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.

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.

I am sure you work "together in the OR room" but I would bet that the MDA is laughing his butt off all the way back to his comfy chair while he is living the good life off of you. Don't mean that just towards an AA either, do it with CRNA's as well.

The ONLY thing that I cannot do is practice independantly. Beyond that, I am trained and fully capable of doing anything that a CRNA can do. Honestly, I can't rise to the level of CRNA practice by virtue of my training?? Now who is insulting whom??

Ahh, the difference in background training... can you give an enema and not have the sheets all discolored?

When you spend time ducking Mortar fire in combat in Vietnam and trying to provide safe anesthesia to our troops, I'll consider your statement as being able to do all a CRNA can, as a possibility. There were no MDA's in the line hospitals. They were back in the rear. in the big towns. There are 2 CRNAs names on the Vietnam Memorial Wall

Jerome E. Olmsted

Kenneth R. Shoemaker

among other RN's that gave it all

Sharon Ann Lane

How many AA's are in Iraq?

When you are called out of bed at 3AM to provide anesthesia for a bunck of teens that have wrappeed their car around a telephone poll, without having a back up MDA to call in to help or "supervise"... then the situation will be different.

Surgeons have said for years tha monkeys can be trained to do anesthesia, maybe a bit of exaggeration, but just as the MDA's tout a background in medicine is needed for anesthesia, it also applies to AA's with NO background in medicine, or medical science.

You are and will always be technicians, or "Bag squeezers". Serving at the whim of your overseer. doing their bidding. Asking permission..

Your restrictions on performance are not the doing of CRNA's, it is the doing of the control freak MDA's that establish the legislation FOR YOU to practice, so there is never another group of bagsqueezers that are allowed independance.

You may be the finest person in the world, but do not equate youself with those that have gone before you and paved the way, and have a 120 year track record for safety.

Send me an email fro Iraq

I can identify two related, but separate goals to this discussion.

First,we are all sharing information in order to make a more informed decision about what each of us personally believe about the appropriate model for the delivery of anesthesia.

Second, we are identifying appropriate, arguments to make the case for our respective positions to the public, legislators, etc.

This forum is more about the first than the second. I think the distinction is important. I am concerned that so many RNS and even SRNAs do not appreciate the full impact of these issues. But the points I emphasize to this audience are not necessarily the same arguments I would make in lobbying my legislator. This is not really the place to discuss lobbying strategy, so I have not really spoken to that aspect of this issue.

But I speak loud and clear to all RNS. If you are not concerned about the proliferation of AAs, you are buying into the physician-always-in-charge model. Is that how you view yourself as a professional nurse?

Hear me now, and believe me later. ASA tried for decades to gain complete control of nurse anesthesia practice. They are driven by many motives. Power, greed, and maybe even the honest belief that anesthesia really is the practice of medicine. We have successfully fought them off at every turn. The latest round was the supervision regulations. They decided then to try an alternate approach. If they could not be succesful making CRNAs the type of dependent practitioner they wanted, they would create/promote another type of provider. One that is more congruent with their philosophy.

There is not doubt in my mind that AAs are being promoted in an attempt to displace CRNAs from the market. Face it, and accept it. Then if you can still feel supportive of the concept of AA practice, at least you are seeing the big picture.

I mean absolutely no disrespect to any individual AA or anesthesiologist. I am speaking globally and philosophically regarding policy. It is important to remember that not all anesthesiologists agree with the ASA. But this is a NURSING forum, so you cannot be surprised that I am taking a very PRO-NURSING position. I would like to see the day that CRNAs and anesthesiologists work together, collaboratively, as professional equals.

loisane crna

I use to work with a AA at a ICU in Chicago. He originally got his AA degree from Georgia, and wanted to practice in Illinois and was not allowed to. He went back to school for his BSN then later went onto CRNA school at Rush. Now that is what I call dedication.

No Swumpgas, I probably can't give an enema and not muss up the sheets. Great skill to have for an anesthetist though....

And while I have not served in the armed forces, I do travel to Equador every year with a Plastic Surgeon that I know personally and give anesthesia for reconstructions on children with cleft palattes and other craniofacial abnormalites. We do travel with an MDA but he runs his own room, while I run mine. No requirement for supervision there, they are just thrilled to have us.

Technician, bag squeezer - again name calling and hostile responses.

What is it with you guys?? Get off your high horses - you are starting to sound a little shrill.

Specializes in Anesthesia.
........

BTW, I did get into medical school (3 acceptances) but chose AA instead. ,,,,,,

But, of course, you're not boasting ....?! Right?

Georgia, when you come into a public forum for CRNAs, SRNAs and wannabees, and post incendiary taunts such as you do, and THEN boohoo that the dialog is becoming hostile ... I just shake my head. And laugh.

You come off much like your masters. Always the A$A repeats the mantra: Our only concern is patient safety. Ridiculous obfuscation. You say you only want to educate us. Ditto.

Another of your masters' propaganda standby lines comes to mind, as it seems to apply to you, Georgia: you just don't know what you don't know.

You think you are my professional equal. You are grossly mistaken.

Be clear: I bear you no personal enmity. No doubt you are an intelligent and articulate person, and possibly you are a superior anesthesia provider as an AA. Never mistake that for being the equal of a CRNA -- not all CRNAs at least. Not me.

