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.

Let's not forget that many of the new CRNA students served the absolute minimum caring for patients before starting there programs. About half of my class has said that they went into nursing just as a path to the CRNA job. I know that in the past nurses worked many years bedside before going into a CRNA program, but that is not the norm today.

As far as the comment about "Wall-Mart" healthcare and it being cheap. Let's be realistic here. We are talking abut "less expensive" and not "cheap" alternatives. With starting salaries for both AAs and CRNAs being around 100K, the word "cheap" just does not apply. This is in no way meant to say that we are not worth the money that the job pays.

ok - i have stayed away from this discussion for a looong time - frankly because noone is gaining anything useful from it anylonger...

but that last post was the most generalized ignorant (in the sense of unknowing) statement i have heard from an educated individual in a very long time. so....let me get this right - a lot of "your friends" went into nursing just for the purpose of advancing to CRNA status - and that is the MAJORITY?!?!?!? i think not! yes - there are those who do that - but in my class of 22 there is maybe 1 person who did less than 4 or 5 yrs in nursing prior to school...

so to openly state that the norm is minimal patient care prior to school is ridiculous and insulting to our profession. So - if you would like CRNA's and SRNA's to not discuss the lack of patient care prior to any medical training then i would imagine one would like to back off of the aforementioned statements.

iF YOU CAN'T UNDERSTAND WHAT A R.N. WITH 11 YEARS IN ICU CAN BRING TO YOUR PRACTICE, OR AS YOU SAY "TEAM",MAN YOU ARE REALLY LIVING IN A CLOUD.THINK ABOUT ALL THE CODES, MEDICATIONS, PHYSICIAN AND OTHER EMPLOYEE INTERACTION THEY HAVE HAD. WOW, THATS ALOT TO INGNORE OR BLOW OFF!

Hi Everyone,

I was getting concerned that this thread was growing increasingly hostile. I was worried that all I was succeeding in doing was fanning the flames which was not at all my intent.

To address the CRNA from Grady. Some of what you said is absolutely true. The restrictions placed on CRNA/AA practice are the norm in the Atlanta area. Very few anesthetists (I am referring to both CRNAs and AAs when I use this term) perform regionals in MD run practices. His observation that anesthetists don't do central lines may have been true at Grady, but we do them every day at my center. At St. Joseph's hospital, a major cardiac center, all anesthetists may insert central lines after demonstrating proficiency at it. I do know that there were some restrictions placed on AAs in Ohio that are in the process of being resolved, but in Atlanta I do everything except regional blocks. In Macon, I know for a fact that AAs are doing lots of regionals.

As far as salary goes, yes my 160k was earned by working lots of OT. I have a young family and am willing to take on all I can get. My base is 115K and I typically work 2 doubles a week plus one weekend a month call from home. When I stated my salary I was not boasting as DEEPZ called it, but merely pointing out that we do not accept lower pay than CRNAs which has been commonly stated.

I am absolutely committed to the anesthesia care team approach. I believe that it is the safest way to receive an anesthetic in the US. If my patient is not doing well or something happens surgically and I just need help, I like knowing that I can have 5 board certified anesthesiologists in the room within 60 seconds. I know, I know, your patients never have problems and nothing unexpected ever happens right?? To me, it's not about showing everyone that I can handle everything myself, but doing what is safest for the patient. Having more than one person in the room skilled at anesthesia during those critical moments is just intuitively more safe to me. The reality is that the MDA doesn't come into the room and take over and shove me out of the way, but rather we work together as a team to get the patient past whatever the problem may be. It is a collaboration where our skills and knowledge complement one another. The line that an AA will do nothing without being told is a total bunch of crap. We can just agree to disagree on that point and call it a day.

