Here's what AAs really think of CRNAs - page 15
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... Read More
May 8, '04Joined: Apr '04; Posts: 51; Likes: 1"Everytime I try to get out, they pull me back in" - Al Pacino .. Godfather III
TraumaTom - thanks for the really great post. I don't know whether you or I have ever crossed paths, but your writing really impressed me. Your thoughtfulness and obvious intelligence predicts to me that you will be an outstanding nurse anesthetist upon completion of your training. I wish you well.
The key point from your post is well taken at least from my perspective. That is the notion that we as AAs are inferior based on our lack of nursing experience is a conclusion drawn purely on supposition and speculation. These statements are made primarily by those CRNAs who have never had the opportunity to observe an AA in person. Similarly, I admit that I have never stood in the shadows at a CRNA only institution and watched one in action. My statements are based on my years of working side by side with CRNAs many of whom had worked in such settings at some point in their careers. I feel that I am qualified to make comparative statements because I have seen both providors in action. If you read my posts, I have been careful to NOT say that AAs are better than CRNAs. My point is that an experienced AA is indistinguishable from an experienced CRNA in terms of breadth of knowledge, skill level, and the ability to respond to whatever goes on in the clinical setting. Do I have the MDA to fall back on?? Yes - that is what I think makes the anesthetic inherently safer. John Neeld (past ASA president and chief at Northside Hospital in Atlanta) describes the relationship as "medical direction" instead of "supervision". A subtle difference, I agree but I think that it allows more room for professional respect.
I personally feel that I am as good as any CRNA that I have ever come across, but I do not feel that I should practice independantly. I also don't believe that CRNAs should either. I would be uncomfortable allowing a loved one to undergo an anesthetic without an anesthesiologist around. That is my personal belief and I would hope that you respect it just as I have tried to respect yours. Am I going to lobby to take away that right that you have gained for yourselves - absolutely NOT! That is not the agenda of the AAAA. Similarly, I don't think that you should deny me my ability to practice within the model that has been set up for us.
To Athomas91: do a Google search using the keywords "anesthesiologists", "assistants", "florida". You will find the many articles and editorials that I alluded to in my very first post (some of them predating Robs article). You will see that his article was a response to what the AANA had been writing and saying about us in some very public places.
May 8, '04Joined: Jun '02; Posts: 365; Likes: 5deepz... i am not going to have a stroke...
i agree that compared to any other specialty we perform a lot of very detailed tasks that revolve around monitoring, assessing vital signs, etc.... which in essence is something a nurse does every day. So anesthesia is the only field (i think) where you will see Drs putting in IVs, central lines, managing changes in vitals and quick and appropriate usage of drugs....
you see... i went into medicine to help people... if that meant changing their sheets because they were sitting in poop... then so be it... if that meant getting a pelvic urinal... then so be it... if that meant rubbing their back while they were throwing-up... then so be it.... if that meant putting in a chest tube, spinal cooling catheter w/ drain for a ruptured thoraco... then so be it...
May 8, '04Occupation: CRNA Joined: Aug '03; Posts: 1,188; Likes: 26i am sorry Tenesma - cause i really respect you and your thoughts....
but i am laughing my butt off at the thought of any doc cleaning dirtied sheets...it would be a cold day in my hell....LOL
May 8, '04Occupation: CRNA Joined: Aug '03; Posts: 1,188; Likes: 26I also don't believe that CRNAs should either. I would be uncomfortable allowing a loved one to undergo an anesthetic without an anesthesiologist around.
i think this debate has worn itself thin...for now.
May 8, '04Joined: Mar '04; Posts: 144; Likes: 519 pages! Well, I wanted to stimulate some conversation....
Seriously, I gotta go run a marathon. It will certainly be less tiring than this thread has become.
My last few clinical days went really well. My patients did well, I learned some new tricks, and I am just generally having a dang good time. The only time I saw an 'ologist was when I dropped my patients off in the PACU. No "popping in" to check on my induction/emergence, no "anesthetic plan" from an MDA. My CRNA and I worked completely independently. One patient said that it was the best anesthesia experience she ever had. Imagine that!
Keep your post handy. Go to school. Spend a couple of years writing tuition checks, gutting it out in class, working like a dog in clinicals, and then re-read your post. It will be interesting to see if you still feel the same.
John Neeld (past ASA president and chief at Northside Hospital in Atlanta) describes the relationship as "medical direction" instead of "supervision". A subtle difference, I agree but I think that it allows more room for professional respect
I personally feel that I am as good as any CRNA that I have ever come across, but I do not feel that I should practice independantly. I also don't believe that CRNAs should either. I would be uncomfortable allowing a loved one to undergo an anesthetic without an anesthesiologist around
Why shouldn't CRNAs work independently? Would it make a difference if it was just a little ditzle, and not a thoracic case? Or do you just feel this way because you can't practice unsupervised?
So anesthesia is the only field (i think) where you will see Drs putting in IVs, central lines, managing changes in vitals and quick and appropriate usage of drugs....Last edit by Athlein1 on May 8, '04
May 8, '04Joined: Apr '04; Posts: 51; Likes: 1Quote from athomas91Dude, I'm sorry - you totally misunderstood me. I have, in fact, been put to sleep for a hernia repair by a CRNA who is one of my best buds. What I said is that I would be uncomfortable if there was not an anesthesiologist in the building. I know all of the stuff that can happen back there. If my wife aspirates on an LMA, I don't want the only help you have available to you to be the podiatrist fixing her bunions. Granted - this mentality is purely a product of the environment which I grew up in anesthetically speaking. I know how good you guys are ... how many times do I have to keep saying it???this is the problem i have...history is very clear NURSES WERE THE FIRST TO ADMINISTER ANESTHESIA...yet you wouldn't trust one to give you yours...you would rather accept it from a "MDA" just because of the title...what a white coat mentality...i respected your arguments up until then.
i think this debate has worn itself thin...for now.
