California Turf War: Anesthesiologists vs. Nurses

Nurses nor any profession are blameless or all knowing. The article is not regarding nurses in general, CRNA's and MD's. I also have seen MD's have a terribly hard time in BLS class as well as being a little behind with standards as well as knowledge, bottom line there are people that get nervous around others in a classroom setting and there are those that may never use the skills. Dentists are required in some states to do BLS and have not even thought about it since graduating and in some cases Primary providers never use it either and are required to use it. I think it is very short sighted to take one class and broad stroke an industry. Also, I know plenty of Doctor's who care and no one person would ever voluntarily ask for a pay cut, only due to circumstance would we ever take less for what we do professionally. Additionally people with authority in knowledge and financially are at times condescending to others and are intimidated by those who know things they don't. Not on point, but think it should be addressed. Overall the post is regarding the anesthesia practice, of which I see no problem keeping with the current competitive situation with CRNA's and Md's with oversight or resources such as MD's on an as needed basis or a case review basis for CRNA's.

To me the irony in all of this is that nurses were the first professional entity to administer anesthesia. One could say they were the first advanced practice nurses. In fact, they were. Here is some background:

http://www.aana.com/crnahistory.aspx

I too would not judge a whole profession based on their CPR skills. As an ACLS, PALS, and CPR instructor I have seen strong and weak performance in people with a variety of backgrounds.

yea there might be irony in it, but at the same time there is also over hundred years of history, technology, and an increasing need to CYA. Honestly as much as I want to got CRNA I think i'd have to side that this might not be the best decision in the long run, but its where medicine is going for the moment.

Really? CRNA's are taught to administer anesthesia and to do it efficiently, safely and competently. I would love to hear your reasons why "this might not be the best decision in the long run". Is it because an MDA is so much more competent to administer anesthesia? Really?

The only reason that the ASA or CSA or whatever is up in arms about this is because it takes cash out of their pockets. This isn't a patient safety issue, unless the a particular CRNA is incompitent, though there are also incompetent MD's (and MDA's) so that isn't an argument why CRNA's shouldn't be able to practice independently.

If you are considering going to CRNA school then I would sincerely like you to reconsider your choice. If you think that MD supervision is so much better/safer then try AA or PA so that you can be certain you can CYA all day long.

Anyway, this type of thing is good news. This, unlike a single payer system, is a step to lower the cost of healthcare without lessening the quality or accessability.

Nurse Midwives have been dealing with this kind of BS for years...and midwives have been around since the Old Testament...way before OBGYNs...I think its time for MDs to mind their own business. When NPs are required to get a DNP will they finally shut up? Probably not, they will push some "not real doctors"crap.

While midwives have worked their "craft" throughout history, those working in these times must be adequately educated as advanced practice RNs, usually having their Master's degree and a whole lot of supervised experience.

I still can't see a need for home deliveries, especially for primips, as the possibility for complications looms for them, as well as it does for grand multips. Those of us who have been present as a laboring mom bleeds out, will agree that there is just not enough time to safely get to a hospital, unless you live next door to it - and even then.........

I've seen same day discharges that worked well for parturients and babies who have been prepared for possible early complications and agree to come back, should they occur. Of course then, the mom and baby may not be able to share a room....... We're still in the dark ages about that!

Doctors have thought they were the last word making medical decisions, until the insurance companies took many of those out of their hands. Now they'll hang on to whatever they have, especially when it's a nurse who is taking responsibility. I think that once docs feel secure about being called by a nurse-midwife as soon as he/she anticipates a need for their intervention, due to some abnormal events.

The amount of education and experience most Nurse midwives have, is easily equal to that of OB doctors (without the added GYN, due to surgical treatment needs with that; and they could handle most non-surgical interventions), other than major surgival interventions. The amount of time they spend with perinatal patients is at least 10 X that which doctors do. No wonder patients prefer a Nurse-midwife! (That rankles some male docs who flirt obnoxiously.)

There are some articles suggesting that nurses weren't the first to provide anesthesia. For example, the following article suggests that a surgeon, Seishu Hanaoka, used general anesthesia in 1804 in a breast cancer surgery: http://www.springerlink.com/content/2310725063684231/. Muslim surgeons also used inhalant anesthesia way back around the 10th century according to wikipedia (I'm too lazy to look at actual historical texts to confirm).

Either way, it's silly to suggest that because someone did something first, they have exclusive rights to it. It should be the level and rigor of training that should play an important role. In a time where research is progressing medicine at such a fast pace, the level of education one receives is the best indicator of competency.

Let me clarify since you did not read the link. I did not mean to insinuate that nurses either invented, discovered or were the first to administer anesthesia. What the link does indicate (and that same information is found in a number of other places), is that nurses were the first professional group to administer anesthesia in the USA.

Further, no one is advocating the notion that CRNAs should have exclusive rights to the field of anesthesia. Just like in your position regarding FNPs, no one is trying to replace anyone. Work with and augment yes, but replace? Please.

Level of education is a great indicator. And the level of education that CRNAs undertake is top notch. Please don't confuse "longer" with "appropriate" or "quality". Unlike with FNPs, there is tons of information out there about CRNA patient outcomes compared to those of MDs. It is well established: there is no difference in patient outcomes. And if you come back with the Silber study, I will laugh at you.