Warning: Political Contents Inside

  1. Howdy. New to the forum. I've been lurking for some time, however. A great source of info and editorials. I am starting a CRNA program in January. An exciting thing, that. Turns out I've been lurking over at the student doctor network, as well. Another great source of clinical info and editorial commentary. Some things I read on the site make me quite apprehensive about what awaits me as a SRNA, and eventual CRNA. So I'm looking for a few soothing words from you guys/gals. (I've read Kevin's post at the top of the thread list. Look what happened there.)
    So, a question. Is the AANA, an organization I have every intention of supporting, truly operating in the best interest of its members by aggressively opposing/undermining the ASA's efforts in regards to resident reimbursement issues? The animosity that this conflict is generating over at the SDN is palpable to say the least, leading some posters to advocate guerilla tactics against SRNA's (one suggested the dreaded "silent treatment". Very scary). Anyway, I want to get the best education possible, I want to find a decent job when I graduate, I want the respect, once earned, of other team members, I want my patients to get optimal anesthesia care, and at this point in my career, I don't especially care about AA issues, supervision issues, or the expansion of CRNA responsibilities. Maybe I should.
    Fact: anesthesiologists undergo much more extensive training than CRNAs. I understand this. Informed members of the general public understand this. They will always have this card to play, regardless of the financial issues, safety studies, or political environment. I for one respect it; sometimes I wonder if our national organization does. If I encounter hostility from anesthesia residents or attendings for that matter due to a so-called "backlash" against CRNAs in general, I will have my own ways to deal with it. My question is, is it fair for me and my classmates to be punished for some of the AANA's more questionable efforts? On a more practical level, how does one even know where to stand on issues like these? I haven't seen this particular conflict addressed here, so I thought I'd start it. Sorry if it gets ugly. If I've breached some unwritten rule about posting on a taboo subject, let me preemptively envoke the First.
    •  
  2. 10 Comments

  3. by   heartICU
    Quote from TheLemur
    ...at this point in my career, I don't especially care about AA issues, supervision issues, or the expansion of CRNA responsibilities. Maybe I should.
    Yes, you should. To sum it up, you don't know what you don't know. When you become more experienced in anesthesia, the bigger picture will become a lot more clear. What you have to understand is that anesthesia, as administered by CRNAs, is SAFE. An MD standing there as you intubate and extubate is not supervision. Supervision implicates a sense of responsibility on the part of the supervisor. If yo would break a tooth while intubating, cause a nerve injury while placing an epidural, or fail to recognize an esophageal intubation, who would be responsible? In a traditional job setting, the supervisor (MD). But in case law, it has been shown multiple times over, that the person responsible for mishaps is the one who administered the drug, placed the needle, or broke a tooth. If it is the CRNA, s/he is responsible. If the MD, s/he is responsible. [I am not sure about how it applies to AAs, so I can't comment on that]. Supervision as it applies to anesthesia has a purely financial/billing meaning. What if your supervising MD is a surgeon? Can s/he be responsible for that nerve injury you caused? Should s/he? NO. Just as YOU would not be responsible for the surgeon nicking the mesenteric vein. So you see, supervision issues ARE important.

    What I think you will find as you begin your training is a much more friendly and collegial environment than you read about on SDN. Not all anesthesiologists subscribe to that way of thinking, nor all CRNAs. Also - the majority of ones who talk about silent treatments, backlash, etc are either medical students or interns/residents. They may very well sing a different tune when they really see how things work. What many of them know about CRNAs is what has been stated on that website, and we all know there are many misconceptions over there. Again, THEY don't know what they don't know. For all we know, they think that a CRNA is simply a nurse with a weekend course in anesthesia providing an anesthetic. I wouldn't place too much stock in what is said over there - nurse anesthesia is not their area of expertise. So why would you listen to what they have to say about it?

    Those who choose to work in an anesthesia care team environment (with anesthesiologists supervising CRNAs) are typically not ones to spout off about supervision and billing issues at any given moment. As far as I know, most anesthesia schools provide clinical training in institutions that use the care team approach. You will find that you will learn a lot from both the CRNAs and the MDs, and most MDs will not begrudge you the education.

    To address the issue of AANA undermining ASA's attempts th change reimbursement for resident education - are you fully educated on the issue? What the AANA was opposed to was to provide incentive to have a residency program instead of a nurse anesthesia program. It was not simply to prevent reimbursement for residents - there is more to it than that. Check it out on the AANA website.

    What you will find is that many anesthesiologists are not even aware of some of the issues their national organization promtoes, as many CRNAs are not aware of the issues the AANA promotes. I think it is a bit premature in your career to form opinions about all this - wait until you are about a year into your program, and things will clear up quite a bit. You will learn all about billing, reimbursement, supervision, medical direction, etc. Don't jump the gun yet - you have to learn to administer anesthesia before you can argue about its political points.

    Did that get too ugly for ya?
    Last edit by heartICU on Nov 5, '05
  4. by   TheLemur
    Thanks for your perspective, heartICU.

