CRNAs in Florida to require anesthesiologist supervision

Specialties CRNA

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I just read in a magazine about a House bill being passed that mandates that CRNAs in that state must now be supervised by anesthesiologists. If this passes the senate, wouldn't this be the end of the CRNA profession in Florida? After all, why would anyone use CRNAs if they would also have to pay for the supervising anesthesiologist? Where are the Florida CRNAs, and what do they have to say about this? I'm surprised to not see more political activity from them.

Just a thought.

I will tell you, regardless of all the negative bickering between CRNA's and MDA's that the CRNA profession is the best job I could ever imagine. It has very liitle to do with the monetary gains (though many do enter the profession for that sole reason). I'd bet that a large number of my CRNA colleagues would also agree. If you like nursing, you'll love nurse anesthesia, so don't let the turf battle deter you from pursuing a career as a nurse anesthetist. Not a day goes by that I'm not thankful for the career path I've chosen.

It's reassuring to see CRNA's who are taking action (paying the dues) because it gives us prospective students, hopes, so that way, when we get there (become CRNA's) we can just add our strength to pull the bus up the hill.

Maxs

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Yes, I agree this is quite a battle. But what do you think will happen to the price of healthcare if all CRNA's are required to be supervised by an anesthesiologist? Perhaps you're not aware that approximately 65% of the millions of anesthetics delivered each year are delivered by CRNA's.

Yep. I was wondering about this point myself. It seems like this bill will be really expensive, especially in a big state like Florida.

:coollook:

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Signing one's name on a chart does not signify active involvement in the case. Are you aware that 13 states have opted out of medical supervision for CRNA's and there are many rural counties in this country where the CRNA is the sole anesthesia provider, so I think the numbers might be a little higher than you think. I don't consider this number propaganda, as in many places the MDA only attends induction and the CRNA manages the case as well as emergence.

Hmmmmm, I think an attorney would tell you that signing one's name on a chart DOES imply involvement, whether momentarily, or from the lounge, or if they're just there for induction, or whatever. If your name is on the chart, particularly an MD, you're on the hook, whether you were ever physically present or not.

I certainly understand that there are lots of CRNA's practicing with no MDA involvement. I know quite a few in Georgia that cover several rural hospitals that the MDA's wouldn't touch.

Even in many care team practices, for all practical purposes, the anesthetist (whether CRNA or AA) is the one managing the case. That's how the real world operates.

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Hmmmmm, I think an attorney would tell you that signing one's name on a chart DOES imply involvement, whether momentarily, or from the lounge, or if they're just there for induction, or whatever. If your name is on the chart, particularly an MD, you're on the hook, whether you were ever physically present or not.

I certainly understand that there are lots of CRNA's practicing with no MDA involvement. I know quite a few in Georgia that cover several rural hospitals that the MDA's wouldn't touch.

Even in many care team practices, for all practical purposes, the anesthetist (whether CRNA or AA) is the one managing the case. That's how the real world operates.

And your point is? And why do you think it should be manadated that MDA's should keep signing those papers? just curious. Do you think it's necessary, if so, how?

Maxs

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I believe only approx. 20% of all anesthetics are done by CRNAs without supervision. Supervision, though as we probably all know is more about payment than actually doing the case. When the shart hits the fan, it will be the CRNA who's going to save the pt.

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Specializes in Anesthesia.
I believe only approx. 20% of all anesthetics are done by CRNAs without supervision. ........

Really?! What's your source to back up this assertion? AND how do you define 'supervision?'

?

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I believe only approx. 20% of all anesthetics are done by CRNAs without supervision. Supervision though as we probably all know is more about payment than actually doing the case. When the shart hits the fan, it will be the CRNA who's going to save the pt.[/quote']

In the end, it's all about $$$.

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Can you tell us what some of the reasons are? I have reasons why I think I will like anesthesia, but would love to hear it from someone who's actually doing it.

I was a critical care/PACU/CVRU nurse for many years and absolutely loved my work, but something was missing. The hospital and surgeons i worked with realy promoted autonomy and the best care possible for the patients. During these years, I had the opportunity to see CRNA's and very congenial MDA's work together in the OR/PACU/CVRU, and even the ICU when we needed anesthesia's assistance with intubation and bed side procedures. So where I came from, they worked hand in hand. I now work in a facility where "Darth Vadar" is the chief of anesthesia. The plus is that I don't work for him, just the hospital. The political climate is probably the biggest deterent to this or any other practice. But, you must look at the many positives. I care for one patient at a time, which permits me to give the best care possible. (no running after 2 or more patients). These people usually remember my name because I introduce myself as a certified registered nurse anesthetist that will be providing their anesthesia today, and I tell them that I will be the one at the head of the bed with them throughout their procedure. I feel that the ability to individually preop each patient gives them the opportunity to see the person that will put them to sleep. Another perk is the schedule. Depending on where you work, almost any schedule is possible.

