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.
Quote
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.
Quote
...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.
So why do LPNs not give IV medications? Are there studies saying its less safe? Or administering blood?
You are a CCRN. You have NO IDEA what we do every day and NO IDEA what our educational experience is. All this time I thought I was chatting with an MDA...ARGHHH! At least they understand what it is we actually do every day. And, what's it to YOU? Why do you want a system changed that has produced an incredible safe anesthesia culture in this country? You are safer on the table than you are driving to the hospital to have your surgery. It's not like we are giving an anesthetic without a surgeon in the room - they are our supervision for conforming to the nurse practice act. Since LPN's have been permitted to give blood transfusions (with extra course work), do ya think the patients are dying at higher rates following transfusion? Is that really what you think?
I’m just stating my opinion. And you keep saying MDs back you up when they really don’t. All of the physicians in online communities I am aware of are actively calling for a challenge to the “nursing lobby”. I think the correct answer is somewhere in the middle.
I am big on holistics, where many physicians are too quick to jump on medicine or surgery, but I just believe oversight is fine. As a physician friend of mine said “if you want to be a physician extender be an NP, CRNA, or PA. If you want to practice medicine go to medical school.”
So why do LPNs not give IV medications? Are there studies saying its less safe? Or administering blood?
You are a CCRN. You have NO IDEA what we do every day and NO IDEA what our educational experience is. All this time I thought I was chatting with an MDA...ARGHHH! At least they understand what it is we actually do every day. And, what's it to YOU? Why do you want a system changed that has produced an incredible safe anesthesia culture in this country? You are safer on the table than you are driving to the hospital to have your surgery. It's not like we are giving an anesthetic without a surgeon in the room - they are our supervision for conforming to the nurse practice act. Since LPN's have been permitted to give blood transfusions (with extra course work), do ya think the patients are dying at higher rates following transfusion? Is that really what you think?
I think the correct answer is somewhere in the middle.
But do you really feel the current state of anesthesia is unsafe, despite the evidence to the contrary? Or are you just supporting the pushback against independent practice for rhetoric's sake, because you are becoming an MD? Again, I ask how all of the rural hospitals, IHS facilities, the military, etc., that utilize lots of CRNAs with little to no MDA backup due to lack of resources, manage to care for patients without issues if CRNAs aren't competent?
I think I'm starting to understandArmyRNtoMD. If you are from another country that does not have master's or doctorate trained nurse anesthestists, then you don't understand the rigors of our education here in the US. It's very tough to get accepted into a program and we do have science pre-reqs. I needed O-chem and physics pre-application. For two or three years you don't have much of a life...just like in med school. I had to wwork alone straight out of training (after 5 and on weekends). While it was harrowing for me and the patients didn't have the benefit of 35 years of experience, I was prepared adequately to at least be safe. And that's all a patient gets when they are assigned an inexperienced doc. And, don't confuse us with NP's who get to go to school online:)
You do realize that there are online medical schools...right?
It isn't the format that is the issue with some NP programs...it is the quality. We are in a new, global age thanks to the internet, and many highly reputable schools are taking advantage of online formats. Being online doesn't make one's education any less than, and it is annoying as hell when people equate online school to a bad education.
Of course hospital administrators are happy with the care. They like whatever saves them a buck. I don’t know which surgeons you’ve talked to, but all of the surgeons I’ve talked to beg to differ. I haven’t had many patients opinions on CRNAs since... they don’t interact with them really. They probably hardly know if they have a CRNA or an MD administering. I have however heard MANY patients angry or frustrated that they want to “talk to the actual doctor and not some NP”. Which I can kind of relate to. If I have something minor I need, such as a prescription refill, I want to be seen ASAP, whoever it is. But if it’s something complex, I want to speak to the doctor. I say this after having been a patient, and had an NP not be able to tell me anything more specific than I know about my disease process just being an RN. Extremely general. Every time I speak to the gastroenterologist he has much more precise explanation that actually puts me at ease and makes me feel informed.
Midlevels are great with supervision. I just don’t agree with independent practice. And when it comes to NPs having no practice requirements (how the hell is someone going to go straight from nursing school to be an NP without several years of ICU experience?) and these degree mills online, I see it as a bubble that will eventually burst.
