Real Talk

allnurses Guide · Dec 9, 2017

Look, you can attempt to equate CRNA training to Anesthesiologist training all you want. They are not the same. Nor is CRNA independence similar to Anesthesiologist independence. The vast majority of CRNAs practice within ACT models. There are varying degrees of restriction/independence, sure. But all anesthesiologists are independent. Anesthesiologists can supervise CRNAs. CRNAs cant supervise/don't need to supervise anesthesiologists.
The training model I described is not limited to my facility/system. It is regional. I have a couple close relatives who are CRNAs and have worked for all the major systems here - this area has many large systems - and the practice is restricted. There are also multiple CRNA training programs that do not train their students to be independent. If a student wants any autonomous CRNA practice they have to arrange a clinical elsewhere. Again, the vast majority of CRNAs practice in varying degrees of ACT models.
I'm certainly not arguing that NP education is as rigorous as CRNA. That's obvious to anyone I think. You took your response in that direction. But I am arguing that CRNA training is nowhere near as rigorous as MD. Further, my main point was, as a job, anesthesia is definitely not for everyone, and as a CRNA you are stuck doing anesthesia. You have to be ok with that. I was not. I need options. CRNA can be a great career. But so can NP, administration, informatics etc. The training is different as is the job. And the job is 100% more important.

1. CRNA and anesthesiologists training is different. I don't think anyone ever said they were not, but can you find any study comparing independent CRNAs and anesthesiologists outcomes that show anesthesiologists are superior? There isn't one.

2. ACT practices are not the vast majority of practices. ACT practices and supervised practices account for a little over half the type of anesthesia practices in the US now with that slowly decreasing in favor of independent practices. Regionallity plays a big part in where different types of practices are located. Anesthesiologists tend to control larger cities in more "desirable" locations, but that is also changing.

I work where anesthesiologists and CRNAs are interchangeable in 99% of the things we do, except for open heart we do the same things. We both cover rooms, we both run the board, we both pull call (with the exception the CRNAs are the ones that pull in house solo call). There are many types of practices in the US from CRNA only to MDA only with almost every flavor in between.

3. You should pick the career field you are comfortable with and that you enjoy.

4. Which type of APRN is more important is relative, but missing a primary care appointment is likely not to cause any problems. Try doing surgery without anesthesia is likely to cause death of the patient.

All APRNs roles are important and all APRNs should professionally support each other's roles.

You may wish to hold your judgements until you have at least some type of APRN training before you start making snide remarks about other APRNs chosen professions.

guest769224 · Dec 9, 2017

Anesthesiologists tend to control larger cities in more "desirable" locations, but that is also changing.

Thankfully. This is long overdue.

staphylococci, NP · Dec 9, 2017

I congratulate you on your aspirations. Although only a short while ago since I've posted this, I've recently found that CRNA is not where my heart is. For the better of my own happiness, and my future patients my place is in a role as an NP promoting wellness and health. The ICU has recently really struck a few strings in my soul and has shown me that I want to be involved in the community medicine, preventative medicine, and wellness. I also want to teach nursing students, as I truly love teaching. Kuddos to those that aspire CRNA and support to them however.

I think you're heading in the right direction, CardiacDork. From reading your other posts, you sound like I did when I was working MICU. I'm grateful for the experience, solid knowledge base, and clinical skills it gave me, but my heart was never in it. I'm an FNP now in Family Medicine/General Peds, and I am much more satisfied with my specialty and role. I even get to precept medical students for their peds clerkship! Becoming an FNP has been one of my best decisions. PM me if you ever have any questions.

