Pain Management CRNA - page 3

So I found an interesting link on the AANA webpage, and I was curious what the group thought about it. I guess the AANA is currently trying to develop guidelines for fellowship programs in pain... Read More

  1. by   UCDSICURN
    That's just Gotosleepy spreading more misinformation like usual. Pay no attention. He's just silly ignorant.

    Donn C.
  2. by   Brenna's Dad
    Excellent arguement Hello Nurse.
  3. by   alansmith52
    I liked it. and I was the one being called a dummy (in jest)
    I think likening nurses to other oppressed groups is a perfect comparison.
    In the nazi prison camps jews were put in charge of other jews. (read victor frankle "mans search for happiness") in this same way I think that phycians who theoreticly should be on our side, have selfishly only elevated themselves to practice some sort of dominion over the rest of allied health.
    go sleepy I find no fault.
  4. by   deepz
    Quote from TejasDoc
    ..... who knows what's going on in Durango ...
    So TD has now become a stalker as well as a troll? Be cautious, TD, searching through my trashcan for souvenirs; never know what you'll encounter.

    Quote from TejasDoc
    BTW, you're welcome to wear clean badges.
    So then ... I guess you're not a classic movie buff? Treasure of the Sierra Madre? Never mind.

  5. by   TejasDoc
    'Stalker' deepz? No not quite. But I have a keen sense of smell, and I'm able to follow the scent of BS from one website and to another. It's not rocket science.

    Hellllllo Nurse, I agree, there is a huge difference in the sub-standard nursing lounge and the opulent physicians lounge. I think it's awful that the nursing staff is given such a horrible facility. I just don't think it's the same as the civil rights movement and "drinking from a different water fountain", in the civil rights sense of it. The difference isn't obviously clear, and you may or may not agree with me, but here's what I think.

    In the civil rights sense of it, you were black, you were treated unfairly, and there was really no escaping it. You, if you don't like the nursing lounge, and feel SO strongly about it, can just quit. No oppression, no being forced into submission, nothing. Just quit ... find another job that treats nurses better. OR, and I can only imagine the **** storm I am opening up by even suggesting this, go to medical school, finish a residency, and then go ahead and enjoy the opulent physicians lounge. That option, while being a lot of work to enjoy a lounge, is also available to you.

    Blacks couldn't just quit being black, and they definitely couldn't just go to school and become white through education. So do I think the nurses lounge you describe is awful? Yes I do. Do I think the physicians should get a beautiful lounge the the nurses a hell hole? No, awful idea. I just don't think it's comparable to the civil rights movement. No, no way, no how. You're not an oppressed people, you described a crummy lounge, that's all.

    You can only imagine how I feel about the Nazi holocaust thing that Alan Smith mentioned. Soon I'm going to have to read a comparison of the treatment of CRNAs to the genocide of Native Americans.

  6. by   Hellllllo Nurse

    I do not think that being a nurse today and being a black person in the old South is the same thing.
    I was using the example of the two lounges to illustrate how in many places, nurses really are treated as second class citizens. In many ways, we really are relegated to a different drinking fountain.
    When I stumbled into the physician's lounge, I was a naive student. The disparity in the two lounges spoke volumes. It really crystalized for me what I had been suspecting for quite some time, based on what I had observed. Docs are treated like kings, nurses like serfs.
    I really felt like "The Little Match Girl" standing out in the cold, peering in at a Christmas feast that I could never be invited to share in.
    This is more that just a problem of a crummy lounge. To a degree, nurses are oppressed.

    I have left jobs because abuse of nurses by physicians was tolerated there.
    I have been screamed at by docs. Once, a doc called me a "f#$%ing whor$" because I called him at 0300 to get a pt's pain med orders increased. (This was at the hospice where we had standing orders, but the pt chose to stay w/ his primary doc, who did not have standing order privileges).

    The disparity between how nurses and docs are treated, and what type of behaviors are seen as acceptable from each is vast.

    I have read several journal articles on studies that have concluded that abusive treatment by physicians and hospitals is a major factor in many nurses leaving specific jobs and leaving nursing altogether.

    A few weeks ago, I posted on a physician's bb, asking members what they thought we could do as nurses and docs to improve our working relations, communication and collaboration, in order to improve pt care, and our working environments. The docs and students there ripped me to shreads.

    I am encouraged by the fact that you are even on this board, and are wanting to communicate with nurses. There have been docs and med students who have come here (and to my own nursing web site bb) just to hurl a few put-downs, and then leave.

    I really want to know- is there any mention in medical school of what nurses really do, what our education entails, and on how nurses and docs can best work together?

    The nursing "shortage" is bound to have a great impact on physicans and their profession. Does the medical community concern themselves with how they can avert these problems and what their role is in retaining nurses?

    Where I work now, the docs are courteous. They do, however, constantly push the nurses do things that are beyond our scope of practice, and are really their responsibility. These docs are the owners of the company where I am employed.

    There would be no need for the new disruptive physician behavior laws, "code pink" practices, nurse-to-pt ratio laws, etc. if nurses were not treated as second class citizens.

