Anyone have any experience with anesthesia assistants compared to CRNAs ?

Laughing Gas · Jul 10, 2005

I cannot speak for other posters, but I have not seen many if any, attacks on the skill of AA's. Much of the problem stems from the path taken to become AA. Also the more "economical" aspect of empoying AA's is a recurrent theme. I am sure that technical anesthesia skills would superimpose closely from AA to CRNA. I admit that I have little working experience with AA's, hence I am careful to watch what I say. Most of us try to advance nurse anesthesia without crediting or discrediting MDA or AA.

jwk · Jul 10, 2005

I cannot speak for other posters, but I have not seen many if any, attacks on the skill of AA's. Much of the problem stems from the path taken to become AA. Also the more "economical" aspect of empoying AA's is a recurrent theme. I am sure that technical anesthesia skills would superimpose closely from AA to CRNA. I admit that I have little working experience with AA's, hence I am careful to watch what I say. Most of us try to advance nurse anesthesia without crediting or discrediting MDA or AA.

Explain to me the "more economical aspect" of employing AA's.

jwk · Jul 10, 2005

I have little experience with AAs beyond relieving them for lunch breaks when I was moonlighting while still in the Army. I will say that some where darned lacidasical (sp?) in setting up a cart for a big case and I let them know it, but I have also seen that problem with CRNAs and especially some MDAs.
So, comparisons in practice are individualized (isn't everything), and comparisons in training aren't comparable . . . just my opinion.

At least you can claim you have some experience with AA's - most don't, just uninformed opinions. Thank you for pointing out that there are problems with CRNA's and MD's and AA's. There are always going to be a few bad ones - however, by and large, most of the providers of all three types do excellent work every day.

As far as setting up a cart for a "big case" - everybody does things differently. And I agree, there are some pretty lazy people in anesthesia. But some want every conceivable drug and device available for every case. Three blades plus a GlideScope in the corner just in case, four tubes, with and w/o stylets of course, two suctions, pre-torn tape for tube and eyes (nasty habit to me) and enough different drugs to totally cover the rest of their work surface. All that for a D&C - really! Personally, I'd rather have the things I know I will use at the ready. The rest? Well, they're within arms reach in about 1/2 a sec if I need them.

Jetman · Jul 10, 2005

The problem is...and I'm sure you've been through this 1000 times, CRNA's already have at least 4 years of healthcare education and at least 1 year of critical care experience (but the average is 5) while some AA's have none. Most people would not have such a problem with it if AA's were required to be PA's first, or EMS or something. Again, I've seen good and crappy providers in both fields BUT.... CRNA's already have experience titrating drips, interpreting hemodynamics, conscious sedation, coding people, understanding of pathophysiology, knowledge of medical equipment, pharmacology, ........and the list goes on........ and AA's have to learn all of that PLUS anesthesia.......and the length of education is the same???? You have to admit that is SCARY. I'm not saying AA's suck or they don't know what their doing or anything of the sort........I'm just saying that is the problem that people have with it. I mean how can you not know what normal blood pressure is and 2.5 years later be safely administering anesthesia? There is NO WAY that AA's, on average, coming out of school are at the same level as CRNA's. Sorry, but IMPOSSIBLE. There are many excellent AA's but the slack healthcare background admission standards are an insult to the complexity of anesthesia and make the AA profession as a whole questionable as far as safety is concerned .

Wow

Is it me or does this sound exactly like the thread over at the Student Doctor Network, http://forums.studentdoctor.net/showthread.php?t=83245&page=2&pp=30&highlight=crna. I just spent the last 20 minutes reading it and getting totally pissed at the way some of the posters talked about CRNAs. Now I'm reading this and thinking what's the difference? Read what ravanbj says on SDN and tell me if this doesn't sound familiar:

"As long as CRNAa realize that they are NURSES not MDs, that's cool with me. I don't mind using them as little worker ants to do all the boring stuff like charting, appy cases, setting up the room, etc.. Whatever makes my life easier. I guess that's the reward for all the years of HARD work --> Having Nurses to help out with the easy mundane stuff. As long as we get the difficult challenging cases. And as long as CRNAs allow me to run multiple rooms and pad my wallet I am cool with it. Yes they make about 100k, but that is the limit. They reach a glass ceiling in their earning potential, while MDs the sky is the limit. I know people pulling >800k a year, and that is with th ehelp of CRNAs working like busy bees to help out. So relax, it's kind of nice to have CRNAs around (just like pilots have air crew to help out, they are a team but the pilots are still the captains). Just remember ALL MDs, make sure you keep the checks and balances system alive, ie do not let CRNAs take any more power than we want them to have."

