Here's what AAs really think of CRNAs

Specialties CRNA

Published

And this comes from the PRESIDENT of the American Society of Anesthesiologist Assistants

Again, assertions that AAs and CRNAs function at the same level -absolutely misleading.

And, what's with "anesthesia nurse"? If it sounds condescending in print, can you imagine how it would sound out of his mouth? What arrogance.

At least there is a phone number listed at the end of the article. Let's call Rob and let him know what we think of his little article!

Read carefully, SRNAs, this is a grim foreboding...

Licensed anesthesiologist assistants help access to medical care

By Rob Wagner

MY VIEW

Re: "Don't weaken the standards for anesthesia providers" (My View, April 11).

Maybe you or someone you know has had surgery delayed. Perhaps hospitals in your

area have closed operating rooms as they have in Miami, Jacksonville, Tampa and

elsewhere in Florida.

One reason for growing problems of this nature for patients is a shortage of

anesthesia providers. These are the assistants who help

physician-anesthesiologists perform the critical task of putting you to sleep

before surgery.

There is a common-sense solution rapidly making progress in the Florida

Legislature and around the country, which is to license anesthesiologist

assistants (called AAs). Key legislative action is expected today in Florida's

House Health Care Committee on HB 1381/SB 2332 and it is important that

lawmakers support it.

They need to be assured that this legislation will not weaken standards because

AAs are highly trained and perform the same function as anesthesia nurses. AAs

like myself serve patients in 16 states and have impeccable safety records. AAs

have worked with a high level of safety for 30 years in Georgia and Ohio.

AAs are required to have three times the hands-on, clinical training than are

most anesthesia nurses who currently assist anesthesiologists. Before we are

allowed to enter AA school, we must take the same courses physicians take as

pre-med students. Nurses do not do that. In fact, as the chief anesthetist at

St. Joseph's Hospital in Atlanta, I am in charge of both AAs and anesthesia

nurses.

If you are "going under," who would you rather have assisting the

anesthesiologist; someone trained to work directly with him or her, or a nurse?

We enjoy our professional relationships with our nursing colleagues. Yet nursing

organizations in Florida continue to misinform, even scare the public, calling

our profession "new" and "experimental."

Try telling that to the prestigious Emory University in Atlanta or Case Western

in Cleveland, which have been training AAs for more than three decades. Or try

to tell that to boards of medicine that oversee AAs in the states in which we

practice and whose members readily vouch for our safety record.

Try telling that to Medicare, the nation's largest health insurer, which

reimburses AAs and anesthesia nurses at the same rate. This means our skill

levels are viewed equally. And tell the insurance companies. They charge no

difference in fees between anesthesia nurses and AAs,

meaning our safety records are equal. Try telling that to the Florida Medical

Association, American Medical Association and American Society of

Anesthesiologists, whose members resoundingly support our working in Florida. In

the era of malpractice crisis, doctors are certainly not going to support

"experimental" health care providers.

Why, then, would the anesthesia nurses be opposed to this? In a word, money.

Because of nurse shortages, their salaries are artificially high, up to $150,000

in Florida. If you made that kind of living, wouldn't you try to keep the

competition out?

This nursing shortage is well documented on the Web sites of Florida schools

that train anesthesia nurses, the U.S. Department of Health and Human Services,

and yes, even on the anesthesia nurses' own Web site, http://www.aana.org, where the

shortage is called "serious" and "acute."

To help relieve the problem, two institutions, the University of Florida and

Nova Southeastern, are ready to open special schools for anesthesiologist

assistants in Florida. Would those schools offer programs if they didn't think

AAs are in great demand? Would they risk their reputations on an "experimental"

profession? Of course not.

One AA can mean five more patients per day will get their surgery. That's 1,200

patients per year treated with the help of only one AA. If you are or know one

of those patients, I'm sure you would be grateful to the Florida Legislature for

passing this common-sense legislation.

--------------------------------------------------------------------------------

Rob Wagner is chief anesthetist at St. Joseph's Hospital in Atlanta and

president of the American Academy of Anesthesiologist Assistants, PO Box 13978

Tallahassee, FL 32317 Phone: 656-8848.

