[stanman1968]

I am not sure what has happened to other posts but I find the concern over public saftery doubtful when ASIPP is sponsering these conferencs, the qualifications to attend and participate are none, other then an MD. I just do not buy the idea that doctors are policing themselves, I just do not see it, however I see numerous efforts both personal and public to limit the practice of CRNA's

[stanman1968]

Let me get this straight, if someone had a surgical rotation regardless of the duration or how long ago as long as they have MD they are good to go for invasive procedures?
Again to repeat to you NG ad nauseum, the vast majority of procedures we are speaking of are those "simple injections" not epiduroscopies, vertebroplasties etc. These procedures are not done frequently by anesthesiologists practicing pain.

"A FP is a medically licensed professional."

And I suppose my licence was issued by gandolf lord of the faeries? Oh look it is issued by the state, I too am a licensed medical professional.

[skipaway]

Originally Posted by paindoc

Of course you haven't seen any evidence to curtail these course offerings since you are not either a program director or course director.

How do you know what my current situation is?

[n_g]

http://www.lasvegassun.com/blogs/new...nder-licenses/

The Nevada State Board of Nursing reports that five certified nurse anesthetists voluntarily surrendered their licenses Wednesday pending the resolution of an investigation into dangerous and irresponsible injection practices at Endoscopy Center of Nevada, which led to the largest hepatitis C scare in the nation.

Why do posters on here wonder why there is such a high bar when it comes to patient safety? Did the patient who was paralyzed by the unsupervised CRNA who was doing interventional pain know that he/she only had 2 weekend courses on pain? To say that a pain doc could have done the same thing is so laughable. That's like saying that if a CRNA does surgery and kills someone is no big deal because a board-certified surgeon could have done the same thing too. If the potential for injury or death is there, then few patients would want some marginally trained person performing anything on them. They want someone who has been fully trained and certified by accredited programs. How many patients want to be guinea pigs for some CRNA who has just received 2 weekend courses? I think that all the defenders of CRNA's doing pain should be those guinea pigs.

The courts ruled the way they did because they saw through the half-truths that the AANA puts out. Unlike politicians, courts can't be bought off. If you want to convince them, bring your evidence and arguments. Like I keep saying, step up to the plate.

[n_g]

Originally Posted by stanman1968

Oh look it is issued by the state, I too am a licensed medical professional.

Oh, are you a licensed medical professional? Or are you a licensed nursing professional? Because pain is "solely the practice of medicine" according to Louisiana. If you want to be licensed medical professional who falls under medicine, then petition the AANA to make that change.

[NRSKarenRN]

Originally Posted by n_g

http://www.lasvegassun.com/blogs/new...nder-licenses/

The Nevada State Board of Nursing reports that five certified nurse anesthetists voluntarily surrendered their licenses Wednesday pending the resolution of an investigation into dangerous and irresponsible injection practices at Endoscopy Center of Nevada, which led to the largest hepatitis C scare in the nation.

Sampling Educational efforts:

2002: AANA - 111302 -- Reuse of Needles and Syringes by Healthcare ...

2005: Syringe Reuse Transmits Infection The article noted the AANA initiative and stated, “CDC is working with professional ... control practices related to syringe and needle reuse were needed. ...
www.apsf.org/resource_center/newsletter/2005/summer/10syringe.htm

2008: AANA - 022908 -- AANA Response to Hepatitis C Outbreak in Nevada

2008: A Patient Safety Threat - Syringe Reuse - Fact Sheet | CDC ...

State boards can request voluntary surrender of license until investigations are complete if part of state practice acts. When one's own individual actions violate professional standards or board regulations, revocation of license is always the penalty across all professions.


Same for these professionals:

Doctor Caught Reusing Syringes - Northern Virginia Personal Injury ...

Doctor Accused Of Reusing Syringe - health News Story - WMOR Tampa

Another Long Island Doctor Commits Malpractice By Reusing Syringes

An Outbreak of Hepatitis C Virus Infections among Outpatients at a Hematology/Oncology Clinic

Doctor heading clinic with hepatitis case has stopped practicing medicine The Nevada State Board of Medical Examiners just announced that Dr. Dipak K. Desai, owner of the Endoscopy Center of Southern Nevada where six cases ...

[n_g]

Originally Posted by stanman1968

Let me get this straight, if someone had a surgical rotation regardless of the duration or how long ago as long as they have MD they are good to go for invasive procedures?

Doing invasive procedures is more than simply performing the procedure. It's also knowing the indications, best treatments, and managing them post-procedure. Do you think that there are no consequences to cutting people open? Things like infections? Don't worry, invasive procedures are not within the scope of nursing. As part of their training, FP and internists learn how to manage these types of patients. The fallacy in your logic is that you think that a CRNA and a primary care are at the same level when they learn some of these basic pain techniques. A primary care is leaps ahead of a CRNA in diagnosis, indications, treatment, and management. A CRNA learns how to deliver anesthesia in CRNA school and not the above. If you read the arguments in the case, the differences in education between a physician and CRNA were entered into evidence and became a factor in the final judgment.

[stanman1968]

As pointed out every type of health professional has had this kind of problem before, and why are you changing the subject?
When we point out that the injections are being taught over a weekend to us you call it unsafe. When it is pointed out that these procedures and more invasive ones are being taught to physicians over weekends we get well we do not approve, When pointed out that it is the professional pain associations performing these seminars it turns to well they have a surgical rotation, given that logic a quick weekend course and they should do CABG. You then say we will run risks of being independent practitioners blithely unaware we are already independent practitioners. And finally you bring up the actions of a few careless practitioners and attempt to make the whole out as unsafe, I guess you were unaware of the multiple infections caused by reuse of syringes and needles by MD practitioners. Given your concern over public safety and a record of unsafe MD practice perhaps they should not be practicing after all look what they do.
With every post it has become more and more obvious that you are untrained /uneducated, or just willfully ignorant of medicine, anesthesia the education process for CRNA's and a multitude of other related topics. One thing is clear though that you can spout a party line with the best of them, please go to SDN the great echo chamber of pain and anesthesia. You will fit right in no independent opinions are required just the ability to regurgitate the party line regardless of evidence. I think you have demonstrated YOUR qualifications on this very well indeed.

