[Dr.Nurse2b]

Originally Posted by ebear

It's been my experience that the majority (not all) anesthesiologists cannot lift a finger to help themselves. The clinical aspect of providing anesthesia care is the same for both. Because they were RNs first, the CRNA seems to be more in tune with pt. care details and comfort measures. The MDAs I've worked with seem to be quite cocky and think they poop ice cream. Give me an excellent CRNA any day!!!! I once worked with an MDA who put the pt. on "auto pilot" and walked up and down the hall reading the Wallstreet Journal ! Got to check those stocks ya know!!!!

Ice Cream! Too funny...I have a buddy who worked in the OR for years...I think he said they poop sorbet...anyway...he told me stories about MDAs taking naps and leaving the nurses to care for the patients...

I think this is why doctors do not want nurses being called "Doctor". God forbid patients see "Doctors" performing menial tasks...like patient care ...then doctors would be expected to care for patients...AND poop ice cream.

[8mpg]

Originally Posted by SuperSleeper

Thank you, GASping, for an intelligent reply.

I think most agree with the fact that not all MDAs can be lumped into the bad apple category. We all appreciate the schooling that MDs endure/aquire. As for your alluding to the lack of critical thinking about disease in nurses, though, one cannot forget that while we get a more holistic training in nursing school, CRNAs have spent time in hands on training in the ICU. This is where we develop that process. Sure we didn't go over it as much in school, but we were thrown to the wolves and learned it do-or-die. I, personally, believe that with the acuity found in hospitals today, the sparse amount of in-depth, detailed disease process study is a sorely lacking point of undergraduate nursing programs. But that is another thread.

It can't be discounted that in one way or another, CRNAs have spent a minimum of 7-8 years of training through school and hands-on experience to get where they are. This is the minimum, most spend a lot longer than that. Many MDs do not realize what the nurses really do. They, understandably, get a snapshot look at it -- when rounding and when the nurse calls. I myself have, over the years, saved many people through dx the immediate problem w/o the help of the MD. I can look at a pt and, if available, the numbers, and pin things down to individual organ or disease process pretty darn well...and I am usually right.

Nurses get placed in situations where there is little to no help. I have delivered babies on my own, I have had my hands inside someone's chest removing clots during a tamponade code, I have had to figure out what the heck was going on and save someone who suddenly crashed while on CVVHD because the machine malfunctioned...but still said everything was fine. I am not going on a high and mighty run here, I'm just giving examples to point out that critical thinking about disease process was my daily gig for years while working in the CVICU...as it is for many nurses. On top of that, we have to be holistic to remain within the definition of our career.

There are CRNAs out there that clock-in, do their time, and go. Most I have known, though, will stick it out as long as necessary. I would be careful about statements like, "They do the bread and butter that I don't care to do." That subtly smells of Bush's comments that we need the illegal immigrants to do the jobs the rest of us don't want to do. I know you didn't mean it that way and I took no offense, but some could -- very easily.

I wholeheartedly agree with you about the clashing only bringing us down. A united front is always stronger. And, yes, if you make more, we will make more. I do have one question, though. In the rural areas where MDAs don't want to practice and CRNAs perform the vast majority of anesthesia care solo, why shouldn't they get the same money? They would be doing the exact same work as MDAs and are held to the same practice standards. Not setting up for argument just legitimately curious.

Like I said, thank you for an intelligent response. We need more non-inflammatory dialogue in order to progress education about our profession.

SS - RN, CCRN, SRNA

Simple..they went to medical school. Just like many other jobs out there, the certificate on the wall means more than anything else. That is just how the world works. BSN's make more than an ADN because the extra schooling but they do the same work. I know the difference isnt much ($.50-2.00) but that is just how it is.

[djc1981]

Originally Posted by 8mpg

Simple..they went to medical school. Just like many other jobs out there, the certificate on the wall means more than anything else. That is just how the world works. BSN's make more than an ADN because the extra schooling but they do the same work. I know the difference isnt much ($.50-2.00) but that is just how it is.

I've never seen a place that pays BSNs any extra actually. There are some (so I've heard) but they are few and far between. It's one reason why most see no real need to get the BSN.

[DocHolliday]

Originally Posted by SuperSleeper

Thank you, GASping, for an intelligent reply.

I think most agree with the fact that not all MDAs can be lumped into the bad apple category. We all appreciate the schooling that MDs endure/aquire. As for your alluding to the lack of critical thinking about disease in nurses, though, one cannot forget that while we get a more holistic training in nursing school, CRNAs have spent time in hands on training in the ICU. This is where we develop that process. Sure we didn't go over it as much in school, but we were thrown to the wolves and learned it do-or-die. I, personally, believe that with the acuity found in hospitals today, the sparse amount of in-depth, detailed disease process study is a sorely lacking point of undergraduate nursing programs. But that is another thread.

