[kestrel1121]

I know this is a sensitive topic to all. My question refers to how would all of you handle this situation that actually occurred in a pt's room preop. I am most interested in how NOT to overreact but to correct the impression left on the pt and family by the MD. What happened:

Pt being prepped somewhat 'emergently electively'. Pt and family present. OR crew, CRNA providing anesthesia for pt and MDA in room all together reviewing procedure, prepping to roll to OR. pt daughter (distressed and acting inappropriate by flirting with all males present in room) at one point made the mistake of referring to the CRNA as 'Doctor'. CRNA politely corrected pt daughter by giving a short explanation of his role/title to daughter.I dont remember exactly what he said but it was basically 'I'm a nurse anesthetist and I'll be giving your dad the anesthesia to get him to sleep for surgery'. SHortly later, daughter again referred to CRNA as 'doctor' (she was most likely not processing any info given due to the stress). Here the MD stepped in and corrected the daughter by stating (direct quote)

Oh, he is not the doctor, he is just one of our support staff.

The CRNA did not say anything about this. I was a lot annoyed and began wondering if the CRNA is 'support staff' how does she (the MDA) view nurses etc she works with??How would all of you have responded to assert your role and also not ruffle the MD's feathers?? Not trying to be inflammatory just want diplomatic responses!

[athomas91]

it definately would have ruffled my feathers......
i have already on numerous occassions educated patients as to what a CRNA is, what they do, and that they can and do function independantly of physicians ..in addition i add that they were the first to provide anesthesia - and provide approx 65% of all the anesthesia today....

many of my classmates have had the opportunity to educate residents and Doc's (believe it or not) who truly didn't know our scope of practice....amazing.

[zenman]

The daughter probably didn't process anything the doc said either. Just let it roll on!

[Dixiedi]

Originally Posted by zenman

The daughter probably didn't process anything the doc said either. Just let it roll on!

Nurses, even those with advanced certs and responsibility, are still support staff. Let it go, nobody (of importance) will support you on this at the facility.

[Gotosleepy]

Correction: CRNAs are involved w/ 65% of anesthetics in the USA - most of it is under MD supervision.

[UCDSICURN]

Troll, troll, troll your boat.

Donn C.

[catcolalex]

there are also situations in which CRNA's administer anesthetics without any supervision or direction from MDA's, but the MDA's are available for backup/support. Can we then refer to these MDA's as backup staff, or support staff? I realize that this is not a big deal, but it is a good example of how some MDA's take every opportunity to make sure that CRNA's are put in their place, at the bottom of the totem pole right? A little respect goes a long way.
Also, to the people that suggested that the nurse just let the comment go and ignore it, thats fine, but it sounded like the MDA should have taken that advice as well. Its not the end of the world if somebody mistakes a CRNA for an MDA.

[alansmith52]

you have to shut the doc down in front of family, painfull I know but it works. phycians are used to having the last say and not being challanged. whey you correct them in public they freeze. they have little emotional intel. meaning the ablility to negotiate a potentially hostile verbal confronation. (only one faset of emotional intel) you simply say "this phycicain is misleading you, I will be providing your anesthesia. the end
if you are the nurse and not the CRNA you have even more time to straiten things out when the phycian leaves. explain his short man syndorme ect. ect..

[jwk]

Originally Posted by alansmith52

you have to shut the doc down in front of family, painfull I know but it works. phycians are used to having the last say and not being challanged. whey you correct them in public they freeze. they have little emotional intel. meaning the ablility to negotiate a potentially hostile verbal confronation. (only one faset of emotional intel) you simply say "this phycicain is misleading you, I will be providing your anesthesia. the end
if you are the nurse and not the CRNA you have even more time to straiten things out when the phycian leaves. explain his short man syndorme ect. ect..

Leaving aside the fact that I think the MDA was wrong in this case...

IMHO, professionals should NEVER do such a thing in front of a patient or their family. Those discussions should be done privately. If you made the statement "this physician is misleading you..." at our institution, you would probably be fired, and rightfully so, for unprofessional behavior.

The disagreement is between the two of you - not the three of you. I always feel free to explain the differences between the MDA, CRNA, or AA, and describe exactly who stays in the room and who doesn't. It's not unprofessional when explained in that way. Bashing the physician (or any other provider for that matter) is not appropriate professional behavior. Leave your turf battles in the lounge or office.

[yoga crna]

Go to Sleepy,
PLEASE, PLEASE, PLEASE do not use the word "Supervise" when dealing with CRNAs. Supervision is for students, not for CRNAs. The wording "medical direction" is also a misnomer, but it is slightly more acceptable than supervise.

I administer anesthesia without any physician telling me what to do. Certainly, I have discussions with my surgeons about the surgical/medical/anesthesia management of the patient. I don't tell them what sutures to use and they don't tell me how to do anesthesia. Fortunately, I don't practice with anesthesiologists, although I have administered anesthesia to many in my "unsupervised practice".

In my opinion, if you need to be supervised, after you become a CRNA, your education was unsatisfactory.

Yoga CRNA