Not trying to stir up bad ideas, but......

[Brian_SRNA]

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 some reason it is getting under my nerves. I know that this battle has been going on for years, and that it will continue, but the arrogance of many of the MDA (attendings mind you) is scary. I almost laugh at some of the crap they say. But I guess I just needed reassurance (I know it sounds stupid), but I have sacrificed and taken out loans for the program...I have always, and will always continue to love this profession, as I grow with it. But I am really curious where everyone (Practicing CRNA's specifically) see this going as it relates to CRNA's ability to freely practice.

Brian

[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.

Brian

[deepz]

....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?

?

[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.

[deepz]

.......I think it is the rogue cowboy CRNA that the legislature was trying to curtail.........

Oh please.

!

[London88]

In response to your last post paindoc, I am assuming these same legislators are trying to protect all patients from a rogue CRNA, or from a midwife from treating a pt typically seen by a NP, or from a NP from doing a procedure that is typically done by a CRNA, or protection from a cardioligist who is trying to practice psychiatry when he is not qualified to do so. As for the issue of APN in your state, please clarify what it is that CRNAs do not "bring to the table." My colleague who graduated from the same school as me is practicing in Texas and is recognized as an APN so she "brings to the table" what other APNs bring to the table but if I chose to work in your state I do not "bring to the table" what other APNs bring the table. To make a long story short the concept of what APNs "bring to the table" is illogical BS.

[jwk]

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.

From what I've seen, CRNA's have FAR more training the most NP's.

[paindoc]

CRNAs have training in a highly technical specialized field while NPs have a very broad swath of training across many fields. It is not reasonable to assume generalists such as family practitioners have less training than anesthesiologists, and the same holds true for CRNAs and NPs: their training exists in different fields and cannot possibly be compared directly. CRNAs may be able to intubate a person and save a life while NPs may recognize an early case of meningitis and save a life. Both are necessary and have merit. Some CRNAs have as much as 2 years of training after their RN: Many NPs have the same.

[dogbone]

CRNAs have training in a highly technical specialized field while NPs have a very broad swath of training across many fields. It is not reasonable to assume generalists such as family practitioners have less training than anesthesiologists, and the same holds true for CRNAs and NPs: their training exists in different fields and cannot possibly be compared directly. CRNAs may be able to intubate a person and save a life while NPs may recognize an early case of meningitis and save a life. Both are necessary and have merit. Some CRNAs have as much as 2 years of training after their RN: Many NPs have the same.

You are right, in essence, that one can't compare apples to oranges. But your assertion that it is better to have an NP in a pain practice than a CRNA is without merit. Using your example, would you want a family practice MD working in a pain clinic? Don't think so...I wouldn't go see him. As JWK said, crna's have far more and intense training than apn's. This is not an insult to apn's, there are other threads about this, but one can look at the curriculums and see this. Also, most crna's have lots more clinical practice prior to na school than one or two years. Although apn's can go directly from a layperson to an apn through bridge programs, most have had many years of clinical experience.

[Brian_SRNA]

I have to agree with paindoc on this post.....you would not want an anesthesiologist or cardiologist working in a pediatric well baby clinic...it wouldn't make sense...our training is specialized and we are great at what we are trained to do...but CRNA's are not general practitioners...nor do i claim to be. I started this post as a rant about the SDN and now, unfortunately, realize that many CRNA's and SRNA's are guilty of the same biased. I appreciate all the posts and it has made me refocus my attenntion. Thank you

Brian

[jwk]

I have to agree with paindoc on this post.....you would not want an anesthesiologist or cardiologist working in a pediatric well baby clinic...it wouldn't make sense...our training is specialized and we are great at what we are trained to do...but CRNA's are not general practitioners...nor do i claim to be. I started this post as a rant about the SDN and now, unfortunately, realize that many CRNA's and SRNA's are guilty of the same biased. I appreciate all the posts and it has made me refocus my attenntion. Thank you

Brian

Just about any doc (especially residents) in any specialty are staffing ER's around the country. They all have a standard base of medical training that enables them to do this - I'm not saying it's ideal, but it's the reality. The intent of my earlier post was that CRNA's have a very set curriculum and accreditation standards - the same does not seem to be true of NP's as I understand it.

[yoga crna]

What you have to remember is that physicians have UNLIMITED LICENSES, which means, based on their medical license they can do anything. Whether or not they can get hospital privileges for anything is another issue. We have seen that a lot with office based surgery, where GP's are doing breast augmentations and liposuctions. I have reviewed lawsuits where GPs were doing general surgery. There is a whole world out there outside of the big hospitals.

CRNAs and NPs are not comparable in education and scope of practice. If nursing boards wish to classify us as advance practice nurses, that is fine. I have taught both groups and can tell you the nurse practitioner curriculum is very soft on the sciences and on clinical experience. Whereas, CRNA students are educated to be self sufficient and independent practitioners when they graduate and our pharmacology and chemistry courses are not for the faint hearted. Clearly, our functions are different and, in no way am I disparaging our nurse practitioner colleagues. But anesthesia involves acute care of cradle to grave patients with all disease processes and pathophysiologic changes. That is what makes it so much fun and what keeps us constantly studying.

yoga crna

[paindoc]

I think it is important to remember that CRNAs are very very good within a focused, very limited scope of practice. It is true they can anesthetize infants and geriatrics. But they have nowhere near the breadth of knowledge of NPs. I too have taught both, and given the vast differences in training of CRNAs (remember, most are certificate CRNAs, not degreed CRNAs), that CRNA 1 does not equal CRNA 2 does not equal CRNA 3.

If CRNAs had a recertification exam required of all CRNAs to be given at intervals, and that certification course was equivalent to the initial board certification in difficulty, you would possibly find a significant attrition in the ranks of CRNAs. Once a CRNA, always a CRNA, regardless of education. I understand CRNAs are making progress in this area, but when nearly 60% have no advanced degree, one does wonder how parity is achieved among the ranks. I am not dissing CRNAs education, simply making a comment about the same disparities that we see existing in medical ranks regarding residency status or subspecialty status. Therefore when one is considering NPs and the variation in education (there are several subspecialty tracks available with different certifications), one cannot forget where CRNAs are now and from where they have come. Both are worthy professions, but it would be a mistake for CRNAs to begin to wax elitist and claim superiority over other nurses due to self-perceived educational differences..