It can't be discounted that in one way or another, CRNAs have spent a minimum of 7-8 years of training through school and hands-on experience to get where they are. This is the minimum, most spend a lot longer than that. Many MDs do not realize what the nurses really do. They, understandably, get a snapshot look at it -- when rounding and when the nurse calls. I myself have, over the years, saved many people through dx the immediate problem w/o the help of the MD. I can look at a pt and, if available, the numbers, and pin things down to individual organ or disease process pretty darn well...and I am usually right.

Nurses get placed in situations where there is little to no help. I have delivered babies on my own, I have had my hands inside someone's chest removing clots during a tamponade code, I have had to figure out what the heck was going on and save someone who suddenly crashed while on CVVHD because the machine malfunctioned...but still said everything was fine. I am not going on a high and mighty run here, I'm just giving examples to point out that critical thinking about disease process was my daily gig for years while working in the CVICU...as it is for many nurses. On top of that, we have to be holistic to remain within the definition of our career.

.

SS - RN, CCRN, SRNA

Please see the areas of your post I put in boldface:

What you described sounds just fine and dandy, but the reality is that everything you point out in your argument exemplifies the problem with CRNAs and other mid-level providers; an almost complete failure to recognize the importance of the didactic training acquired in medical school, and the ultra-intensive training (which includes didactic) acquired in residency.

I have no doubt that you've learned some valuable things hands-on, but your knowledge of the finer points of anesthesia will never match that of an anesthesiologist. As a surgeon, I deal with both CRNAs and anesthesiologists, and when dealing with critically-ill patients, the difference between CRNAs and anesthesiologists is very apparent.

I appreciate CRNAs for what they do--they have an important job. But what I find extremely disturbing about them is that there is a common sentiment above them that they are basically anesthesiologists, minus the MD degree and the four-year residency.

If there's one all-important thing I've learned since becoming a doctor, it's that there is absolutely nothing more dangerous than a practitioner who doesn't know what he/she doesn't know.

Finally, your comments about CRNAs having "7 to 8 years of training" is a blatant distortion of the facts. CRNAs are required to have a nursing degree, which may be acquired in two years as part of a four-year four-year undergraduate degree. Your undergraduate degree is not considered to be "training". I sure as hell never considered my four years as an undergrad at UVA to be "medical training"! After your two years of nursing training (which is of minimal pertinence to the science of anesthesia), you are required to have work experience in some sort of ICU setting. Again, this is not considered to be "training" either, rather, it is simply work experience.

Your actual training is merely two to three years in duration.

Compare that with an anesthesiologist, who has spent (after spending four years in college, just like you), four years in medical school (which is bar-none the most grueling educational program of all), and four years in residency training (approximately 80+ hours a week). Some anesthesiologists even go on to do fellowships.

There is absolutely no comparison between an anesthesiologist and a CRNA with regard to training. Anesthesia is more than sticking a tube down a patient's throat, administering halogenated ethers, and pushing benzos and narcs. It is a specialty of medicine, and the anesthesiologist is the doctor who must be not only be able to examine a patient, but must have an intimate knowledge of a patient's condition and formulate an anesthesia plan accordingly. If CRNAs could do that with the same competence that anesthesiologists could, they'd have been awarded MD degrees somewhere along the way! The anesthesiologist is a physician. The CRNA is a skilled worker. There is an enormous difference between the two.

[SuperSleeper]

GASping
Believe me, I would never confuse myself for an MD, nor would I want to.

Yes, you are right. Individuals who took the minimum track to get to CRNA time-wise spent a couple of those years in non-nursing training. However, that is NOT the path most have taken.

You are grossly mistaken when you plaster the title "skilled worker" on a CRNA. They are advanced practice nurses with knowledge, abilities, and judgments that many MDs will never dream to acquire simply by virtue of their paths of training, experience, and personalities. These attributes are like gold with patient diagnosis and care. This on top of their anesthesia training. (Note: I didn't say they know more than MDs or even as much as MDs know about all they know!) You have no way of knowing the background of all CRNAs. Your comment is inflammatory here and you know it.

Stereotyping and insults. I was obviously incorrect in my judgment about your communication style.

SS

[8mpg]

Originally Posted by SuperSleeper

GASping
Believe me, I would never confuse myself for an MD, nor would I want to.

Yes, you are right. Individuals who took the minimum track to get to CRNA time-wise spent a couple of those years in non-nursing training. However, that is NOT the path most have taken.

You are grossly mistaken when you plaster the title "skilled worker" on a CRNA. They are advanced practice nurses with knowledge, abilities, and judgments that many MDs will never dream to acquire simply by virtue of their paths of training, experience, and personalities. These attributes are like gold with patient diagnosis and care. This on top of their anesthesia training. (Note: I didn't say they know more than MDs or even as much as MDs know about all they know!) You have no way of knowing the background of all CRNAs. Your comment is inflammatory here and you know it.

