My wife's physiology professor who is also a chiropracter...

Tenesma · Dec 15, 2002

for brenna...

i don't know where you came up with the gender thing, but i will try to address it - since i disagree with you. Nurses are paid the same regardless of gender, and most critical care nurses are better compensated than your average floor nurse...

most CRNAs historically have been women - and the reason for their higher compensation is closely linked to the anesthesia provider shortage as well as their billing practices... for example, medicare reimburses procedures at a higher rate than anything else... that is why pediatric NP or psych NP with few procedures usually get paid less than cardiothoracic NPs with multiple procedures and heavy involvement with surgery....

now in some rare instances you might find gender-based differences in pay, but that is more the exception and has nothing to do with the disparity in pay between CRNAs and RNs

for UFMATT,

my brother is also a recent graduate from chiropractic school, and I would agree that it is a shame that so many quacks have hurt that fields general perception by allopathic physicians... but to imply that chiropractic school is tougher than medical school makes me laugh :)

ufmatt · Dec 15, 2002

Tenesma,

If you had read my post, I said SOME programs. I know this because I have had several med student/resident/fellow roomates over the years. I have seen 2 programs in depth, and what my brother in law covered was moderately more in-depth. I have not implied a thing regarding med school as a whole.

Roland · Dec 15, 2002

than other "APN's" in general involves simple supply and demand. Health care service providers would prefer to pay the least amount possible in order to obtain the services their facility requires. Thus, were if possible they would have no problem paying top neurosurgeons ten dollars an hour! Of course at that rate of pay they would do good to retain a CNA, let alone a doctor.

To become a CRNA requires a substancial amount of education and experience that few people posess (somewhere between being a CNA and a neurosurgeon in ball park terms) thus they earn an amount which tends to be intermediate between those two positions. A salary is simply a "price" for a service which varies according to the same rules of economics that all other goods and services follow. That's why teachers are "underpaid" at 45K per year, and some CEO's are "over paid" at fifty million per year (non withstanding illegal activities on the part of certain executives that inflate their income). It's just business in a free market economy.

loisane · Dec 16, 2002

I think Tenesma's observation is right-procedure orientation leads to higher reimbursement. However, I think this is more true of medicine than of nursing. (But isn't it great to have a true interdisciplinary discussion?). Nursing pay has not evolved from the same environment as medical pay.

Historically, nursing charges have always been lumped into "room charge" from the hospital. And that even applied to CRNAs in the days when the hospital-employer model predominated. Nursing (and I mean traditional bedside nursing) is only beginning to do the research and the lobbying that it will require to "prove our worth" line by line on the budget. (Have you noticed the studies linking nursing staffing to complications, length of stay, medical errors, etc.?) Nursing is way behind on outcome oriented research.

But Brenna's Dad's point is not unfounded either. CRNAs have been on the cutting edge when it comes to reimbursement issues. And we have the highest percentage of men among all the nursing specialties. Coincidence or correlation? No way to know for sure, but you can form your own opinion.

And of course, Roland is right, in America "market forces" are what make the world go round. But it didn't just magically happen for nurse anesthesia. Our professional organization has had to learn how the government controlled reimbursement works, and how we can negotiate a place for ourselves within this. These are lessons mainstream nursing is still working on. And thankfully (after many years of animosity toward each other) I think mainstream nursing and nurse anesthesia are trying to help each other out on these issues. (Although old wounds are slow to heal, and there is still alot of bad blood out there, on both sides.)

All of you SRNAs/CRNAs be careful dogging the chiropractors. They have been our allies at times. And of course, we all know the dangers of making generalizations about an entire profession based on a few individual observations. (Don't we hate it when people do that to us?)

I am disappointed to learn that some states (like Kansas) lump CRNAs in with NPs. This is very misleading, and to me reflects the traditional lack of CRNA involvement with Boards of Nursing (see my animosity comment above).

As a profession-meaning educators, associations, etc.-nursing recognizes the four specialties as advanced practice. If states (within their regulatory agencies, the Boards of Nursing) want to issue a specific license for APNs that is within their rights. But please don't call us all NPs! That is truly unfortunate.