He has more idiotic ramblings in the thread, but I won't post them. My point is just because someone does not get a BSN and have 1yr critical care experience does not mean that they start life as an anesthetist at a disadvantage to anybody else.

I don't know where sandman1 went to college but 4yrs of healthcare education is misleading. I had 2 yrs of prereqs (Chem I, Microbiology, Anatomy, Physiology, plus history, english, economics,etc) and then 2 yrs of actual nursing courses. I learned more my first 6 months of actual nursing than in school. I now have 4 years ER experience and have in the last 3 months started in the CVICU. ER did little to prepare me for CVICU and CVICU isn't going to turn you into an immediate CRNA god. I was accepted to the January 2006 class for NA with only 3 months CVICU experience. That tells me it isn't the holy grail that some people believe it to be. It is good to be familiar with Swans, A-lines, hemodynamics, etc., but this isn't stuff that can't be learned and hardly takes a year to understand.

Whatever route you choose, you should just strive to be the best that you can be and get as much out of you education as you can.

Laughing Gas · Jul 10, 2005

Explain to me the "more economical aspect" of employing AA's.

Money. Less of it.

I had occasion to talk with the MDA director of a local hospital which employs AA's and CRNA's. He told me that he prefered AA's over CRNA's due to the fact that he could hire them at a rate of almost two to one. To keep the story honest, he also said he didn't see a difference in performance.

In keeping with typical JWK fashion, I'm sure you'll expound on how salaries are identical, and I am full of phooey.

Laughing Gas · Jul 10, 2005

Wow
Is it me or does this sound exactly like the thread over at the Student Doctor Network, http://forums.studentdoctor.net/showthread.php?t=83245&page=2&pp=30&highlight=crna. I just spent the last 20 minutes reading it and getting totally pissed at the way some of the posters talked about CRNAs. Now I'm reading this and thinking what's the difference? Read what ravanbj says on SDN and tell me if this doesn't sound familiar:
"As long as CRNAa realize that they are NURSES not MDs, that's cool with me. I don't mind using them as little worker ants to do all the boring stuff like charting, appy cases, setting up the room, etc.. Whatever makes my life easier. I guess that's the reward for all the years of HARD work --> Having Nurses to help out with the easy mundane stuff. As long as we get the difficult challenging cases. And as long as CRNAs allow me to run multiple rooms and pad my wallet I am cool with it. Yes they make about 100k, but that is the limit. They reach a glass ceiling in their earning potential, while MDs the sky is the limit. I know people pulling >800k a year, and that is with th ehelp of CRNAs working like busy bees to help out. So relax, it's kind of nice to have CRNAs around (just like pilots have air crew to help out, they are a team but the pilots are still the captains). Just remember ALL MDs, make sure you keep the checks and balances system alive, ie do not let CRNAs take any more power than we want them to have."
He has more idiotic ramblings in the thread, but I won't post them. My point is just because someone does not get a BSN and have 1yr critical care experience does not mean that they start life as an anesthetist at a disadvantage to anybody else.
I don't know where sandman1 went to college but 4yrs of healthcare education is misleading. I had 2 yrs of prereqs (Chem I, Microbiology, Anatomy, Physiology, plus history, english, economics,etc) and then 2 yrs of actual nursing courses. I learned more my first 6 months of actual nursing than in school. I now have 4 years ER experience and have in the last 3 months started in the CVICU. ER did little to prepare me for CVICU and CVICU isn't going to turn you into an immediate CRNA god. I was accepted to the January 2006 class for NA with only 3 months CVICU experience. That tells me it isn't the holy grail that some people believe it to be. It is good to be familiar with Swans, A-lines, hemodynamics, etc., but this isn't stuff that can't be learned and hardly takes a year to understand.
Whatever route you choose, you should just strive to be the best that you can be and get as much out of you education as you can.

