CRNAs in Florida to require anesthesiologist supervision - page 3

I just read in a magazine about a House bill being passed that mandates that CRNAs in that state must now be supervised by anesthesiologists. If this passes the senate, wouldn't this be the end of... Read More

  1. by   jwk
    Quote from sherbcrna
    Signing one's name on a chart does not signify active involvement in the case. Are you aware that 13 states have opted out of medical supervision for CRNA's and there are many rural counties in this country where the CRNA is the sole anesthesia provider, so I think the numbers might be a little higher than you think. I don't consider this number propaganda, as in many places the MDA only attends induction and the CRNA manages the case as well as emergence.
    Hmmmmm, I think an attorney would tell you that signing one's name on a chart DOES imply involvement, whether momentarily, or from the lounge, or if they're just there for induction, or whatever. If your name is on the chart, particularly an MD, you're on the hook, whether you were ever physically present or not.

    I certainly understand that there are lots of CRNA's practicing with no MDA involvement. I know quite a few in Georgia that cover several rural hospitals that the MDA's wouldn't touch.

    Even in many care team practices, for all practical purposes, the anesthetist (whether CRNA or AA) is the one managing the case. That's how the real world operates.
  2. by   Maxs
    Quote from jwk
    Hmmmmm, I think an attorney would tell you that signing one's name on a chart DOES imply involvement, whether momentarily, or from the lounge, or if they're just there for induction, or whatever. If your name is on the chart, particularly an MD, you're on the hook, whether you were ever physically present or not.

    I certainly understand that there are lots of CRNA's practicing with no MDA involvement. I know quite a few in Georgia that cover several rural hospitals that the MDA's wouldn't touch.

    Even in many care team practices, for all practical purposes, the anesthetist (whether CRNA or AA) is the one managing the case. That's how the real world operates.
    And your point is? And why do you think it should be manadated that MDA's should keep signing those papers? just curious. Do you think it's necessary, if so, how?

    Maxs
  3. by   Brenna's Dad
    I believe only approx. 20% of all anesthetics are done by CRNAs without supervision. Supervision, though as we probably all know is more about payment than actually doing the case. When the shart hits the fan, it will be the CRNA who's going to save the pt.
  4. by   deepz
    Quote from Brenna's Dad
    I believe only approx. 20% of all anesthetics are done by CRNAs without supervision. ........

    Really?! What's your source to back up this assertion? AND how do you define 'supervision?'

    ?
  5. by   jwk
    Quote from Brenna's Dad
    I believe only approx. 20% of all anesthetics are done by CRNAs without supervision. Supervision, though as we probably all know is more about payment than actually doing the case. When the shart hits the fan, it will be the CRNA who's going to save the pt.
    In the end, it's all about $$$.
  6. by   sherbcrna
    Quote from apaisRN
    Can you tell us what some of the reasons are? I have reasons why I think I will like anesthesia, but would love to hear it from someone who's actually doing it.
    I was a critical care/PACU/CVRU nurse for many years and absolutely loved my work, but something was missing. The hospital and surgeons i worked with realy promoted autonomy and the best care possible for the patients. During these years, I had the opportunity to see CRNA's and very congenial MDA's work together in the OR/PACU/CVRU, and even the ICU when we needed anesthesia's assistance with intubation and bed side procedures. So where I came from, they worked hand in hand. I now work in a facility where "Darth Vadar" is the chief of anesthesia. The plus is that I don't work for him, just the hospital. The political climate is probably the biggest deterent to this or any other practice. But, you must look at the many positives. I care for one patient at a time, which permits me to give the best care possible. (no running after 2 or more patients). These people usually remember my name because I introduce myself as a certified registered nurse anesthetist that will be providing their anesthesia today, and I tell them that I will be the one at the head of the bed with them throughout their procedure. I feel that the ability to individually preop each patient gives them the opportunity to see the person that will put them to sleep. Another perk is the schedule. Depending on where you work, almost any schedule is possible.
    Now to the money, yes the money is nice but don't do it for the money, you'll be very unhappy. Look at the money as a perk for taking care of some very sick people,where their lives are essentially in your hands while asleep. We probably stick together for the common cause greater that any other nursing specialty which gives you many networking opportunities for future employment. Last but not least-how i feel when I go home at the end of the day. Tired, but proud of those I was able to help today, were it to be the 80 year old teary eyed gentleman that had a CABG or the parents of a downs baby that's having dental issues. This job allows you to care for others because after all we are all nurses first then CRNA's with the knowledge to care for very complex situations. You'll come out of CRNA school floored with what you have learned and exactly how much you didn't know as a staff nurse. Take the jump, I really don't think you'll regret your decision to do it!!!!Everyday is totally different from the day before. Different cases different faces and different health problems to contend with = too busy to be bored.
    :angel2: :angel2:
  7. by   Tony35NYC
    Quote from jwk
    In the end, it's all about $$$.
    I have a few friends here in New York who are CRNAs. They are very passionate about their work and its not just because of the money. Listening to these guys talk about their work is what inspired me to want to become a CRNA. If your comment is in reference to some MDAs determination to restrict CRNA practice then you might be right.

