I am an operating room nurse; have worked all over the country for over 25 years. Don't want to ruffle any feathers; I have worked with some awesome CRNAs, and have also worked with some anesthesiologists "supervising" them who could not even start an IV, let alone intubate. I chose a CRNA for my last surgery and for my child's surgery. But, I knew there was also an awesome anesthesiologist assigned to that CRNA to supervise.
Howvever, I have also been in situations where something went totally, unexplainedly wrong: a tension pneumothorax caused by a CRNA knocking a bleb off while intubating with a double lumen tube in preparation for a scheduled thoracotomy; as the patient went into PEA, and developed massive subcutaneous emphysema, the CRNA literally froze, never having seen this before, and uncertain as to how to proceed.
Luckily, there WAS an anesthesiologist who was supervising (though not in the room) when he came in, he just looked, said calmly, "Looks like a tension pneumo. Here, gimme an 18 g IV catheter." He then stuck the IV catheter in an intercostal space and released some of the air, while we got a chest tube and a pleurevac, and the patient returned to NSR once that was done.
Now, that could have happened to anyone; it could have happened to the anesthesiologist. But, what if the anesthesiologist hadn't recognized the situation for what it was? If the CRNA HAD been functioning as an independent practitioner that day, who would have come to his aid? He would have been SOL. Even the thoracic surgeon did not recognize what was going on, at least not immediately, so how do you know another CRNA would have?
Another time, right after we started a thoracotomy and gained exposure, the thoracic surgeon said, "Let down the left lung." The CRNA said, "I've never been taught how to do that." Again, lucky there was an anesthesiologist who came and bailed him out.
Yet another time, different hospital, thoracotomy: Surgeon: "Let down the lung." CRNA: "You're kidding, right? For that I would need a double lumen tube." Surgeon: "You mean, you didn't put in a double lumen tube?!" CRNA: "Well, you didn't ask for one..."
I promise you I am not making these stories up. I have been in hospitals where the anesthesiologists said words to this effect: "So, they want to function as independent practitioners, do they? Well, don't count on ME to bail any one of them out when they get into trouble..." so the poor circulator is left alone to deal with what might be a dangerous patient care situation.
Now, don't flame me!!! Like I said, there are some awesome CRNAs out there. I also understand the need for autonomy; I get tired of being micromanaged in the OR, instead of being left to run my own room as I see fit, which is, after all, what a good circulator (and her scrub, and the rest of the team) is SUPPOSED to do; or being told by managers who don't scrub how I am supposed to set up my back table and mayo stand. I just don't see whay a CRNA would want to be put into a situation where no help is forthcoming, should there be an emergency.