Let me put it a different way: If your mother-in-law needed a double valve CABG, who would you want to take care of her (assuming you like your mother-in-law)
a) a seasoned and experienced cardiac CRNA working alone (lets leave AAs out of it)
b) an experienced fellowship trained cardiac anesthesiologist certified in TEE
c) both of the above working together as a team
If you chose (a) then I have just lost respect for YOUR opinion.
I also know as most of you do that some MDAs are knuckleheads and can't change the batteries in a laryngoscope without calling bioengineering and that the anesthetists that they are directing are sometimes more skilled and aware then they are. That's in my experience more the exception then the rule however. I would MUCH rather have a seasoned CRNA or AA under the direction of a good MDA do my anesthetic, than an MDA good or bad who might rarely do his or her own cases.
As far as this thread wearing thin - I couldn't agree more.
BTW my wife just read my post and told me to keep her and her bunions the hell out of it.Last edit by georgia_aa on May 8, '04
May 8, '04Occupation: CRNA Joined: Aug '02; Posts: 409; Likes: 12Quote from georgia_aaActually, there is a HUGE difference between these two words in the anesthesia community.John Neeld (past ASA president and chief at Northside Hospital in Atlanta) describes the relationship as "medical direction" instead of "supervision". A subtle difference, I agree but I think that it allows more room for professional respect.
It all has to do with billing. And remember, billing standards are not professional standards of care. They only exist to determine how much money to pay for the anesthesia delivered.
ACT care can be medically directed, or medically supervised. The differences are complicated. But the essential differences are in ratios of providers. In order to bill medically directed, the anesthesiologist may be involved in no more than 4 anesthetics at a time, and must comply with the TEFRA regulations.
Most of you will recognize these stipulations. You probably thought that was the only way the ACT ever worked. In my experience, this seems to be the preferred model for most ACTs. I suspect Dr. Neeld was fully aware of the financial implications of his words, it might not have as much to do with professionalism as finances.
ACTs can also work in the medically supervised model. There are no minimum ratios, and TEFRA regulations do not apply. Many CRNA perfer these type of ACTs, they practice with autonomy, but have the availability of an anesthesiologist if needed.
CRNAs who work medically supervised usually report that this model works very well. So why do so many ACTs insist on medically directed? It is a question much debated in anesthesia circles. Personally, I think if more ACTs were in this model, it would do alot to heal some of the anger and friction between us.
May 8, '04Joined: Jun '02; Posts: 299; Likes: 4Tenesema
I simply have to respond to your comment in reference to my so called "cocky" statement. The truth of the matter is that a good critical care nurse has to think on his / her feet and make life saving decisions without a physician being present. This is not egoism it is the reality of critical care. When I decided to put my patient on an external pacemaker today because she had a six second pause, and her heart rate was in the 20's after, had nothing to do with cockiness. Do I wait for her attending to call me back while she goes asystole, or do I pace her. I chose to pace her. Her attending did not find my actions "cocky." Hence my comment about taking care of patients on the brink of death! As a critical care nurse, if you cannot act immediately in certain situations without having a doctor's guidance then that nurse is practicing in the wrong area of nursing. Do I need to notify the attending of the situation? Absolutely, and ASAP! But I will not sit and wait for a return phone call before acting in critical situations especially if it is the difference between coding somebody in the next few minutes or not. I have to ask you is it the standard where you work for the nurses in the critcal care areas to wait for a doctor in life threatening emergencies. What would they have done in the above situation, wait for the patient to go asystloe!
May 8, '04Specialty: Anesthesia ; Joined: Oct '03; Posts: 630; Likes: 61[QUOTE=georgia_aa].......Do I have the MDA to fall back on?? Yes - that is what I think makes the anesthetic inherently safer. John Neeld (past ASA president and chief at Northside Hospital in Atlanta) describes the relationship as "medical direction" instead of "supervision". A subtle difference, I agree but I think that it allows more room for professional respect.........
Well, when it comes to respect, Georgia, what is one to think of Dr Neeld after he told Congress that he had PERSONALLY performed 300,000 anesthetics in his career, up to the time of testimony? Do the math. Ridiculous.
May 8, '04Specialty: Anesthesia ; Joined: Oct '03; Posts: 630; Likes: 61Quote from TenesmaOMG ... tenesma and I agree on something. Unprecedented. It must signify the end of this thread. Where's my merlot?... i went into medicine to help people... if that meant changing their sheets because they were sitting in poop... then so be it...
May 9, '04Joined: May '04; Posts: 14Quote from deepzLet me divert the thread.. AMA is considering FMG (Foreign Medical Graduates) (IMG to be politically correct), that do not meet standards for an internsahip in the US to get licensure, for rolls in medicine. Possibly working as NURSES. in the US and Canada, due to the Nursing shortage. Lab techs, etc. Not sure what mechanism would be used to verify their skill levels, or even aptitude.Historical point, the A$A was not incorporated until 1937, even though they like to claim 1905, when the Long Island Journal Club, or some such local entity was founded. Typical exaggeration from the OneUpManship mentality of the A$A leadership.
But it is being talked about. These are DOCTORS in their own countries that will be stepped down in STATUS to the roll of nurse. Talk about attitide problems? skill deficits?
Just something to think about and Look out for.
May 9, '04Occupation: CRNA Joined: Aug '02; Posts: 409; Likes: 12Quote from swumpgasCareful Swumpgas! People here are not quite as responsive to the "stream of consciousness" method of discussion, as you and I are used to in other areas of cyberspace ;-). Hehehe. Here, when things get "off track" (that is what they call it), somebody will start shouting to start another thread.Let me divert the thread..