How do CRNAs/SRNAs benefit anesthesiology residents?

TejasDoc · Jun 17, 2004

OMG. Can't change a leopard's spots. Can we really have a free and open conversation, grounded in the here and now, if your preconceptions keep getting in the way? Legislate our way into exactly what, doctor? CRNAs've been doing the heavy lifting for over a hundred years now already. We are not doctor wannabees, just anesthetists. It seems you don't distinguish between the two. Perhaps you still believe general anesthesia 'cures' asthma?

Someone is a little touchy, don't you think?

You yourself have not been doing anything for a 100 years, so stop saying it as though you have.

Really though, isn't that what's happening deepz? You think you do what an anesthesiologist does, just as well. Yet the anesthesiologist makes more money, gets more respect, and isn't in a position to be supervised, etc. (I know someone out there is going to say that they are a CRNA and are the only person within a 100 miles that does anesthesia, so they get plenty of respect, are never supervised, do pediatric hearts and make a gazillion dollars a year. Don't. I know you exist, I'm generalizing.) So you have 2 options, you can go to school and train to be an anesthesiologist, which will gain you all the before mentioned things, or you can try to legislate changes to get what an anesthesiologist has. I'm just trying to state facts.

I didn't call you a 'wannabe'. I never said anesthesia cured asthma, though I think I made a reference to the post that did. I think you might just be angry I call you out on your D.O.A. fantasy. Sorry.

TD

Athlein1 · Jun 17, 2004

Is it because you really want to be a CRNA, with everything that it means to be a CRNA now, or is it because you want to be in the anesthesia field, but don't want to spend 4 years in medical school and 4 years as a resident?

How presumptuous this statement is! It implies that we secretly wish to be physicians, but we found a way to skirt the rigors of med school and residency. So, we are taking this shortcut - the nurse anesthesia profession.

Here is another angle to the question you asked about career paths. For those of us with families, outside interests, and life goals that do not center around what goes on inside the walls of a hospital, the nurse anesthesia path is a far superior choice. Post-baccalaureate, you can spend a couple of years in the ICU making good money and getting a great foundation for your future anesthesia practice. Then, gut it out in an anesthesia program for two and a half years. Thereafter, you have entered a profession that offers autonomy, flexibility, intellectual stimulation, and enough financial remuneration so that you can support your family and enjoy all that free time for which you have worked so hard.

Makes me wonder why anyone with an interest in anesthesia would choose to spend more than a decade, and tens of thousands of dollars (if not hundreds) to become an anesthesiologist!

You think you do what an anesthesiologist does, just as well. Yet the anesthesiologist makes more money, gets more respect, and isn't in a position to be supervised, etc.

Surgeon: Anesthesia, what the hell are you doing over there? Sleeping? The patient is not relaxed. I can't operate if the patient is not relaxed.

Anesthesiologist: The patient is pretty relaxed.

Surgeon: You don't know what the hell you are doing. You are not a real doctor.

(Granted, the surgeon who said this is a real piece of work)

I've seen plenty of disrespect of anesthesiologists from surgeons and other physicians. Could it be that some of these physicians consider anesthesiologists to be "just anesthesiologists" in the same manner than some anesthesiologists consider CRNAs to be "just anesthetists"?

deepz · Jun 17, 2004

..... I think you might just be angry I call you out on your D.O.A. fantasy. ......

Angry? WTF. Quite the ... interesting ... manner of argument you display. Perhaps you might re-read post #64 in this thread in its entirety. It's a joke, doctor; a mere attempt to demonstrate the bias in your reasoning, not my fantasy. Whose ox is being gored means views will often be predetermined by your starting point.

Early in your training for your career, as you apparently are, one might hope you'd be more open to multiple viewpoints and less accepting of the A$A boilerplate. Much of their BS doesn't stand up to examination, even so basic a point as 'ASA, since 1905.' Typical exaggeration. Incorporated in 1937. But they needed something to pre-date the AANA in 1931. Oneupmanship, ego-driven, what do we call it?

You don't play second fiddle in the OR, you say; you play a 'different' fiddle? Is that your M-Deity shining through?

?