Now to the money, yes the money is nice but don't do it for the money, you'll be very unhappy. Look at the money as a perk for taking care of some very sick people,where their lives are essentially in your hands while asleep. We probably stick together for the common cause greater that any other nursing specialty which gives you many networking opportunities for future employment. Last but not least-how i feel when I go home at the end of the day. Tired, but proud of those I was able to help today, were it to be the 80 year old teary eyed gentleman that had a CABG or the parents of a downs baby that's having dental issues. This job allows you to care for others because after all we are all nurses first then CRNA's with the knowledge to care for very complex situations. You'll come out of CRNA school floored with what you have learned and exactly how much you didn't know as a staff nurse. Take the jump, I really don't think you'll regret your decision to do it!!!!Everyday is totally different from the day before. Different cases different faces and different health problems to contend with = too busy to be bored.

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In the end, it's all about $$$.

I have a few friends here in New York who are CRNAs. They are very passionate about their work and its not just because of the money. Listening to these guys talk about their work is what inspired me to want to become a CRNA. If your comment is in reference to some MDAs determination to restrict CRNA practice then you might be right.

I doubt that most MDAs practice anesthesia only for the money (although I've worked with a few at my hospital who clearly do). Its mostly a power thing for them because the state boards of medicine aren't comfortable with the idea of nurses invading what they consider to be 'thier turf.'

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Specializes in Trauma, ER, ICU~CCRN,CNRN.
I was a critical care/PACU/CVRU nurse for many years and absolutely loved my work, but something was missing. The hospital and surgeons i worked with realy promoted autonomy and the best care possible for the patients. During these years, I had the opportunity to see CRNA's and very congenial MDA's work together in the OR/PACU/CVRU, and even the ICU when we needed anesthesia's assistance with intubation and bed side procedures. So where I came from, they worked hand in hand. I now work in a facility where "Darth Vadar" is the chief of anesthesia. The plus is that I don't work for him, just the hospital. The political climate is probably the biggest deterent to this or any other practice. But, you must look at the many positives. I care for one patient at a time, which permits me to give the best care possible. (no running after 2 or more patients). These people usually remember my name because I introduce myself as a certified registered nurse anesthetist that will be providing their anesthesia today, and I tell them that I will be the one at the head of the bed with them throughout their procedure. I feel that the ability to individually preop each patient gives them the opportunity to see the person that will put them to sleep. Another perk is the schedule. Depending on where you work, almost any schedule is possible.

Now to the money, yes the money is nice but don't do it for the money, you'll be very unhappy. Look at the money as a perk for taking care of some very sick people,where their lives are essentially in your hands while asleep. We probably stick together for the common cause greater that any other nursing specialty which gives you many networking opportunities for future employment. Last but not least-how i feel when I go home at the end of the day. Tired, but proud of those I was able to help today, were it to be the 80 year old teary eyed gentleman that had a CABG or the parents of a downs baby that's having dental issues. This job allows you to care for others because after all we are all nurses first then CRNA's with the knowledge to care for very complex situations. You'll come out of CRNA school floored with what you have learned and exactly how much you didn't know as a staff nurse. Take the jump, I really don't think you'll regret your decision to do it!!!!Everyday is totally different from the day before. Different cases different faces and different health problems to contend with = too busy to be bored.

BRAVO!!!

Great post. Wonderful insight to those of us who can't put into words the decision to become a CRNA!

I look forward to joining your respected profession.

Thanks once again.

elizabeth

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Hmmmmm, I think an attorney would tell you that signing one's name on a chart DOES imply involvement, whether momentarily, or from the lounge, or if they're just there for induction, or whatever. If your name is on the chart, particularly an MD, you're on the hook, whether you were ever physically present or not.QUOTE]

So the MD's name on the chart is strictly for liability? Retention of power? It is technically needed for supervision even though the MDA usually has little to do with actual case managment? If that's how the definition of supervision reads, then the AMA has a nice scheme going.

And yes, a lawyer looking at a case with an MDA's signature could assertain the implication of involvement. You used caps on the wrong word, "name on a chart DOES imply involvement" Imply should be in caps. There is very little pertainence to reality in a lawyer's world.

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In the end, it's all about $$$.

No, it's about control. Everyone wants to control their own destiny. Money can be a by-product of control.

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