This sounds alot like an inflammatory troll post. I am sure some MDA's may feel this way, but I assumed most were smart enough not to aire it on a public forum. I'll bet this is some nobody trying to stir the pot.

sandman1 · Jul 10, 2005

Jetman. What I said was harsh but every bit of it is true. And please don't compare my post to the one below on the SDN. There's no comparison to my laying the facts on the table and that typical MD self righteous

attitude. And yes, if you have "two years" of healthcare education and one year of critical care experience.......and that's a minimum..because most have 5 years experience, it DOES mean that you have an advantage to those that have nothing. How can you say that? 2 years school plus 1-5 years experience versus ZERO? Come on! Lastly, Jetman.......if you have not started school yet yourself, wait and see how amazingly tough and intense it is and then imagine yourself with nothing but a forestry degree and no healthcare background and then come back and read my post.

Wow
Is it me or does this sound exactly like the thread over at the Student Doctor Network, http://forums.studentdoctor.net/showthread.php?t=83245&page=2&pp=30&highlight=crna. I just spent the last 20 minutes reading it and getting totally pissed at the way some of the posters talked about CRNAs. Now I'm reading this and thinking what's the difference? Read what ravanbj says on SDN and tell me if this doesn't sound familiar:
"As long as CRNAa realize that they are NURSES not MDs, that's cool with me. I don't mind using them as little worker ants to do all the boring stuff like charting, appy cases, setting up the room, etc.. Whatever makes my life easier. I guess that's the reward for all the years of HARD work --> Having Nurses to help out with the easy mundane stuff. As long as we get the difficult challenging cases. And as long as CRNAs allow me to run multiple rooms and pad my wallet I am cool with it. Yes they make about 100k, but that is the limit. They reach a glass ceiling in their earning potential, while MDs the sky is the limit. I know people pulling >800k a year, and that is with th ehelp of CRNAs working like busy bees to help out. So relax, it's kind of nice to have CRNAs around (just like pilots have air crew to help out, they are a team but the pilots are still the captains). Just remember ALL MDs, make sure you keep the checks and balances system alive, ie do not let CRNAs take any more power than we want them to have."
He has more idiotic ramblings in the thread, but I won't post them. My point is just because someone does not get a BSN and have 1yr critical care experience does not mean that they start life as an anesthetist at a disadvantage to anybody else.
I don't know where sandman1 went to college but 4yrs of healthcare education is misleading. I had 2 yrs of prereqs (Chem I, Microbiology, Anatomy, Physiology, plus history, english, economics,etc) and then 2 yrs of actual nursing courses. I learned more my first 6 months of actual nursing than in school. I now have 4 years ER experience and have in the last 3 months started in the CVICU. ER did little to prepare me for CVICU and CVICU isn't going to turn you into an immediate CRNA god. I was accepted to the January 2006 class for NA with only 3 months CVICU experience. That tells me it isn't the holy grail that some people believe it to be. It is good to be familiar with Swans, A-lines, hemodynamics, etc., but this isn't stuff that can't be learned and hardly takes a year to understand.
Whatever route you choose, you should just strive to be the best that you can be and get as much out of you education as you can.

jwk · Jul 11, 2005

Money. Less of it.
I had occasion to talk with the MDA director of a local hospital which employs AA's and CRNA's. He told me that he prefered AA's over CRNA's due to the fact that he could hire them at a rate of almost two to one. To keep the story honest, he also said he didn't see a difference in performance.
In keeping with typical JWK fashion, I'm sure you'll expound on how salaries are identical, and I am full of phooey.

Sorry, I think that's total "phooey". Feel free to PM me the specifics - I'll be glad to check it out and report back.

It would be pretty stupid for an AA to work for 1/2 of what a CRNA makes. It makes no sense to me for an AA to work for any less than a CRNA in the same group, although admittedly, I know a FEW that do, usually because they really want to be in a specific town, regardless of their compensation. I assure you, it's not typical. Same work, same job description, same $$$.