    And let me add that it is incredibly embarassing to end one's very first post by "envoking" the First Amendment.
  5. by   sirI
    Quote from thelemur
    thanks for your perspective, hearticu.

    and let me add that it is incredibly embarassing to end one's very first post by "envoking" the first amendment.
    just want to you to allnurses.com

    sorry you had to feel as if you needed to "invoke" the 5th. you may discuss freely any subject here at allnurses.com. friendly, flame-free debates/discussions are always welcome here. we are unlike other forums where we actually respect the views of others.

    hope you enjoy the forums.
  6. by   Nitecap
    Hello and welcome. Listen the AANA doesnt dispute the training that MD providers have, not at all. If you look at it from a historical perspective these issues have been going on since the early 1900's. Had CRNA's and then the AANA once formed not been extremely proactive in protecting its practice right then CRNA's would either not exist or our practice would be totally regulated by that of an MD. YOu would basically have no descision making power. I guess you really wont understand until you truely learn the history as well as current political battles. Heres the issue though, say you dont want to support the AANA and their cause, and hey it may never effect you. But say you have been a CRNA practicing for 15yrs and then one day a MD comes in and tells you can not do what you have been doing successfully and are damn good at it. Then who will help you, who will have your back, who will take these issues to all levels of the court to fight for you. The AANA will, straight up. It is there to protect the profession, to promote the profession, to protect your practice rights and lively hood. Why do you think CRNA's have the great profession that they have? It is due to hard work, excellence, lobbying, unity and the AANA's extremely proactive ways of handling issues, court battles, thwarting future problems ect. You should without a doubt join. The profession just didnt evolve to what it is today by doing nothing.
  7. by   London88
    TheLemur:
    As others have stated, do not worry so early in your career. A lot of what is said about the issue on SDN are by residents and interns who are clueless about hospital policy and the real world, such as "zero tolerance" for hostile behavior. Some of the attitudes projected by these guys will land them on the streets in the real world. Wether or not I agree with the AANA or ASA on the issue is besides the point, but I can assure you I will not tolerate hostile behavior from anybody because of what is going on between the ASA or AANA. You will find that as you do your clinical rotations what is being said on SDN is not projected in the OR. I, like many others, have done rotations where there are residents and it has been a lot of fun. Please do not put so much stock into what you are reading on SDN.
  8. by   deepz
    Quote from TheLemur
    ..........
    Fact: anesthesiologists undergo much more extensive training than CRNAs. I understand this. Informed members of the general public understand this...........

    This sounds more like a trolling provocateur than a prospective CRNA student. Could this actually be Dr Mark Lema speaking for the A$A?

    'Informed' members of the general public? Oh please. Sorry to say, but such unfounded and unjustified presuppositions as the above have landed many an American patient in the graveyard.

    deepz
  9. by   jwk
    Quote from deepz
    This sounds more like a trolling provocateur than a prospective CRNA student. Could this actually be Dr Mark Lema speaking for the A$A?

    'Informed' members of the general public? Oh please. Sorry to say, but such unfounded and unjustified presuppositions as the above have landed many an American patient in the graveyard.

    deepz
    Here we go.....
  10. by   canoehead
    you guys are getting so predictable...too much gas I guess
  11. by   TheLemur
    Quote from deepz
    This sounds more like a trolling provocateur than a prospective CRNA student. Could this actually be Dr Mark Lema speaking for the A$A?

    'Informed' members of the general public? Oh please. Sorry to say, but such unfounded and unjustified presuppositions as the above have landed many an American patient in the graveyard.

    deepz

    Appears as though I struck a nerve. So do you refute the statement? MDA's are NOT more extensively trained? Anyway, it was beside the point I was making, probably should have left it out. I don't mean to offend.

    Look, I haven't been an SRNA a day yet, and there's no guarantee until I take the last board question that I will make it to CRNA status. So let me qualify my perspective by acknowledging that. I am ignorant of much of these issues. I'd rather discuss clinincal topics, but it's a little premature for me until class/clinicals start. Just looking for CRNA input on a particular debate that I had only seen over "there". Thanks for the responses.
  12. by   sirI
    Quote from TheLemur
    Appears as though I struck a nerve. So do you refute the statement? MDA's are NOT more extensively trained? Anyway, it was beside the point I was making, probably should have left it out. I don't mean to offend.

    Look, I haven't been an SRNA a day yet, and there's no guarantee until I take the last board question that I will make it to CRNA status. So let me qualify my perspective by acknowledging that. I am ignorant of much of these issues. I'd rather discuss clinincal topics, but it's a little premature for me until class/clinicals start. Just looking for CRNA input on a particular debate that I had only seen over "there". Thanks for the responses.
    Hello, TheLemur,

    Try the Pre-CRNA Inquiry forum. You might find this helpful.

    http://allnurses.com/forums/f227/
    Last edit by sirI on Nov 7, '05

close