What is up with CRNA/AA/MDA politics.

[dreatx]

I am way not in it but long term, i am aspiring to be a CRNA so i hang out on various boards and i am amazed at what i see. I see MDAs to be talking about having nurses do the mundane work becasue they deserve it after all the hard work they put in. I see AAs saying that they get a better education, though how they come up with that i don't know.

Why are people, who are supposedly well educated and claim to be adults, so monstrously disrespectful of the work others have done or are doing.

What's the deal here? and if i successfully complete a program, am i gonna have to hear that kind of nonsense from people in my professional life?

[alansmith52]

this is classic, here he is trying to seperate the men from the boys.

A residency is by definition " a period of advaced trainning" we are residents we do a residency. yeah its shorter, be cause we don't need years of learning how a hosptial works. you might say your years in the ICU and on th floor are a residency. its an apprenticeship.

its funny to me how these medical residents (clinical doctorates) what to oppress us constantly when without us they would be unable to produce the product of anesthesia.

for example at my clinical residency site we run 17 operating rooms every day. 15 out of 17 operating rooms are staffed by RRNA's this leaves about 15 medical residents free to A) rotate out, B) do research or C) their favorite watch sport center.

they need us and they hate us.

the isssue is that they think we are undereducated or "not educated like them"

the fact is that CRNA's when they graduate have about 13000 hours of Diadactic instruction and MDa's have about 3000 hours of diadactic instruction. they are expected to learn on their own by meshing their one hour of class/week, thier own reading and clinical experince. so at the end of the day they are not all the same. some study and some don't. most actually are not even board certified. only 40% of them can pass their oral boards.

[Tenesma]

alan... where do you get your information from?

first of all the definition is as follows: "period of advanced medical training and education that normally follows graduation from medical school and licensing to practice medicine"

a post-doctoral period of training of 4-6 years where most of your life is spent living in a hospital - thus the word resident.

but it sounds like an attempt to equate SRNAs w/ residents... we might as well call any period of training in a hospital a residency then. Are PA students residents? are NP students residents? are medical students residents? .....

how is being referred to as a SRNA a form of oppression? you should be proud to be an SRNA (as i understand it is relatively competitive to get into?)...

and how is this "oppression" due to this "inability to produce anesthesia" without SRNAs??? that doesn't make much sense to me... if that is the case at your program, then i would say that that is a very shittty residency program.

13000 hours of didactics??? really...hmmm.. that is the equivalent of 24 hours a day of didactics monday-friday, every week for 27 months!!!! wow, how do you get into the OR with that kind of didactics program? That is amazing since as residents we could only fit in 10500 hours of OR time into our residency (compared to the average 1500 hours SRNAs would put into their OR time).... on the whole you are right about the discrepancy of didactics, that is partially because we already got a decent portion of those didactics in medical school....

actually no resident is board certified until after they finish residency, then take their written board exams followed by their oral board exams.... again you must have pretty low-quality residents since the written board pass rate over the last 5 years, nationally, has been between 77 and 87% and the oral board pass rate has been 78-84%... for first time takers.... which statistically is the ideal pass rate to weed out those that need to study more. (i think the CRNA certification exam pass rate in 2003 was 83.5% - but then again, that is a completely different exam).

by the way, 96-99% of all anesthesiologists who finished residency since 1992 are board certifiied --- and 99% of all anesthesiologists from before 1992 have successfully recertified. There is only a very small handful of anesthesiologists who aren't board certified/re-certified, and that group is made up of 1) pain docs who don't do anesthesia anymore 2) ICU docs who don't do anesthesia anymore 3) administrators who don't do anesthesia anymore 4) recent graduates from residency programs who are in the certification process 5) a handful of unreliable quacks who shouldn't be practicing but are selling their services to dentists/plastic surgeons usually in rural settings where they can get away with ith...

all i can say, alan, is that i am glad that you are at a program that gives SRNAs so much experience - you staff 15/17 ORs while the residents watch sports center... what a great experience!!! most other SRNAs at other programs w/ residents aren't that lucky!

[alansmith52]

my numbers came from the medical residents I "work" with,

in an effort to justify why they are paid so much more they and to quantify how hard their board exam is. they tell me it only has a 40% pass right. "that is why we are paid so much more than you guys" their words.

besides if your getting paid, do you thus still consider yourself a "student" or are you an employee.

because if you are now an employee its seems dishonest to count the residency as "time in trainning".

yeesh that would just about reduce medicine to little more than a bacholors degree.

lets see two years for your excercies science bacholors degree and 4 years fo medical school. thats 6 tottal . about the same as my BSN degree.

and don't tell me most medical students have four year BS degrees. becuase that is simply not true.

if you look at the roster at any medical school you will see a healthy mix of sociology, music, excercise science and a host of other "short" BS degrees.

with some physiololgy and biology mixed in.

the diadactic numbers where spouted out to me by the chief medical resident. it sounds about right. we are talking about Anesthesia didactics hear not basic physiology and medschool type stuff. we should all be about the same as far as those hours go.

when it comes to Anesthesia the medical residents go to class one day a week. they are thrown into surgery barley knowing how to hook a needle to a syringe.

