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CRNAs Should Not be Allowed to Practice Independently - One Anesthesiologist’s Opinion

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tnbutterfly is a BSN, RN and works as a Content/Community Director @ allnurses.

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Jonathan Slonin, an anesthesiologist and past president of the Florida Society of Anesthesiologists, believes that lawmakers should not allow the administration of anesthesia without a physician in the room.  Although he works with and respects Certified Registered Nurse Anesthetists (CRNAs), they are not physicians.

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They have years of training, but they are not trained in medical diagnosis and treatment, and while they are highly skilled and a vital part of the medical care team, they should never be the lead of that team.

 

While the American Association of Nurse Anesthetists are advocating for a proposed bill that would allow CRNA’s to practice without the supervision of a physician, some see this as a dangerous and costly move.  

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...safety should be the primary goal and that is why physician-led care must remain the standard. If CRNAs were given complete independence to practice complex medicine, costly mistakes will happen.  And when they do, we all pay for those mistakes through increased healthcare costs.

What do you think???

For more on this story, see Anesthesia without a physician in the room? Lawmakers should not all that / Opinion

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LibraSunCNM has 10 years experience as a MSN and works as a CNM.

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What do I think?  I think somehow, CRNAs in rural and underserved areas, the military, and many other setting manage to practice without an MD in the room for every procedure and do just fine.  It's my understanding that the evidence supports this fully (though I have no research to quote, it's just what I've always heard is the case).  

As an advanced practice nurse, it's incredibly infuriating how many physicians feel threatened by us and keep their heads firmly in the sand about how necessary we are to the healthcare system.  These doctors insisting that NPs, CNMs, and CRNAs aren't "safe" need to adapt or die because we have the evidence on our side.  And at the end of the day, our system is BROKEN and if we're going to fix it, the answer is going to involve even more APRNs.  We can't continue to support specialist MDs with giant salaries in every single setting.  

Rant over.

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What do you think???

What would  you expect an anesthesiologist to say? This is neither new nor unique. Aside from trolling controversial exchanges, the point here is what?

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I read the article and I have to agree with the author.  I have had surgeries and an anesthesiologist provided and was in charge of my anesthesia.  I was comfortable with undergoing the surgeries because I knew that the anesthesiologist was extensively trained in medicine and anesthesiology, had significant experience, had a clear license, and had the confidence of the surgeon who was performing the surgeries.  I had no problems post-operatively from either the surgery or the anesthesia.

Other family members with significant medical problems have also had long and complicated surgeries under the care of an anesthesiologist who was very highly trained and skilled.  The night before the surgery we spoke at length with the anesthesiologist; our conversation covered many medical issues that required a physician level of training.  Problems that arose after the surgery were very carefully and appropriately managed, and my family members had a very good outcome.

Edited by Susie2310

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LibraSunCNM has 10 years experience as a MSN and works as a CNM.

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1 hour ago, Susie2310 said:

I read the article and I have to agree with the author.  I have had surgeries and an anesthesiologist provided and was in charge of my anesthesia.  I was comfortable with undergoing the surgeries because I knew that the anesthesiologist was extensively trained in medicine and anesthesiology, had significant experience, had a clear license, and had the confidence of the surgeon who was performing the surgeries.  I had no problems post-operatively from either the surgery or the anesthesia.

Other family members with significant medical problems have also had long and complicated surgeries under the care of an anesthesiologist who was very highly trained and skilled.  The night before the surgery we spoke at length with the anesthesiologist; our conversation covered many medical issues that required a physician level of training.  Problems that arose after the surgery were very carefully and appropriately managed, and my family members had a very good outcome.

Have you also had bad experiences with CRNAs?  I'm confused as to how your good experiences with anesthesiologists mean that CRNAs are less competent.  Do you have reason to believe the average CRNA does not have "significant experience" or "a clear license?"

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9 minutes ago, LibraSunCNM said:

Have you also had bad experiences with CRNAs?  I'm confused as to how your good experiences with anesthesiologists mean that CRNAs are less competent.  Do you have reason to believe the average CRNA does not have "significant experience" or "a clear license?"

CRNAs are not trained at the level of anesthesiologists and physicians.  

Edited by Susie2310

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LibraSunCNM has 10 years experience as a MSN and works as a CNM.

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2 hours ago, Susie2310 said:

CRNAs are not trained at the level of anesthesiologists and physicians.  

Right...what I'm asking is why you think that the education of CRNAs is insufficient to provide safe care, when no studies actually back this up.  It's fine if you prefer to see an MD, but that doesn't mean that APRNs are actually poor quality care providers.

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Nurse Beth has 30 years experience as a MSN and works as a Nursing Professional Development Specialist.

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As a nurse, when I've had surgery, I've asked a colleague in PACU to make sure I got the best anesthesiologist care. Nurses's recommendations count for a lot in my book.

Time after time, my family members or I have had a CRNA and I am completely comfortable with that.

 

 

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Emergent has 25 years experience and works as a Emergency Room RN.

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I think a statistical analysis of outcomes would speak volumes over anecdotal stories. Does anyone have some concrete evidence here?

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2 hours ago, LibraSunCNM said:

Right...what I'm asking is why you think that the education of CRNAs is insufficient to provide safe care, when no studies actually back this up.  It's fine if you prefer to see an MD, but that doesn't mean that APRNs are actually poor quality care providers.

No-one is saying that CRNAs are poor quality care providers, just that they are not trained as anesthesiologists/physicians, so they do not provide an anesthesiologist/physician level of care.

Edited by Susie2310

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LibraSunCNM has 10 years experience as a MSN and works as a CNM.

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12 hours ago, Susie2310 said:

No-one is saying that CRNAs are poor quality care providers, just that they are not trained as anesthesiologists/physicians, so they do not provide an anesthesiologist/physician level of care.

And what I'm saying is that that evidence doesn't actually bear this out.  And actually, you did imply that CRNAs are straight-up poor care providers in your first post, when you wrote that in your experience with anesthesiology MDs, you could feel confident that they had a "clear license," as if that is automatically in question with a CRNA.  That's why I was curious where that opinion stemmed from.

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subee has 45 years experience as a MSN, CRNA and works as a CRNA, retired.

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On 4/19/2019 at 4:48 PM, Susie2310 said:

I read the article and I have to agree with the author.  I have had surgeries and an anesthesiologist provided and was in charge of my anesthesia.  I was comfortable with undergoing the surgeries because I knew that the anesthesiologist was extensively trained in medicine and anesthesiology, had significant experience, had a clear license, and had the confidence of the surgeon who was performing the surgeries.  I had no problems post-operatively from either the surgery or the anesthesia.

Other family members with significant medical problems have also had long and complicated surgeries under the care of an anesthesiologist who was very highly trained and skilled.  The night before the surgery we spoke at length with the anesthesiologist; our conversation covered many medical issues that required a physician level of training.  Problems that arose after the surgery were very carefully and appropriately managed, and my family members had a very good outcome.

My experience is that non CRNA nurses have no idea what we do or what our education is....not online for starters:)  Even nurses in our PACU didn't realize that CRNA's did their own intubation!  That was a real eye opener for me on the ignorance of some RN's and, actually, it makes sense.  They have never worked in an Or, ICU or ER so don't even see us.  There are plenty of studies at AANA.com, not done by CRNA's, that show care is equal.  Anesthesia isn't rocket science but does require vigilance and perfectionism.  We nurse anesthetists simply, have to be better so the MDA's that want control of us, can't ever get it.  After all, we did anesthesia before doctors did.

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