Again, if you read my posts I have never said anything that could be construed as CRNA bashing. That being said, I do believe that your leadership is hurting you on the national level. In every instance that we have sought legislation allowing us to practice, the AANA has argued that we are not qualifed by virtue of not being nurses first. They completely ignore the fact that 60-70% of every AA class did indeed have healthcare experience before enrolling in AA school (resp therapy, EMT, and yes even a few RNs being the most common). In each and every case, the legislators travelled to Atlanta, Ohio, or other states in which AAs practice and saw with there own eyes AAs and CRNAs coexisting peacefully and doing the EXACT SAME JOB. In many instances CRNAs train AA students and vice versa (shocking!!). So in light of what they see with their own eyes, the AANA rhetoric just doesn't ring true and you come off as a group with a huge chip on your shoulders just trying to protect your turf.

Please, I want to keep this friendly. I really think that most of you don't really know the first thing about us and I'm just trying to dispel some of the falsehoods. I know for a fact that you don't have to be a nurse to be a talented, skilled, compassionate anesthesia provider. What you DO have to be is intelligent, analytical, able to think fast on your feet, and have the ability to funtion in a fast paced, and at times very tense environment. If you don't possess those attributes, nurse or otherwise, you will not be a good anesthetist.

BTW, I did get into medical school (3 acceptances) but chose AA instead. I was a little older and decided not to invest the amount of time it would take to get there. I'm very happy with my choice.

Let's not forget that many of the new CRNA students served the absolute minimum caring for patients before starting there programs. About half of my class has said that they went into nursing just as a path to the CRNA job. I know that in the past nurses worked many years bedside before going into a CRNA program, but that is not the norm today.
Yeah, I would agree with this, partly. When I was in my BSN program, about half my class also said they wanted to be a CRNA. Then again, we were also 18 years old and didn't even know what the inside of an operating room looked like. My point is, a lot of people say they want to do this or that, for various reasons. The number of people who actually follow through with this is much smaller. The number of RNs I graduated with who still have the goal of anesthesia is very small...I can count them on one hand.

Had to weigh in here! I am an ICU nurse with the requisite number of year's experience and believe I have some knowledge on this matter. As much as 2 years ago I became increasingly interested in complicating my life by either going to CRNA School or medical school. As the former would provide a very good living and the latter would too, I had to ask myself " were do I want to be?" Truth is that in speaking with surgeons, of whom I know many, I have come to the conclusion that they don't really care. MDA Vs CRNA. All they want is that their patient are "gassed" safely. The MDA's in my hospital don't want any competition. AA's and CRNA's are prohibited from coming here. We are the regional trauma center in Wyoming! Does this make any sense at all? So while everyone is bickering back and forth about CRNA and AA the physician are deliberately obstructing pts right to safe, cost effective anesthesia delivery. Resolve this matter.... The AA Vs CRNA controversy will fix itself. Let's have a clear, national standards conference on anesthesia. Lets outline exact scope of practice for all disciplines. Lets implement these guidelines nationally and get on with the business of safe anesthesia delivery for our patients. :angryfire

Had to weigh in here! I am an ICU nurse with the requisite number of year's experience and believe I have some knowledge on this matter. As much as 2 years ago I became increasingly interested in complicating my life by either going to CRNA School or medical school. As the former would provide a very good living and the latter would too, I had to ask myself " were do I want to be?" Truth is that in speaking with surgeons, of whom I know many, I have come to the conclusion that they don't really care. MDA Vs CRNA. All they want is that their patient are "gassed" safely. The MDA's in my hospital don't want any competition. AA's and CRNA's are prohibited from coming here. We are the regional trauma center in Wyoming! Does this make any sense at all? So while everyone is bickering back and forth about CRNA and AA the physician are deliberately obstructing pts right to safe, cost effective anesthesia delivery. Resolve this matter.... The AA Vs CRNA controversy will fix itself. Let's have a clear, national standards conference on anesthesia. Lets outline exact scope of practice for all disciplines. Lets implement these guidelines nationally and get on with the business of safe anesthesia delivery for our patients. :angryfire

Issues of licensure and scope of practice have always been left up to the individual states, and I doubt that will change.

