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

[tnbutterfly - Mary]

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

[DirtyVA]

On 4/19/2019 at 7:33 PM, 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.

Asking for a friend...are you a nurse, PA???

[Jory, MSN, APRN, CNM]

This is physician fear-mongering.

There is zero evidence to back up their claims.

[subee, MSN, CRNA]

On 4/19/2019 at 6:01 PM, Susie2310 said:

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

We CRNA's have MUCH more classroom courses in anesthesiology than the MDA's do. We also generally have 5 to 10 years of experience before becoming CRNA's. MDA's learn on the job...in a residency. But DNP has become the new standard of CRNA education. There's room for BOTH but, if one were to go into a country that was a medical blank slate and design a system, you would probably need about 1 MDA for every 10 CRNA's. That was a study done about 20 years ago at Kaiser in California. Doctors AND CRNA's were found to be totally congruent in what the distribution of CRNA's should be to MDA's...1 to 10. It's crazy the salaries MDA's make! If you put a CRNA and an MDA working side by side on 2 patients, you would not be able to tell which was the CRNA and which was the MDA. You have no idea what kind of rigor is included in our classroom hours.

[offlabel]

2 hours ago, subee said:

We CRNA's have MUCH more classroom courses in anesthesiology than the MDA's do. We also generally have 5 to 10 years of experience before becoming CRNA's. MDA's learn on the job...in a residency. But DNP has become the new standard of CRNA education. There's room for BOTH but, if one were to go into a country that was a medical blank slate and design a system, you would probably need about 1 MDA for every 10 CRNA's. That was a study done about 20 years ago at Kaiser in California. Doctors AND CRNA's were found to be totally congruent in what the distribution of CRNA's should be to MDA's...1 to 10. It's crazy the salaries MDA's make! If you put a CRNA and an MDA working side by side on 2 patients, you would not be able to tell which was the CRNA and which was the MDA. You have no idea what kind of rigor is included in our classroom hours.

I do wish CRNA's were as interested in talking about the technical/theoretic aspects of the job as much as the political aspect. Remember NA.org? That place tanked. Not much on this site either. It'd go a long way in terms of backing up those equivalency claims. The residents and MDA's on SDN have regular clinical discussions and it just looks poor for us that we can't seem to pull that off consistently. Even the people that want to go to anesthesia school have little to no interest in the more advanced, critical care conversations. The SRNA forums are filled with nothing but WAMC threads and interview advice requests. Kind of pathetic.

[rn&run]

Former OR nurse here— I’ve always found that CRNAs are 100% competent to safely intubate and/or manage the sedated/anesthetized patient. Just because a higher level of training exists doesn’t mean it’s required to practice safely within a well-defined scope. I support the practice of having a designated anesthesiologist supervisor — it’s great to have a collaborative team — but it would be so excessive to require him/her to remain in the same room at all times. Talk about role redundancy!

[fourthtimesacharm, CRNA]

CRNAs already practice independently in many states...

[10GaugeNeedles, BSN]

I remember reading an analysis that showed outcomes for CRNA V MDA were pretty much equal. IMO, MDs don’t like others on their turf. They like the money and who can lame them. CRNAs are much more cost effective. They are also highly trained. MD does not equal good care always. Case in point: hospitalists managing icu pts (gerrrrrrt snarl short huff huff!!).But I digress. Most doctors don’t provide direct bedside care. NURSES do that. Through our careers, we see the pt directly for 12 hrs a day at minimum. Drs don’t do that. To discount RN experience as irrelevant shows his ignorance of actual pt care. IMO, like so many things, this isn’t about pt care. This is an ongoing turf war. Dr god wants to be dr top dog. They are afraid nurses will be able to command equal wages which will drive their own wages down as Medicare becomes insolvent. If they CRNA can do the job well, they can do it by themselves.

[LM NY]

In the last 4 years of being in a med-surg unit, 9 out of 10 times it was a CRNA showing up to every code. They are the ones intubating if needed. To be quite honest, I feel very proud when it is them. There will always be an argument over APRN vs MD. No one is perfect. Nurses catch MD mistakes all the time, without letting patients know. For some, it is just their ego.

[Emergent, RN]

Not to diminish CRNAs but, intubation is just one skill. Paramedics and RTs intubate. There's so much more to CRNA than that! It's a set of skills requiring high level critical thinking and experience.

I think ARNP programs should have modeled themselves after the demanding training those guys get. I go to a ARNP because I know of her vast experience, but otherwise I don't trust the training they get. I definitely would trust a CRNA.

[JKL33]

16 hours ago, subee said:

We CRNA's have MUCH more classroom courses in anesthesiology than the MDA's do. We also generally have 5 to 10 years of experience before becoming CRNA's. MDA's learn on the job...in a residency.

What is the remaining necessity of anesthesiologists?

It sounds like the medical education system is simply outdated and is supplying an unnecessary product that no one wants or needs.

[subee, MSN, CRNA]

I think we still need anesthesiologists, just a lot less if them. Some patients require complex medical care that a specialty can supply. But those are around 10% of the cases. Don't flame me for saying . There is room for both. Remember Joan Rivers died with an anesthesiologist in attendance

And she didn't need rocket science..just someone who utilized basic airway management and got someone who used excruciatingly bad judgement. If CRNA only model were unsafe, the patients would be dying enmasse and thus obviously isn't the case. Our safety record us just the same as MD's. MD's who are often very happy to do a nurse's job but get paid for doing a much riskier job.

[No Pain No Gain]

On 4/19/2019 at 5:56 PM, 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?"

Interesting. What is a clear license. I’ve heard of anesthesiologists and Anesthetists being drug addicts but then getting clear licenses after coming back from rehab. Another interesting philosophical point. If nurse practitioners where trained to do surgery how many CRNAs would be comfortable with a nurse taking out their appendix or amputating grandmas leg while the surgeon was at home watching tv or sleeping. Inviting discussion on this topic.