Md's Against Crna's?

deepz · Dec 12, 2005

........... they are letting us do GA, but nothing else. ..........

Formal A$A policy, promulgated by radical doc chauvinists, officially prohibits CRNAs from performing block and lines.

Not all MDAs go along with that radical leadership, thank goodness. And our clinical practice as CRNAs follows our own AANA practice guidelines. Eg.:

http://www.aana.com/crna/prof/regional.asp

deepz

Pete495 · Dec 14, 2005

So why did your CRNA school decide to have a clinical rotation here in the first place if there are so many downsides? Surely they knew this would be the case ahead of time.

Very good question. I'm not sure I can answer it. This particular school is advocating its long distance program to medium sized hospitals closer to the middle of the state where there are not many CRNA schools. It knew ahead of time that if my hospital did not allow students to do procedures, then it would have to farm students out. I also knew, but did not want to move 3 hrs. away to attend school. They had also thought the hospital would agree to such procedures, which is the impression they were given. Since I work here, I know the surgeons and MDA's though, and I knew it would not happen, so I was not surprised. I just thought the reasoning was not atypical.

All in all, it's okay that they're sending me elsewhere, cuz I don't want to learn under someone who does not want to teach it to me, and is uncomfortable with this area. The sad part is though, I do have to learn the general anesthesia portion here, and have to step aside with the CRNA's whenever a procedure comes up. Granted, I will get the experience I need elsewhere, but when I come back to my primary clinical site, sorry, I can't utilize what i've learned.

Pete

DAREINGTX · Dec 14, 2005

Most do even if you don't witness it in public.

This is crap. You either don't know many MD's, or you're a jerk around them and they respond in kind.

To any MD that wants to eliminate CRNA autonomy, do you want to go to a rural area and make 125k doing mostly bread and butter cases? There are tons of CRNA's that do. With very good results I might add.

Brenna's Dad · Dec 16, 2005

I'm sorry, but this topic is lame and very much overdone.

Nurse GOODNIGHT · Dec 16, 2005

I think we need to do a little publicity ourselves as a profession [regarding the AMA ad thanking the doctor]. I see the same thing in practice. I do all the work, etc. and when the doctor comes in the patient is falling all over themselves and I barely get a nod. We need as a nursing community to spend some $$ on money. I think as a general rule the nursing unions haven't done as much good as people think. For one example, OT but the selling point to our state association is ohhh they successfully stopped a $100 license fee raise. Hmmm. when our fees for the association are $400 a year and they "saved" us 100.00, hmmm. Now I know I'm not a finance major (anymore-graduated) but .........

Pete495 · Dec 17, 2005

I'm sorry but this topic is lame and very much overdone.[/quote']
You're entitled to your opinion. However, I think you know that many CRNA's experience a lot of battle when it comes to practice. I'm not even a full fledged student yet, and I've run into many brick walls when it comes to some of the MDA's conducting my clinical. Maybe you can read what I wrote, and offer something to the discussion instead of bashing it down like it's meaningless.

jabsmom · Dec 17, 2005

This topic is commonly discussed around any of us in Advanced Practice. I have been an Advanced Practice Acute Care NP for over 10 years. In my personal experience I found and continue to find that we need to be our own PR agency. I have also reaffirmed that mutual Respect is earned. OUR patients knew that we were each an intricate part of their care..the surgeon did the surgery...I took care of everything else. I can't do the surgery and he can't take care of "everything" else. We have mutual respect as professionals. Communication with your patients provides them a foundation of knowledge...in the end they all know who to call if they really need assistance or want something answered..the NP! But yes..in the room and to their friends it is all about the MD ..until he walks out and then they say.."this is the person who makse sure everything is taken care of for me..he could'nt do it without her help"..patients/NUrses/Consulting MD's see us not as a surgeon or an NP but as a team ! and I remind them that individually we could not provide the care to them they are receiving..that is why we see the importanace of each others role. (Over 1000 Cardiothoracic cases/year by one MD)

As I enter this new area of advanced practivce..I willl have to once again gain the confidence and respect of those I practice. I hope to develop the same communciation with my new patient/professional group and foster a TEAM environment.

Maybe I am Polyanna..but my experience tells me otherwise. Just my two cents worth...

