Jump to content

Colorado Doctors Sue After RNs Approved To Give Anesthesia

News   (16,352 Views 79 Comments)
by DoGoodThenGo DoGoodThenGo (Member)

40,277 Profile Views; 4,115 Posts

advertisement

You are reading page 3 of Colorado Doctors Sue After RNs Approved To Give Anesthesia. If you want to start from the beginning Go to First Page.

subee has 45 years experience as a MSN, CRNA.

1,743 Posts; 17,892 Profile Views

My opinion?

I offer no opinion as to the validity of the governor's actions with regard to CRNA privileges in either post #3 nor #10.

My opinion, to my mind was quite clear, that clinical privileges for any discipline is a matter for legislative authority, not gubernatorial edict.

Please read your quote on page one where you "would think that the governor has overstepped his bounds." You might "think" that he has overstepped his bounds but you really have to follow this issue along for years to understand it. And the fact is that no state has overturned the opt-out provision yet because the laws of the no state are not being violated. CRNA's have argued that the laws are being violated when Medicare and insurance companies refuse to pay us for services that we have been providing all along. Suddenly a state anesthesiology society decides that since they can't stop us from practicing by law, they can effectually smother our businesses by getting some insurers to stop paying us. This is how the supervision laws came into effect. They are very recent and didn't exist in the 80's when I started. We have three huge studies to back up our contention that the results of the care are the some - regardless of who administers the anesthetic. So when a governor signs op-out legislation, he or she is only heeding the intent of the law - not the intent of the political action committee of some state society of MD's. The governor is, in effect, abiding by the original legislation which defined the clinical privileges of the CRNA in that state.

Share this post


Link to post
Share on other sites

460 Posts; 7,175 Profile Views

And the fact is that no state has overturned the opt-out provision yet because the laws of the no state are not being violated.

How would I know this if not following along due to professional interest if I am not a CRNA?

So I offered an opinion of law based on a single article, without commenting on the merits of privilege one way or the other.

That opinion, did not warrant the response in post #19 ,..in my opinion.

Edited by Flying ICU RN

Share this post


Link to post
Share on other sites

subee has 45 years experience as a MSN, CRNA.

1,743 Posts; 17,892 Profile Views

How would I know this if not following along due to professional interest if I am not a CRNA?

So I offered an opinion of law based on a single article, without commenting on the merits of privilege one way or the other.

That opinion, did not warrant the response in post #19 ,..in my opinion.

Flying ICU RN: The first response in which you thought you were being flamed - I'm sorry. It was not directed to you personally but to all the other posters who have no idea who CRNA's are or what we do. It's hard to debate in print. I'm still learning the subtleties.'

However, it never behooves one to comment on the law unless you're familiar with that law. That's why we have to hire lawyers because things are never what they seem.

Share this post


Link to post
Share on other sites

460 Posts; 7,175 Profile Views

However, it never behooves one to comment on the law unless you're familiar with that law. That's why we have to hire lawyers because things are never what they seem.

Ah, but what fun is debate if one cannot offer an opinion on the broader context of an issue? I conceded formulating an opinion based on a single article and no personal frame of reference, it's up to someone else to offer up the counterpoint. I'm not obtuse, I can be swayed by facts to another point of view than the one originally formulated.

Incidentally, in post #3, I presented an initial point of fact. Let me elaborate that point of fact with a question in the form of a riddle.

Points of fact: I as a unit RN for many years was administering conscious sedation until recently stopped by new facility policy, (no problem there). EMT's routinely intubate in the field. ACLS is applied equally to all despite underlying diagnosis whenever rescue is necessary.

Then how do you suppose I personally feel about CRNA's functioning independently?

Share this post


Link to post
Share on other sites

TDCHIM specializes in Health Information Management.

686 Posts; 7,861 Profile Views

Flying ICU RN: The first response in which you thought you were being flamed - I'm sorry. It was not directed to you personally but to all the other posters who have no idea who CRNA's are or what we do. It's hard to debate in print. I'm still learning the subtleties.'

However, it never behooves one to comment on the law unless you're familiar with that law. That's why we have to hire lawyers because things are never what they seem.

So only lawyers who specialize in this area or those who have thoroughly researched all relevant laws and issues are entitled to express an opinion on this matter? Isn't that going to be an awfully limited discussion?

I don't advocate anyone shooting off his or her mouth and trying to pose as an expert about an issue without any knowledge of it. However, one of the best ways to learn is through discussion. That's a terrific aspect of this site - there are people who specialize in just about every area of nursing as well as those from many allied health areas who frequent AllNurses. We can all benefit from discussion with those from different backgrounds, who bring a broad variety of thoughts, perspectives, questions, and areas of knowledge to each debate. IMHO, you shouldn't have to be a legal expert or be totally familiar with every aspect of a law in order to voice an opinion about it.

Share this post


Link to post
Share on other sites

linearthinker has 25 years experience as a DNP, RN and specializes in FNP.

1,688 Posts; 12,089 Profile Views

In my state, CRNAs are supposed to be supervised. In practice, an MD is the official department head, writes (or more likely just signs) the policy and procedure manual and protocols. The office of the supervising anesthesiologist for my hospital system is 150 miles away, and he has never once set foot in 3 of the 4 hospitals he is "supervising" dozens of CRNAs in. The Colorado MDs probably want the same set up, which is clearly all about money.

Share this post


Link to post
Share on other sites

PostOpPrincess has 19 years experience as a BSN, RN and specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

2,211 Posts; 11,958 Profile Views

Um. With the CRNAS graduating these days after only ONE YEAR of practice prior to school, this is NOT a good idea. The overachieving, super experienced prior to anesthesia school nurse--hard to find--when they are CRNAS, they ROCK.

