Here's what AAs really think of CRNAs

Specialties CRNA

Published

And this comes from the PRESIDENT of the American Society of Anesthesiologist Assistants

Again, assertions that AAs and CRNAs function at the same level -absolutely misleading.

And, what's with "anesthesia nurse"? If it sounds condescending in print, can you imagine how it would sound out of his mouth? What arrogance.

At least there is a phone number listed at the end of the article. Let's call Rob and let him know what we think of his little article!

Read carefully, SRNAs, this is a grim foreboding...

Licensed anesthesiologist assistants help access to medical care

By Rob Wagner

MY VIEW

Re: "Don't weaken the standards for anesthesia providers" (My View, April 11).

Maybe you or someone you know has had surgery delayed. Perhaps hospitals in your

area have closed operating rooms as they have in Miami, Jacksonville, Tampa and

elsewhere in Florida.

One reason for growing problems of this nature for patients is a shortage of

anesthesia providers. These are the assistants who help

physician-anesthesiologists perform the critical task of putting you to sleep

before surgery.

There is a common-sense solution rapidly making progress in the Florida

Legislature and around the country, which is to license anesthesiologist

assistants (called AAs). Key legislative action is expected today in Florida's

House Health Care Committee on HB 1381/SB 2332 and it is important that

lawmakers support it.

They need to be assured that this legislation will not weaken standards because

AAs are highly trained and perform the same function as anesthesia nurses. AAs

like myself serve patients in 16 states and have impeccable safety records. AAs

have worked with a high level of safety for 30 years in Georgia and Ohio.

AAs are required to have three times the hands-on, clinical training than are

most anesthesia nurses who currently assist anesthesiologists. Before we are

allowed to enter AA school, we must take the same courses physicians take as

pre-med students. Nurses do not do that. In fact, as the chief anesthetist at

St. Joseph's Hospital in Atlanta, I am in charge of both AAs and anesthesia

nurses.

If you are "going under," who would you rather have assisting the

anesthesiologist; someone trained to work directly with him or her, or a nurse?

We enjoy our professional relationships with our nursing colleagues. Yet nursing

organizations in Florida continue to misinform, even scare the public, calling

our profession "new" and "experimental."

Try telling that to the prestigious Emory University in Atlanta or Case Western

in Cleveland, which have been training AAs for more than three decades. Or try

to tell that to boards of medicine that oversee AAs in the states in which we

practice and whose members readily vouch for our safety record.

Try telling that to Medicare, the nation's largest health insurer, which

reimburses AAs and anesthesia nurses at the same rate. This means our skill

levels are viewed equally. And tell the insurance companies. They charge no

difference in fees between anesthesia nurses and AAs,

meaning our safety records are equal. Try telling that to the Florida Medical

Association, American Medical Association and American Society of

Anesthesiologists, whose members resoundingly support our working in Florida. In

the era of malpractice crisis, doctors are certainly not going to support

"experimental" health care providers.

Why, then, would the anesthesia nurses be opposed to this? In a word, money.

Because of nurse shortages, their salaries are artificially high, up to $150,000

in Florida. If you made that kind of living, wouldn't you try to keep the

competition out?

This nursing shortage is well documented on the Web sites of Florida schools

that train anesthesia nurses, the U.S. Department of Health and Human Services,

and yes, even on the anesthesia nurses' own Web site, http://www.aana.org, where the

shortage is called "serious" and "acute."

To help relieve the problem, two institutions, the University of Florida and

Nova Southeastern, are ready to open special schools for anesthesiologist

assistants in Florida. Would those schools offer programs if they didn't think

AAs are in great demand? Would they risk their reputations on an "experimental"

profession? Of course not.

One AA can mean five more patients per day will get their surgery. That's 1,200

patients per year treated with the help of only one AA. If you are or know one

of those patients, I'm sure you would be grateful to the Florida Legislature for

passing this common-sense legislation.

--------------------------------------------------------------------------------

Rob Wagner is chief anesthetist at St. Joseph's Hospital in Atlanta and

president of the American Academy of Anesthesiologist Assistants, PO Box 13978

Tallahassee, FL 32317 Phone: 656-8848.

Specializes in Anesthesia.
....The ASA might have tried to take control of your practice in previous years, but that's not on the table anymore. .......

Excuse me, Lizz -- there's no kind way to express this, and I really do not wish to sound offensive to you -- but you apprently don't know what you're talking about.

The A$A bought entry into Florida for their AA lackeys with hard cash. Read the Palm Beach article:

http://www.palmbeachpost.com/opinion/content/auto/epaper/editions/tuesday/opinion_04175f9ff233c01e00db.html

deepz

Deepz, I was referring to this quote from Loisane:

ASA tried for decades to gain complete control of nurse anesthesia practice. They are driven by many motives. Power, greed, and maybe even the honest belief that anesthesia really is the practice of medicine. We have successfully fought them off at every turn. The latest round was the supervision regulations. They decided then to try an alternate approach.