So what if you work with a brow-beaten crew of dumbed-down, oppressed nurse anesthetists forced to accept you as their organizational superior, the "Chief Anesthetist.' Sorry, Georgia, you are an AA, an *assistant*, not an anesthetist. The fact of your functional work description does not entitle you to the professional title Anesthetist. An anesthetist does it all. Names are funny that way. It's like the difference between lightning and a lightning bug.

So, as the saying goes: you want to be my equal? "Send me an Email from Iraq."

deepz

Just MHO. I could be wrong, as I've been observing the anesthesia scene from inside for only 40 years (but of course I'm not boasting!) ... and it's possible I may yet change my mind.

http://www.gaspasser.com/CRNAinIraq.html

Nice link Deepz to that article about the Military CRNA.

No Swumpgas, I probably can't give an enema and not muss up the sheets. Great skill to have for an anesthetist though....

And while I have not served in the armed forces, I do travel to Equador every year with a Plastic Surgeon that I know personally and give anesthesia for reconstructions on children with cleft palattes and other craniofacial abnormalites. We do travel with an MDA but he runs his own room, while I run mine. No requirement for supervision there, they are just thrilled to have us.

Technician, bag squeezer - again name calling and hostile responses.

What is it with you guys?? Get off your high horses - you are starting to sound a little shrill.

It is a matter of correcting misinformation spread by yourself and your MDA masters. Lies will not go unchallenged, just as touted studies by the ASA in regard to saftey of anestheisa (Silber, Pine et all), but did not stand up to scrutiny by independant clinicians.

Technician and bagsqueezer are terms MDA's use to designate and denigrate those that are not trained in the medical model, part of the old boys club.

I admire your trips for humanities sake. There is not enough recognition of those that do volunteer work for the poor, either on purpose or the poor and indigent population.

Let us not forget the sole purpose for the creation of the anesthesia assistant 40 years ago I bellieve. CRNA's got too uppity, did not jump to the whim of those that would dictate methods of practice and needed to be slapped down. This cannot be ignored. Statements from the ASA "leaders", your own Atlantian MDA Neeld, who claims to have pesonally performed 300,000 anesthetics in his lifetime.. as a clinician, you should see that is impossible for anyone younger than Methuselah.

Misinformation, Misrepresentation, and outright lies are rampant among your MDA mentors, in an effort too control anesthesia services.

I do not have a quarrel with MDA's that do their own cases, but those that sit back and sponge off the efforts and labors of others, be it CRNA, or AA, I hold in contempt.

Do not equate an AA with a CRNA. The keyword ASSISTANT is placed in your title by design by your bosses. You are their assistant, not a colleague, not a peer.

There is not doubt in my mind that AAs are being promoted in an attempt to displace CRNAs from the market. Face it, and accept it. Then if you can still feel supportive of the concept of AA practice, at least you are seeing the big picture.

Why would AA's displace CRNA's? Isn't the demand for anethesia, as well as all health care services in general, expected to grow with the aging baby boom generation in the next 20 years? Isn't it possible that there's room for both?

:confused:

Actually I prefer the term Anesthesia Specialist. lol ... since we are having a battle of names.

or "lord Anesthesia".. top that... wait here comes one.

"anesthesia mac-daddy"

" distiguished Anesthesia crem-dela-crem"

woo, I am almost dessert now. :)

just trying to add some lightheartedness.

I do like the anesthesia specialist one though.

How about "someones sugar daddy" hehe

Personally I loved my anestesiologist, And everytime I had surgery was before school and I didnt ask credentials being out side of field. I just knew they gave me some good S$%# and I love them for it

i was wondering if ohio law was different from georgia in how they regulate AA's, and if so how. athlein made a good point and i saw no response to her post. if georgia is like ohio then arent you (georgiaAA) practicing outside your scope?

4731-24-04 Anesthesiologist assistants: prohibitions.

(A) Nothing in this chapter of the Administration Code or Chapter 4760. of the Revised Code shall permit an anesthesiologist assistant to perform any anesthetic procedure not specifically authorized by Chapter 4760. of the Revised Code, including epidural and spinal anesthetic procedures and invasive medically accepted monitoring techniques. For purposes of this chapter of the Administrative Code, "invasive medically accepted monitoring techniques" means pulmonary artery catheterization, central venous catheterization, and all forms of arterial catheterization with the exception of brachial, radial and dorsalis pedis cannulation.

(B) An anesthesiologist assistant shall not practice in any location other than a hospital or ambulatory surgical facility.

© An anesthesiologist assistant shall not practice except under the direct supervision and in the immediate presence of a supervising anesthesiologist as defined in this chapter of the Administrative Code and Chapter 4760. of the Revised Code.

Effective: May 30, 2003

Note: this excerpt from the Ohio practic regs governing AAs

You think you are my professional equal. You are grossly mistaken.

Be clear: I bear you no personal enmity. No doubt you are an intelligent and articulate person, and possibly you are a superior anesthesia provider as an AA. Never mistake that for being the equal of a CRNA -- not all CRNAs at least. Not me.

[]

Now I know we have to be supportive of each other as CRNA's and SRNA's but I can't help but notice that this sounds exactly like an MDA talking to a CRNA. It appears that your hostility is aimed in the wrong direction. This man comes and offers information on his profession to people who don't know much about it. And how have some people responded, like the residents and interns on studentdoctor.net when I posted there. I can see being upset with the policies of the ASA and what they are attempting to do. But to direct that anger at one person who is obviously trying to be open and helpful is misguided in my opinion. We shouldn't stoop to the level of some of those who have said the same things about us.

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