Specializes in Anesthesia.
...... The MDA's in my hospital don't want any competition. AA's and CRNA's are prohibited from coming here. ......

Prohibited only in the sense that MDAs have their ways of monopolizing resort-type areas. Although often contrary to anti-trust law, these behaviors are widespread. It's only local politics, not a legality.

deepz

Prohibited only in the sense that MDAs have their ways of monopolizing resort-type areas. Although often contrary to anti-trust law, these behaviors are widespread. It's only local politics, not a legality.

deepz

Deepz, are CRNA's able to go in and aggressively challenge the policy in a case like this based on an anti-trust or restraint of trade argument? Are cases such as this simply too expensive to attempt to fight or litigate or are they successfully fought in similar instances?

Specializes in Anesthesia.
..... Are cases such as this simply too expensive to attempt to fight or litigate or are they successfully fought in similar instances?

CRNAs have successfully prosecuted some cases under the Sherman Antitrust Act, but yes indeed, it gets very expensive very fast and sometimes the prevailing party gets NO cash payout, only the satisfaction of winning those elusive clinical privileges.

deepz

I just found this thread, so please forgive me if I wake up a sleeping dragon!

I just wonder, what is the big deal? I would like to be a CRNA one day, but a lot of this animosity is making me rethink things. I personally don't care if some MD has to sign off on my work, so long as I can find a good job doing what I enjoy.

I did a summer experience in college where I shadowed Anesthesia in the OR at the local teaching hospital and at a private hospital. I worked with residents, attendings and CRNAs at the teaching hospital and MDAs and CRNAs at the community one. There were CRNAs at the community hospital and there was one of the MDAs who was "in charge" of the OR (I mean, all the ORs - they took turns). He was available for consult in the PACU (so someone didn't have to come out of a case...), the floor/ICU (pre-op consults) and also "supervised" the CRNAs. He basically popped in for induction and emergance and was available if needed. He said, "I've worked with these guys and trust them to do a top-notch job." So, he let them pratice pretty much on their own except as required by law.

What I'm getting at is, I wouldn't have any problem with that. It seems like an ego thing. (I don't mean to sound offensive) If there's more to it, please educate me. From what I'm reading, I see a lot of "I worked hard enough and I want my respect" kind of thing. I can certainly understand that, but in the end, isn't that just a matter of pride? Again, not to sound offensive, but is there more to it?

As far as the public not respecting me, to the extent that that hurts my employement (ie public outcry for unwarrented restrictions based on erroneuos information) that's fine. I know it's not true, my collegues know it's not true.... (BTW, off the subject, but when you introduce yourself to pts, how do you identify yourself? Most of the people I saw - MDAs and CRNAs alike - said something like, "Hi I'm Bob from anesthesia." Never saw it as an issue whether or not they id'd themselves as MDA or CRNA)

I don't understand how the AA-CRNA thing hurts CRNAs in the job market. Isn't "a lot of AAs coming in taking our work away," the same as "more CRNAs graduating"? Would CRNAs be equally upset if there was a sudden increase in people wanting to be CRNAs?

That same MDA that I worked with that sumemr was the one who told me, "it's not the intials after your name that make you good." He said that he would gladly step away from a intubation he couldn't get and let a CRNA try and vice-versa.

Please understand that I am not trying to offend, simply understand what all the fuss is about as I decide a career path for myself.

bryan

Your stated is noted but an AA is not a CRNA. Research the history of this topic and you will begin to see the difference. An AA must always be under the medical direction of an MDA, whereas a CRNA can practice independent of an MDA.

Mike

The times that I have surgery, I said "I do not want a CRNA or other anesthesia assistant. You will provide an MD or you will have a problem."

You can't pull that crap the day of surgery.

Their answer to "you'll have a problem" - not having surgery. Take it or leave it.

+ Add a Comment