*******SUPERVISION REQUIRED or NO for CRNAs?*******

Specialties CRNA

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I am confused. Do CRNAs work ONLY under supervision of anesthesiologist or any physician? I was thinking they can work even independently all over USA with no supervision. Correct me if I am wrong. Do the rule change from state to state if so please describe more on that. What about NORTH CAROLINA state issue ??? Any changes are expected in terms of supervision on CRNAs?

Can this also be implemented all over USA so that NO CRNA can work by them self with no supervision?? R they going to make supervision on CRNAs mandatory soon or what?

I didn't realize LPNs are performing the same job as RNs. I know in our state they have limitations on the type of care they provide like giving IV meds for example. I have never seen an LPN in an ER or an ICU (correct me if I'm wrong, I'm not trying to insult) or one with ACLS,TNCC,IABP,CCRN etc. As far as the CRNA/MDA issue, one thing that people who aren't familiar with anesthesia is they don't have a knowledge of the history of anesthesia. CRNAs never needed to be supervised before, our profession was created for the safety of the patient, when surgery really got rolling and there was a need for attentive individuals to focus just on the patient and keep them alive. MDAs came around later. So you see, it has never been an issue of CRNAs breaking the physician led model, but rather protecting the responsibility they have always had.

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I didn't realize LPNs are performing the same job as RNs. I know in our state they have limitations on the type of care they provide like giving IV meds for example. I have never seen an LPN in an ER or an ICU (correct me if I'm wrong, I'm not trying to insult) or one with ACLS,TNCC,IABP,CCRN etc. As far as the CRNA/MDA issue, one thing that people who aren't familiar with anesthesia is they don't have a knowledge of the history of anesthesia. CRNAs never needed to be supervised before, our profession was created for the safety of the patient, when surgery really got rolling and there was a need for attentive individuals to focus just on the patient and keep them alive. MDAs came around later. So you see, it has never been an issue of CRNAs breaking the physician led model, but rather protecting the responsibility they have always had.

You are taking what I said out of context. I did not say LPNs are performing the same job as RNs. I said much the same. We have LPNs in the ICU, none currently in ER though.

Anyway, that's not what I am trying to ask.

Supervision should not be needed. CRNAs are quite capable of performing their job. Yes, some people may see it as symantics, but direction and supervision are two very different things.

I am an LPN and I would get involved in it in my state if they wanted CRNAs or any other advanced nurse to require supervision. Any nurse at all for that matter! We have supervisors, but that is a hiararchy word, not a pracitcal word, that's why we have been changing terms, and the "nursing supervisor" will also change.

I work at the direction of my pts surgeon and/or attending. Yet they are not present (most of the time) during the execution of my performance. I also have a charge nurse (RN) who makes my assignment (I am working at her direction, but again, she is not present in the performance of my duties, nor is MD or RN responsible for my actions. But, if they were supervising me, they would be responsible. It's a BIG difference and any nurse, advanced practice or not should be outraged at the thought of being tolds/he needs supervision.

I just don't see why the CRNAs are opposed to such a thing as direction. We as nurses always have to answer to somebody. 'At the direction of' truly is symantics. So what if an MDA has to say, you "do" Mr Smith, Mrs Applegate and Ms Jones? Or even say what type of anesthesia is used?

An MDA who you are working under the direction of would not need to be in-house, just available, so the repercussions to rural area hospitals should not be overwhelmingly impossible to manage. Much as the RN must be available via telephone or other electronic method for LPNs in LTC.

OR is there something that has not been mentioned and I am therefore ignorant of?

That is just it, what does the MDA need to be available for?

I just don't see why the CRNAs are opposed to such a thing as direction. We as nurses always have to answer to somebody. 'At the direction of' truly is symantics. So what if an MDA has to say, you "do" Mr Smith, Mrs Applegate and Ms Jones? Or even say what type of anesthesia is used?

An MDA who you are working under the direction of would not need to be in-house, just available, so the repercussions to rural area hospitals should not be overwhelmingly impossible to manage. Much as the RN must be available via telephone or other electronic method for LPNs in LTC.

When you say we have to 'answer' to someone, do you mean that we have to 'answer' to physicians? I don't think this is true at all, if that is the way you meant it. I believe the only person I have to answer to is the patient. Did I misunderstand what you are saying?

I also disagree with your first paragraph about an MDA directing my practice, especially what type of anesthesia is used. If an MD would dictate my practice (select the meds I use, how I deliver it, how much I deliver, whether I use a regional or general technique), then I don't think this makes me an advanced practice nurse. I think that makes me the same as an OR nurse. There is no point to obtain this advanced degree and education if all I will do is follow orders. Does that make sense? I want to exercise my critical thinking skills in caring for my patients, and not have to rely on someone else to make decisions regarding patient care.

I also disagree with the second paragraph above, about having an MDA available. I don't believe there is a point to this - a CRNA is educated to treat all aspects of anesthesia and any anesthetic complications that may arise. Now, don't get me wrong - I am not saying that it doesn't help to have an extra pair of hands in an emergency situation - but those hands don't have to be attached to an MDA. A extra CRNA would be just as much help in a stressful situation.

That is just it, what does the MDA need to be available for?

LOL, no I don't mean to be laughing at you but I think you have just answered what I have spent all day trying to figure out!