The newly minted, minimally experienced ones? OY. No thanks!

Share this post


Link to post
Share on other sites

31 Posts; 2,070 Profile Views

I work with anesthesia providers on a daily basis, both MDs and CRNAs. There is a lot of variation in attitude between the two. In general, the MDs come in, turn on their ipods and speakers to obnoxious music, then once the patient is sedated and intubated, they do things like text, make personal phone calls, play on their ipads, or even go to sleep. It annoys me to no end. Some of the CRNAs also play music, but I have yet to experience one who was not completely focused on the patient throughout the procedure.

In the end, who cares how much you "might" know, if you aren't tuned in to the patient undergoing the procedure, you are worthless should something go wrong.

Share this post


Link to post
Share on other sites

grandmawrinkle specializes in adult ICU.

272 Posts; 6,897 Profile Views

Perhaps a stand-alone 4 yr anesthesia program could train up competent, skilled anesthesia providers, whether RNs or not.

They have these in some states. They are called anesthesiology assistants (AA's.)

Here is some info on them - it looks like there are only seven programs nationwide. The Ultimate Anesthesiologist Assistant Educational site, for the Anesthesia Assistant, Anesthesiologist Assistants!

Some MD anesthesiologists claim to prefer these because they are trained in the "medical model" and, in no way by any type of legislation practice independently, which keeps them firmly under their thumb and out of the running as far as competition. Some MDAs also advocate for training PAs in anesthesiology for the same reason.

I have never met an AA (I don't think my state uses them at all) so I don't know if they are any good, but at first glance, I wouldn't want a non-medical person with a couple extra years of grad school administering my anesthesia. However, I could potentially be swayed if I knew more about them.

Um. With the CRNAS graduating these days after only ONE YEAR of practice prior to school, this is NOT a good idea. The overachieving, super experienced prior to anesthesia school nurse--hard to find--when they are CRNAS, they ROCK.

The newly minted, minimally experienced ones? OY. No thanks!

Nearly all CRNAs that I know or those that I have known that have made it into a CRNA program have been stellar nurses even if they have only had a few years of practice under their belt (I have only met one that IMO didn't think should have been admitted ... didn't even have a whole year in, very green, but very book smart and I am sure she rocked her GPA/GRE/interview, which is why she got in.)

I would honestly rather have even a relatively new CRNA provide my anesthesia as opposed to an MDA, any day of the week. All the MDAs I know are pretty sloppy, "cowboy" sort of practitioners - not exactly the type that you want to very carefully administer medications that might kill you. ICU nurses turned CRNAs are used to administering dangerous IV gtts and monitoring patients all the time, are usually supremely detail oriented, and pretty anal retentive. IMO, pushing drugs and monitoring patients (a big part of what CRNAs do, every day, all day) is totally, completely, exactly what a nurse does. Doctors don't really do that, at least not as a part of their core training.

Does anyone know if any MDs from other states had such an uprising after this type of legislation was passed in other states, or is CO trying to set a precedent here? I am pretty sure this is already a lost battle for them, but it would be interesting to know if anyone had attempted this.

Share this post


Link to post
Share on other sites

wtbcrna is a MSN, DNP, CRNA and specializes in Anesthesia.

5,000 Posts; 51,818 Profile Views

1. This has nothing to do with extending scope of practice for CRNAs. There were already CRNAs who practiced independently in Colorado and every other state. Opt-out for CRNAs just allows CRNAs to bill medicaid/medicare independent of having a physician sign off.

2. CRNAs are the oldest nursing speciality in the U.S.. Nurse Anesthetists have been around before there was any formal training in anesthesia. One of the earliest anesthesia formal training sessions was 3 weeks long on a back porch of a hospital where nurses and physicians both attended that wanted to learn how to administer anesthesia. AANA - History of Nurse Anesthesia Practice

3. There has yet to be a study that shows any difference in the care provided by anesthesiologists and CRNAs. In fact there are multiple studies that show CRNAs provide just as safe and effective care as anesthesiologists. AANA - Search Results

4. The Colorado Opt-Out challenge by Anesthesiologists has little chance of succeeding. The Colorado Board of Nursing and the Board of Medicine both agreed to the Opt-Out. This is nothing more than CSA grasping at straws, and spending their money while costing tax payers millions to fight something that is already a done deal.

5. To my knowledge there has only been one reversal of an Opt-out to date and that was during the change of governors in Montana, and was again re-instated several months later. AANA - Fact Sheet: Concerning State Opt Outs

Share this post


Link to post
Share on other sites

wtbcrna is a MSN, DNP, CRNA and specializes in Anesthesia.

5,000 Posts; 51,818 Profile Views

Read the comments below the article.

"I am President of an anesthesiology group that employees a large number of Physician anesthetist and nurse anesthetist. Our group administers 25,000 anesthetics per year with quality, and safety. All of our cases are unsupervised. Our physicians would admit that there is little difference in the quality when an anesthetic is administered by a CRNA, or a Physician. In the 30 plus years that I have been in the anesthesia field the greatest change I have seen is not in the knowledge that either group has, but in the drugs and equipment we now have. When I started in anesthesia we didn't have cardiac monitoring On all patients, no pulse oximetry, no capnograph, no glydescope, or LMA. I believe this is the reason for the advance in patient safety. Not whether a doctor or a nurse is administering the anesthetic.

 

 

Read more: Keep anesthesia doctor-supervised | freep.com | Detroit Free Press Keep anesthesia doctor-supervised | freep.com | Detroit Free Press"

Share this post


Link to post
Share on other sites
  • Recently Browsing 0 members

    No registered users viewing this page.

×