Why don't CRNA's like AA's - page 4

i've noticed a sense of hostility on this forum towards aa's by nurse anesthetist or student nurses of anesthesia. why so hasty? i always read on this forum about the shortage of anesthesia... Read More

  1. by   NOPAIN
    I am sorry, I am so happy that I posted this on the wrong tread. I mean to start a new tread, I apologize
  2. by   PA-C in Texas
    It's the same old turf war. It has nothing to do with providing quality anesthesia. MD's fought against N.P.'s and CRNA's, R.N.'s fought against repiratory therapists and are now fighting paramedics, and CRNA's are going to fight AA's.

    It's all thinly-veiled in noble causes like "patient safety" and "quality health care", but nobody really believes that.
  3. by   SOCALRACERX911_RN
    Sorry to be so egg-no-went, but what the heck is an AA?
  4. by   ep71
    Quote from libmi
    Sorry to be so egg-no-went, but what the heck is an AA?
    An AA is an Anesthesiologist Assistant.
  5. by   subee
    The only sensible "addition" to AA training would be a degree in nursing with experience. Its our nursing backgrounds that make us ready for anesthesia training. We're already seasoned veterans by the time we get into our anesthesia programs - without that intensive patient care background, we could never hit the ground running the first year in anesthesia training. We can already separate the zebras from the elephants. If you want to give anesthesia, just do what you have to do and get your undergraduate degree in nursing.
  6. by   jwk
    Quote from subee
    The only sensible "addition" to AA training would be a degree in nursing with experience. Its our nursing backgrounds that make us ready for anesthesia training. We're already seasoned veterans by the time we get into our anesthesia programs - without that intensive patient care background, we could never hit the ground running the first year in anesthesia training. We can already separate the zebras from the elephants. If you want to give anesthesia, just do what you have to do and get your undergraduate degree in nursing.
    And it is the contention of AA's, and I know you fully disagree, that a nursing degree is not needed.

    Although many of you think we come from just any old bachelors degree major, I honestly don't think any of my colleagues went into their AA program holding only a bachelors degree in religion, or philosophy, or Spanish. Pretty much all of us have science degrees of some sort, whether that be biology, chemistry, physiology, engineering, or (gasp) nursing. All of us have extensive undergraduate coursework (not freshman-level) in biology, biochem, physics, etc., which gives us what we feel is a better background to understand the "science" of anesthesia, the real nuts and bolts pathophysiology and pharmacology, etc. I know, I know, you disagree.

    But please, give me a break with the "seasoned veterans" stuff. You act like all of you are in your 40's before you even consider anesthesia after 20 years in the ICU. The minimum requirement is a year of critical care (a fairly recent requirement as I recall - correct me if I'm wrong, I know you will). I know RN's who have been accepted into their anesthesia program months before they've completed a year in the ICU. As in many things it's not what you know, it's who you know.
  7. by   subee
    Snotty, snotty. Actually I was 35 when I went to anesthesia school with a background in nursing administration. However, my program required organic chem which I took at 34 and also required physics, which I had as an undergrad already. I was not up in arms against AA's when I first heard of them over 10 or 12 years ago. I thought you were a well educated group and that some CRNA's were getting all atwitter about their salaries (an ugly quality in any human). However, now that I've been doing it for 20 years I think differently about the obligation to the patient, who is trusting you to be the best you can be at what you do, and I think the years I spent in nursing contributed to making better critical decisions earlier in my CRNA career. And oh no - I did not go straight from administration to anesthesia school - I quit administration and worked intensive care before starting school. Next time I think I'll be a nuclear engineer. I'll tell them that I don't need the basic undergrad engineering program because my two year program will include it ALL.
  8. by   alansmith52
    ep71:
    I have to agree that nurses do supervise lots of providers that are non-nurses.
    PT, OT, RT, MA, phlebotomists, secretaries, techs,food service worker.
    no one goes into a patients room without the blessing of the nurse. especially a critical care patient.
    you used a word that you made up "nursing system" why don't you briefly explain what you consider the "nursing system". none of the workers I listed above are nurses and yet they are most certainly supervised by them. not that I tell an OT how to do her assesssment but I did tell her when she could or couldn't and what the pt was able to tolerate or not tolerate before she ever went in the room to conduct her "formality"
    I personally don't want to ever supervise an AA because I don't want the liability of someone whose training I don't know. or havn't been through myself.
  9. by   jwk
    Quote from subee
    Snotty, snotty. Actually I was 35 when I went to anesthesia school with a background in nursing administration. However, my program required organic chem which I took at 34 and also required physics, which I had as an undergrad already. I was not up in arms against AA's when I first heard of them over 10 or 12 years ago. I thought you were a well educated group and that some CRNA's were getting all atwitter about their salaries (an ugly quality in any human). However, now that I've been doing it for 20 years I think differently about the obligation to the patient, who is trusting you to be the best you can be at what you do, and I think the years I spent in nursing contributed to making better critical decisions earlier in my CRNA career. And oh no - I did not go straight from administration to anesthesia school - I quit administration and worked intensive care before starting school. Next time I think I'll be a nuclear engineer. I'll tell them that I don't need the basic undergrad engineering program because my two year program will include it ALL.
    Not snotty - just a different approach. And please, not again with the clinical comparisons. It's a turf battle, about competition and money and who gets what, and it always has been. You have the same battle with MDA's. DO's and MD's sometimes have the same arguments. PA's and NP's are the same. Orthopods with foot fellowships vs. podiatrists (there's a good one!) Competition and money. You know it - I know it. The difference is, we're not questioning your competence and skill as a smokescreen to the real issue, which ALWAYS comes down to money. You and many of your colleagues simple can't make the same claim.

