FNP vs CRNA crossroad

fidelio · Sep 9, 2005

This seems to be the classic dilemma for the nurse who loves medicine as much as nursing. CRNA is so attractive to them. I'm only a nursing student but last year one of our guest speakers was an NP who worked solely in a pain management dept at the local university hospital (OHSU). Her entire job is pain management in a huge variety of cutting edge methods for numerous diseases. Her expertise in the field is amazing.

loisane · Sep 9, 2005

Papadoc,

While on a theoretical level one could argue that all anesthesia practice is "pain management", the reality is that there are a limited number of CRNAs whose primary practice is in this sub-specialty. I don't think there are any that participate on this board (please chime in if I am wrong). We have talked about pain management specialization in the past, you might be interested in those old threads.

You ask about the scope of pain management practice for CRNAs. In my estimation, this is an all or none situation. The average CRNA does zero (of what I would call specialized pain management). For CRNAs who specialize in pain management, it is 100% of their practice.

Pain management as an anesthesia sub-specialty is an evolution of expertise in regional anesthesia skills. I would generalize to say it usually goes like this-after school you work for a few years in the OR doing "regular" anesthesia. During that time you develop a particular interest in regional techniques. You gain above average skills in common blocks (spinal, epidurals, and some peripheral nerve blocks). You branch out and start doing some of the lesser known type of peripheral nerve blocks. You become the "go to guy" in your department for regional blocks in surgery cases. You learn how to apply these technical skills to patients with pain treatment needs that are not associated with surgery.

At this point, it would be possible to do some of both. And there are CRNAs who continue to do OR anesthesia, and also see office patients for pain treatment. Especially in a rural setting where there are limited providers, so the ones that are there have to cover more ground. But I think it is more likely that you would set up your own private practice (or enter into a partnership) to develop an office practice to treat pain patients using the regional expertise you have acquired.

There a couple issues I think you should consider about your crossroads:

NP is mostly an office based type of practice. You would follow patients over time, in an outpatient setting. While CRNA pain specialists end up in the same type of practice setting, they have to pay alot of "CRNA dues" before they get there. Meaning they work for some time like an average-Joe CRNA, working with surgical patients, in the OR, that you see once, turn over the care to someone else, and likely never see again. Some of my NP friends say it would drive them crazy to work like that.

Another issue is technology vs. alternative techniques. IMO, CRNA pain management's primary emphasis is on the technology. Ways to identify the nerve-fluro, peripheral nerve stimulator, ultrasound. Many different drug choices to inject. There may be some who incorporate alternative techniques, but I would guess that the technological ones are still their main business. If your main interest is alternative, the CRNA route may not be the most direct way to get where you want to be.

The beautiful thing about nursing is the diversity of practice. It is possible to develop any type of practice you desire, if you have the entrepreneurship and drive to make it happen. No matter your choice between NP and CRNA, also consider the business aspects of your career goal, and develop your expertise in this area as well through classes, mentoring by someone already practicing, etc.

Best of luck,

loisane crna

Papadoc · Sep 9, 2005

Wow!

Thanks all very much!

Loisane, great and very informative post. I realy appreciate it.

You see,my problem is that I still don't know what I want to be when I grow up :chuckle .I guess the very puzzle of "crossroads" comes from lack of true understanding, on my part, of what can and cannot be done by either profession. My biggest concern now is that I could invest time and $$$ only to find out that for the things I want to do, I should've pushed myself through the med school and residency.Another big (?) is "how to" on the business side. But doing OR for the most part is definetely not what I want at 100% effort. Although I realy should not say that because I've never realy done OR, esp not as CRNA. Could be the coolest thing to ever come by. And having access to the "Big Guns" Tx is sure an advantage. Acupuncture only I could do now, I already have my license for it. On the other hand FNP may turn out to be way too general and routine, and educationaly insuficient for clinical subspecialty i.e pain management. Disclaimer: I mean no offence to anyone in either profession. I admit my ignorance, and just trying to learn about them as much as I possibly could before jumping in. I have some acquantancies in both, but they are practicing in the traditional roles, and mostly as an alternative to the bedside nursing, or a paper pushing in home care. I wish I could talk to some folks who are doing something along those lines. If you happened to now someone in that field who doesn't mind sharing some practical info, please point out good old Papadoc in the right direction.

Thanks all again very much :thankya: