CRNA Debate from www.studentdoctor.net

bubba · May 26, 2002

nrw 350,

You stated something to the effect that a bad nurse could ruin all the good work of a doctor. I just want to let you know that a bad doctor can ruin all of the work of a good nurse as well. The nursing staff spends most of the time with the patient. Sometimes, a nurse will realize that a particular treatment is not good for a patient just because the nurse has spent more time with the patient and may know the patient's condition or progress in respose to current treatment better. After discussion, the doctor refuses to cancle the treatment. Maybe it is one of those doctors that think nurses are stupid and don't know anything. This is one of the bad doctors.

Also,there are times when a good nurse will not carry out a doctors orders because they are grossly inappropriate, unsafe, or even harmful to the patient. Remember, doctors treat diseases. Nurses treat people and their response to disease. Nurses are the patient's advocate. One of the main goal of nursing is to help restore a patient to an optimal health status. One of the main goal of doctors is to eliminate diseases. Sometimes these goals are at odds with each other. For example, a patient has a serious infection. The doctor orders a high powered antibiotic which is supposed to be the most effective antibiotic available for this infection. The nurse who will be giving this antibiotic has never given it before, so he/she looks it up in a drug book. The drug book says that the antibiotic is contraindicated for patients with poor renal function. The nurse reviews the patient's chart and discovers that the patient lab indicates poor renal function. The nurse questions the patient and finds out that the patient has even had dialysis before due to kidney failure in the past. So, the nurse appropriately holds the medication, calls the doctor to discuss the problem with the doctor and recieves a new order for an antibiotic that will work, but is not toxic to the kidneys. You see, the first antibiotic ordered by the doctor was the best for that particular infection/disease, but it was not best for the patient. Beeing a good nurse, he/she identified this problem. The nurse is the patient advocate.

There are good nurses and bad nurses. There are good doctors and bad doctors. When you get a nurse that hates doctors or a doctor that thinks nurses are stupid, you had better put on your seat belt. It takes both good nurses and good doctors, as well as others, working together as a team to provide optimal health care. The health care team!

bubba · May 26, 2002

This was posted on studentdoctor.net by kmiska, I thought it was very good:

I've been watching this debate over the last few days and finally have decided to put in my two cents worth. First of all, I am not a doctor (at least not the medical sort I have a PhD) nor a nurse, so let's just say I'm an impartial third party. Let me just say that following this debate has been entertaining to say the least, but surprising as well. I have been pleasantly surprised at the eloquence and the intelligence of some of the nurses that have posted their replies on this thread. On the other hand I was unpleasantly surprised to see the bitter, unbending, and sometimes even hateful nature of some of the posts made by doctors or soon to be doctors. Goodness,. I guess spending thousands of dollars on med school certainly does not teach politeness, common sense, or the ability to listen to others' point of view. The interesting thing here is that these doctors are the ones who "listen" to patients and make important decisions that patient's life or death. Pretty darn scary.

I

n of the post "drfeelgood" points out that doctors need to make the public see that services of the CRNA are not as good as those provided by the MDA. Well, I can tell you that I am one of the public and I am not so convinced that I would let any of these doctors touch me with a ten foot pole.