    What's changed in 30 years of AA's? Not much for us. Always a Masters Degree - always a med-school educational environment - always part of the anesthesia care TEAM (I know, lots of you don't like the concept - we fully supported it even before the ASA started liking us). We've practiced our craft competently and safely. We're not idiots. We're not English majors with laryngoscopes. We're highly educated (just like you), Medicare and private insurance alike reimburse for our services, and we love what we do. As our numbers expand, we simply seek the right to practice in other states.

    What's changed in nurse anesthesia in 30 years? Or lets not even go back that far. How about 10-15? There was NO degree requirement. There was NO critical care requirement - that's an even newer "must have". Many of the schools granted NO degree in anesthesia because many of the schools were hospital-based only, with no affililiation with any kind of university that could grant a degree. Care to tell me how many thousands of CRNA's are practicing with no degree?

    But guess what? I have no problem with that. I think it's GREAT that after that much time spend in education that you have the degree that goes with it. It only makes sense. I know hundreds of CRNA's, many of them with a hospital diploma and an anesthesia certificate, and they're GREAT practitioners.

    You personally do not know us. You've never met one of us, much less worked with one of us. You've only heard about us from your association or this board. We're not the devil incarnate. We're not out to steal your job. I interview anesthetists for my group (70+, even split AA/CRNA). I hire new grads, I hire experienced providers. CRNA's with or without a degree. The main thing I want to know is whether or not you're competent. If you can do the job and work within our particular practice parameters, I'll not only respect you, I'll hire you! Call me and we'll chat.
  10. by   deepz
    Quote from jwk
    Not snotty - just a different approach. And please, not again with the clinical comparisons. ........You personally do not know us. You've never met one of us, much less worked with one of us. You've only heard about us from your association or this board. ........I interview anesthetists for my group (70+, even split AA/CRNA). ........If you can do the job and work within our particular practice parameters, I'll not only respect you, I'll hire you! Call me and we'll chat.
    Yes, snotty, my dear jwk, GeorgiaAA, or whatever pseudonym you hide behind this week. I seriously doubt that I am the only person on this CRNA/SRNA board growing tired of your repititious self-serving rants and boasts. Surely somewhere you could find an AA board where someone might actually care what you have to say? I'd invite you to go there.

    Second, how on earth could you venture to claim to know the minds of others: who it might be that all of us might know, who we've met in our various lives, or where we might gather our information? Presumptuous, I guess. Snotty, for sure. Perhaps you learned that arrogance, and learned it well, from your A$A masters. They've also never understood the primary importance of the bedside nursing skills we CRNAs bring to anesthesia, and obviously you don't either. So be it.

    As to your last offer, does the phrase 'where the sun don't shine' ring a bell?

    deepz
  11. by   u-r-sleeepy
    You wrote:

    "What's changed in 30 years of AA's... (I know, lots of you don't like the concept [ACT setting] - we fully supported it even before the ASA started liking us..."

    Ahhhhhh yeah, so the establishment of AAs just "happened" um... HOW? Without the A$A's imput or help? Is that really true? ;-) You guys must be GOOD! You just up and decided on your own one day that you're going to create another anesthesia provider and hoped someone (A$A) might like you and bring you in and offer you a job?!? That's an AMAZING story!!!

    "We're highly educated (just like you)..."

    Ahhhh, no. You're NOT educated "just like me". Reality can be difficult for some personalities to grasp, but I encourage you to "get over it" and accept it. You're education and overall training is considerably different from ours.

