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More Fights between CRNA's and AA's?



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Jan 08, 2004 05:45 PM

More Fights between CRNA's and AA's?

Updated Jan 08, 2004 at 08:58 PM by Sheri257

First, I'd like to say I'm just a lowly nursing student. I'm not a CRNA so I am, by and large, ignorant on this subject. I've tried to do some board searches but couldn't find much except some general discussion on this issue.

However, a good friend of mine is a Washington D.C. attorney who is representing CRNA's before the local city council. Apparently they are fighting some action from the Board of Medicine which recognized AA's, and the CRNA's are requesting that the AA's also become licensed PA's before they are allowed to practice in D.C. Apparently the CRNA's are arguing that the patient outcomes with these AA's aren't as good as CRNA's, but I don't have any specifics or data on this claim.

My attorney friend says the Health Department is supporting the CRNA's, and that hearings were held on this issue just today, but the outcome is uncertain. I've also heard of CRNA's fighting similar actions by the Veterans Adminstration to allow AA's in their hospitals.

My question is: Are these political battles growing in number, and what do you think the outcome/trend will be, let's say, in ten years? I know that there are only two AA schools in the country, but the physicians definitely seem to be pushing for this. (My attorney friend says this comes at a time where two D.C. area colleges are planning to launch new CRNA programs and he thinks this has something to do with the D.C. action.)

Unfortunately, I don't have much more information than this. (I'm trying to bug my attorney friend to send me more data, but he's very busy.)

So what do you guys think about all of this? Will the AA's win on this eventually and, if so, what does this mean for CRNAs?


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32 Comments
No. 1
from deepz
Old Jan 08, 2004, 06:43 PM

Default AAs
Lizz, if I understand correctly, there have been only 800 graduates of the two AA programs in thirty years and fewer than 600 remain in active practice today. Compared to 31,000 CRNAs nationwide these AA handmaidens of the A$A don't appear to me to pose a great threat.

Fuggidaboudit.


deepz
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No. 2
from Sheri257
Old Jan 08, 2004, 06:52 PM
Updated Jan 08, 2004 at 07:08 PM by Sheri257

Default Re: AAs
Originally posted by deepz

Lizz, if I understand correctly, there have been only 800 graduates of the two AA programs in thirty years and fewer than 600 remain in active practice today. Compared to 31,000 CRNAs nationwide these AA handmaidens of the A$A don't appear to me to pose a great threat.

Fuggidaboudit.

deepz
I understand. I just can't figure out why the physicians are pushing for this. Are there plans for additional AA schools perhaps? Or is there some other "training" mechanism in the works?

Certainly they wouldn't go to all of this trouble with the DC government, VA etc. for nothing. Would they?

I'm not disputing what you're saying. I'm just trying to understand what's going on here.
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No. 3
from hbscott
Old Jan 08, 2004, 07:04 PM

Arrow MDA Vs CRNA Vs AA
Liz,

I certainly have seen more friction in the past few years between MDA's and CRNA's (over pretty stupid stuff if you ask me). Nonethless AA's are getting attention again but it remains to be seen if this is short lived or a long term trend.

http://allnurses.com/t53691.html


-HBS
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No. 4
from CRNA, DNSc
Old Jan 08, 2004, 07:29 PM

Default Why the MDs are pushing for AA
It's all about control. AA's MUST practice under the direct supervision of an Anesthesiologist- therefore they are completely under the control of the Anesthesiologist. Think about the issue in the VA and military systems, the AA's can only work where there is an Anesthesiologist- CRNAs don't "require" the presence of an Anesthesiologist to practice. So which type provider is more deployable?????? The thought is (from the medical profession) if we can't control the CRNAs lets push another provider we have complete control over (under the guise of being trained in the "Medical Model" and therefore "better prepared").
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No. 5
from Headhurt
Old Jan 08, 2004, 07:32 PM

At the risk of sounding like a dork...

What's an AA??
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No. 6
from CRNA, DNSc
Old Jan 08, 2004, 07:33 PM

Default What's an AA?
Anesthesiologist Assistant
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No. 7
from Sheri257
Old Jan 08, 2004, 08:55 PM

I understand why the Doc's are pushing AA's. They're obviously putting a lot of resources into getting AA's approved by the states and the feds.

But with only two schools, HOW are they going to accomplish this? Is the first step getting the regulatory authority in place so that the state schools will come on board and launch more AA programs, perhaps?

I don't know much about the history of PA's, but they seem to be more common now. I wonder if this is a comparable example of how AA's might become more common as well.
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No. 8
from swumpgas
Old May 06, 2004, 12:20 AM

Thumbs up More History (yawn)
Originally Posted by lizz
I understand why the Doc's are pushing AA's. They're obviously putting a lot of resources into getting AA's approved by the states and the feds.

But with only two schools, HOW are they going to accomplish this? Is the first step getting the regulatory authority in place so that the state schools will come on board and launch more AA programs, perhaps?

I don't know much about the history of PA's, but they seem to be more common now. I wonder if this is a comparable example of how AA's might become more common as well.
There are definitely moves afoot, snuck into legisation by ASA minions to begin AA training programs in other states. Many have been shot down..

Also surreptitious attemptst to introduce AA's into the VA healthcare system. Now a given of the VA healthcare system is that a practitioner licensed in any state may work in any VA hospital anywhere.. This is an attempt to get AA's working in VA Hospitals even in states that do not allow the practice of AA's as well as adding to the cost of VA healthcare by requireng that an MDA be present to supervise the AA when providing anesthesia.

PA's (Physician Assistants) came into being initially in the 60's as an attempt to use the skills of medics and corpsmen trained in the military. By using them informally, then formally, the PA came into being, with sub specialties, Ortho, Medicine, Surgery, etc.

there is no aneshtesia counterpart of the Medic/corpsman to be incorporated into the roll as a PA. That roll has traditionally been filled by well trained CRNA's in times of war. The Military schools of anesthesia are excellent.
The web site for the AA's goes into some detail
http://anesthesiology.emory.edu/PA_Program/whatis.html
if you read betwqeen the lines of Emory's own web site, you should be able to see the "Hems and Haws" as the difference between classs A Practitioner (PA) and class B praxctitioner (AA)

Here is a quote from the Emory web site: describing AA's
"Because his knowledge and skill are limited to a particular specialty, he is less qualified for independent action."

the Original PA's will not even accept AA's as PA's.

http://www.aapa.org/

The duties of the PA and the Advanced Nurse practitioner more overlap, with prescriptive authority being given to both under varying circumstances , state by state.

again, it's a matter of background training of the individual.

The web of deception is a tangled one, with legislation being made under the sheets, on the golf course, at cocktail or fundraising parties, etc. Sometimes we are lucky in rooting it out, sometimes some slip by.

CRNAS are traditionally doing the workload while MDA's who are being paid to "Supervise" may be out on the golf course, wheeling and dealing with legislators.
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No. 9
from CougRN
Old May 06, 2004, 12:33 AM

Now I read that the U of Florida is planning on starting an AA program too. So it seems that the ASA is trying to get more programs out there so that they can put out more AA's. I haven't heard of other programs looking for accreditation though.
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