Do crnas deserve that much salary?

Horseshoe, BSN, RN · Sep 13, 2016

A CRNA is still an advanced degree NURSE. So, stop acting like they are above and beyond the Physicians. And to the CRNA who hasn't seen an
MDA in 10 yrs, if you are practicing in the state of Texas, you are providing anesthesia under a Physician. So technically, you ARE NOT in SOLO practice. Come down from your High Horse, it takes the whole team to get a job done!!

I work at a surgery center in Texas. We use CRNAs. There are no MDAs involved in this center. The only anesthesiologists ever seen at this center have been as patients, receiving their anesthesia from CRNAs.

Garden,RN, ASN, RN · Nov 8, 2016

The advance practice nurses will end up in the same boat the MD's are in they will eventually have to do more and more for less and less money. In the end we are all being used by the many decision makers that could not possibly care any less about patients.

CRNAGuide2016 · Jan 21, 2017

You seem to have an extremely limited view of what a CRNA can do, is capable of doing and what earning an MSN or DNP in Nursing Anesthesia actually entails. It sounds as if you might be an OR RN? It also sounds like you may work in a facility that utilizes a "team model" of anesthesia where an MDA medically directs several rooms run by CRNAs. A "team model" in its ideal state considers an MDA and a CRNA to be colleagues and it can be quite a cost effective and collegial model for delivering anesthesia care in large facilities that have many OR's and offsites. But on the flip side, many facilities and private practices utilize CRNAs as sole providers, i.e. there are no MDA's in the OR at all. And, in the military, CRNAs are often the sole providers on the front lines taking care of our soldiers and foreign citizens that have become injured in war zones.

Unfortunately, in some "team models," (some not all!) doctors treat the CRNA's poorly, like assistants, which is mostly related to politics and a struggle to hold on to power (and money) in an ever changing healthcare market that wants to reduce compensation to physicians and Anesthesia departments in general. CRNA's are licensed to be independent autonomous practitioners- we can administer our own medications, place airways (via direct laryngoscopy, video laryngoscopy or with a fiberoptic scope), and place invasive lines (arterial, central, etc.). We can run codes, enter order sets, etc. I find it odd you say we don't do anything autonomously- aren't your CRNAs constantly administering medications and adjusting dials and settings while the MD is away in his office or do your CRNAs call them before they give any med? Also, 220K is on the high end of the salary range for a very experienced practitioner- a practitioner that is highly desirable to a hospital because they've likely been there done that for every patient and case. Most salaries for new grads start at about half that. And do you know how much the MDA gets paid? It's a substantial amount larger than that- and they also get some very cushy fringe benefits as well.

Because of the politics involved in team models (especially in large hospitals or teaching facilities), it is often the case that the MDs attempt to limit the practice of the CRNA. For example, where I work, the CRNA's used to consent their own patients, run the heart rooms, do pre-op and post-op regional anesthesia (nerve blocks, epidurals, etc), place CVL's, etc. But as the practice of CRNA became more threatening to the MD's paycheck, anesthesia departments run by MD's started to say ok, let's not have CRNA's run the heart rooms, let's not have them do blocks, let's not have them place CVL's...and so on. But there are thousands of facilities where CRNAs do all of these things- YOU, Garden, RN, just happen to work in a facility that doesn't, am I right?

If an MDA comes in when something goes wrong and appears to take charge, this does not mean the CRNA is unable to perform that leadership role. We train for long periods of time to be able to do this. There is so much that goes on in a CRNA's mind before, after, and during a case which you obviously are completely oblivious too and the fact that you are oblivious to it is a good thing- unless you think the CRNA is just sitting there messing every thing up and the MDA has to come fix it?