    I doubt that most MDAs practice anesthesia only for the money (although I've worked with a few at my hospital who clearly do). Its mostly a power thing for them because the state boards of medicine aren't comfortable with the idea of nurses invading what they consider to be 'thier turf.'
  8. by   gwlillith
    Quote from sherbcrna
    I was a critical care/PACU/CVRU nurse for many years and absolutely loved my work, but something was missing. The hospital and surgeons i worked with realy promoted autonomy and the best care possible for the patients. During these years, I had the opportunity to see CRNA's and very congenial MDA's work together in the OR/PACU/CVRU, and even the ICU when we needed anesthesia's assistance with intubation and bed side procedures. So where I came from, they worked hand in hand. I now work in a facility where "Darth Vadar" is the chief of anesthesia. The plus is that I don't work for him, just the hospital. The political climate is probably the biggest deterent to this or any other practice. But, you must look at the many positives. I care for one patient at a time, which permits me to give the best care possible. (no running after 2 or more patients). These people usually remember my name because I introduce myself as a certified registered nurse anesthetist that will be providing their anesthesia today, and I tell them that I will be the one at the head of the bed with them throughout their procedure. I feel that the ability to individually preop each patient gives them the opportunity to see the person that will put them to sleep. Another perk is the schedule. Depending on where you work, almost any schedule is possible.
    Now to the money, yes the money is nice but don't do it for the money, you'll be very unhappy. Look at the money as a perk for taking care of some very sick people,where their lives are essentially in your hands while asleep. We probably stick together for the common cause greater that any other nursing specialty which gives you many networking opportunities for future employment. Last but not least-how i feel when I go home at the end of the day. Tired, but proud of those I was able to help today, were it to be the 80 year old teary eyed gentleman that had a CABG or the parents of a downs baby that's having dental issues. This job allows you to care for others because after all we are all nurses first then CRNA's with the knowledge to care for very complex situations. You'll come out of CRNA school floored with what you have learned and exactly how much you didn't know as a staff nurse. Take the jump, I really don't think you'll regret your decision to do it!!!!Everyday is totally different from the day before. Different cases different faces and different health problems to contend with = too busy to be bored.
    :angel2: :angel2:

    :hatparty:
    BRAVO!!!
    Great post. Wonderful insight to those of us who can't put into words the decision to become a CRNA!
    I look forward to joining your respected profession.
    Thanks once again.
    elizabeth
  9. by   Laughing Gas
    [QUOTE=jwk]Hmmmmm, I think an attorney would tell you that signing one's name on a chart DOES imply involvement, whether momentarily, or from the lounge, or if they're just there for induction, or whatever. If your name is on the chart, particularly an MD, you're on the hook, whether you were ever physically present or not.QUOTE]

    So the MD's name on the chart is strictly for liability? Retention of power? It is technically needed for supervision even though the MDA usually has little to do with actual case managment? If that's how the definition of supervision reads, then the AMA has a nice scheme going.

    And yes, a lawyer looking at a case with an MDA's signature could assertain the implication of involvement. You used caps on the wrong word, "name on a chart DOES imply involvement" Imply should be in caps. There is very little pertainence to reality in a lawyer's world.
  10. by   Laughing Gas
    Quote from jwk
    In the end, it's all about $$$.

    No, it's about control. Everyone wants to control their own destiny. Money can be a by-product of control.
  11. by   AWDC
    Speaking as an interested observer (since I don't really have any experience in anesthesiology.) I don't think it's all about money and control. Much of it is, but let's say you remove money and control from the arguments. From what I gather, it seems both MDAs and CRNAs are ingrained with their concept of what's best for patients. So I'm going to try to bring in some balanced arguments here.

    from the perspective of the nurse anesthetist
    CRNAs believe that they provide cost-effective access to anesthesia care and that their education and training is sufficient for safe practice. CRNAs cite their data/studies and criticize data and methodology of MDA studies. They lay claim to starting the specialty (in the U.S.) and for providing 65% of anesthetics. Furtermore, CRNAs do not think a medical (school) education and internship is necessary (or perhaps even relevant) in the care of patients undergoing and recovering from anesthesia.

    from the perspective of the anesthesiologist
    Anesthesiologists believe that the best care is provided when CRNA's involve the anesthesiologists in the care (if even only as a readily available consultant). MDAs cite their data/studies and criticize data and methodology of CRNA studies. MDAs also say their model of anesthesia practice is cost-effective. Physicians say they were the ones who trained nurses in the first place to deliver anesthesia (in the U.S.) and state that in reality 10-20% of anesthetics delivered are without MDA supervision. Furthermore, MDAs say their medical education and internship gives them greater insight in the care of patients undergoing/recovering from anesthesia.

    My conclusion? I'm concluding that this debate will never cease. I guess who you believe largely depends on your loyalty, experiences, and inherent bias. For every point, there's a counterpoint. Everything has become so predictable. This paper pretty much sums up the differing views:

    http://www.outpatientsurgery.net/2000/os12/f2.htm
  12. by   Laughing Gas
    Let's get a couple definitions set here...

    Supervision implies a legal relationship. There is no implication that the physician will ever touch or see the patient. The CRNA may be the only anesthesia person taking any clinical role in the care of the patient.

    Direction implies that one is carrying out medical orders for another. Direction implies control and the ability to change the coarse of action only when ordered by a physician.
  13. by   Laughing Gas
    [QUOTE=AWDC] I don't think it's all about money and control. Much of it is, but let's say you remove money and control from the arguments. From what I gather, it seems both MDAs and CRNAs are ingrained with their concept of what's best for patients.

    Yes both are interested soley in the well being of the patient. I firmly believe that with both CRNA and MDA. But the ugly matter of housekeeping does arise.

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