[zrmorgan]

Originally Posted by foraneman

Collaboration and supervision ARE the same thing in this context. The surgeon does not supervise or dictate the manner in which the anesthetic is delivered...ever....in any state.

right....that is my point, "supervision" is misleading to some patients, surgeons, and obviously from this discussion, many of us...

the wording needs to be simplified "collaboration", so those people who don't have first hand knowledge of the setting to which this applies do not assume there is a supervisor / supervised relationship in anesthesia.

my main point being the context is flawed AEB the controversy.

[foraneman]

Originally Posted by Summitk2

Angel (and loisane), I couldn't agree more. However, you may have noticed that CRNAs don't participate too much in this forum anymore. I think those of us who are not CRNAs and truly want to be correctly informed would love for a CRNA to set things straight. However, even the CRNAs don't seem to agree and others are vague. Is aana.com really the only reliable source of info? I noticed you (as a CRNA, I assume) didn't add anything to clarify this discussion aside from the aana website link. Do you have the correct info on this legal and practice topic? If so, please help clarify the answer to the OP's question. We need CRNA input on this CRNA forum.

I have tried to answer this as best I can. To put it simply, the surgeon "supervises" by being present in the room. Nothing else is required. The CRNA can bill insurance companies and medicare and medicaid independently. The surgeon is not required to sign the anesthesia record, nor have i ever had one sign it. I am a CRNA and a law school graduate. I hope this helps.

[platon20]

Originally Posted by zrmorgan

the wording needs to be simplified "collaboration", so those people who don't have first hand knowledge of the setting to which this applies do not assume there is a supervisor / supervised relationship in anesthesia.

Fine, then lets throw out the term "supervision" and use "collaboration" instead.

How does a surgeon "collaborate" with a CRNA when the surgeon doesnt know jack about anesthesia?

Is a rocket scientist capable fo "collaborating" with a civil engineer?

Is a garbage man capable of "collaborating" with a McDonalds employee?

Of course not, because they are two totally separate jobs that have nothing to do with each other.

So thats my question. How does a surgeon "collaborate" with a CRNA when surgeons dont know ANYTHING about anesthesia?

[xflyingfox]

The CRNA forenaman has the answer, and IS a CRNA

[foraneman]

Originally Posted by platon20

Fine, then lets throw out the term "supervision" and use "collaboration" instead.

How does a surgeon "collaborate" with a CRNA when the surgeon doesnt know jack about anesthesia?

Is a rocket scientist capable fo "collaborating" with a civil engineer?

Is a garbage man capable of "collaborating" with a McDonalds employee?

Of course not, because they are two totally separate jobs that have nothing to do with each other.

So thats my question. How does a surgeon "collaborate" with a CRNA when surgeons dont know ANYTHING about anesthesia?

Unfortunately, switching the terms does not help much either depending on your view of the definition of collaborate. Certainly persons of two diferent disciplines collaborate on projects all the time.

Etymology: Late Latin collaboratus, past participle of collaborare to labor together. (Websters)
So, the surgeon and the CRNA labor together. The real intention of state requirements for collaboration being written into a nurse practice act, as far as I have been able to surmise, is to provide that when a CRNA administers anesthesia, there will always be a reason. In other words, a CRNA cannot open an "anesthesia botique" in his or her basement anestheizing customers at will. Collaborating with a surgeon, there will always be a patient and a physician (dentist, podiatrist) prsent with the patient having a procedure done. Since changing the word to collaborate, you have to drop the common definition (and idea)of supervision since collaboration's definition is very diferent.

[deepz]

Originally Posted by platon20

...... two totally separate jobs that have nothing to do with each other.

So thats my question. How does a surgeon "collaborate" with a CRNA when surgeons dont know ANYTHING about anesthesia?

Sheesh. Obviously you don't know what you're talking about.

And you give surgeons far too little credit.


d

[dfk]

Originally Posted by deepz

Sheesh. Obviously you don't know what you're talking about.

And you give surgeons far too little credit.


d

[zrmorgan]

Originally Posted by platon20

Fine, then lets throw out the term "supervision" and use "collaboration" instead.

How does a surgeon "collaborate" with a CRNA when the surgeon doesnt know jack about anesthesia?

Is a rocket scientist capable fo "collaborating" with a civil engineer?

Is a garbage man capable of "collaborating" with a McDonalds employee?

Of course not, because they are two totally separate jobs that have nothing to do with each other.

So thats my question. How does a surgeon "collaborate" with a CRNA when surgeons dont know ANYTHING about anesthesia?

wow! "Anything about anesthesia?" I guess it is safe to say that you don't know "jack" about surgery? Or that you don't know "ANYTHING" about surgery.

if that is the case, maybe you should be supervised!

please tell me you were being a tad bit extreme.

as someone said on this post before....you were a bit apples and oranges as well.

also, the collaboration example I posted earlier...see above.

z

[nurse2bKY]

Originally Posted by platon20

Thats what I'm talking about though. If there are no MDAs on staff and its just hte CRNA and surgeon, how does this work? Does the CRNA go up to the surgeon and ask "will you collaborate with me or supervise me on this case?" Or does the law state that the surgeon AUTOMATICALLY is supervising/collaborating with the CRNA?

For the states that require some kind of collaboration/supervision, how could this possibly work with a surgeon?

BTW, surgeons dont know anything about gas. If you asked them what the method of action of propofol was, they wouldnt have a clue.

Thats why I dont understand how a surgeon could possibly "supervise" or "collaborate" with a CRNA. Its the same thing as asking a family practice doctor to "collaborate" with a neurosurgeon.

You are assuming that the CRNA needs supervision. Your assumption is wrong! CRNA's do not need supervision!

[foraneman]

here is an excerpt from the Montana Supreme Court defining supervision in a case decided this week.

MONTANA SOCIETY OF ANESTHESIOLOGISTS,
MICHAEL D. STERBIS, M.D.,
Plaintiffs and Appellants,
v.
MONTANA BOARD OF NURSING,
Defendant and Appellee,
MONTANA ASSOCIATION OF NURSE
ANESTHETISTS,
Intervenor and Appellee.

"In addition, the MMA argues in its amicus brief that the level of supervision anticipated does not involve the surgeon instructing the CRNA on just how anesthesia should be administered as the surgeon does not exercise control over the "means and method" used by CRNAs in administering anesthesia. Rather, according to the MMA, the supervision involves the responsibility of the physician to ensure that the proper decisions regarding patient care are made in the operating room; that the CRNA is competent, qualified and mentally alert; and that the CRNA keeps the surgeon informed of any changes the CRNA may detect in the patient’s status. However, it could be argued that a surgeon would require the exact same things from an anesthesiologist."

This is an excellent definition of supervision. This case involved an attempt by the Montana Society of Anesthesiologists to prevent CRNA's from practicing without physician supervision and to reverse the "opt-out" in Montana. This despite every professional board having supported the opt-out, including physicians. The anesthesiologists lost on partial summary judgment, although they are still fighting what is an absurd battle on other issues.

Greg Stocks CRNA EJD