You fooled me too. It's that punk-rock avatar and SoCal location, lizz! :wink2:

Why? Is everybody from SoCal a punk rocking kid? There's 35 million people in this state. Surely some of them are older too and, maybe they just like music. :chuckle

I understand why you guys are upset, and I never said you don't have a right to be upset. As I've stated before, my arguments come from a realistic PRACTICAL standpoint, i.e. losing Florida and, potentially, other states.

Maybe the ASA did buy this but, in my experience, it's much easier to buy political influence when the other side doesn't have an argument. These arguments are great if your audience is mostly CRNAs, other nurses and medical professionals.

But, outside of that, your arguments aren't so great unless you can prove patient endangerment. Forgive me for stating the obvious, but you all have a science background. Surely you know that mere predictions of patient endangerment aren't enough? You need proof that this is a public health hazard. Otherwise, everything else is mostly irrelevant, and you lose.

That's the practical reality, IMHO.

:p

Quote: These arguments are great if your audience is mostly CRNAs, other nurses and medical professionals.

That is the real problem for CRNA's. Because, while anyone working in US healthcare is familiar with what a nurse brings to the table, the public and legislators still have this picture of a person who only functions in the realm of what the physician orders. One of the many things that need to change....and it is getting better.

The other point that I would like to make is that if this argument is " great if your audience is mostly CRNAs, other nurses and medical professionals." Then it obviously has merit, so why discount it just because John Q Public does not understand?

These links are to the curriculum of both programs, I believe that they clearly demonstrate that upon graduation the AA's are ready to function as a technician. (Noun 1. technician - someone whose occupation involves training in a specific technical process). They are not learning about anything beyond anesthesia, and you should all know that most patients present with a myriad of issues which impact anesthesia.

http://www.anesthesiaprogram.com/curriculum.html

http://anesthesiology.emory.edu/PA_Program/coursework.html

READ the curriculum THINK about what is NOT there and then read this statement.

Georgia AA's statement "As a senior anesthetist I am given free reign to manage my cases as I see fit. Very rarely does my attending dictate what the anesthetic should be. They may make a suggestion here or there like "work in a little Morphine towards the end" but I am not required to check with them about most decisions that come up during a case. New grads on the other hand (AA and CRNA) really are expected to communicate with their attendings a little more often. I commonly do extremely complicated cases from beginning to end with little to no involvement from my supervising MD."

Surely you know that mere predictions of patient endangerment aren't enough? You need proof that this is a public health hazard. Otherwise, everything else is mostly irrelevant, and you lose.

:p

Well said Lizz.

Without some proof on outcomes that shows a difference between an AA with 2.5 years of medical training and a CRNA with 5+ years of training it can easily be turned on you. Your arguments can be thrown back at you as being overqualified for what you do.

If it can be proven that the model of supervised AAs is detrimental to the public health that is an argument that the masses will get behind (including me). All of the other arguments IMHO will not stir the public masses.

The other point that I would like to make is that if this argument is " great if your audience is mostly CRNAs, other nurses and medical professionals." Then it obviously has merit, so why discount it just because John Q Public does not understand?

This is where you don't understand. I don't discount the arguments from that perspective. My point is that the CRNA message gets sidetracked with all of this other stuff, and there's a real danger of losing this battle because of it.

Afterall, it is John Q public (or, rather, his elected representative) who's going to decide this issue.

;)

Afterall, it is John Q public (or, rather, his elected representative) who's going to decide this issue.

;)

Liz, your point is not lost, I believe you are absolutely right.

My comments here are directed to this audience of (mostly) nurses. Nurses are the largest group of health care professionals. If we would learn to support each other's causes, we would have tremendous influence. When I read the opinions from members of this forum that AA practice is benign, or doesn't affect them, it motivates me to action. I want to win these people over to understand why autonomous CRNA practice is important to all of nursing. I am also supportive of other APN issues, something I try to motivate CRNAs about (so it is a two way street).

I am also active in my state association. Do I use the same arguments in lobbying as I do here? Heck, no. Do I really think I am going to get anywhere with a legislator if I say "You should vote against AAs because nurses have the right to practice autonomously". He/she would laugh in my face. We have to tailor our arguments to the audience. As professionals develop in leadership, they learn how to do this. I am no expert, but I have witnessed experts in action.

