[platon20]

I dont get it. A surgeon knows NOTHING about gas at all.

So I'm confused when I hear some CRNAs say that their "supervising physician" (in states that require a supervising physician) are the surgeons running the case.

Explain to me exactly how a surgeon can "supervise" or "collaborate" wtih a CRNA.

[Hopefull2009]

Good question...I always thought that a CRNA was supervised by the Anesthesiologist, much like NP's and PA's are supervised by physicians.

I would disagree that they don't know anything about gas. Anesthesia is a drug and I can't imagine a surgeon being completely untrained on this aspect...he would HAVE to know exactly how they worked in case he has to order meds during the surgery and how it's going to affect the patient.

[NurseBill]

I've worked in an OR for many years, our CRNA's always had to have a Anesthesiologist as their Staffing MD. They didn't have to be in the room for the whole case, but had to be available if needed, and in my years in the OR, I was glad to have them for those unexpected emergencies! Mind you I've worked with some AMAZING CRNA's, but even the best could always use help in an emergency. While the physician in the room may have some knowledge of anesthetics and such that is NOT his specialty or his focus. Sounds fishy to me!

[penguin2]

I have never heard of a surgeon supervising a CRNA, only anesthesiologists. And in my experience, the CRNA really doesn't need "supervising" & works independently. Believe me, most surgeons don't know much about the gases, they just don't want their patients moving during surgery. The anesthetics used are determined by the anesthesia provider, and have little bearing on pain meds ordered by the surgeon; in fact, in the immediate post-op period, the analgesics & antimetics, fluids, etc. are ordered by the anesthesia provider. If a patient is having pain/nausea in PACU we call the anesthesia provider, not the surgeon.

[CRNA, DNSc]

Originally Posted by penguin2

I have never heard of a surgeon supervising a CRNA, only anesthesiologists. And in my experience, the CRNA really doesn't need "supervising" & works independently. Believe me, most surgeons don't know much about the gases, they just don't want their patients moving during surgery. The anesthetics used are determined by the anesthesia provider, and have little bearing on pain meds ordered by the surgeon; in fact, in the immediate post-op period, the analgesics & antimetics, fluids, etc. are ordered by the anesthesia provider. If a patient is having pain/nausea in PACU we call the anesthesia provider, not the surgeon.

In many hospitals, especially in the rural areas, CRNAs are the only anesthesia provider working in that hospital. Therefore, if required by state laws or other regulations, CRNAs can be "supervised" by the surgeon or other physician who is requesting that an anesthetic be given. The CRNA is still legally responsible for the administration of the anesthetic and held to standards of care.

Medicare conditions of participation (for hospitals) require that a CRNA is "supervised" by a physician (note: no regulations require that the physician is an Anesthesiologist) unless the Governor of the State "OPTS OUT" from the requirement. Currently 14 states have "opted out" of the supervision rule.

[n_g]

If you had to place your bets, how much longer before the number of states that pass AA legislation eclipses the number of states that have opted out? The current score is 11 vs. 14.

[platon20]

Originally Posted by CRNA, DNSc

In many hospitals, especially in the rural areas, CRNAs are the only anesthesia provider working in that hospital. Therefore, if required by state laws or other regulations, CRNAs can be "supervised" by the surgeon or other physician who is requesting that an anesthetic be given. The CRNA is still legally responsible for the administration of the anesthetic and held to standards of care.

Medicare conditions of participation (for hospitals) require that a CRNA is "supervised" by a physician (note: no regulations require that the physician is an Anesthesiologist) unless the Governor of the State "OPTS OUT" from the requirement. Currently 14 states have "opted out" of the supervision rule.

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.

[GmanRN]

Anyone have a link that would show the states who have opted out?

[Electric]

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 totally and absolutely correct here.

By the way, how does propofol work?

[deepz]

Originally Posted by platon20

......Its the same thing as asking a family practice doctor to "collaborate" with a neurosurgeon.

Completely wrong. The CRNA is an independent specialist.

Apparently you have a viewpoint to push.

What you are not understanding is in DNSc's post: the surgeon orders the anesthetic, the CRNA delivers it. Each is a specialist in their own right. The surgeon does the mechanical cutting, CRNAs do the physiological manipulation. The CRNA is not liable for the surgeon's acts or omissions, nor is the surgeon liable for the CRNA's.

http://www.aana.com/uploadedFiles/Re...iefsp89-93.pdf

In all 50 States, CRNAs are legal independent providers.

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