In one of the posts "Klebsiella" says that he will not look at research published by the association of CRNAs because it's not worth looking at. And I guess that Klebsiella has the knowledge (or at least thinks he/she does) to make that decision. Geez, not only is he a doctor but he has the ability to make judgements on things he/she refuses to look at. Gosh I wish I was that smart or maybe it's just telepathy. Also klebsiella believes that "Nurses in general, and CRNA's in particular lack the understanding and wisdom behind their actions" Actually based on their "prose" I believe that Mr. McHugh understands most of what he's doing far far better than klebsiella. And how exactly might klebsiella know what nurses know and don't know. He must know everything that goes on in CRNA schools and hospitals to make statements like that. Sadly, I believe that some of these folks will have some catching up to do in the real world to do. It's a nasty world out there especially if you're an unpleasant know-it-all. I also found the post made by Hopkins 2010 very intriguing. Especially this part "Since there is no hard evidence one way or the other, could it be possible that you don't really need an MD to do anesthesia" I was wondering that myself yesterday. I was thinking more the lines of a plumber....who certainly knows how to fix leaky faucets but I don't think he knows much about fluid dynamics, he does get paid pretty well and he could care less about the theory. I suspect that there is a point here. I know I know all the doctors will scream, "what about that 1:5000 chance that something strange comes up, a nurse can't deal with that" but I suspect that neither would a doctor. That is the nature of things which are rare. Most of the time when a problem is not common it has to be looked up or researched. Most of us don't remember facts about things that we may encounter once a decade. Or perhaps Mr. K your memory is soooo good after memorizing all your books that you can remember every disorder, even the ones that only 5 people in Alaska have. Sure. I even have a personal vignette to share with you. About 10 years ago I got sick. I was throwing up, running a fever, couldn't sleep eat, just generally miserable. So I went to the doctor, she said I had the stomach flu, I said OK and went home. However, after 4 weeks of feeling like crap I was suspecting that something else was up, but my doctor (after about 5 visits) still insisted I had the flu. Finally, my husband said this is bull***t and took me to the ER. There I found out that instead of the flu I had a collapsed lung. After almost losing my lung (since it was collapsed for a month), two weeks in the hospital and a surgery, I was much better. I had a congenital cyst that expanded very slowly and collapsed the lung over a period of 10 years. I thought about suing the doctor but I didn't. What really shocked was how my doctor would not listen to me, when I said something is seriously wrong here. Why couldn't she look up what else it might be, or realize that this was over her head, or maybe do something dramatic like listen to my chest. This is an example of a RARE case. Did my doctor with all her understanding of pathophysiology see that something was really wrong. Maybe the clue that I couldn't sleep could have tipped her off that I was hypoxic. But the bottom line is that she could not diagnose the rare case, could you?

On the other hand if I went to a nurse practitioner, would this diagnosis have been made more quickly, because she would have realized after a couple weeks that this may be something more complex....of course I could speculate forever. However, don't think that four years of med school makes you all knowing. It doesn't, if anything it should teach you how little you actually know and how you will have to rely on others for help.

Now, you're probably all pissed off that someone who is not an MD or "MD to be" posted on this site. But hopefully, some you can take what I said to heart. Thanks

TEXASWAG, MSN, RN · May 26, 2002

To all the CRNA's who responded to the studendoc.net. You nurses ROCK!! Keep up the good work.

nilepoc · May 27, 2002

oooops i did it agian.........

on studentdoctors.net

I am just in awe of the one sided opinions presented by the soon to be doctors on this site. I am consistently amazed at the inability of these trained observers to take into account any opinion that is not their own. This thread was initially started with a reference to whether or not CRNA's should be making as much as some types of doctors. It quickly devolved into a discussion on the merits of the educations of MDA's versus CRNA's. While I see the Nurses are presenting facts, some of the doctors are presenting intuition and calling it fact. Please tell me who sounds more educated?

Klebsiella

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Interesting point. I will ponder it on philosophy rounds this afternoon. Problem is your thoughts are designed to undermine anything that is intuitively true. At some point, we must take the leap of faith (shiver). In point of fact, intuitive truth is something that we all rely on thousands of times a day. I simply don't have the time to study and publish multi-collaberated studies in nature on gravity before I get out of bed in the morning. Too little funding out there for this sort of thing.

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As a matter of record, I would like to say that the much vaunted article in the ASA was not even peer reviewed, (to the best I can tell, I have a copy here in my hand). Other distinguished journals have a peer review process to make sure that research was done in a scientific manner. I see no indication that a peer review was ever done on this paper. On the contrary, the paper was accepted and published one month later. I agree with you Klebsiella show me a paper in Nature or Science discussing outcomes of anesthesia administration related to level of certification and I will consider what you say. If you are only going to present one paper that comes from the opposition, I will hold the same reservations you do.