But Liz's message is an important one. The factors in an issue that have influenced your personal opinion, are not necessarily the most important factors to use in presenting your message to "outsiders" who have different goals and priorities. The way to influence people is to identify how your position makes a positive impact on the things they value.

How to present our case to the media, politicians and outsiders is a different discussion than the one we are having here, IMHO. And it is one not completely appropriate for this forum. That explains why you are not seeing it here, not because it does not exist.

loisane crna

What can I as a nurse/student/activist do to assist in maintaining the future of CRNAs? Kate

Kate, I am really glad you asked that. I love the attitude it displays, and it makes me consider something I had never thought of. I always tell CRNAs and SRNAs to get involved in their state association. But surely there is a role for RNs and SRNs as well.

The things that come to my mind quickly are to promote nurse anesthesia in your everyday life. Make sure whenever anesthesia is discussed, socially or professionally, that you spread the message that most anesthesia in this country is provided by CRNAs. Just tell people we exist, and the work we do. Request CRNAs for your anesthesia, and your family's, and encourage other people to do the same. Yes, odds are that even without a request, it will be a CRNA providing that anesthesia. But to request a CRNA shows that you know how things are really done.

It is also important to get involved politically. Get to know your local representatives, attend political functions, stuff envelopes, etc. I know that is tough for a student/mom, but maybe there will be a point in the future when it is more fesible. It is those personal connections that are important to getting any message across when issues come up for vote.

Stay informed, know when bills are being discussed in your area and write letters/make phone calls making your opinion known to your representatives.

I am sure there is more. Participating in discussions like this is a good place to stay involved, and get ideas.

loisane crna

How to present our case to the media, politicians and outsiders is a different discussion than the one we are having here, IMHO. And it is one not completely appropriate for this forum. That explains why you are not seeing it here, not because it does not exist.

loisane crna

The article cited in this thread was published in Florida newspapers as part of that debate. And there have been numerous threads on the board and, even, posts in this discussion about the Florida decision. As GeorgiaAA pointed out, this will issue will probably be considered by other states. I thought it was relevant but if you don't, ok.

It's rather strange: I guess the point of this forum is to criticize AA's and make CRNA's feel better about the issue. Seems like anything else is "not completely appropriate."

Perhaps the moderators should post that restriction so we'll all know what to post and what not to post in the future.

;)

Perhaps the moderators should post that restriction so we'll all know what to post and what not to post in the future.

;)

You're right, I should have been more clear. This is simply the reason I won't personally speak to it. Others are, of course, free to do as they like.

loisane crna

Kate, I am really glad you asked that. I love the attitude it displays, and it makes me consider something I had never thought of. I always tell CRNAs and SRNAs to get involved in their state association. But surely there is a role for RNs and SRNs as well.

thanks for the direction loisane....and for the nice feedback :)

have a great day,

Kate

Lizz, i agree with your point that a more "tangible" proof of safety would be nice...the problem with that theory is however that AA's DO NOT practice like CRNA's in that they are not responsible for their patients - the MDA's are - so it would just be another CNRA vs MDA study that couldn't be accurate. the safety problem doesn't lie alone in the use of AA's but more specifically in the misuse of AA's ...to be more exact - when there are written guidelines basically saying that a MDA is responsible for all major decisions, yet are not present during the case like GeorgiaAA alluded to....and let's face it...in a study - what AA or MDA is going to admit they weren't following the guidelines?? - your study would be signifigantly misdirected and the results false........that is where our burden of proof problem lies.

Lizz, i agree with your point that a more "tangible" proof of safety would be nice...the problem with that theory is however that AA's DO NOT practice like CRNA's in that they are not responsible for their patients - the MDA's are - so it would just be another CNRA vs MDA study that couldn't be accurate. the safety problem doesn't lie alone in the use of AA's but more specifically in the misuse of AA's ...to be more exact - when there are written guidelines basically saying that a MDA is responsible for all major decisions, yet are not present during the case like GeorgiaAA alluded to....and let's face it...in a study - what AA or MDA is going to admit they weren't following the guidelines?? - your study would be signifigantly misdirected and the results false........that is where our burden of proof problem lies.

i agree...didn't someone post earlier about it being like comparing apples to oranges???

Call the Ref and let them make a ruling.

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