That's exactly what I mean about the RN:LPN. Once a week we may see a pt with IV push meds that I can not give. In that case, an RN is usually assigned to that pt. This eliminates any potentional problem with scope of practice.

This is why I wondered why it would be a big deal? Let them have their symantics, it makes them (the BON, AMA, etc) happy to think they are important and that they are needed to manage our license and scope of practice. You don't need them, in all but a rare case. So why bother with the symantics of it all.

As long as we are nurses, someone will attempt to "control" us. By the way, changing our name to anything else besides nurse does not change who we are. The "they's" will still need to control us. The "they's will still need to stiffle our progress as professionals. All the way from LPN to Advanced Nurse Practitioner.

I just don't see why the CRNAs are opposed to such a thing as direction. We as nurses always have to answer to somebody. 'At the direction of' truly is symantics. So what if an MDA has to say, you "do" Mr Smith, Mrs Applegate and Ms Jones? Or even say what type of anesthesia is used?

you see, as a person who is responsible for giving an anesthetic is responsible for that anesthetic. even in the act model, (anesthesia care team) where there are mdas, the crna is no less responsible for the anesthetic that they deliver. if an md tells you to use a lma on an obese diabetic patient with gerd and you do it and that pt aspirates, the crna is ultimately responsible, there may be some shared repsonibility when it comes to being sued, but the crna will still be sued. so i would rather not have someone trying to dictate what type of anesthetic it is i deliver if i am to be responsible for that anesthetic.

also the direction issue brings up certain aspects of how to deliver anesthesia in office settings etc.

crnas have delivered safe quality anesthesia in a variety of settings for years without some md telling them how to do it. so why should we change now when anesthesia is safer than it has ever been? the mds what to change it for their per$onal $$ benefit, not the patients.

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When you say we have to 'answer' to someone, do you mean that we have to 'answer' to physicians? I don't think this is true at all, if that is the way you meant it. I believe the only person I have to answer to is the patient. Did I misunderstand what you are saying?

I also disagree with your first paragraph about an MDA directing my practice, especially what type of anesthesia is used. If an MD would dictate my practice (select the meds I use, how I deliver it, how much I deliver, whether I use a regional or general technique), then I don't think this makes me an advanced practice nurse. I think that makes me the same as an OR nurse. There is no point to obtain this advanced degree and education if all I will do is follow orders. Does that make sense? I want to exercise my critical thinking skills in caring for my patients, and not have to rely on someone else to make decisions regarding patient care.

I also disagree with the second paragraph above, about having an MDA available. I don't believe there is a point to this - a CRNA is educated to treat all aspects of anesthesia and any anesthetic complications that may arise. Now, don't get me wrong - I am not saying that it doesn't help to have an extra pair of hands in an emergency situation - but those hands don't have to be attached to an MDA. A extra CRNA would be just as much help in a stressful situation.

We all have someone to 'answer to' means there is a hiararchy in everything. Not one specific professional answering to another. This hiararchy would feel important to say the MDA is directing the care provided by the CNA. No, you don't need them, didn't mean to imply you do. As the poster mentions below your post, it's all about the AMA seeing fees go to a nurse instead of them!

LOL, no I don't mean to be laughing at you but I think you have just answered what I have spent all day trying to figure out!

That's exactly what I mean about the RN:LPN. Once a week we may see a pt with IV push meds that I can not give. In that case, an RN is usually assigned to that pt. This eliminates any potentional problem with scope of practice.

This is why I wondered why it would be a big deal? Let them have their symantics, it makes them (the BON, AMA, etc) happy to think they are important and that they are needed to manage our license and scope of practice. You don't need them, in all but a rare case. So why bother with the symantics of it all.

As long as we are nurses, someone will attempt to "control" us. By the way, changing our name to anything else besides nurse does not change who we are. The "they's" will still need to control us. The "they's will still need to stiffle our progress as professionals. All the way from LPN to Advanced Nurse Practitioner.

You need to educate yourself in the practice of nurse anesthesia. We are not in a position where our actions are determined by anyone other than the patients needs. We do not need an order to administer a drug, we do not need an order for the type of anesthetic.

All we need is an order for anesthesia or pain management from a physician. Just as any physician writes an order when another specialty is needed.

The issue is not just symantics, rural patients would be without surgical/pain services if it were not for CRNA's. There are very few MDA's working in or anywhere near rural facilities. CRNA's currently bill directly, if we said oh....it is just symantics let them say we are supervised, then again there would be patients without reasonable access to services.

I could go on ad-nauseum but I will stop now. The issues go beyond this message board.

I have to agree with smilingRu, lpner please spend some time - and more then a few hours with a CRNA - then state your opinions. If it is a position you seem to be interested in then by all means please start your path to the pursuit. RN degree (diploma or Assoc) then onto your BSN - work a year or two in a critical care unit - take your certifications CCRN etc - GRE's, apply to the graduate programs, interview, gain acceptance. Then quit working for 28 months - borrow thousands of dollars to finance your education - wake at 3:00am each day, drive hours and hours a week - while trying to study for extremely difficult exams. With success you will graduate and then pass your boards, yes you will still be a Nurse - but you will also have a better understanding of the responsibilty that comes with being a CRNA. GOOD LUCK:p

The problem is that once you give into something in this kind of turf battle you can't change it back and the more powerful group will try to enact more restrictions on your practice. So you see, we can't simply give in to be directed because 1st we don't want to and 2nd they would try to exert more control over our practice.

:p
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