It sounds as if you don't know what NPs do either, as well as CRNAs. I'm a critical care NP with 30 years experience, also a CCRN, and I've worked with some absolutely amazing critical care NPs that can run rings around the residents. Not all of us have completed online degrees. I myself went to a top 100 school to do my graduate degree, and it wasn't online. I also did my clinical rotations in the best hospitals in the state. As a student I was given my own patients and expected to perform at exactly the same levels as the MDs. There's a whole class of acute NPs who are very well versed in the role, and very well educated. When you spout personal opinion that smacks of derision and jealousy, it speaks volumes about the weight of your opinion. It's hard to take what you say seriously.
As far as CRNAs go, they've been practicing safely and independently for decades and have proved their worth many times over. There are multitudes of studies to support this. This is a disproven theory.
Well yeah... they’re residents. Show me an NP that run rings around a competent MD in their same field.
The ceiling is just much higher with MD. Also, I’m not arguing that some NPs are great. My best friend is a FNP. But the reason he did it is he is married with 4 kids. I have no kids, and I have GI Bill paying for school. He told me he would’ve gone MD as well had his situation been the same as mine.
I want the complete knowledge. Not a cliffs notes and then learning on the fly, which is how he explained it. Already just studying biochem and organic have taught me many things I wish I knew sooner.
And I have more respect for the NP schools that you actually attend. It’s not that all NP schools are poor. It’s that you have more and more degree mills, and I feel like it’s a bubble- until nursing does something to stop that. It’s going to water down the field with less competent NPs.
And my opinion isn’t of jealousy. I am extremely dissatisfied with nursing and I see the education as a joke. I respect CRNA but it just seems extremely boring. I encourage nurses who are interested to pursue it as a field.
My NP friend I mentioned previously told me “half of NP school is the same bullsh theories they cram down your throat in nursing school”. I honestly couldn’t listen to any more bull with no more scientific credibility than sociology. So much opinion and indoctrination rather than scientific fact. And a lot of the education was taught in medical micro, and other prenursing/nursing classes. (I had a coworker that was in NP school and excitedly telling me BASIC *** stuff that I learned in 2000 level biology and medical micro. Did you even pay attention?) And much is on the legal and billing side. Considering you can complete it in 3 years, that makes me concerned with how much knowledge I’d gain compared to premed science, 4 years of med school, a residency, and possibly a fellowship.
I get why NP is a great route for people stuck in family life, but for me it would be settling considering I have free education, I get VA disability, and a VFW scholarship. I feel it would be a waste not to use it.
As as far as Nursing in general, I feel it needs to up its game starting with BSN. Some nurses haven’t even taken basic biology or chemistry. How is this possible?
Okay. Go ahead and be an MD....please. If you're not interested in nursing for your self, just leave. Especially since you are going to get med school for free. I was 35 when I applied to med school and just decided that I was too old to start a career so far in debt. The only reason I became a CRNA was that I didn't take organic until I was 34 and didn't want it to be for naught. What else required that organic I asked? Dentistry and nurse anesthesia. I had terrible feet so asked them to sign me up for that nurse anesthesia thingie not knowing that in the future I would be telling myself that I am so blessed that I don't ever have to go to a partners' meeting:) Go and take that perfect medical school education. Enjoy it and see if you can have a happy life without disparaging other people. In the long run, you will be happier.
Oh med school education isn’t perfect. My friends have told me how much BS it is too, but it would be nice to be able to make more money. I only work 4 days a nurse right now, and would plan on working few days as an MD. Tutoring is what I am passionate about. I enjoy teaching, and it’s also very lucrative so it’s a double win. I’m pursing MD for the challenge. I want to see if I can do it.
subee, MSN, CRNA
1 Article; 6,166 Posts
You are a CCRN. You have NO IDEA what we do every day and NO IDEA what our educational experience is. All this time I thought I was chatting with an MDA...ARGHHH! At least they understand what it is we actually do every day. And, what's it to YOU? Why do you want a system changed that has produced an incredible safe anesthesia culture in this country? You are safer on the table than you are driving to the hospital to have your surgery. It's not like we are giving an anesthetic without a surgeon in the room - they are our supervision for conforming to the nurse practice act. Since LPN's have been permitted to give blood transfusions (with extra course work), do ya think the patients are dying at higher rates following transfusion? Is that really what you think?