CRNA vs AA?

Anesthesiaman · Sep 30, 2022

But here's the issue with the CRNAs outlook on AAs. Just because the rules for direct are more strict does not mean that AAs are any less capable than CRNAs. The job is the same and we can do anything a CRNA can do. Just as well and just as safely.

allnurses Guide · Sep 30, 2022

4 hours ago, Crimson0087 said:

But here's the issue with the CRNAs outlook on AAs. Just because the rules for direct are more strict does not mean that AAs are any less capable than CRNAs. The job is the same and we can do anything a CRNA can do. Just as well and just as safely.

When AAs can work independently/solo then AAs can claim they can do the same thing as CRNAs.

I didn’t see any AAs with me in the Middle East or Afghanistan when I was deployed.

CRNAs and AAs are not the same.

loveanesthesia · Oct 1, 2022

CRNAs are recruited from the strongest ICU RNs. During the pandemic CRNAs went to the ICU to provide support. Did any AAs do that? CRNAs have a broad background in management of critically ill patients. This is one important reason why AAs and CRNAs are never interchangeable. Even if they work in the same practice.

Anesthesiaman · Oct 1, 2022

Why don't you describe your daily routine at your job and I'll describe mine...I guarantee you were doing the same thing.

allnurses Guide · Oct 1, 2022

32 minutes ago, Crimson0087 said:

Why don't you describe your daily routine at your job and I'll describe mine...I guarantee you were doing the same thing.

Solo doing exploratory laparotomy on a ASA 4E over 160 miles from the nearest next largest medical center with minimal blood supplies, no overnight lab or radiology. That was after responding to hemorrhage in OB.
How about solo anesthesia provider for a surgical team in Afghanistan FOB near the Pakistan border or how about the surgical commander for what was the largest US/NATO surgery group in Afghanistan while also working as a CRNA?..

How about solo call at the USAFs largest hospital?

Tell me which on of those can AA do solo?

Anesthesiaman · Oct 1, 2022

During the pandemic none of the CRNAs at my practice provided support in the ICU. The CRNAs at my practice do nothing differently than the AAs...go figure. They are also paid the same... Go figure...

loveanesthesia · Oct 1, 2022

Collaborative practice with physician anesthesiologists in busy community hospital. About 60% CRNAs, and CRNAS do the overnight in house call. Whatever comes in we do-SBO is a common one. The CRNA will probably be the only anesthesia provider in house doing the case. During the day we swap cases as the schedule demands. I decide my anesthetic plan and am 100% responsible. On that SBO I decide wether to extubate at the end of the case, or send to ICU intubated. If I keep intubated I write vent settings and sedation orders. This is where my 4 years ICU is beneficial.

Oh, and the surgeon satisfaction with the anesthesia department is in the top 5% in the nation. I am 100% comfortably having anyone in the group give my family anesthesia. The entire group is strong providers because there’s no place for a weak provider to hide. The schedule moves very efficiently because as long as 1 provider is ready the cases roll. This is the future of anesthesia.

loveanesthesia · Oct 1, 2022

21 minutes ago, Crimson0087 said:

During the pandemic none of the CRNAs at my practice provided support in the ICU. The CRNAs at my practice do nothing differently than the AAs...go figure. They are also paid the same... Go figure...

I’m not doubting this at all. Some CRNAs are required to function as AAs-which is the exact reason I will do everything I can to prevent AAs in our state. We just have to hold out because the medical direction model is not sustainable and will die.