staphylococci, NP · Dec 9, 2017

You use the term "hang up" about training in relation to physician anesthesiologists. With a non descript term like that I'm assuming you're referring to talk of the political interference that goes on at some rotation sites with MDAs. You listed a very restrictive anesthesia care team model near your hometown and that would be a prime example of a rotation site that would hinder your training due to the MDAs political power at that facility. Luckily heavily restrictive practices like that are not the norm and most MDAs will tell you CRNAs typically will do whatever plan they want because you are an independent licenced provider in all 50 states. Even when you have an MDA in house you must be capable of interpreting and immediately treating changes in the patient without them there. It's very different to walking out of the patients room, calling your MD you're under and asking his opinion about a diagnosis or prescription and making sure he's cool with it.
Being independent by talking to a patient and writing prescriptions, possibly not even controlled substances depending on the state, is a different animal to performing interscalene blocks, CVLs, spinals/epidurals, difficult intubations and manipulating the hemodynamics of all disease type patients independently. So I think the training that prepares you for independence and autonomy is very important, at least in anesthesia. We may just have a difference of opinion.
Any layperson who is ignorant of the skills and training of CRNAs who would not equate them with MDAs can simply be shown research that shows patients have similar outcomes between the two providers. Then you could inform them that a CRNA is trained and licensed to do everything in anesthesia that an MDA does. If they are still skeptical you could point them in the direction of the many (and increasing) CRNA only anesthesia practices that offer full services of safe anesthesia to their patients. See, it's all just about simple education for our patients and layperson.
I have many friends that are NPs and would love to see great strides of improvement and advancement in the education and career field. I get the sense from your comments that you're feeling defensive. You won't be the first or the last NP (student) to get defensive when talking about the differences in training, education, autonomy or pay in relation to CRNAs. I suppose I'll learn as the experienced CRNAs already have to just keep quiet and nod my head in these types of conversations.
Good luck with your education and I wish you the best.

My FNP program definitely trained us for independent practice as primary care providers. There was only one course on nursing theory, and we never touched on it again after that. Our learning focused on the medical model of care, which as you have experienced is a completely different way of thinking. We also learned A LOT about specialty medicine, even how to manage medical conditions in the OB patient.

Independent NP practice does look different from independent CRNA practice, yes. I don't do many procedures in primary care, but there is a lot more to diagnosing, prescribing, and managing multiple medical conditions than what meets the eye. It's not glamorous, but there is a lot of mental work involved. No one APRN is better or smarter than the other. We just practice in different specialties.

Dodongo, APRN, NP · Dec 9, 2017

1. CRNA and anesthesiologists training is different. I don't think anyone ever said they were not, but can you find any study comparing independent CRNAs and anesthesiologists outcomes that show anesthesiologists are superior? There isn't one.
2. ACT practices are not the vast majority of practices. ACT practices and supervised practices account for a little over half the type of anesthesia practices in the US now with that slowly decreasing in favor of independent practices. Regionallity plays a big part in where different types of practices are located. Anesthesiologists tend to control larger cities in more "desirable" locations, but that is also changing.
I work where anesthesiologists and CRNAs are interchangeable in 99% of the things we do, except for open heart we do the same things. We both cover rooms, we both run the board, we both pull call (with the exception the CRNAs are the ones that pull in house solo call). There are many types of practices in the US from CRNA only to MDA only with almost every flavor in between.
3. You should pick the career field you are comfortable with and that you enjoy.
4. Which type of APRN is more important is relative, but missing a primary care appointment is likely not to cause any problems. Try doing surgery without anesthesia is likely to cause death of the patient.
All APRNs roles are important and all APRNs should professionally support each other's roles.
You may wish to hold your judgements until you have at least some type of APRN training before you start making snide remarks about other APRNs chosen professions.

I agree with your first point. There are studies showing NP practice is equivalent or superior to MD practice as well, so to counter bluebolt's previous point, what does training even matter then?

In the majority of states, CRNAs function in an act model with a physician anesthesiologist OR under the supervision of the operating surgeon, dentist or some other non-anesthesiologist physician to satisfy CMS requirements. Even in the 17 opt-out states many hospital systems still require this and analysis have been done that have shown that even in the opt-out states, when billing with the QZ modifier, there was still physician involvement in care (often from anesthesiologists). No one is an island in healthcare. ICU NPs are often handling emergencies in the units without physician involvement similar to a CRNA would in the OR. And half of the US states have given NPs independent practice. My point in all of this is to counter Bluebolt, by saying again, that independence is an irrelevancy. No one is truly independent in healthcare. Training does not gain independence. Legislation does. So using these arguments to compare NP to CRNA or CRNA to MD is pointless.

Completely agree with point 3.

I think you mistook my statement here. I was saying that the job (whichever you have chosen) is 100% more important than the educational process. CRNA education is more stringent than NP by and large. But what does that matter if you hate being a CRNA. You choose a career not the educational process. All nursing jobs are important and vital and none are more important than the other. But enjoying your chosen career is extremely important. And the career is 100% more important than the pathway to get there.

I realize I am on a CRNA forum so me coming on here encouraging someone to pursue a different path in my first post ruffled some feathers (I'm looking at you Bluebolt). I recognized the difficulty in making the choice of which career to pursue. I commended him on making his choice. I said CRNA is not the pinnacle of nursing as it's just one of many avenues within nursing.