Hope that was the typical response you were looking for.

macanes, BSN, MSN, DNP, CRNA · Jul 11, 2005

As far as setting up a cart for a "big case" - everybody does things differently. And I agree, there are some pretty lazy people in anesthesia. But some want every conceivable drug and device available for every case. Three blades plus a GlideScope in the corner just in case, four tubes, with and w/o stylets of course, two suctions, pre-torn tape for tube and eyes (nasty habit to me) and enough different drugs to totally cover the rest of their work surface. All that for a D&C - really! Personally, I'd rather have the things I know I will use at the ready. The rest? Well, they're within arms reach in about 1/2 a sec if I need them.

Yes, yes. I agree that we don't need all the bells and whistles for every case, no matter how small. However, especially for someone with some of the most commonly encountered problem in anesthesia (e.g., hypertension), I insist on a frickin' pressor or two. Also, sux and an induction agent are non-negotiable. I'm REALLY talking here about people who have ABSOLUTELY nothing on top of their cart. Sorry. To me, it's indefensible, because I _have had_ routine cases (ok, two in five years) where a crisis moment would have been a bad outcome if I had not had those things drawn up.

So. We pretty much agree on the rest.

Z

Jetman · Jul 11, 2005

Jetman. What I said was harsh but every bit of it is true. And please don't compare my post to the one below on the SDN. There's no comparison to my laying the facts on the table and that typical MD self righteous
attitude. And yes, if you have "two years" of healthcare education and one year of critical care experience.......and that's a minimum..because most have 5 years experience, it DOES mean that you have an advantage to those that have nothing. How can you say that? 2 years school plus 1-5 years experience versus ZERO? Come on! Lastly, Jetman.......if you have not started school yet yourself, wait and see how amazingly tough and intense it is and then imagine yourself with nothing but a forestry degree and no healthcare background and then come back and read my post.

Sandman, I agree that with all things being equal, the experience gives the nurse the edge. I just don't agree that AA's can't possibly learn hemodynamics and drips etc. while going to anesthesia school and practice at a level of a CRNA upon graduation.

You state "slack healthcare background admission standards are an insult to the complexity of anesthesia and make the AA profession as a whole questionable as far as safety is concerned". This is just speculation unless you have studies to back up your claim. In fact, I checked the AA website www.anesthetist.org and found this:

"AAs have long been recognized for their impeccable safety records. A recently-concluded four year data review at the University Hospitals in Cleveland, Ohio, comparing the safety records of AAs and Certified Registered Nurse Anesthestists (CRNAs) concluded that the two are on equal footing, saying, "Complication rates were no higher for AAs than CRNAs." The Medical Center conducted the research over four years (1999 - 2003) and measured more than 46 thousand cases involving AAs and CRNAs (23,000 cases each). This was an unbiased comparison because the medical center trains both AAs and CRNAs."

Sandman, I do appologize for comparing your post with that moron on SDN. You obviously do not have the same view of AA's as he does of CRNAs. Laughing Gas, really not sure what your problem is unless it's an ego thing. You can call me a "troll" and a "nobody" if it makes you feel better about yourself.

Jetman

lmdscd · Jul 11, 2005

If AA's get the same education why don't they get their own license ? They should be able to pass the same board exam since they think they have the

same education as CRNA's . Why do you think MD like AA's, because they are not a threat!

Jetman · Jul 11, 2005

If AA's get the same education why don't they get their own license ? They should be able to pass the same board exam since they think they have the
same education as CRNA's . Why do you think MD like AA's, because they are not a threat!

I have seen almost the same thing on the MD board about CRNAs.

My initial post really didn't come out the way I meant it to. It is really more about respect for fellow human beings. I've worked with some great doctors and some real jerks. I've seen good nurses totally humiliated and talked down to by those jerks and nothing done to them because of their MD. I believe AAs deserve respect for a job well done, just as a CRNA or an MD would deserve it. If AAs are killing patients off left and right, then absolutely, let's address the situation. I don't think AAs are a threat to CRNAs in any way and at this point in time, there seems to be an abundance of jobs for everyone. So why talk bad about them.

In the end, what does this discussion matter anyway. What really matters in life is the relationship we have with our family, our friends, and our God. Having MD or CRNA on your tombstone does not make you a better person in life.

Respectfully, Jetman