Stereotyping and insults. I was obviously incorrect in my judgment about your communication style.

SS

LOL...you were wrong and you know it. DocHoliday is correct. Medical doctors do went to medical school and did way more specialty training than any CRNA did. It is unfair to say that a doctor does the job of a nurse. Would you say a paramedic is the same as a flight nurse, and that a flight nurse does the job of a paramedic? No, they do more, did different schooling, etc...

[wtbcrna]

Originally Posted by 8mpg

LOL...you were wrong and you know it. DocHoliday is correct. Medical doctors do went to medical school and did way more specialty training than any CRNA did. It is unfair to say that a doctor does the job of a nurse. Would you say a paramedic is the same as a flight nurse, and that a flight nurse does the job of a paramedic? No, they do more, did different schooling, etc...

I see from your profile that you are speaking from a vast amount of experience and knowledge on this matter. Would you like to pull up some research to show that MDAs have better outcome than CRNAs?..

CRNA school builds on your undergraduate nursing education (2yrs),requires a minimum of one year acute care nursing experience, & 2-3yrs of actual nurse anesthesia school. So, for us it is 5-6yrs of schooling if you don't count the 1st two years of undergraduate education, and it is 7-8yrs for physicians (depending on if you count there internship year). CRNA school is different from medical school, but there still is not one valid study that shows a difference in patient outcomes when you compare CRNAs and MDAs.

Just for the record most of the instructors at my school that teach both med students and nurse anesthesia students think our program is more intense, because we have to cover so much material in such a short period of time.

Not all schools require the same time committment, but I have to pull call just like the MDA residents. I have to go to the same classes during my clinical phase, and my hours suck just as bad as theirs. The big difference is I will graduate a lot sooner, and we are way ahead on clinical skills/general anesthesia knowledge from day one. Our school is applied graduate education from day one. Where medical students are generalists until they get to usually their 2nd year after graduation (depending on how they do their 1st year/internship).

Everyone has a opinion on if the education of one anesthesia provider over another is better, but the simple truth is that the research just doesn't pan out showing a difference. So, if one surgeon wants to have an MDA do all his "critically ill" patients more power to him or her. The rest of us will just hope him or her won't base the rest of their practice on anecdotal evidence.

[DocHolliday]

Believe me, I would never confuse myself for an MD, nor would I want to.

Yes, you are right. Individuals who took the minimum track to get to CRNA time-wise spent a couple of those years in non-nursing training. However, that is NOT the path most have taken.

You are grossly mistaken when you plaster the title "skilled worker" on a CRNA. They are advanced practice nurses with knowledge, abilities, and judgments that many MDs will never dream to acquire simply by virtue of their paths of training, experience, and personalities. These attributes are like gold with patient diagnosis and care. This on top of their anesthesia training. (Note: I didn't say they know more than MDs or even as much as MDs know about all they know!) You have no way of knowing the background of all CRNAs. Your comment is inflammatory here and you know it.

SuperSleeper, your comments are in boldfaced text above.

Your problem, Supersleeper, is that you fail to recognize the significance of the word "doctor". To you, my M.D. indicates that I possess "just a little more education" than what an advanced practice nurse possesses. As long as you harbor that perception of the difference between doctors and advanced practice nurses, you will forever pose a danger to your patients. Why? Because, whether you're willing to admit it or not, and whether you're even cognizant of it or not, you will always be performing your duties as a CRNA having something to prove. This attitude will make you a little more likely to take risks tackling problems you are incompletely trained to tackle....unlike an anesthesiologist who has nothing to prove, and who feels no shame in asking a more experienced colleague for advice.

The reality is that many mid-level providers have an inferiority complex. It is not only apparent on this board, it is apparent in practice--both in private practice settings and hospital settings. They are, as you are, a little....how shall I put it...."sensitive" about the fact that they are healthcare providers, but not doctors. So, in order to compensate, they try and argue that they have some element of parity with doctors--both in terms of education and scope of work--by tweaking, distorting, and even misrepresenting their educational and work experiences.

What you mid-levels need to understand is doctors are not smarter than you by virtue of being doctors. We simply chose a career path that covers medical sciences in much greater detail than you did.

Finally, as for your argument that "most CRNAs have had more training than the minimum required": I don't give a hoot what "extra credit" you guys performed. The bottom line is that you can become a CRNA with about 2.5 years of anesthesia training---training that is not only shorter in duration and geared toward producing a mid-level provider, but training that is also of less thoroughness than that endured by an anesthesiologist.

They are advanced practice nurses with knowledge, abilities, and judgments that many MDs will never dream to acquire simply by virtue of their paths of training, experience, and personalities.