Also, I do have some type of APRN training... And I agree with systole00 - I haven't taken one nursing theory course in my entire nursing career, not even my BSN. Thank goodness. And many NPs are trained to be "independent", whatever that means. So previous comments trying to underhandedly demean NPs to promote CRNA practice was bizarre.

rhinoroc · Dec 9, 2017

Are you done yet? I don't think anyone is saying CRNAs are better than NPs. CardiacDork shared with everyone his taking of a different route and good for him to realize this and pursue something I'm sure he'll be great at. Can we just focus on realizing such a goal and be happy about that? The argument of who's better or why they're the same is unnecessary and takes away from CardiacDork's moment. Good for you by the way, CardiacDork. I've been following your posts for a bit and I'm glad you came to a decision you feel good about. Best of luck to you!

twozer0, NP · Dec 9, 2017

I wanted to be a CRNA but instead went to NP school. I worked in PACU for several years before and during NP school. One of my best friends is a CRNA. I was encouraged by all of the MD's and CRNA's to do school but I didn't. In the end I chose NP school for the fact I wanted more patient interaction and I didn't want to work those call hours (I mean I did several years of them in the PACU, ain't nobody got time for that!). As a father I wanted to be able to do things with my children where being stuck in the OR on a call weekend or having to stay to run an OR room after scheduled hours just wasn't what I wanted. The pay is great but more money wouldn't necessarily equate into more job satisfaction or happiness. Pre children CRNA was like a flashing neon sign, post children it wasn't that lucrative to me. Just my experience with it all.

CardiacDork, MSN, RN · Dec 10, 2017

Yeah I'm not sure how this became a comparison of CRNAs v. NPs in terms of who is better or whatnot. I was just pointing out my new path. NP fits my personality better. Especially in a preventative medicine and health and wellness aspect.

I'm not really crazy about technical skills or psychomotor aspects of anesthesia. I don't want to be in the OR for hours. I don't want to work my time around a surgery. Just don't.

I want to be interacting with patients formulating diagnoses and treatments. Counseling patients on their health. Especially in a family type approach. Being the "go to" for the health and wellness of a family.

I'd also be interested in where FNP can take me in terms of community health.

The world needs smart and passionate NPs. My efforts and time would be wasted in anesthesia because it's not where my heart is.

Anesthesia and FNPs/NPs both have important roles in healthcare and both are needed without a doubt.

np830 · Dec 15, 2017

A couple of my doctoral research courses include the nurse practitioners who are on a doctoral track and we have to work on projects with each other, do research, have conversations about topics weekly. There is a very clear difference between the perspectives, mindsets, training and often the professor will remark on it. The NPs are taught with a continuation of a nursing model. Not to mention they get to do a majority of their work online and all work full-time jobs, create their own clinical schedules, etc.
There's nothing wrong...

Dude, blueball, or whatever your name is-- we all know NP education needs a ton of help. A LOT of us wish all online nursing classes would be outlawed and that there were a 2000-hr clinical minimum.

But throwing your NP colleagues under the bus for things they can't control makes you look less like a proper "doctor" and more like something else.

Bluebolt · Dec 15, 2017

Dude, blueball, or whatever your name is-- we all know NP education needs a ton of help. A LOT of us wish all online nursing classes would be outlawed and that there were a 2000-hr clinical minimum.
But throwing your NP colleagues under the bus for things they can't control makes you look less like a proper "doctor" and more like something else.

I don't think anything I've said could be related to "throwing them under the bus". Especially considering we are on an APRN forum discussing the topic with presumably other APRNs or students in the program. By discussing things that need change it encourages those invested in the career to change it. While I'm not an NP student, if I were the first thing I'd do is seek out the rare programs that do require some guidelines for admission, years of didactic education, structured clinical rotations (2000 hours) etc. Then I would encourage my fellow NP students to do the same, attend meetings with the AANP and suggest a change. The change will only come from within. If students keep paying tuition to all these NP programs that are subpar, flooding the market with subpar students it will directly affect NPs but also cast a negative light on all APRNs in general.

I've known some great critical care NPs who could run circles around the intensivist they worked with. They had extensive education and ambition, one of them was a lawyer first. I want that to be said for all CRNPs sometime soon.

CardiacDork, MSN, RN · Dec 15, 2017

Dude, blueball, or whatever your name is--

Without any offense to anyone, this here made me laugh! I wonder if np830 did that on purpose.... blueball...

sweetspirit · Dec 20, 2017

I'm just here for the comments ðŸ˜