Don't know if I have clarified anything for you, 2banurse. Complex issues, with good discussion.

loisane crna

London88 · Dec 16, 2002

Loisane,

Not that I disagree with you, but why the " please don't call us NPs! That is truly unfortunate" Out of curiosity why do you believe it unfortunate?

kmchugh · Dec 17, 2002

Originally posted by loisane
I am disappointed to learn that some states (like Kansas) lump CRNAs in with NPs. This is very misleading, and to me reflects the traditional lack of CRNA involvement with Boards of Nursing (see my animosity comment above).

loisane crna

Maybe I was not clear, but I don't really feel that we have been "lumped in" with NP's. As I said, I not only have a license as an ARNP, but also as a CRNA. You can not practice nurse anesthesia in Kansas without both licenses. I always felt the additional licensure marked CRNA's as ARNP's with specific, unique (among ARNP's) abilities.

Kevin McHugh, CRNA

loisane · Dec 17, 2002

Oh, I in NO way mean to speak ill of NPs. (I happen to believe they are a big part of the answer to our health care delivery crisis-but that is another thread).

But the fact remains that we are two entirely different specialties. CRNAs are NOT anesthesia nurse practitioners. Our education and certification has evolved separately.

But you have given me an insight. Maybe this confusion is why so many people think nurse anesthesia is "new". When the fact is nurses have been giving anesthesia for over 100 years. On the other hand, nurse practitioners began in the 1970's (in Colorado, I believe).

So, IMHO, any state nursing board that issues a license with the phrase "nurse practitioner" in it to a CRNA, CNS or CNM has missed the mark. It would be more accurate to issue an "advanced practice nursing" license, again IMHO.

As I said, most BON do not get much CRNA input. The blame lies on both sides-they don't seek it and we don't offer it. So many times they tend to forget about us. I am sure there are regional differences. Maybe some of you are fortunate to have state boards that include CRNAs at the table. But I know I am not the only one that lives in a state where the BON is CRNA-indifferent (not anti-CRNA, just indifferent). It is one of the many issues where there is progress to be made.

loisane crna

Brenna's Dad · Dec 18, 2002

Tenesma,

I must disagree with you that critical care nurses make more money than floor nurses. This just isn't the truth, at least not on the west coast. Perhaps you might obtain a sign-on bonus due to the shortage of critical care nurses in some areas, but it has been my experience that their is no improvement in compensation.

I also know, of course, that most CRNAs have historically been women. Most nurses have been women. However, I don't believe that it is a coincidence that such a far greater percentage of CRNAs are men and the profession is the highest reimbursed nursing discipline. I wish it were not so and gender had nothing to do with the equation, but I just don't think this is true.

Of course the lobbying efforts of CRNAs have been highly successful and supply and demand have also affected compensation, but I still believe gender has played a part. If not, then why do we not see the same pattern in other nursing disciplines?

We have already touch on critical care. There is an obvious shortage of critical care nurses accross most of the country. As a nursing discipline it is highly advanced and speciallize. The responsibility might be considered enormous.

Like anesthesia, critical care nurses are responsible for keeping the patient alive, administering complex medications with potentially fatal effects, monitoring vital signs and obtaining hemodynamic profiles, titrating adrenergic medications based on these profiles, managing the ventilator, interpreting ABGs, performing complex multitasks such as IABP and CCVHD, and so on. No one can argue the job is highly specialized and requiring a high degree of knowledge and skill.

Yet, I do not see that the compensation for critical care nurses improving more than nursing in general. And I think this is bacause society (and many nurses) still considers nursing to be women's work and not worthy of respectable compensation.

To clarify, I'm not saying that gender is the entire reason for this phenomena. I think losianne and other made many valid points. But I do think the fact that most nurses have been women has played a very strong part.

AL bug · Dec 18, 2002

I worked in northern Alabama and was never compensated for working in the ICU, ACLS, or having a BSN as opposed to ADN. I believe critical care nursing is a very advanced position, but is not compensated as such. It is a shame, but does not seem to be considered important enough for hospitals to respect the critical care staff and reward them for advanced skills and education. So on to a more rewarding career(at least professionally and financially)...