AA vs. CRNA - Let's Discuss.

[warzone]

Let's have a discussion/debate (although it will probably be one sided) about AA vs. CRNA. These are just some topics I thought of off the top of my head. Any input or 'playing devil's advocate' would be appreciated.

- What is the difference in schooling/certification/academics?

- What is the difference in their scope of practice or autonomy?

- What economic factors are behind the push of AAs, if any?

- Can we relate this situation to another in Healthcare? Possibly LPN vs. RN?

- What are the best and worst case scenarios for CRNAs in the future, as it pertains to AAs vs. CRNAs?

- Why should one become a CRNA, rather than an AA?

- How does the MDA benefit from the increased use of AAs vs CRNAs?

- How does all this factor into the level of care a patient receives?

We need some AAs or MDAs to log on here to stir up the pot.

This is probably an emotional subject for some, but let's keep it civil. Ultimately we are all on the same team...I guess everyone just wants to be the MVP.

Who wants to cast the first stone?

[warzone]

I am wondering if MDA's will use their power to push AA's autonomy level up almost on par with CRNAs, while still keeping their leverage over them. MDAs are probably looking at CRNAs, similar to the way CRNAs view AAs. Will patient care suffer? I don't know, but I bet that is not a driving force in this.

As far as economics goes. . . what kind of staffing ratios or staffing heirarchy can be achieved by using MDAs, CRNAs, and AAs that still allows for the same patient volume? Which ends up being the most cost effective?

[warzone]

I am wondering if MDA's will use their power to push AA's autonomy level up almost on par with CRNAs, while still keeping their leverage over them. MDAs are probably looking at CRNAs, similar to the way CRNAs view AAs. Will patient care suffer? I don't know, but I bet that is not a driving force in this.

As far as economics goes. . . what kind of staffing ratios or staffing heirarchy can be achieved by using MDAs, CRNAs, and AAs that still allows for the same patient volume? Which ends up being the most cost effective?

[New CCU RN]

Originally posted by warzone

I am wondering if MDA's will use their power to push AA's autonomy level up almost on par with CRNAs, while still keeping their leverage over them. MDAs are probably looking at CRNAs, similar to the way CRNAs view AAs. Will patient care suffer? I don't know, but I bet that is not a driving force in this.

As far as economics goes. . . what kind of staffing ratios or staffing heirarchy can be achieved by using MDAs, CRNAs, and AAs that still allows for the same patient volume? Which ends up being the most cost effective?

The CRNA was around before an MDA actually. Anethesia has always been a nursing specialty. Like I said earlier, it would benefit you to look into the history of nurse anethesia.

Economically, MDA's make the most (at least twice that of a CRNA), CRNA's second, and AA's third.

However, AA's cannot do anything without the MDA present. I don't see how this can be effective. The AA's scope of practice has already been defined, and these are the guidelines. CRNA's, it all depends on the state and facility, but they never have needed the MDA in the room. Economically, I don't see how the AA will benefit bc they are still tying up the MDA. The MDA cannot be doing another surgery simultaneously, unlike with the CRNA.

I don't see the NP/PA being comparable to the CRNA/AA because the PA/NP can still see patients on their own, develop their own plan of care, implement, prescribe. AA's must have the OK with every move they make in the OR.... I see an AA as having even less autonomy as a nurse.

[New CCU RN]

Originally posted by warzone

I am wondering if MDA's will use their power to push AA's autonomy level up almost on par with CRNAs, while still keeping their leverage over them. MDAs are probably looking at CRNAs, similar to the way CRNAs view AAs. Will patient care suffer? I don't know, but I bet that is not a driving force in this.

As far as economics goes. . . what kind of staffing ratios or staffing heirarchy can be achieved by using MDAs, CRNAs, and AAs that still allows for the same patient volume? Which ends up being the most cost effective?

The CRNA was around before an MDA actually. Anethesia has always been a nursing specialty. Like I said earlier, it would benefit you to look into the history of nurse anethesia.

Economically, MDA's make the most (at least twice that of a CRNA), CRNA's second, and AA's third.

However, AA's cannot do anything without the MDA present. I don't see how this can be effective. The AA's scope of practice has already been defined, and these are the guidelines. CRNA's, it all depends on the state and facility, but they never have needed the MDA in the room. Economically, I don't see how the AA will benefit bc they are still tying up the MDA. The MDA cannot be doing another surgery simultaneously, unlike with the CRNA.

