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Colorado Doctors Sue After RNs Approved To Give Anesthesia

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by DoGoodThenGo DoGoodThenGo (Member)

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PMFB-RN has 16 years experience as a BSN, RN and specializes in burn ICU, SICU, ER, Traum Rapid Response.

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The creation of CRNA's were meant as physician extenders, not a replacement.

*** You are so badly informed on this subject I don't know where to start. CRNAs where NOT created as physician extenders. The first anesthesia providers where nurses, not physicians. The very first physician anesthesiologists where trained by CRNAs. Anesthesia was a nursing (specialy trained nurses) duty until physicians learned they could make money billing ofr it, THEN they got in on it.

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PMFB-RN has 16 years experience as a BSN, RN and specializes in burn ICU, SICU, ER, Traum Rapid Response.

5,143 Posts; 68,996 Profile Views

I work in a large teaching hospital. Here the MDA residents are taught by CRNAs. I see it all the time, the resident being instructed in regional blocks, intubating and all sorts of other procedures by the CRNAs.

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

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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.

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.

Sorry. I'm not persuaded. I work in a PACU. I see new CRNAS. The ones going into school now have minimal bedside and you can tell. I have seen patients not properly reversed, severe pain because of fear of giving pain meds, and reversing with Narcan so they can take the patient out because "the room had to be turned over."

YIKES.

No, no, no, no.

The ONES with MULTIPLE YEARS of experience and THEN become a CRNA? THEY ROCK BIG TIME.

I see on a daily basis. The docs I have some are good--some are not--just like everywhere else.

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grandmawrinkle specializes in adult ICU.

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Sorry. I'm not persuaded. I work in a PACU. I see new CRNAS. The ones going into school now have minimal bedside and you can tell.

I wasn't trying to persuade you in particular.

I work in a SICU that takes CVICU patients direct from OR and turns into the PACU on evenings and weekends, in a hospital that is affiliated with a CRNA program. Many of my former colleagues have gone through this program and I would estimate they all had a minimum of two years in the SICU, some more like 10 years (with the exception of one bad egg, and there is always one of those.) All had other bedside practice prior to working in the SICU. A lot of them get hired. From what I have seen, they are excellent practitioners right out of the gates.

Maybe the new grad CRNAs you are used to seeing come out of a crappy program. IDK. There is a program in my area that is on probation/in review right now and I can't speak for those graduates. Or, perhaps the program that I have been exposed to the most is exceptional -- can't really say.

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subee has 45 years experience as a MSN, CRNA.

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Maybe it's one of the characteristics of a crappy program to enroll students who only have one year of experience. Yes, there is a shortage of providers, but to churn them out so quickly might be self-defeating. Anyone who is bright can pick up quickly on the technical aspects of nursing (labs, drugs) but it's an unfortunate fact that becoming experienced in the broader sense of the word takes tincture of time.

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ctmed has 4 years experience and specializes in PACU, LTC, Med-Surg, Telemetry, Psych.

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Hasn't there been a push to make CRNAs (as well as Nurse Practitioners) have doctorate level degrees anyways?

It seems to me to be more degree inflation. Everybody wants the high respect, high autonomy jobs. But, since so many people have BS and BAs, something has to be done to keep folks doing the grunt level stuff no one else wants to do and keep the good jobs from being over crowded and taking the money out.

I can see a future where folks will need an AA in hotel/restaurant management to flip burgers at Micky D's not very far away.

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460 Posts; 7,175 Profile Views

Hasn't there been a push to make CRNAs (as well as Nurse Practitioners) have doctorate level degrees anyways?

Personally, except to perhaps effect the supply side in a manner to make the discipline(s) more valuable by default, I think it's overkill.

My question would be why is there a need for medically trained anesthesiologists?

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4,268 Posts; 34,161 Profile Views

As a former OR nurse, I have seen many times that a CRNA does a case from start to finish, all alone, no MD supervision at all.

I have seen, too, that an anesthesiologist will tell a patient that he'll be giving her anesthetic, then gives it, but is quickly relieved by a CRNA, who finishes the case while the 'ologist goes on to the next patient, presumably gets another CRNA to take over, and the 'ologist goes on to yet a 3rd patient. Bills all 3, probably full price, as if he'd been with them all along is my guess. Ain't that something'? Again, no MD monitoring the CRNA at all.

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2,801 Posts; 13,301 Profile Views

My question would be why is there a need for medically trained anesthesiologists?

(Putting on devil's advocate horns...)

Why is there a need for RN-trained anesthetists? If a full medical education isn't required to provide anesthesia safely, then maybe a full nursing education isn't required either? The job of administering anesthesia is very specialized, while general RN education is very, very broad. Anesthesia school would have to require some of the same pre-reqs as nursing and medicine. But that just means that RNs and MDs would have a leg up on non-RNs and non-MDs applying for spots in an anesthesia program. Schools would probably give preference to those with the most relevant clinical experience, whatever their other licensure is.

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460 Posts; 7,175 Profile Views

(Putting on devil's advocate horns...)

Why is there a need for RN-trained anesthetists? If a full medical education isn't required to provide anesthesia safely, then maybe a full nursing education isn't required either? The job of administering anesthesia is very specialized, while general RN education is very, very broad. Anesthesia school would have to require some of the same pre-reqs as nursing and medicine. But that just means that RNs and MDs would have a leg up on non-RNs and non-MDs applying for spots in an anesthesia program. Schools would probably give preference to those with the most relevant clinical experience, whatever their other licensure is.

An interesting point, I see your reasoning.

However, considering the limited seats and competitive nature of admission to those seats, non-medical applicants would stand no chance even if that were the case.

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