Not trying to stir up bad ideas, but...... - page 3

Trying to stay away from the SDN is like the forbidden fruit. And I know i am stupid for even caring....but i do. My program starts is 2 months...I have worked for years to get to this point and for... Read More

  1. by   micugirl
    In NC, our Nursing practice act allows CRNA's to practice independently, as long as another MD is present, but it does not have to be an anesthesiologist. Thus, in private practices, a CRNA can work under a cosmetic surgeon, although that surgeon usually knows little to nothing about the drugs & techniques of anesthesia.
  2. by   micugirl
    Ultimately, it appears you would have to trust a CRNA with a family member, because there are not enough of them to do all the cases needed to be done, unless you have one at your beck & call as a favor to the family.
  3. by   Brian_SRNA
    Quote from paindoc
    Indiana. And I did not say there was legislation...but that the legislature made that determination in their deliberations regarding CRNAs vs APNs.
    We have specific requirements in IN for APN that are in excess of what CRNAs bring to the table. Of course CRNAs have the option of going to NP school for 2 years if they really want to be treated as APNs.
    I think we owe a round of applause to the state legislature of indiana. I just spent about 20 minutes looking over the Indiana state code and it is fascinating.....and in response to
    "We have more specific.....CRNA's have the option of going back to school for 2 years if they really want to be treated as APN's."

    Here are a few direct quotes from the state law IC (Indiana Code)

    IC 25-23-1-1
    Sec. 1. As used in this chapter:
    (a) "Board" means the Indiana state board of nursing.
    (b) "Advanced practice nurse" means:
    (1) a nurse practitioner;
    (2) a nurse midwife; or
    (3) a clinical nurse specialist;
    who is a registered nurse qualified to practice nursing in a specialty role based upon the additional knowledge and skill gained through a formal organized program of study and clinical experience, or the equivalent as determined by the board, which does not limit but extends or expands the function of the nurse which may be initiated by the client or provider in settings that shall include hospital outpatient clinics and health maintenance organizations.

    IC 25-23-1-19.4
    Advanced practice nurses; collaboration with licensed practitioner
    Sec. 19.4. (a) As used in this section, "practitioner" has the meaning set forth in IC 16-42-19-5. However, the term does not include the following:
    (1) A veterinarian.
    (2) An advanced practice nurse.
    (b) An advanced practice nurse shall operate in collaboration with a licensed practitioner as evidenced by a practice agreement, or by privileges granted by the governing board of a hospital licensed under IC 16-21 with the advice of the medical staff of the hospital that sets forth the manner in which an advanced practice nurse and a licensed practitioner will cooperate, coordinate, and consult with each other in the provision of health care to their patients.
    As added by P.L.185-1993, SEC.7.

    From my understanding the APN MUST be in collaboration with a physician in order to be able to practice....hmmm lets look at the rules for CRNA's, in the State Code

    IC 25-23-1-1.4
    "Certified registered nurse anesthetist" defined
    Sec. 1.4. As used in this chapter, "certified registered nurse anesthetist" means a registered nurse who:
    (1) is a graduate of a nurse anesthesia educational program accredited by the American Association of Nurse Anesthetists (referred to as the "AANA" in this chapter) Council on Accreditation of Nurse Anesthesia Educational Programs or its predecessor;
    (2) is properly certified by successfully completing the certification examination administered by the AANA's Council on Certification of Nurse Anesthetists or its predecessor; and
    (3) is properly certified and in compliance with criteria for biennial recertification, as defined by the AANA Council on Recertification of Nurse Anesthetists.
    As added by P.L.185-1993, SEC.3.

    And on the issue of "forced collaboration" or "under medical Direction" the next one is the kicker.

    (4) Requires that a:
    (A) licensed physician with specialized training or experience in the administration of an anesthetic; supervise the administration of or
    (B) certified registered nurse anesthetist (as defined in IC 25-23-1-1.4 );
    the anesthetic to a patient and remain present in the facility during the surgical procedure, except when only a local infiltration anesthetic is administered.
    Looks like they took out the MDA requirement for supervision.

    I think this looks good for our profession. and maybe we shouldn't be considered APN's, I dont know. It looks like CRNA's are looked differently, higher?, in indiana, I dont know.

    But please, especially anyone out there reading this verrry long post as a not get the idea that this profession is about being the boss...its about being a team player...and if you can't agree with that...than maybe this isn't the right job.

    Sorry for being long winded. wheeew

  4. by   deepz
    Quote from paindoc
    CRNAs in our state are by law NOT advanced practice nurses. ......The state legislature has determined they do not have enough training to be considered advanced practice nurses and just because they can pass gas, that doesn't make them competent to engage in diagnosis and treatment outside the operating room and L&D suites......

    Can you back up these assertions with reference citations? Or is they merely your personal opinions, paindoc?

  5. by   deepz
    Quote from sc17
    ANESTHESIOLOGY is the practice of medicine. The term "nurse anesthesiology" is incorrect. You are not a physician and you do not practice anesthesiology. Nurse anesthesia is a more accurate term.