I don't see the NP/PA being comparable to the CRNA/AA because the PA/NP can still see patients on their own, develop their own plan of care, implement, prescribe. AA's must have the OK with every move they make in the OR.... I see an AA as having even less autonomy as a nurse.

[warzone]

Originally posted by New CCU RN

... Economically, I don't see how the AA will benefit bc they are still tying up the MDA. The MDA cannot be doing another surgery simultaneously, unlike with the CRNA...

Well then AAs are dead in the water, if it can't be marketed as a viable option. Would the AA profession have been 'created' if there was no viable way to market it? I highly doubt that the role of AAs, if given the right amount of time, will stay stagnant. If they are directly supervised by MDAs, and proven reliable, why would they not be afforded more autonomy?

[warzone]

Originally posted by New CCU RN

... Economically, I don't see how the AA will benefit bc they are still tying up the MDA. The MDA cannot be doing another surgery simultaneously, unlike with the CRNA...

Well then AAs are dead in the water, if it can't be marketed as a viable option. Would the AA profession have been 'created' if there was no viable way to market it? I highly doubt that the role of AAs, if given the right amount of time, will stay stagnant. If they are directly supervised by MDAs, and proven reliable, why would they not be afforded more autonomy?

[EmeraldNYL, BSN, RN]

Originally posted by warzone

I am wondering if MDA's will use their power to push AA's autonomy level up almost on par with CRNAs, while still keeping their leverage over them.

This is an interesting point and a scary possibility, although I think it's unlikely anytime in the near future for all the reasons that CCU RN stated. I could definitely see how the job description of the AA could be stretched somewhat. I'm really not that worried though, especially considering there are only 2 AA schools. I don't think this is cause for panic but I'd be really interested to hear what the long-time CRNA's on this board think.

[EmeraldNYL, BSN, RN]

Originally posted by warzone

I am wondering if MDA's will use their power to push AA's autonomy level up almost on par with CRNAs, while still keeping their leverage over them.

This is an interesting point and a scary possibility, although I think it's unlikely anytime in the near future for all the reasons that CCU RN stated. I could definitely see how the job description of the AA could be stretched somewhat. I'm really not that worried though, especially considering there are only 2 AA schools. I don't think this is cause for panic but I'd be really interested to hear what the long-time CRNA's on this board think.

[CRNA, DNSc]

Of course the Anesthesiologist will push the use and education of the AA since the fundemental different is that the AA is complete under the control of the MDA. CRNAs can practice without the supervision of an MDA, that mean we are not under their direct control. Control is a great motivator that's why the MDA are looking for another provider that they have complete control over. Before anyone considering becoming a CRNA panics remember there are over 28,000 practicing CRNAs in the US and around 600 AA. Become a CRNA, it's a wonderful profession!!!!!:kiss

[CRNA, DNSc]

Of course the Anesthesiologist will push the use and education of the AA since the fundemental different is that the AA is complete under the control of the MDA. CRNAs can practice without the supervision of an MDA, that mean we are not under their direct control. Control is a great motivator that's why the MDA are looking for another provider that they have complete control over. Before anyone considering becoming a CRNA panics remember there are over 28,000 practicing CRNAs in the US and around 600 AA. Become a CRNA, it's a wonderful profession!!!!!:kiss

[loisane]

You guys are testing me, here (which I love, btw). I have been meaning to do some serious research on AAs. They are not an issue in my area, but that is no reason to ignore them. Many people feel this will be the next defining issue in anesthesia.

Ok, here goes what I know off the top of my head. True, there are a limited number of AAs now. They started out being unlicensed providers, working only on the authority of the MDA. Now, some states are licensing them (Is this a good thing, or a bad thing. I don't know.)

Recently some states have attempted to increase the supervision ratio from 1:2 to 1:4. Now, how immediately available is the MDA if he is supervising 4 AAs?

"Immediately available" has been defined in different ways. Some places it means "in the building". So, as I understand it, the MDA does not have to be physically in the room to supervise the AA. (Again, I have no direct knowledge of AAs or how they function).

These are just some of the issues. This is huge guys. I don't think we can afford to take the attitude that there is no way it will affect us.

The most concerning thing to me is the ASA definition of the anesthesia care team. The ASA position is the anesthesia is the practice of medicine. According to them, the only thing that legitimizes CRNA practice is that they are carrying out delegated medical acts. So by their definition, there is no difference between CRNAs and AAs.

Our position is that anesthesia is medicine when done by MDs and nursing when done by CRNAs. Thus, we hold that CRNAs have the legitimate right to practice anesthesia independent of MDA supervision. (You may need MD supervision depending on your state nurse practice act, but no state requires that the MD be an anesthesiologist.)