TennRN2004 · Jun 17, 2004

I see reading my post now it wasn't very clear on the whole senior nurse/junior doctor thing. What I meant is that by choosing to be a CRNA we are not trying to "legislate our way into being treating like an anesthesiologist". If that was the case, then we as nurses would feel like junior doctors- because we are more than a floor nurse, but yet less than a doc. By choosing to be a CRNA we are choosing to be advance practice nurses, CRNA is the summit of the nursing profession and so we are senior nurses. Does that make sense?

TennRN2004 · Jun 17, 2004

On the issue of going back to school for CRNA vs. MDA I can 100% tell you why my choice is to stay in the nursing profession and not become a MDA. Let me start by saying We do have a med school about 2 hours from here and if I decided that was what I wanted to do, then yes my husband and son would move and sacrifice and struggle to see me go to med school. However, I choose not to do that because the entire philosophy of medicine and nursing have different fundamental assumptions. I believe the nursing philosophy and base my practice on the following.

I was told repeatedly in nursing school "medicine is the study of treating disease, nursing is the study of how the disease affects the person". Nursing has a wholistic approach to patient care. When I walk in a pts room I see the interactions between the patient, the disease, the family- it is all interconnected and must be considered as I provide care. MOST (I stress most) docs go into the room and do not care about anything but the heart or lung and do a minimal assessment of the pt at best. Some don't do an assessment at all, but look at the nurses notes and copy what the nurse charted about the pt. The doc walks in the room and says "I'm DR. ______..." and has usually a formal unequal relationship where the doctor is in control and the pt is dependent upon the doctor. I as a nurse walk in and within a few minutes I'm on a first name basis with the pt, the spouse, and whoever else is in the room.

Just this week I can give you a few experiences I've had that make me want to stay in nursing by being a CRNA. One of my pts is brain dead on the vent, with absolutely no chance of recovery. The docs come in and tell the family this and then walk out. It is the nursing staff who explains all the medical jargon, why the pt will not recover, and deal with all the tears and emotions the family has. In another room, one of my patients is dying from cancer, and we feel the pt won't make it through the shift. We call the family they are out of town but on their way. I as the nurse go in to comfort the patient, hold the pts hand until the family gets there. Now I ask you, how many doctors do you see who have this much interaction with the pt? Most I know would be above holding a dying pts hand. Again, I am saying most, not all.

Your professional education teaches you (if I'm wrong here correct me) in a philosophy that makes you distant from human interactions between you and the pt. Pts become "the heart in bed 7". My professional education teaches me that the human interaction is the basis of my existence as a nurse. I am constantly watching, observing not only the pts medical condition, but helping emotionally as well. If I chose to and become a MDA, I would miss this essential link between me and the pt, because as a doc, I would think in terms of "treatment" and compartamentalize the pt.

I LOVE my job and I go home and everyday and know I've made a difference. Why? Because I feel good about what I do, but also because the pt and families tell me so. Now, I know that docs do make a difference as well, but who does the patient know and have a closer relationship with?

So, I have a question for you now. I want to know honestly if you think being a MDA is superior to being a CRNA? Why? I know there is the supervision thing you have that CRNAs must be supervised by MDAs. (I wonder though if they really need supervision or if it is similar to how I think on nurse practioners in that FNPs are fully capable of treating and writing prescriptions. But they have to be cosigned in most states by a MD. Now why is this? Maybe it is because docs want to keep that power over us (nurses) because if all of a sudden we can do something independent without them then the MD profession is threatened by us. I am not being bitter here, that is just my oppinion from what I've seen in clinical areas.) So, do I think CRNAs need supervision? Absolutely not. If they do, then why are there rural areas where CRNAs are the only anesthesia providers for 100 miles as you said earlier. We are capable of being independent, but I think that very independence threatens your profession, and so you want to think we need to have you supervise for your own security.

TejasDoc · Jun 17, 2004

Angry? WTF. Quite the ... interesting ... manner of argument you display. Perhaps you might re-read post #64 in this thread in its entirety. It's a joke, doctor; a mere attempt to demonstrate the bias in your reasoning, not my fantasy. Whose ox is being gored means views will often be predetermined by your starting point.
Early in your training for your career, as you apparently are, one might hope you'd be more open to multiple viewpoints and less accepting of the A$A boilerplate. Much of their BS doesn't stand up to examination, even so basic a point as 'ASA, since 1905.' Typical exaggeration. Incorporated in 1937. But they needed something to pre-date the AANA in 1931. Oneupmanship, ego-driven, what do we call it?
You don't play second fiddle in the OR, you say; you play a 'different' fiddle? Is that your M-Deity shining through?
?