    According to The Dept of Labor, Bureau of Labor Statisics, there is actually a surplus of nurses, not a shortage. Recent figures show that their are approx 500,000 currently licensed registered nurses in The U.S., who are not working as nurses. Recent figures estimate the number of nurses needed to fill all nursing job vacancies in The U.S. is 400,000.

    I have been a nurse for 12 years. I know many nurses who have left nursing or are looking to leave it. I have personal knowledge and plenty of anecdotal evidence that has convinced me that poor treatment of nurses by hospitals and docs, and lack of respect and regard for nurses are the primary reasons that so many nurses are leaving nursing.

    Do you have any thoughts or opinions about this? Are physicians concerned about the nursing "shortage", nurses leaving nursing and how this will impact their practices and the state of pt care?

    I would really be interested in hearing your thoughts on this.
    Last edit by Hellllllo Nurse on Jul 8, '04
  7. by   steve0123
    OK, well, just getting back to the topic of CRNA's prescribing analgesia for a moment...

    My view (I'm not saying this is the correct view, just mine) is that physicians diagnose and treat illness and disease, while nurses promote optimum health and comfort (in a general roundabout way of talking, I understand that its deeper than that). So in that sense, it seems perfectly acceptable for a nurse with the education of a CRNA to prescribe medication to relieve the symptoms of pain (thus promoting comfort). Just because someone can prescribe doesn't mean they are encroaching on someone elses turf - so long as they are adequately qualified and their occupation can justify what they are doing, whats the problem?
  8. by   loisane
    Hellllo nurse: EXCELLENT post. I believe you have a great command of this complicated issue! You have asked some great though provoking questions, and I look forward to further discussion.

    Quote from steve0123
    OK, well, just getting back to the topic of CRNA's prescribing analgesia for a moment...
    There is a difference between pain management and Pain Management.

    You are talking about pain management. Nursing and medical care related to the relief of pain.

    TD started this thread about Pain Management, which is a subspecialty of anesthesia. These are anesthesia providers with advanced skills in the assesment and treatment of pain. Although they can and do work with acute pain, the biggest part of their practice is usually patients with chronic pain.

    These are the people that can do the "unusual" type of blocks, meaning these blocks are not the usual, ordinary type that most any anesthesia provider can perform. It takes extra education and training to learn these. For instance, in a post-residency fellowship.

    There is a separate, but related issue, of prescriptive authority for nurses. All states now have prescriptive authority for advanced practice nurses, and in some cases CRNAs are covered. APNs only need prescriptive authority if they need to write a prescription, to be filled by the patient at a pharmacy. So it is more important to NPs than CRNAs, in most cases. The everyday practice of CRNAs to choose drugs in the OR and administer them themselves does not require prescriptive authority.

    CRNAs in states where they are eligible for prescriptive authority might find a use for it in their practice. For instance, they might need to prescribe a preoperative med, that they want the patient to take it before coming to the OR. It would be kind of unusual, but not impossible. These CRNAs are not practicing Pain Management.

    A CRNA doing Pain Management could do so without prescriptive authority, if they do not write prescriptions. If they need to write prescriptions, then they would need prescriptive authority, in addition to their Pain Management designation.

    loisane crna
  9. by   Kiwi
    Not a coherent argument.

    Quote from TejasDoc
    I can only imagine the **** storm I am opening up by even suggesting this, go to medical school, finish a residency, and then go ahead and enjoy the opulent physicians lounge. That option, while being a lot of work to enjoy a lounge, is also available to you.TD
    Thanks for the option, but I already make a mean batch of Maryland crab cakes on my own!...

    Although if we're getting into historically accurate civil rights, I prefer the Rosa Parks move. "If the nursing lounge is nasty and crowded, go finish nursing care plans in the nice, spacious resident lounge up in the front of the bus." To the surprise of my fellow nursing students, this is exactly how I complete my nsg care plans each tues and thurs.

    Why are we 2nd class citizens? Because most of us put up with it! Move on up to the front of the bus.
  10. by   deepz
    Quote from TejasDoc
    ..I have a keen sense of smell, and I'm able to follow the scent of BS .....

    Quote from TejasDoc
    ... how is it that an anesthesiologist can't earn his/her salary by saving your butt once or twice a year?

    Hmmmm. ... What's that odor?

  11. by   deepz
    Quote from qanik
    I have a relative(who is a RN) that was sent to Cottage Hospital in New Hampshire for their pain clinic......

    Thom Bloomquist was one of those NH CRNAs:

  12. by   Hellllllo Nurse
    Quote from loisane
    Hellllo nurse: EXCELLENT post. I believe you have a great command of this complicated issue! You have asked some great thought provoking questions, and I look forward to further discussion.

    Thank you so much, loisane.

    TejasDoc hasn't been back. I was looking forward to his reply.
    Somehow, I think we won't be hearing from him.
  13. by   catcolalex
    i always enjoy a good argument, thanks TD and deepz

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