Anesthesiaman · Oct 1, 2022

And to your comment love anesthesia. I handle difficult asa 4e cases regularly with little to no input from the anesthesiologist. At the end of the case the anesthesiologist doesn't tell me whether to extubate or not...he asks me. Because I'm the one who was in the room managing the patient. If I say extubate he says OK. So yes I am trained to handle these cases solo as are you. But let me ask you... What is truly safer us handling difficult patients who are hemorrhaging solo? Giving blood drawing and sending labs? All of the above on our own? Or is it better to have a team someone who can be an extra set of hands. Because no one else in the room could help. Just this week I had a last spasm on an LMA and I tried to get the nurse in the room to help with a 2 hand bag and she couldn't help so I called my attending to assist and he came and assisted....a few months ago a CRNA called for help and I was the first to arrive her patients sat was in the 30a I intubated them without the anesthesiologist... The care team model is safer because it frees up qualified individuals to assist in emergencies. And even though we are trained to handle it alone it's better to have someone....

allnurses Guide · Oct 2, 2022

4 hours ago, Crimson0087 said:

And to your comment love anesthesia. I handle difficult asa 4e cases regularly with little to no input from the anesthesiologist. At the end of the case the anesthesiologist doesn't tell me whether to extubate or not...he asks me. Because I'm the one who was in the room managing the patient. If I say extubate he says OK. So yes I am trained to handle these cases solo as are you. But let me ask you... What is truly safer us handling difficult patients who are hemorrhaging solo? Giving blood drawing and sending labs? All of the above on our own? Or is it better to have a team someone who can be an extra set of hands. Because no one else in the room could help. Just this week I had a last spasm on an LMA and I tried to get the nurse in the room to help with a 2 hand bag and she couldn't help so I called my attending to assist and he came and assisted....a few months ago a CRNA called for help and I was the first to arrive her patients sat was in the 30a I intubated them without the anesthesiologist... The care team model is safer because it frees up qualified individuals to assist in emergencies. And even though we are trained to handle it alone it's better to have someone....

allnurses Guide · Oct 2, 2022

You have never worked solo or independently. That’s the point. You cannot do either of those. You don’t know what’s it’s like and you aren’t trained to do either.

Assuming you are functioning legally and not committing billing fraud the MDA tells you the type of anesthesia to do, designates the plan, is there for intubation, extubation, all “critical” parts of anesthesia, and determines the PACU course.

No one is arguing it is not better to occasionally have help, but help isn’t always available. The majority of hospitals aren’t large city hospitals and can’t have multiple anesthesia providers all the time. That’s why it’s important to have all independent anesthesia providers something that AAs aren’t and will never be.

The care team model has never been shown to be safer or more efficient. Working with (nothing to do with medical direction, supervision, or mix of MDA/CRNA) a team of anesthesia providers has shown to be safer. Two CRNAs working together are just as safe as two MDAs or mix of the two.

You only function like a CRNA because your place of employment restricts CRNA scope of practice. MDAs like ACTs, because it ensures they spend minimal time in the OR and provides job security all while keeping their pay high and all other anesthesia providers pay lower than what it would be otherwise.

loveanesthesia · Oct 2, 2022

4 hours ago, Crimson0087 said:What is truly safer us handling difficult patients who are hemorrhaging solo? Giving blood drawing and sending labs? All of the above on our own? Or is it better to have a team someone who can be an extra set of hands.

Great question, I always discuss this with SRNAS. When you’re doing cases by yourself it’s a different mind set. I start a second IV if I think there’s any chance of significant blood loss,, maybe blood tubing flushed, have the Cmac ready to go, pressors drawn up, etc. Be prepared for any possibility. Then know who can assist you. For us it’s the PACU RN. We ask them to help with pumping blood, etc. They’re great help. Often we’ll have a 3rd year SRNA and they’re great.

I never hesitate to text or call the call MD if I want to discuss something. For example a liver failure patient with ascites for ex lap. We discussed different scenarios for albumin anticipating the fluid shifts.

I know of no evidence that ACT is safer. If the MDs aren’t resounding to critical portions of the case at your practice, then they are violating billing regulations.

Our group has a waiting list of MDs who want to join the group. A lot of MDs want to do anesthesia and don’t want to medically direct. They also do well financially because the CRNAS are employees and the MDs benefit from the efficiency. The ACTs have to be subsidized by the hospital, and if the hospital can’t or won’t, it will fall apart. It’ll probably last a long time in GA though because it’s so entrenched.