Organized anesthesiologists/ASA tried very hard to gain complete control of CRNAs. In the past they have tried to regulate our practice through Boards of Medicine instead of Boards of Nursing. They have tried to gain control of our education programs, accrediting bodies and certification process. They have failed at all this.

My personal opinion is that they have changed tactics. There is now a provider shortage. This would be a perfect time to push a (relatively) new provider, one that they could control. They wanted CRNAs to be their assistants, and to be completely dependent on them. They couldn't make CRNAs conform to their view, so they create another provider that fits the mold that they feel is appropriate.

Obviously, I am biased in my opinions. I am a firm adherent to the AANA definition of the anesthesia care team. I am not in favor of AAs. But I am trying to present a fair assessment of things as I see them. In the interest of fairness, let me also say that:

1) There may be some practice settings were AAs are just that, assistants to the process, and the MDA is always physically present.

2) Not all individual anesthesiologists agree with the stated agenda of their professional organization.

3) It is possible that MDAs who do agree with the stated agenda are motivated by an altruistic desire to give patients the best care possible, and they really believe that can only happen when all care is controlled by a physician

4) There is a provider shortage now, and we do need more help. On the surface, what's to say that AAs couldn't help the mess we are in. Disagreeing with the AA concept just to "protect our turf" is not a honorable position to take.

So, charting a course through this upcoming storm is going to be tough. CRNAs have their best minds working on it, and you are all smart to stay apprised of the situation. It is definitely not one to be dismissed lightly.

loisane crna

[loisane]

You guys are testing me, here (which I love, btw). I have been meaning to do some serious research on AAs. They are not an issue in my area, but that is no reason to ignore them. Many people feel this will be the next defining issue in anesthesia.

Ok, here goes what I know off the top of my head. True, there are a limited number of AAs now. They started out being unlicensed providers, working only on the authority of the MDA. Now, some states are licensing them (Is this a good thing, or a bad thing. I don't know.)

Recently some states have attempted to increase the supervision ratio from 1:2 to 1:4. Now, how immediately available is the MDA if he is supervising 4 AAs?

"Immediately available" has been defined in different ways. Some places it means "in the building". So, as I understand it, the MDA does not have to be physically in the room to supervise the AA. (Again, I have no direct knowledge of AAs or how they function).

These are just some of the issues. This is huge guys. I don't think we can afford to take the attitude that there is no way it will affect us.

The most concerning thing to me is the ASA definition of the anesthesia care team. The ASA position is the anesthesia is the practice of medicine. According to them, the only thing that legitimizes CRNA practice is that they are carrying out delegated medical acts. So by their definition, there is no difference between CRNAs and AAs.

Our position is that anesthesia is medicine when done by MDs and nursing when done by CRNAs. Thus, we hold that CRNAs have the legitimate right to practice anesthesia independent of MDA supervision. (You may need MD supervision depending on your state nurse practice act, but no state requires that the MD be an anesthesiologist.)

Organized anesthesiologists/ASA tried very hard to gain complete control of CRNAs. In the past they have tried to regulate our practice through Boards of Medicine instead of Boards of Nursing. They have tried to gain control of our education programs, accrediting bodies and certification process. They have failed at all this.

My personal opinion is that they have changed tactics. There is now a provider shortage. This would be a perfect time to push a (relatively) new provider, one that they could control. They wanted CRNAs to be their assistants, and to be completely dependent on them. They couldn't make CRNAs conform to their view, so they create another provider that fits the mold that they feel is appropriate.

Obviously, I am biased in my opinions. I am a firm adherent to the AANA definition of the anesthesia care team. I am not in favor of AAs. But I am trying to present a fair assessment of things as I see them. In the interest of fairness, let me also say that:

1) There may be some practice settings were AAs are just that, assistants to the process, and the MDA is always physically present.

2) Not all individual anesthesiologists agree with the stated agenda of their professional organization.

3) It is possible that MDAs who do agree with the stated agenda are motivated by an altruistic desire to give patients the best care possible, and they really believe that can only happen when all care is controlled by a physician

4) There is a provider shortage now, and we do need more help. On the surface, what's to say that AAs couldn't help the mess we are in. Disagreeing with the AA concept just to "protect our turf" is not a honorable position to take.

So, charting a course through this upcoming storm is going to be tough. CRNAs have their best minds working on it, and you are all smart to stay apprised of the situation. It is definitely not one to be dismissed lightly.

loisane crna