Every comorbidity has an anesthesia consideration. Every patient receives a different combination of medications. This doesn't get verbalized out loud to the OR RN or to anyone else unless they ask, it is just inherently known by anesthesia providers (thanks to the intensive study/testing and years of clinical training). In a CRNA program, the SRNA has to meet competencies in every type of procedure with every age group- from NICU babies to geriatrics, from a colonoscopy to thoracic and cardiac procedures. Just because you don't see the CRNA doing it, it doesn't mean that they CAN'T do it. Also consider the experience level of the CRNA, if they're brand new, they may require some extra guidance- especially if they did not train where they currently practice- different facilities have different methods of providing care- there is no "right" way to perform anesthesia- it is the discretion of the provider and is often referred to as an art. This is the same for new MDA's. We have two freshly graduated MDA's and they are still learning the ropes as well and have made mistakes which had to be fixed by a CRNA- oooh scandalous! We have MDAs that have had bad and VERY bad outcomes with patients because he/she went against the advice of the CRNA and other MD's. My point is, anyone can make a mistake. Being a doctor doesn't mean you know everything. Anesthesia complications are extremely rare- it's very safe to receive anesthesia for the vast majority of the population. We train for those highly unlikely events so we can save a life if we need to.

Currently, the VA is attempting to determine whether CRNA's in the VA system should be independent practitioners. You can access research that shows how safe anesthesia care is when provided in a CRNA only model, but as you can imagine, the MD's do not want to give up this control and they do not want to create competition in their marketplace. If CRNA's become independent practitioners in the VA system as they already are elsewhere, this gives MDA's a run for their money (and they make a lot of it). They are doing everything in their power to fight against this- including spending hundreds of thousands of dollars to lobby against CRNA's. AND, they use perception to undermine our skills- which apparently is working because you are falling for it. We actually had one of our worst and most lazy MDA's who never comes into the patient's room and doesn't want to do any intervention that takes extra time despite it being the right thing to do- well he actually made a comment on the VA website that he had to "save a CRNA at least twice a week." You have to take this with a grain of salt and look at what is motivating the doctors. The same doctors that say they have to save CRNA's are pushing to hire Anesthesia Assistants (who basically go to school for a few years and have no background in medicine) - but they are unable to practice on their own- therefore are not a threat to the MD practice.

I can and do see my own patients, I can and do push my own drugs (although some docs still want to do it on their own- and they sometimes overdose the patient and leave the room- *you should take a look at the blood pressure post induction after an MDA pushes all those drugs the CRNA "hands him", I can troubleshoot my own airway if allowed to do so without the MDA feeling like they want to do it themselves, determine my own plan of care, determine what types of medications I want to give each patient, send labs/blood gases/interpret results, and emerge a patient on my own as well as treat a spasm or other issue if one arises. Do not get me wrong, I very much enjoy working with most of our MDA's and many are highly intelligent with training that extends way beyond what is useful in the daily ebs and flows of the OR, but CRNA's can reach an expert level of anesthesia care too when not limited- as proven in facilities that rely solely on CRNA care. Note that I did not say we can become an Anesthesiologist nor do we want to, which is why went into nursing instead. There are a lot of MDAs who don't even want to sit in the OR and take care of their patient (I've asked many of them)- they want the freedom of being able to pop in and out.

And even though I know I can do things on my own, I work in a team model so I keep my staff informed as a professional courtesy and as an extra set of ears- there are often different interventions for different problems and you discuss to determine which you'd like to prioritize. Every Anesthesia provider will admit that when something is going downhill, an extra set of hands is essential- whether it's another CRNA or an MDA. Sometimes even a well trained OR RN can get you out of a pickle. You said that during an emergency the MDA takes over. Does the CRNA then leave the room? I doubt it, I bet they work as two sets of hands to resolve the situation. If a patient spasms after extubation, I might give my staff the airway to jaw thrust, while I close down my APL and give pressured breaths to break the spasm or draw up drugs to break the spasm and get ready to reintubate if I need to. Does this mean I don't know what I'm doing and I gave up? I don't think so- but to an uninformed bystander it could seem this way if the MDA comes in to stand at the head of the bed and then the problem magically resolves...

I really don't want to be harsh to you, but your post is just so wrong that it's embarrassing and frustrating. We don't go to school for 3 years to learn to intubate- that IS actually a skill that anyone can learn- EMT's (high school kids!) do it every day. They say once you've done 30 airways (or PIV's or arterial lines or spinals or epidurals) you are considered competent. The MD's don't "let us" intubate anymore than the surgeon "lets you" drive the patient into the OR and put in a foley catheter and "lets you" get him the right size gloves and gowns and suture- that's a very condescending way to phrase that statement. We go to school for years to learn the anesthesia considerations for every comorbidity, the pharmacokinetics for every single drug we give, how to best ventilate individual patients, how to interpret lab results, ECHO's, TEE's, PFT's, the list goes on and on! I do not mean to be rude, but the knowledge I gained as an SRNA and as an active CRNA goes so far beyond what I learned in nursing school that I feel like a different person altogether.