Cyndee, MSN, NP · Dec 27, 2005

I work in a large academic medial center in the SICU. I am also interviewing next week for anesthesia school!!! (this is a whole other discussion!!:imbar ) Today while at work one of the anesthesia residents came to preop one of my patients for tracheostomy surgery in the morning. As I was chit chatting with him about anesthesia school the resident for my patient's primary team came over and joined our conversation. The surgical resident has made comments to me about calling anesthetists "NINJAS". I asked him about this one day and he said because they are "silent asassins". As we were joking today I told the anesthesia resident about this "nick" and the surgery resident said that only applied to CRNA's not MDA's. The anesthesia resident in turn made several ugly remarks about CRNA's and their incompetence. This infuriated me! I (very nicely) pointed out to them that there is incompetence in every field, MD's included! I have been reading in these forums about the struggle for power between these two groups of professionals, but have yet to witness any of it untill today. I just don't understand why MD's have such a problem with the practice of CRNA's!
Any one have any "reasonable" ideas?

I know exactly why MD's have a problem with CRNA's or any advanced practice nurse...competition for $$$! I graduated from a NP program in August and I've already encountered doctors who have a problem with the scope of practice that NP's enjoy. One day, CRNA's will be preferred over the MDA's b/c CRNA's are reimbursed at a lower rate...same thing for NP's. We can save insurance companies, Medicare and Medicaid big bucks and doctors know this. In several states, NP's are already listed as primary care providers on some HMO/PPO's. Think about it though...wouldn't you be a little upset if you had spent all that time and money in college/residency and then someone with less education came along and took your job? Advanced practice nurses are a real threat to anesthesiologists, OB-GYNs, pediatricians and primary care physicians. If I were you I would get on the internet and print off a bunch of studies that have been done comparing patient outcomes, then I would show those to that anesthesia resident. I don't know of a single study that suggests the care given by MD's is superior to the care given by ANP's!

Cyndee, MSN, NP · Dec 27, 2005

bull____t
d

I agree! I went on an interview at a large internal medicine clinic and they had never had a "mid-level" practitioner there before. I just about fell out of my chair when one of the doctors told me that several of his peers were concerned about my lack of clinical experience in school. He said that they had decided that I would have a "preceptor" for THREE years before they would let me practice without oversite. Their reasoning was that they had to complete a 3 year residency and since I was basically doing the same thing, then I should do the same. Never mind that I wouldn't get a medical degree or comparable pay after 3 years. Needless to say, I'm not working at that place!

Cyndee, MSN, NP · Dec 27, 2005

I agree with you ether. It's mostly the residents and students on the SDN site that fan the flames. It's amazing how arrogant they can be. Although, I shouldn't be to surprised. I've worked with physicians for the last 8 years :chuckle. One day they will be out in private practice, and hopefully they will understand the importance of CRNA's in that practice.
They can choose to work with us or not, but the number of nurse anesthetists graduating from anesthesia schools are increasing:
I found an interesting piece of info in the CMS Medicare Part B Update Final Rule: Agency Language on Anesthesia Teaching Rules
"...there has been an increase in the number of nurse anesthesia programs from 83 programs in 2000 to 105 programs projected for 2006. The number of nurse anesthesia graduates has surged from 1075 nurse anesthetist in 2000 to 2035 projected for 2006."...
Strength in numbers:cheers:

YEA for ALL advanced practice nurses. I truly believe that the day will come when hospitals, insurance companies, Medicare and Medicaid MANDATE that patients be treated by the NP or given anesthesia by the CRNA because we give AFFORDABLE and HIGH QUALITY CARE!

jwk · Dec 27, 2005

YEA for ALL advanced practice nurses. I truly believe that the day will come when hospitals, insurance companies, Medicare and Medicaid MANDATE that patients be treated by the NP or given anesthesia by the CRNA because we give AFFORDABLE and HIGH QUALITY CARE!

Dream on - it will NEVER happen. But hey, at least you found the right board.

Cyndee, MSN, NP · Dec 27, 2005

Dream on - it will NEVER happen. But hey, at least you found the right board.

Are you kidding? Are you aware that VA's across the U.S. have replaced doctors with NP's? This has saved the taxpayers millions of dollars. Are you aware that physicians are being REPLACED by NP's at clinics throughout the nation? This is a trend that will continue, especially considering the state of our healthcare system. The AMA may be powerful, but guess what...there is POWER IN NUMBERS and we're (NP's & CRNA's) are coming out of school in record numbers. Just wait...