    Allow me to list a few areas of difference that I see:

    1 - Because of the way some MDAs practice in "your neck of the woods"... some AAs practice outside their scope of practice at times, and yet the docs let it continue. Do you have a through understanding of the TEFRA shackles? Are you following them completely? Or rather - are your MDA "supervisors"?? I know for a fact they are not in many instances. Word does get around and that is part of what concerns people like me. Do you realize both the MDA and YOU are technically committing "fraud" when you don't follow TEFRA to the letter? Just think about it....

    What happens when an MDA is "supervising" 2 rooms and OB...? and something starts to "happen" in one of your rooms? 8-O

    2 - Limited role. Do you really enjoy knowing that your umbilical cord can never be cut from the MDA "Masters"? That would get to me after a while. That and a more narrow scope of practice overall.

    Still, I have an idea for you - if your numbers ever do grow significantly, I would like to encourage you to begin forming a committee - or even a union!! - to plot and plan how to break free from the MDA shackles and be able to provide anesthesia without MDA supervision!!! "YEAH BABY!!!!!!!" That will get the A$A's attention!!!!! Hahahahahaha!!! I'm serious about this - if your numbers ever grow large enough... just start talking about your desire to "help the under-served areas of healthcare" in America and your willingness to provide anesthesia there and see how the docs respond. If you have a more or less steller record for safety - have at it!

    Then again - maybe the AANA should think about offering some kind of "bridge program" for AAs to become full-fledged CRNAs? Then they could have the choice of ACT setting or independent practitioner. That would make the A$A soil their britches in record time! ;-) hahahahaha!!! (no - I don't really think that would be possible, but still, just the thought of it...!)

    3 - The $$$$. I don't believe you're aware of this, but you are NOT making what most CRNAs are earning. Sure, there are some who are in your income level who practice near (or right next to!) you, but for the most part, you're not making the $$$$ we are. Proof you want? How's this little snippet from a CRNA:

    "I have a CRNA friend in Atlanta and she said as soon as the hospital where
    she worked in Atlanta hired enough AAs, her salary was cut by $20/hour with
    no explanation given. Like it or lump it. I think that is where we are
    headed."

    That's a little over $40k/yr cut not including any OT. Why? Because she practiced in the Atlanta area... where AAs are employed, but YOU know better because you know Atlanta, right?

    Most of us don't talk about our incomes too much, but let me just say - you're not close to me. I am a recent graduate also. The reason CRNAs you work with are making what you're making... is because their pay has been "downsized" to what you were offered. That's the only reason it is "equal" where you are.

    When I was nearing graduation the offers for me were amazing! It was very "encouraging" to see what I was "worth" to so many potential employers. One of the things I decided on before interviewing was that I absolutely REFUSED to work in a setting that employed AAs. I also made it a point before accepting an invitation to interview: "Do you employ AAs? Would you ever consider employing AAs?" Yes, I did this!

    The top MDA at the Austin (HUGE!) group where I interviewed was a little bit "weak" on his response to that question. He knew where I was coming from and got the point. He wanted me to work with them very much as my training was steller having done a lot of my clinicals in one of the top training hospitals in the country. I passed on their offer for several reasons. Still, I was just letting him know my take on the subject.

    WHY don't YOU want to do better for yourself? Do you have any idea what the docs you're "under" are making? Don't you realize you could be making a lot more as a CRNA or MDA/DOA? Well, it was a thought of mine. If you're really as bright as you ??? want me to believe, why don't you go on to be an MDA or CRNA?

    I don't know where this struggle will end. To me - it is all about "power and money" and you - the lowly AA - are caught in the middle. I don't like to "come down hard on you" in part because I know what that feels like. Basically, I don't want to "do to you" what some MDAs want to "do to me"! You seem bright and you're obviously a competent practitioner already. I think it's a pity the A$A is as "dirty" as they are and wonder where this will lead.

    Only time will tell....

    Sleeepy
  12. by   jwk
    Quote from deepz
    Yes, snotty, my dear jwk, GeorgiaAA, or whatever pseudonym you hide behind this week. I seriously doubt that I am the only person on this CRNA/SRNA board growing tired of your repititious self-serving rants and boasts.

    Perhaps you learned that arrogance, and learned it well, from your A$A masters.

    deepz
    Actually, GeorgiaAA and I are two different people. And there's only two of us "ranting". We're only trying to get a little balance into the discussion and a little real knowledge about AA's, something that is sorely lacking.

    I'm not the one being arrogant. I don't claim that I'm better than anyone else.

    This little "A$A" thing several of you are fond of using - that says a lot.
    Last edit by jwk on Jun 5, '04
  13. by   deepz
    Quote from jwk
    This little "A$A" thing several of you are fond of using - that says a lot.
    Snotty to the last.

    As an old soldier I will refuse, under the terms of the Geneva Convention, to deal harshly in a battle of wits with an unarmed opponent.

    deepz

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