This is an utterly meaningless statement. Not only is there absolutely nothing to substantiate it, it serves no purpose in this argument. We are comparing the training required to become an anesthesiologist vs. the training to become a CRNA. Moreover, the "paths of training and experience" of anesthesiologists is a lot longer and more thorough than that of a CRNA. You know this. So please don't try and white-wash me with preposterous statements like the one above.

Finally, my previous post was not meant to be inflammatory. It was meant to be direct. If the truth is inflammatory, I suggest you go to medical school and work harder than you ever have and become an anesthesiologist. It sounds to me like you wish you had.

[DocHolliday]

I see from your profile that you are speaking from a vast amount of experience and knowledge on this matter. Would you like to pull up some research to show that MDAs have better outcome than CRNAs?..

CRNA school builds on your undergraduate nursing education (2yrs),requires a minimum of one year acute care nursing experience, & 2-3yrs of actual nurse anesthesia school. So, for us it is 5-6yrs of schooling if you don't count the 1st two years of undergraduate education, and it is 7-8yrs for physicians (depending on if you count there internship year). CRNA school is different from medical school, but there still is not one valid study that shows a difference in patient outcomes when you compare CRNAs and MDAs.

Just for the record most of the instructors at my school that teach both med students and nurse anesthesia students think our program is more intense, because we have to cover so much material in such a short period of time.

Not all schools require the same time committment, but I have to pull call just like the MDA residents. I have to go to the same classes during my clinical phase, and my hours suck just as bad as theirs. The big difference is I will graduate a lot sooner, and we are way ahead on clinical skills/general anesthesia knowledge from day one. Our school is applied graduate education from day one. Where medical students are generalists until they get to usually their 2nd year after graduation (depending on how they do their 1st year/internship).

Everyone has a opinion on if the education of one anesthesia provider over another is better, but the simple truth is that the research just doesn't pan out showing a difference. So, if one surgeon wants to have an MDA do all his "critically ill" patients more power to him or her. The rest of us will just hope him or her won't base the rest of their practice on anecdotal evidence.


I have read a number of those articles comparing "outcomes" of CRNAs vs. anesthesiologists. They are similar to the articles comparing outcomes between ARNPs and MDs.

Such articles are utterly nonsensical. Let me give you a little story, just to illustrate a point:

Just recently, I was having some aching in my maxillary teeth extending up the side of my face, and I was certain that I had cracked a tooth. I went to my dentist, who checked the teeth, and found nothing dental in origin. He then asked me some questions, palpated my mid-face (which hurt like hell), and diagnosed me with a sinus infection. He put me on a 10-day course of amoxicillin, and by the 5th day, my pain was gone.

How many of us would consider a dentist as someone from whom you'd seek treatment for a sinus infection? I sure as hell didn't! After all, they aren't trained to deal with pathologies of the sinuses--at least, general dentists aren't. Apparently, they do know a thing or two about the subject matter. As much as a physician would? Probably not.

But you know what? The outcome of my dentists treatment of my sinus infection was every bit as good as an ENTs. Would I dare conclude from this that a dentist is as qualified to treat sinus infections as an ENT?

Absolutely not. And why not? Because, my case was a simple case.

Most diabetics can be controlled with dietary changes or medications. Most hypertensive patients can be controlled with lifestyle changes, ACE inhibitors, beta-blockers, or some other anti-hypertensive med.

The statistics surrounding "outcomes" are flawed for two reasons:

1. Because the vast majority of problems crossing the path of mid-levels or primary care physicians are relatively simple and straightforward.

2. Because mid-levels often send to physicians the more complex cases, i.e. the cases where the mid-level is unable to address it. These are not reported as "bad outcomes"

Is a CRNA going to be as skilled intubating and anesthetizing a healthy 30 year-old male? Sure. But is a CRNA going to be as qualified to put a severely medically-compromised patient under as an anesthesiologist would? Is a CRNA going to be as qualified to formulate an anesthesia plan for this patient as the anesthesiologist? Of course not.

A CRNA, like any mid-level, is not a doctor who has had extensive training not only in human health and disease, but in diagnosis as well.

[wtbcrna]

DocHoliday,

The proof is in the research, and you just spent your time posting your opinion and nothing else. Simply put the research has long been established that CRNA/MDA outcomes are the same.

If you want to state opinions all day long then my opinion is MDAs really only get 3yrs of anesthesia training. The 1st year of residency training is traditionally an internship year followed by 3yrs of actual anesthesia training, and most of a residents 1st year anesthesia training is just learning how to do direct patient care.

If 4yrs of medical school/3yrs of residency training make MDAs better than CRNAs then provide one valid research study to prove your point.


FYI:

I am not anti-MDA, but I do believe that a CRNA does not need supervision of an MDA/physician, but should work cooperatively with all healthcare providers.