[stanman1968]

Good for louisiana not the case in indiana, and to say bad outcomes cannot occur to doctors doing the same procedure as a CRNA shows an absolute ignorence of medicine and anesthesia. Please tell me what is the incidence spinal hematoma in sab or epidural hematoma in epidural placement?

Done any research on outcomes between providers? The arguments you espouse have been used to try to prevent CRNA's to perform regional anesthesia place lines, use a flouroscope etc, etc.
They have been shown false everytime. Please if you want to discuss the issue rationally then educate tourself on CRNA education skills and practice, quit spouting the party line and THINK use that muscle between your ears, it is the strongest one you will ever have.

[NRSKarenRN]

Originally Posted by n_g

. As part of their training, FP and internists learn how to manage these types of patients. The fallacy in your logic is that you think that a CRNA and a primary care are at the same level when they learn some of these basic pain techniques. A primary care is leaps ahead of a CRNA in diagnosis, indications, treatment, and management.

2003: Students need more pain management training: education effort ...

WASHINGTON -- Medical students aren't getting adequate training to address pain problems that afflict more than 75 million Americans.
That's what health officials and medical school representatives said at a press conference sponsored by the American Academy of Pain Medicine (AAPM), in launching a new "virtual textbook" that students can use on their own time to learn about pain diagnosis and treatment.

Only 3% of medical schools have a separate required course on pain management, and 4% require a course on end-of-life care, according to statistics from the Association of American Medical Colleges (AAMC).
Less than a third of schools offer elective courses in pain management, and only a quarter provide electives in end-of-life care.
"If we are to effectively treat a future generation of pain patients, we first must educate the next generation of doctors who will care for them," said Dr. Jordan Cohen, AAMC president.
The concept of a virtual textbook "is very appealing and has the potential for broad usage," Dr. Deborah McPherson, assistant director for medical education with the American Academy of Family Physicians, told this newspaper. But she questioned whether students would find time in their busy schedules to do this type of supplemental work. "The reason why we're not teaching appropriate pain management is because there's just not enough room in [current] curriculums," Dr. McPherson said.

Medical Education A Barrier to Pain Therapy and Palliative Care. Journal of Pain and Symptom Management, Volume 21,
Issue 5, Pages 360-362

State Continuing Medical Education Policies for Pain and Palliative Care

Most state medical boards require continuing medical education (CME) for physicians to renew their license. Recently, legislatures and state regulatory boards have begun to require or encourage that CME include education on pain management or palliative care for all or some licensees to provide physicians with updated medical, scientific and clinical knowledge. Evidence that many physicians lack knowledge about pain management and received little training in medical school suggests that such policies are needed and may be a positive step toward improving pain management. Emphasis should be placed on the quality of the curriculum and teaching methods. These policy initiatives should be viewed as experiments until evaluations demonstrate their value.

AANA: Education of Nurse Anesthetists in the United States

Nurse Anesthesia Program Curriculum
The didactic curricula of nurse anesthesia programs are governed by COA standards and provide students the scientific, clinical, and professional foundation upon which to build sound and safe clinical practice. Most nurse anesthesia programs range from 45 to 75 graduate semester credits in courses pertinent to the practice of anesthesia. The science curriculum of graduate nurse anesthesia programs includes a minimum of 30 semester credit hours of courses in anatomy, physiology, pathophysiology, pharmacology, chemistry, biochemistry, and physics. Courses in anesthesia practice provide content such as induction, maintenance, and emergence from anesthesia; airway management; anesthesia pharmacology; and anesthesia for special patient populations such as obstetrics, geriatrics, and pediatrics. Students are instructed in the use of anesthesia machines and other related biomedical monitoring equipment and are evaluated didactically using such traditional evaluation methods as examinations, presentations, and papers. Patient anesthesia simulators are an emerging technology used in many programs to develop dexterity and critical thinking skills essential for the practice of nurse anesthesia.

The supervised clinical residency of nurse anesthesia education provides students the opportunity to incorporate didactic anesthesia education into the clinical setting. Nurse anesthetists are prepared to administer all types of anesthesia, including general, regional, selected local and conscious sedation, to patients of all ages for all types of surgeries. They are taught to use all currently available anesthesia drugs, to manage fluid and blood replacement therapy, and to interpret data from sophisticated monitoring devices. Other clinical responsibilities include the insertion of invasive catheters, the recognition and correction of complications that occur during the course of an anesthetic, the provision of airway and ventilatory support during resuscitation, and pain management.

To meet COA standards and be eligible to take the Council on Certification of Nurse Anesthetists (CCNA) Certification Exam, a student must have performed a minimum of 450 anesthetics, which must include specialties such as pediatric, obstetric, cardiothoracic, and neurosurgical anesthesia. This anesthesia experience includes the care of not only healthy but also critically ill patients of all ages for elective and emergency procedures. In most programs, this minimum is surpassed early in their clinical practicum and the average number of anesthetics performed upon graduation is 773. The results of a 1998 survey of program directors show that Nurse anesthesia programs provide an average of 1595 hours of clinical experience for each student.

During their clinical anesthesia experience, students are supervised by CRNAs or anesthesiologists who provide instruction in the safe administration and monitoring of various techniques, including both general and regional anesthesia. The clinical faculty also evaluate the technical and critical thinking skills of students on a regular basis.