Deepz,

You're just a tough guy to have a discussion with - partially because of childish things like 'A$A', but mostly because you say things that either aren't really true, or only partially true, don't ever give references, and then when somone calls you on it (see post about the # of board certified anesthesiologists) you ignore it.

Because you believe the things you write does not so much bother me. You're only one person, lots of people have beliefs that aren't true. But you're a senior experienced nurse anesthetist. The people on this board probably look to you for your opinion and knowledge.

So you're right, the American Society of Anesthesiologists was not formed in 1905. Their website it pretty clear on that.

http://www.asahq.org/aboutAsa/history.htm

Here's another pretty good page, it gives you more details, if you're interested.

http://www.nyssa-pga.org/society_hist.html

And it wasn't the AANA in 1931. http://www.aana.com/archives/imagine/1997/04imagine97.asp

The group that would become the AANA was founded in 1931, but called something else. But you did have 'national' or 'american' in your name from the get go, congratulations.

'M-Deity' --> Wow, are these all original, or is there a website that posts these for people to use? I just don't think what we do is the second most important thing happening in the OR. General anesthesia may not be the reason why people come to the OR, but modern surgical practice as it exists today owes itself to our ability to keep patients alive and make them unconscious and insensible to pain.

TD

TejasDoc · Jun 17, 2004

On the issue of going back to school for CRNA vs. MDA I can 100% tell you why my choice is to stay in the nursing profession and not become a MDA. Let me start by saying We do have a med school about 2 hours from here and if I decided that was what I wanted to do, then yes my husband and son would move and sacrifice and struggle to see me go to med school. However, I choose not to do that because the entire philosophy of medicine and nursing have different fundamental assumptions. I believe the nursing philosophy and base my practice on the following.
I was told repeatedly in nursing school "medicine is the study of treating disease, nursing is the study of how the disease affects the person". Nursing has a wholistic approach to patient care. When I walk in a pts room I see the interactions between the patient, the disease, the family- it is all interconnected and must be considered as I provide care. MOST (I stress most) docs go into the room and do not care about anything but the heart or lung and do a minimal assessment of the pt at best. Some don't do an assessment at all, but look at the nurses notes and copy what the nurse charted about the pt. The doc walks in the room and says "I'm DR. ______..." and has usually a formal unequal relationship where the doctor is in control and the pt is dependent upon the doctor. I as a nurse walk in and within a few minutes I'm on a first name basis with the pt, the spouse, and whoever else is in the room.
Just this week I can give you a few experiences I've had that make me want to stay in nursing by being a CRNA. One of my pts is brain dead on the vent, with absolutely no chance of recovery. The docs come in and tell the family this and then walk out. It is the nursing staff who explains all the medical jargon, why the pt will not recover, and deal with all the tears and emotions the family has. In another room, one of my patients is dying from cancer, and we feel the pt won't make it through the shift. We call the family they are out of town but on their way. I as the nurse go in to comfort the patient, hold the pts hand until the family gets there. Now I ask you, how many doctors do you see who have this much interaction with the pt? Most I know would be above holding a dying pts hand. Again, I am saying most, not all.
Your professional education teaches you (if I'm wrong here correct me) in a philosophy that makes you distant from human interactions between you and the pt. Pts become "the heart in bed 7". My professional education teaches me that the human interaction is the basis of my existence as a nurse. I am constantly watching, observing not only the pts medical condition, but helping emotionally as well. If I chose to and become a MDA, I would miss this essential link between me and the pt, because as a doc, I would think in terms of "treatment" and compartamentalize the pt.
I LOVE my job and I go home and everyday and know I've made a difference. Why? Because I feel good about what I do, but also because the pt and families tell me so. Now, I know that docs do make a difference as well, but who does the patient know and have a closer relationship with?
So, I have a question for you now. I want to know honestly if you think being a MDA is superior to being a CRNA? Why? I know there is the supervision thing you have that CRNAs must be supervised by MDAs. (I wonder though if they really need supervision or if it is similar to how I think on nurse practioners in that FNPs are fully capable of treating and writing prescriptions. But they have to be cosigned in most states by a MD. Now why is this? Maybe it is because docs want to keep that power over us (nurses) because if all of a sudden we can do something independent without them then the MD profession is threatened by us. I am not being bitter here, that is just my oppinion from what I've seen in clinical areas.) So, do I think CRNAs need supervision? Absolutely not. If they do, then why are there rural areas where CRNAs are the only anesthesia providers for 100 miles as you said earlier. We are capable of being independent, but I think that very independence threatens your profession, and so you want to think we need to have you supervise for your own security.