[Tenesma]

alan... i usually enjoy/value your posts, but i am afraid that your recent postings must be made by somebody else or maybe you were on call last night??? (that would explain the english syntax/grammar).

1) resident pay is through a medicare grant to the hosting institution/hospital... residents are considered students from a federal point of view, and their income is considered a stipend from a federal point of view. That is why residents aren't able to use the Fair Labor Standards Act in their favor: as junior residents we worked for LESS than MINIMUM WAGE and never are we reimbursed for OVERTIME (because that doesn't apply to us). The reason why there is a stipend (it used to not be the case, residents used to live in the hospital for free and eat for free and free healthcare but no salary) is because Medicare made changes allowing for residents to live outside of the hospital and the stipend was originally a cost of living stipend for post-doctoral education. In fact, every university provides stipends for their post-doctorates (some even provide stipends to their master's students) - in return for services rendered, as well as providing teaching to the students (in this case medical students).

2) short BS???? ALL medical schools require a minimum of a bachelor's degree for matriculation - some programs will allow some students to start on an accelerated pathway (if they have completed all the pre-requisites), but still require of those students the completion of a bachelors degree prior to graduating w/ their doctorate. Now if somebody can complete 120 hours of credits for their bachelors degree within 2 years, more power to them - haven't heard of it. And what is wrong with a music degree or a philosophy degree or a humanities degree, they still have to have ALL of the medical school pre-requisites before hand anyway!

3) i am sorry it took you 6 years to complete your BSN.

4) the didactic numbers sound wrong --- your chief resident obviously can't count. 13,000 hours of didactics is just not mathematically feasible (see previous post). But i do agree with you about the fact that SRNAs spend more time in didactics, because you have to relearn physiology and pharmacology from a medical point of view, no longer a nursing point of view.... something that was accomplished in medical school already.

5) "they are thrown into surgery barely knowing how to hook a needle to a syringe".... okay... wow... that takes all of 30 seconds to demonstrate...

and there is a reason why SRNAs don't get paid - they don't provide a financial service until they are done. It takes ONE CRNA or ONE MDA to supervise ONE SRNA during a case - whereas an MDA can run FOUR rooms with residents in them - therefore residents actually generate more income for the hospital.... The same reason why PA students don't get paid compared to surgical residents (who do get paid)... The same reason why MIDWIFERY students don't get paid compared to OB/GYN residents.... etc...

[Athlein1]

What's the deal, Tenesma? Who's picking on who here?

You know we enjoy hearing from you about clinical pearls, and I thank you for the clinical imput that you provide, but this diatribe is tiresome. Some time ago, you said that you were posting for the last time, and now you are back to educate us about the rigors of a residency. Enough already.

Like it or not, my program calls us residents, too. Nurse Anesthesia residents. NARs. I introduce myself as a nurse anesthesia resident, as my program stipulates. Occasionally, a patient will say, "Huh? What's that?". I will then provide an appropriate explanation. Most of the time, they just want to get the show on the road and don't give a rat's fanny about the title of the person who pushes the versed.

And, for what it's worth, your assertions about the supervisory ratio of students to licensed providers is incorrect. While that may be true in your institution, many programs delineate a ratio of 2 students to 1 provider (CRNA or doc) in the senior year.

Finally, there are a number of programs that pay a stipend (not a loan) to students in their senior year, which reflects the fact that these students are working and provide anesthesia services, albeit under supervised conditions. Granted, these are not as generous as resident salaries, but then, they are not subsidized by the federal government.

[Tenesma]

athlein... i am glad that SRNAs get stipends - because I can imagine it must be tough to go from making good money as a nurse back to needing student loans again!

you are right --- this is tiresome... and i will cease and desist. It is just painful when people (maybe out of frustration with the system) write things that are either propagandist or wrong, and it is hard for me to resist.

[Kiwi, BSN, RN]

Tenesma, I checked out your very first post on allnurses...

"Hello everybody...

I'd like to introduce myself: I am an anesthesia resident, and I have been following with much amusement the carnage over at the studentdoctor network as well as this thread on allnurses.

First off, I am very grateful for CRNAs. They provide an invaluable service to patients both in the rural/physician-underserved areas as well as in the urban/rock'n'roll setting...

Second off, I am very grateful for Nurses... Because without them my patients would be in a lot of trouble!

It is funny how a thread about CRNA salaries quickly changed into a fight about who is better, yada, yada.... I am glad to hear that CRNAs are well compensated, and hopefully as news of compensation gets around we will start seeing an improvement in the shortage of CRNAs, and patients will thus have better access to care.