If it looks like I'm just sitting down doing nothing- I'm not. I am listening to the HR on the monitor and the tone that tells me the O2 sat without having to read the number. I am listening to how much blood the surgeon is suctioning. I am listening to the terminology he is using and what tools he is requesting from his scrub tech. When I hear and see blood going into the suction canister, I have already calculated how much blood this patient could likely tolerate losing and when to istat a Hgb or get a type and screen converted to a type and cross with units en route to the OR. I know what is happening physiolgically to my patient in different positions and how to adapt ventilation (supine/prone/lateral/reverse T/trendelenburg, I know the danger that insufflation can cause and am hyper-vigilant during risky times that the OR RN isn't even aware of. I know which drugs are most likely to cause anaphylactic reactions and how to treat it if it occurs. I now how to treat Malignant Hyperthermia and I know all of the ACLS megacode algorithms. I am on constant guard for the rare complications that can happen during surgery even though I'm just "taking vitals and doing paperwork".

We "stock our rooms" and "prepare the meds" because we are the ones in the trenches and if the S hits the F, my MD isn't going to get there in time and they definitely aren't bringing any drugs with them. Did you know we prepare different drugs based on the patient's history, size, procedure, and post op plan?

Just because I haven't "seen" my patient (because the CRNA is the last one with the patient from the case before giving report in PACU) and then has to set up for the next case while the MDA is free to walk around day surgery and have lengthy conversations with patients and their families doesn't mean I haven't looked them up the night before, made notes, researched a rare disorder or refreshed myself on a medication the patient takes, checked lab values in the chart, texted my staff about concerns to get on the same page etc.

We don't just "take vitals," we interpret what they mean. Does an elevation in HR mean the patient is being stimulated, are they in pain, are they dry, is it an arrhythmia? and what can I do about it that won't affect how long it takes the patient to wake up, e.g. if the surgeon is manipulating the uterus- it's highly stimulating to the patient- but if you give a boatload of narcotics- you're going to burn yourself because as soon as the surgeon lets go of the uterus, the stimulation has gone away. We don't tell you that as an OR RN, but these thoughts are constantly circulating in our brains- and they get into our brains because we have had years of training and textbook knowledge. The medications the patient takes at home can also affect what and how much we need to give in the OR and we prepare accordingly.

Any nurse can do what a CRNA does? True, if they can get accepted into a highly competitive program, make it through the demanding 3 year program with grades always higher than an 83% (anything less is failing- it's not like it is in RN school), and then pass boards and continue their education annually and recredential every 4 years. Super simple, yep.

No Anesthesia provider is perfect. You can have a bad CRNA, a bad Anesthesiologist, a bad resident, a bad Anesthesia Assistant (AA). Anyone can also have an off day- but be a great practitioner. Doctors consult other doctors all the time about train wreck patients...no one knows everything. But CRNA is also a profession that is constantly training, learning, gaining experience and ready to get more respect. And when not limited, the practice is quite impressive and has proven to be just as safe as MD care.

I apologize for the tone of this post- as I am sure it reads as defensive and frustrated as I feel. As I began to respond to your post I became more annoyed at your perception of what I do for a living and have difficulty masking that. I hope that you will start to open your eyes to what we do, discuss things with your CRNAs (try to learn from them about your patients and the medications they're giving, what they're listening for and thinking about, etc.) so you do not continue to belittle our role inside and outside of the facility you work for.

If you or anyone else has questions, I would love to answer them honestly. I love what I do and I know that I am great (with room to grow!) at what I do. Our MDA staff, for the most part, are supportive of our practice and rely on us heavily when difficult cases arise.

jasy · Jan 21, 2017

Wowwww. Thanks for your time. How long you have been a Crna?

Bluebolt · Feb 2, 2017

Are CRNAs paid too much? - YouTube

This video is about If CRNAs are paid too much, interested in what you guys think.