TennRN2004,

I agree with you, it is a struggle and a sacrafice for the families of physicians in training ... my spouse would be more than happy to tell you all about it. :)

As for anesthesiologists being superior to nurse anesthetists ... I have to be very careful with this, 'cause if I breathe the wrong way, somebody is going to be offended. I think an anesthesiologist receives superior training when applied to the practice of anesthesia.

It sounds like the physicians you work with don't try very hard to have meaningful relationships with their patients. I don't really know what to say about that, except that we're not training to be that way. As for physicians not examining their patients on rounds and using your assessment. It's one thing to use your assessment of vitals, it's another to just copy "III/VI holosystolic murmur best heard in the axillary line". BUT, nurses get lazy too, how many times have I read that a patient's respiratory rate is 20? Do you know what kind of **** storm I would hear if I pulled a nurse aside to explain that 20 wasn't normal?!

I appreciate you explaining your training to me, and how you approach patients. I can tell there are even differences in the terminology we use, I don't say 'assess', I use the word 'examine'. You and I have to approach patients differently, my paradigm is one of diagnosis and treatment, and this is where I think my training is superior when applied to the practice of anesthesia. All of my training is suposed to be able to prepare me to recognize the signs of pathophysiology, whether that be through examination or interpretation of tests and labs, and make a differential diagnosis or a definitive diagnosis. If I have a differential, I must decide what options are available for me to attain a specific diagnosis, weigh the pros and cons, and decide what tests/exams/studies I should order. I have to be able to interpret these and then come up with a treatment plan. This is what happens in the OR, but it's a critical care setting and very acute. If for example, I see that a patient is hypoxemic. I have to decide why --> e.g. make a diagnosis. If I can't, it becomes my job to narrow down the differential through interventions, tests, or examination. Once I have a diagnosis, I need to treat, otherwise, what was the point of figuring out why? This is why I see anesthesia as a medical profession, one of diagnosis and treatment.

In addition, my clinical anesthesia training is longer and encompasses a wider range of care, including the ICU. If I choose, I may receive advanced subspecialty training in many fields as well, further expanding my body of knowledge and experience. As far as I know, the option to fellowship train in anesthesia subspecialties does not exist for CRNAs.

Anyway, I hope this kind of answers your question. I think I was long winded, and may or may not have made the point I was trying to. I just didn't think I could say that I thought my training was superior, and then not say why.

TD

deepz · Jun 17, 2004

.... childish things like 'A$A', but mostly because you say things that either aren't really true, or only partially true, don't ever give references ....[ ]
Ad hominem. 'Always' this and 'never' that. You this, you that.
When unable to reason your way out of a paper bag, then forge personal attacks. Call them names. Angry. Childish. ... Whatever, doctor. I don't need your approval. I only point out that the emperor's got no skivvies.
Such behaviors are very familiar to me, having dealt with physicians most of my adult life. A complication? Must be the patient's fault, not mine. Attack, attack. As TennRN points out, how different are the behaviors typical of MDs from those typical of RNs. Has a lot to do with the historical success of CRNAs.
Originally it seemed as if you came to this nurses board to learn, doctor. But instead you came to beat your chest, didn't you? Are we impressed? We've seen others like you come and go. Fact is, this CRNA BB doesn't need supervision.
deepz
When you're in a hurry, take the long way.
---- Japanese proverb