    Actually my diploma from CRNA school, issued by no less than the US Army Medical Service, states that I graduated from the course entitled 'ANESTHESIOLOGY for Army Nurse Corps Officers.' Emphasis added.

  6. by   cathys01
    From the Texas Board of Nurse Examiners:

    Sec. 301.152. Rules Regarding Specialized Training.
    (a) In this section, "advanced practice nurse" means a registered nurse approved by the Board to practice as an advanced practice nurse on the basis of completion of an advanced educational program. The term includes a nurse practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist. The term is synonymous with "advanced nurse practitioner."
  7. by   subee
    Quote from paindoc
    CRNAs in our state are by law NOT advanced practice nurses. They cannot write narcotic or other prescriptions and can only administer drugs. The state legislature has determined they do not have enough training to be considered advanced practice nurses and just because they can pass gas, that doesn't make them competent to engage in diagnosis and treatment outside the operating room and L&D suites. I know this varies state by state, and largely hinges on whether they will engage in collaborative agreements. When the issue came up in my state, CRNAs did not want to be required to have collaborative agreements with any physician, therefore, they cannot by law be APNs.
    And why would a CRNA want to "diagnose and treat" patients outside of the surgical setting? CRNA's aren't APN's in a lot of states but this is the result of political decisions, not educational background. I don't think that there is any other advanced practice option that requires the amount of time, educational preparation or sacrifice in personal life that the 24-27 month (year round) CRNA program requires. I'm not sure what the point of your post is. Do you have any idea what your point is?
  8. by   paindoc
    The definition of an APN does vary from state to state. In Indiana, it is a law that CRNAs are not APNs, it is not opinion. As for the legislative comments, you must be kidding if you think legislators are going to put that in print. But they did tell me those things personally, and quite frankly I am perplexed at their attitudes. Nonetheless, in Indiana (a place quite hostile to CRNAs with a 5:1 MDA/CRNA relative population and living in the legacy of Stoelting, not a huge advocate of CRNAs), CRNAs cannot be APNs.
  9. by   LuvMyGamecocks
    Here's what SC says....
    Title 40 - Professions and Occupations
    CHAPTER 33

    ARTICLE 1.

    SECTION 40-33-20. Definitions. . .
    (5) "Advanced Practice Registered Nurse" or " APRN" means a registered nurse who is prepared for an advanced practice registered nursing role by virtue of additional knowledge and skills gained through an advanced formal education program of nursing in a specialty area that is approved by the board. The categories of APRN are nurse practitioner, certified nurse-midwife, clinical nurse specialist, and certified registered nurse anesthetist. An advanced practice registered nurse shall hold a doctorate, a post-nursing master's certificate, or a minimum of a master's degree that includes advanced education composed of didactic and supervised clinical practice in a specific area of advanced practice registered nursing. In addition to those activities considered the practice of registered nursing, an APRN may perform delegated medical acts.
  10. by   Wash31
    Yoga, I love how you love your job. I am in ungraduate school at this moment to get my nursing degree, so that I can get into
    CRNA school. Hearing you has made me want it even more. I just wanted to ask you the best route for me to take. When you started your profession, did you shadow a CRNA? How long were you a nurse before you applied, and was it hard for you getting in the school? Do I need to take certain subjects to help me get in? They told me I had to be on ICU for one year before I could apply, and i can understand that, but do you think that will be enough for me to do good in CRNA school? I just want to go into the school and be ready for what they have for me to be one of the best. Thank you for your time, and hope to hear from you soon.
  11. by   Brian_SRNA
    I think some people are taking what paindoc said out of context.....and that is not the point of these forums...he said that in indiana CRNA's are not APN's. I think many of us, including me at first, took that as a blanket statement that CRNAs are not APN's in the broader sense of the meaning.He is and only has been talking about the state of indiana...of which he is correct....I looked up the laws in indiana and CRNA's are not APN's, which in this state i feel is a good thing...there are MANY more restrictions on APN's in indiana (NP's, CNS, Midwifes) than are needed in CRNA practice. SO we can all stop the posts about everyother state out there....thank you.

  12. by   deepz
    Quote from paindoc
    ....Indiana ... legislators .... did tell me those things personally, and quite frankly I am perplexed at their attitudes.........
    Well, doctor, I'm perplexed quite frankly that you did not then set those legislators straight -- you didn't tell them all about the intensive education CRNAs receive? -- what all it is that CRNAs bring to the table?

    If you have their ear, sic 'em!

    Or are you only pro-CRNA if the CRNAs would sign collaborative agreements and hand you their independent billing rights perhaps?

  13. by   paindoc
    CRNAs now have excellent training for providing most anesthetics, but placing a CRNA in a clinic situation treating patients typically seen by trained NPs would not make any sense and may be unsafe for patients. I think it is the rogue cowboy CRNA that the legislature was trying to curtail.
    I have no axe to grind with CRNAs...I have known some excellent CRNAs in my lifetime and have worked closely with them on many occasions. This I did make known to the legislators.