i add that they were the first to provide anesthesia - and provide approx 65% of all the anesthesia today....

    many of my classmates have had the opportunity to educate residents and Doc's (believe it or not) who truly didn't know our scope of practice....amazing.
  4. by   zenman
    The daughter probably didn't process anything the doc said either. Just let it roll on!
  5. by   Dixiedi
    Quote from zenman
    The daughter probably didn't process anything the doc said either. Just let it roll on!

    Nurses, even those with advanced certs and responsibility, are still support staff. Let it go, nobody (of importance) will support you on this at the facility.
  6. by   Gotosleepy
    Correction: CRNAs are involved w/ 65% of anesthetics in the USA - most of it is under MD supervision.
  7. by   UCDSICURN
    Troll, troll, troll your boat.

    Donn C.
    Last edit by UCDSICURN on Jul 6, '04
  8. by   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.
  9. by   alansmith52
    you have to shut the doc down in front of family, painfull I know but it works. phycians are used to having the last say and not being challanged. whey you correct them in public they freeze. they have little emotional intel. meaning the ablility to negotiate a potentially hostile verbal confronation. (only one faset of emotional intel) you simply say "this phycicain is misleading you, I will be providing your anesthesia. the end
    if you are the nurse and not the CRNA you have even more time to straiten things out when the phycian leaves. explain his short man syndorme ect. ect..
  10. by   jwk
    Quote from alansmith52
    you have to shut the doc down in front of family, painfull I know but it works. phycians are used to having the last say and not being challanged. whey you correct them in public they freeze. they have little emotional intel. meaning the ablility to negotiate a potentially hostile verbal confronation. (only one faset of emotional intel) you simply say "this phycicain is misleading you, I will be providing your anesthesia. the end
    if you are the nurse and not the CRNA you have even more time to straiten things out when the phycian leaves. explain his short man syndorme ect. ect..
    Leaving aside the fact that I think the MDA was wrong in this case...

    IMHO, professionals should NEVER do such a thing in front of a patient or their family. Those discussions should be done privately. If you made the statement "this physician is misleading you..." at our institution, you would probably be fired, and rightfully so, for unprofessional behavior.

    The disagreement is between the two of you - not the three of you. I always feel free to explain the differences between the MDA, CRNA, or AA, and describe exactly who stays in the room and who doesn't. It's not unprofessional when explained in that way. Bashing the physician (or any other provider for that matter) is not appropriate professional behavior. Leave your turf battles in the lounge or office.
  11. by   yoga crna
    Go to Sleepy,
    PLEASE, PLEASE, PLEASE do not use the word "Supervise" when dealing with CRNAs. Supervision is for students, not for CRNAs. The wording "medical direction" is also a misnomer, but it is slightly more acceptable than supervise.

    I administer anesthesia without any physician telling me what to do. Certainly, I have discussions with my surgeons about the surgical/medical/anesthesia management of the patient. I don't tell them what sutures to use and they don't tell me how to do anesthesia. Fortunately, I don't practice with anesthesiologists, although I have administered anesthesia to many in my "unsupervised practice".

    In my opinion, if you need to be supervised, after you become a CRNA, your education was unsatisfactory.

    Yoga CRNA
  12. by   athomas91
    Gotosleepy.....

    CRNAs are the sole anesthesia providers in approximately two thirds of all rural hospitals in the United States, enabling these healthcare facilities to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100% of the rural hospitals.
    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.
  13. by   stevierae
    Quote from yoga crna
    Go to Sleepy,
    PLEASE, PLEASE, PLEASE do not use the word "Supervise" when dealing with CRNAs. Supervision is for students, not for CRNAs. The wording "medical direction" is also a misnomer, but it is slightly more acceptable than supervise.

    I administer anesthesia without any physician telling me what to do. Certainly, I have discussions with my surgeons about the surgical/medical/anesthesia management of the patient. I don't tell them what sutures to use and they don't tell me how to do anesthesia. Fortunately, I don't practice with anesthesiologists, although I have administered anesthesia to many in my "unsupervised practice".

    In my opinion, if you need to be supervised, after you become a CRNA, your education was unsatisfactory.

    Yoga CRNA
    You are so right, yoga. This is why I like to work in CA, where, when a CRNA is doing anesthesia, he or she is generally doing it as an independent practitioner. If there is an anesthesiologist in the facility, he has his or her own room and responsibilites. He or she is glad to consult with any CRNA who asks, but he does not intrude unasked into their cases. In fact, younger anesthesiologists are just as likely to ask the advice of more experienced CRNAs.

    Now, here is an experience that I have had in Oregon that made me more than a little uncomfortable--anesthesiologists who tell the patient "We" (meaning he and the CRNA who he is supposedly "working with" that day) "work as a team. We'll be doing your anesthesia together." However, he is there for induction, and he comes back (maybe, and then only after being repeatedly paged) for extubation and emergence from anesthesia.

    Why not tell the patient the truth? That the CRNA is the anesthesia provider, and he is there, if needed, in a consulting role? If that's even the proper term? Why the deception?

    Here's one that made me even more uncomfortable--one anesthesiologist likes to "jokingly" tell patients, "I'm his baby sitter today." Then if the patient looks panicked or puzzled, he laughs and says, "Just kidding! We work as a team!! I'm supervising him!" (Again, there for induction, not seen again until extubation--and STILL the wrong term!) Talk about passive aggressive!

    I have no idea what the CRNAs say to him about the inappropriateness of that comment, or if they just consider the source and let it roll off their backs like water off a duck's back. Never seen a confrontation in front of a patient; can't say that I think one would be appropriate or professional.
  14. by   stevierae
    Quote from Dixiedi
    Nurses, even those with advanced certs and responsibility, are still support staff. Let it go, nobody (of importance) will support you on this at the facility.
    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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