TejasDoc · Jun 17, 2004

.... childish things like 'A$A', but mostly because you say things that either aren't really true, or only partially true, don't ever give references ....[ ]
Ad hominem. 'Always' this and 'never' that. You this, you that.
When unable to reason your way out of a paper bag, then forge personal attacks. Call them names. Angry. Childish. ... Whatever, doctor. I don't need your approval. I only point out that the emperor's got no skivvies.
Such behaviors are very familiar to me, having dealt with physicians most of my adult life. A complication? Must be the patient's fault, not mine. Attack, attack. As TennRN points out, how different are the behaviors typical of MDs from those typical of RNs. Has a lot to do with the historical success of CRNAs.
Originally it seemed as if you came to this nurses board to learn, doctor. But instead you came to beat your chest, didn't you? Are we impressed? We've seen others like you come and go. Fact is, this CRNA BB doesn't need supervision.
deepz
When you're in a hurry, take the long way.
---- Japanese proverb
Like I said before, not a comment about things you said that weren't actually true, or only partially true, just attacks on me.
You're right, I called you childish, and I even gave reasons why. Everyone else can decide if they agree or disagree.
And I did come here to learn, and it's been a pretty informative lesson so far. If nothing else, I've learned to always check whether or not the stuff you say is actually true, and that really makes it all worth it in the end. The things I've learned just fact checking you has been impressive - thanks for the education.
Chest beating? Come on. Are you talking about my comments about supervision and superior training? I was asked those questions specifically, if people didn't want my opinion about those things, they shouldn't ask. I didn't bring those things up, and I didn't come to this discussion to have those conversations. But I think people ask because they knew what I would say, and that's what they wanted me to say. Everyone needs a villain.
And the "... this ..., doctor", "... that ..., doctor" is getting old already, but if you say it a million times, I could see if the ASA would send you a set of steak knives.
TD
Instead of looking up catchy proverbs on the web, one should check their facts.
---TejasDoc Internet Proverb

jwk · Jun 17, 2004

Early in your training for your career, as you apparently are, one might hope you'd be more open to multiple viewpoints and less accepting of the A$A boilerplate. Much of their BS doesn't stand up to examination, even so basic a point as 'ASA, since 1905.' Typical exaggeration. Incorporated in 1937. But they needed something to pre-date the AANA in 1931. Oneupmanship, ego-driven, what do we call it?
?

So all I hear is how CRNA's have been doing this for over 100 years, yet the AANA was incorporated in 1931? Hmmmmmmmmmmm....

And as far as "early in your training...one might hope you'd be more open to multiple viewpoints..." How many student nurse anesthetists on this board get on the "bash the MDA, ASA, and AA" bandwagon? Some of the posters aren't even finished with nursing school, much less anesthesia school, and have already been indoctrinated. And I'm so tired of hearing "you shouldn't get on this board if you don't want a pro-CRNA viewpoint". An opinion is one thing - statements that sometimes border on libelous are entirely another.

I understand the bias, but can you at least be civil about it? loisanne, user69, kmchugh, and others at least engage in a more adult manner of discourse, even though TD and I and others may disagree with them.

CougRN · Jun 17, 2004

So all I hear is how CRNA's have been doing this for over 100 years, yet the AANA was incorporated in 1931? Hmmmmmmmmmmm....
And as far as "early in your training...one might hope you'd be more open to multiply viewpoints..." How many student nurse anesthetists on this board get on the "bash the MDA, ASA, and AA" bandwagon? Some of the posters aren't even finished with nursing school, much less anesthesia school, and have already been indoctrinated. And I'm so tired of hearing "you shouldn't get on this board if you don't want a pro-CRNA viewpoint". An opinion is one thing - statements that sometimes border on libelous are entirely another.
I understand the bias, but can you at least be civil about it? loisanne, user69, kmchugh, and others at least engage in a more adult manner of discourse, even though TD and I and others may disagree with them.

jwk, just to clarify. the aana was formed in 1931. that does not mean that nurses were not trained to perform anesthesia before that.

although documentaion of nurse anesthesia roots are sketchy prior to 1877 it is well documented that nurses were trained to perform anesthesia and oversee all anesthesia duties at certain hospitals in 1877. In 1889 wtih help of Dr. Willam W. Mayo nurses began being trained to perform anesthesia in Rochester. So this is were the 100 years of service comes in to play.

now i'm not trying to say anything about your training or history. just trying to set the record straight so that you know where this comes from when it is stated on this board.

deepz · Jun 17, 2004

.........
Instead of looking up catchy proverbs on the web, one should check their facts.
---TejasDoc Internet Proverb

My local potter friend Chyako Hashimoto will be disappointed to learn of your high esteem for her favorite proverb from her native village of Mashiko.

Really, doctor, your snottiness titer has approached levels high enough to qualify you for an AA. Don't make us medicate you!

All due respect.