I can understand that it is frustrating for many doctors in different specialties/sub-specialties to see many years of training and sacrifice be reimbursed at a lower rate than some CRNAs... but most of them chose their careers based on what they enjoyed and their talents, and not because of future supply and demand laws.... or at least one would hope. If those primary care docs want to earn more than well-paid CRNAs then they should move to more rural areas were they in turn can start applying the laws of demand and supply in their favor."

I belive that your posts have demonstrated an appreciation for nurses/advanced nurses, and hope that the anonymous, incessant bickering doesn't break your stride on allnurses.

-Kelly

[alansmith52]

allright, allright I am done. I am gonna go to bed and fight with tommy thomson (the god father) in my sleep.

[gaspassah]

i was going to stay out of this one but there are a few things i felt needed saying.

1. i have worked with residents in their first weeks and were told quote "you guys are much more prepared for this than we are, they gave me a copy of morgan and mikhail and told threw me in a room and said give and learn anesthesia" my response was do you get any classroom? yeah we have journal club once a week. while you may have medical education, there is little to some ANESTHESIA education. maybe it was just the rotation i was at but hey cant be the only program in the country that does that.

2. critical care environments provide invaluable learning for dealing with critically ill patients with the subtleties of patient assessment, and patient response to all kinds of interventions. this is the nurses idea of a preanesthesia education, otjt.

3. 13,000 hours divided by average 12 hour days = 1,083 days or 2.96 years.

i dont think there are many crna schools doing this. not real sure about residents. i have 1000 hours and i'm a little over half done.

4. no we dont get paid and are usually paired with a crna or have a mda pairing, but at least someone is actively (usuall) instilling knowledge in how to provide anesthesia. just makes sense to me. i'm not sure i would want a srna or medical resident providing my anesthesia without some sort of experience provider input. yes i have provided anesthesia without any preceptor input or involvement or even being in the room starting with induction and through rr but i dont necessarily believe that is the best way. the farther into training i do believe one must be able to learn to spread their wings but with immediate backup. a resident albeit an md having never given anesthesia...no thanks. no way,,not without experienced provider input and tutelage, in the room, giving instruction.

5. there is differences in how the profession is taught. medical, here's a book, read up go in this room and do anesthesia. learn your own way and perfect it.

crna, here's how i do it, the next person so on and so on. as crnas we work with so many different preceptors that by the time we are done we will have a basis to practice that came from the best parts of many ppl.

i'm not sure residents get this indepth nuaceal (i made up that word) teaching.

d.

[ul239]

Tenesma, first let me say that I do enjoy most of your posts. They are generally educational and well reasoned and for that I thank you. That being said, your comment re: RRNA's (cute) is offensive to many on this board. I can tell by your posts that you're a pretty smart guy so I feel pretty confident that you knew the response you would get by this comment. After all this is a CRNA and CRNA wannabe site.

There are currently several nurse anesthetist programs that use this term. My guess is that there are no physician anesthetists on their Nurse Anesthesia Graduate School Board to veto such a term. I could go on about physician anesthetist gate keepers within Nurse Anesthesia programs but I won't. My point here is that CRNA's are CRNA's. They are not MDA's. If they want to call themselves RRNA for whatever reason, and their reasons seem well reasoned, it's no ones business outside of their profession.

[jwk]

Some programs use Resident Registered Nurse Anesthetist as the title during the clinical phase of the program. The term recognizes the learner as a professional RN (i.e. Bachelor's degree and licensed RN). It also removes the stigma of 'student' which is not palatable to some patients.

And there you have it, already stated many posts back. They don't want to be referred to as students.

Sorry, that's what anesthetists in training are, whether they be SRNA

or AA-S. They are still working towards a graduate degree, whereas MD's have already earned their terminal degree. I think any attempt to somehow hide that fact from patients is unacceptable.

Granted, I've known plenty of residents who were clueless at the start. And guess what - they get paired with CRNA's or AA's one-on-one their first month in the OR, day or night.

Are there any other advanced practice nursing specialties that refer to themselves as residents? Are there OBGYN-NP residents? FNP residents? Somehow, I doubt it, but hey, correct me if my guess is incorrect.

Oh, and lets quit debating the 13,000 hours crap. It's simply not possible.

[loisane]

And there you have it, already stated many posts back. They don't want to be referred to as students.

I should probably listen to my instincts, and stay out of this, but just one comment.

Listen to how the phrase "student nurse anesthetist" sounds. You tend to hear "student nurse--------anesthetist". It leads to the impression that the SRNA is some person off the street, who is at the very beginning of their education, a student nurse.

The change in terminology is an attempt to acknowledge that the SRNA is already a functioning, experienced professional, who ALREADY HAS a licence to practice at one level, and is currently in training to expand that to another level of professional responsibility.

So the profession is evolving. If "resident" ends up not fitting, maybe some other term will appear. But a "hidden agenda" to sound more like medicine??? Come on!!!

loisane crna