The Silber paper also has some interesting statistics that point to some interesting conclusions. The paper states that in the cases studied, the CRNA's handled sicker patients, and the statistics had to be adjusted to compensate for the lack of acuity in the MDA samples. The calculation for this compensation is quite mind-boggling, I challenge you to explain it to anyone.

The authors go so far as to state that their evidence is stronger than four other papers calculating the safety of anesthesia delivery. They have to make this claim, as they are claiming mortality rates 2000 times higher than the figure you all quote and attribute to the increased intervention of MDA's, of 1 death in 250,000 cases. The ASA alleges that anesthesia delivered without the supervision of an MD results in 25 deaths in 10,000 anesthetics administered. This is quite a difference, and cannot correct since there are 3 CRNA's practicing for every one MDA. As you can see, it is impossible to account for the large numbers obtained by the Silber study. There are, however, four independent papers supporting 1 death in 250000 anesthetic administrations, regardless of provider type.

On the supervision issue, how would you all define supervision? From what I have seen, supervision only goes as far as taking half of the fee collected for a given anesthetic administration. So maybe those CRNA salaries are too low instead of too high?

Ryo-Ohki

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Of course, if this path is as intellectually challenging and difficult as you nurses allege, then you guys don't have to worry about a thing.

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Thank you for this comment, I agree with you, the proof will be in the pudding. CRNA programs are very competitive, and rigorous in there demands on the student.

As for the individuals that wish for all the non-doctors to leave this board, get over it. This board actually is harder to join than many of the others I frequent; they actually make you wait a day to get your registration completed. So be happy you are protected from the trolls of the world, by a strong bunch of moderators that take a stance on non-productive banter that is meant to inflame the board contributors. These same moderators, obviously feel that diverse participation is important, and that this should not become a "good ol' boys" club of only doctors, and doctors to be. If that is what you require, I suggest you start your own site and have a good time there. Because on this site you are obviously going to have to deal with your ideas being challenged.

alansmith52 · May 27, 2002

" I am out of it for a week and everyone starts having delusions of grandure". (Han Solo)

well I'll be jiggered( and that depends on where you jigger me) you guys are phenomenal I have to admit I could not stay totaly away from the retard site. infact I became one of the most inflamatory. under an assumed name of course. although you can always tell its me by the atrosious spelling.

love the blog nilepoc its on my favorites list I visti it all the time.

I must say. I wish we would get over this thread soon and get back to buisness.

Matt

meandragonbrett · May 27, 2002

bump

meandragonbrett · May 27, 2002

Who is "SandMan" I know it's got to be somebody from here!

Brett

g8rlimey · May 27, 2002

To say the CRNA salary issue over at SDN has been intriguing would be a severe understatement. That discussion has consumed 7 pages--the largest in that forum. Aside from the petty namecalling and stone throwing, the majority of the posts provided for insightful reading. What still shocks be is the nature of the members that post regulary. I don't remember where I read it, but someone said something about amount of education not equalling manners or polite behavior---so true...

ufmatt · Jun 2, 2002

you couldn't be more right Sam, and the sad thing is most of the future and current med students I have known are a bunch of trust fund cry-babies.

I'm pretty sure that their contentions would be that we as nurses have "holes" in our training and education (totally untrue), but i can guar--an--tee that patients will appreciate our bedside manner especially when they have experienced some MD's lack thereof. :chuckle

shay · Jun 3, 2002

Bleah!! I hate them, I hate them, I hate them!!!!!!!! That whole debate really pissed me off. Hats off to you guys who gave it right back to them. I couldn't have kept such a cool head. You all rock.

fergus51 · Jun 3, 2002

Shay, imagine how pleased I was to read this post right around the same time the anesthesiologist refused to treat one of my patients!!! LOL!! Maybe that's why I threw caution to the wind and ripped him a new one! Bitterness from allnurses.com can have lasting effects!

hoolahan, ASN, RN · Jun 3, 2002

I'm no CRNA, but when I saw all the posts surrounding this site and infamous post....I just had to check it out for myself.

These docs are hilarious! I am sooooo glad I don't work with residents anymore!