If they could not be succesful making CRNAs the type of dependent practitioner they wanted, they would create/promote another type of provider. One that is more congruent with their philosophy.

loisane crna

Specializes in Anesthesia.
Deepz. I was referring to this quote from Loisane:

It's an ongoing struggle, Lizz, the A$A power grab; that's my point, not, as the saying goes 'past history,' but *present* history. Thanks for clarifying.

deepz

Its funny to me. Some AA's seem to feel like they provide very good anesthestic care, which they might do. All us CRNA's seem to feel like we provide quality anesthetic care, which we hopefully do. At least Georgia AA seems to feel like he can stand his own independantly, but like he said likes to have a safety net around, like we all do. Both AA's and CRNA's make considerably less than the MDA. If all supposedly provide quality anesthetic care but the MDA costing more money, phase out MDA's and CRNA's and AA's can work together.

I know I know that AA's by law must be under and MDA but if all provide safe care, who needs the MDA?

If, by chance, the ASA floods the market with AA's, that's life. It's called capitalism. The same capitalism that provides the great salaries for CRNA's. If all you can do is whine about the competition, you're going to lose.

Excuse me, Liz, but I tried to make it clear I was speaking to philosophy and personal professionalism. I am not making a case here for the media or legislators. I would present that in an entirely different way.

And health care is not completely ruled by market forces that define pure capitalism. There is the artifical influence of legislation and regulation that alters the picture from what it would be if market influences were the only consideration. Interestingly, there are CRNAs who are not the least bothered by the prospect of AAs, because they believe CRNA practice to have advantages that will naturally "win" because of these very same market forces of capitalism.

Are you a nurse? My position is grounded in my view of professional nursing and its role in health care. Wouldn't any nurse like to see a group of advanced practice nurses who have practiced with autonomy for a century retain that scope of practice? Wouldn't any nurse like to see that protected, and maybe trickle over to other (appropriate) areas of nursing?

But I agree with you about salaries. It bothers me to see people look at this issue completely as "How will this affect me and the money I make". I did not go into nurse anesthesia for the money. None of us who have been around awhile did, because back then the money was not really there like it is now.

Actually, I believe it is this same "I, me, mine, show me the money" that ruined anesthesiology, and is now threatening to ruin nurse anesthesia. But I guess that is another thread.

loisane crna

Excuse me, Liz, but I tried to make it clear I was speaking to philosophy and personal professionalism. I am not making a case here for the media or legislators. I would present that in an entirely different way.
And health care is not completely ruled by market forces that define pure capitalism. There is the artifical influence of legislation and regulation that alters the picture from what it would be if market influences were the only consideration. Interestingly, there are CRNAs who are not the least bothered by the prospect of AAs, because they believe CRNA practice to have advantages that will naturally "win" because of these very same market forces of capitalism.

well said....

just for the "record" - i don't believe it was any of the CRNA/SRNA's that brought money into the discussion...it was others stating that was our motivating factor in this debate...i didn't go into this for the money (i will not lie and say it doesn't make it more tolerable...buy anyway...) - i went into it for the advanced education, the advanced training and the chance to treat my patients one on one which is nearly extinct in anyother nursing realm.

i think that all of us have made very valid points for why we will continue the fight in the use of AA's (sorry Georgia...)

I have an idea on how the AANA can stop the whole model of an "Anesthesia Team" where the MDA "sits in his office and "checks the stock ticker". If evry CRNA refused to work for an MDA and only practiced on there own or in CRNA groups there supply of AAs could not fill the void. And the AANA could force the MDAs into not supporting the legislation for AAs and kill off the profession. And I am guessing that the AANA (or specific regulating body) has the power to pull or refuse to renew the license for any CRNA tries to work with a MDA. It has been said many times that there is plenty of demand for anesthesia, so why not make a play and force the removal of the entire AA issue. And next year once this is done we can use the same power to push all of the medical schools (that are turning out those pesky MDAs that compete with us) to convert their Anesthesiologist programs to CRNA programs. Then we will be unstoppable!!!

i also think there is no reason to be absurd in the matter......

i will say one thing to you lizz...i remember when i was younger..i too believed that "there was always a better way"...but then real life slapped me in the face and i realized that you cannot fight deceptive maneuvering with good hearted hopes. for USER69- when i spoke of "them" - i was referring to the ASA and the power that lies therein.

It isn't about money...it is about our patients - and the fact that they deserve to know who is really caring for them - and what experience they bring...and LEGALLY who can provide the most comprehensive responsible care.

I am about ready to see this thread die. its getting run from the global allnurses.com body.

all in favor.

Specializes in Anesthesia.
......I know that AA's by law must be under and MDA but if all provide safe care, who needs the MDA?

You've touched on the deepest level of the conflict, Ducky. Who does need them? Bar none, the worst behavior I've witnessed over the years is the blatant HYPOCRISY of certain MDAs. Say one thing, do another. When the gullible are watching, the MDAs're all "We're so indispensable, keeping a close eye on these 'nurses.' Take our word for it -- we're doctors!" When the public's back is turned, however, they're off 'supervising' from the golf course.

They know that we CRNAs see through their BS. We all know who does the real work. It's our shared 'secret' -- something akin to the way pedophiles have 'secrets' with their victims. Don't tell, or else. They have the power to fire us on a whim. And they do. They also pocket the major share of the cash. Yes, it's fraudulent. All of which drives them to resent us at the same time that they exploit us. It's truly sick.

Of course MDAs'll always be around. Joe Sixpack's unfounded presuppositions of physician superiority over nurse practitioners will guarantee that. And truthfully we do need them, in certain places on occasion, for their input in that one in a thousand or ten thousand cases complicated patient, to oversee management of perioperative problems. Do I think I'm a peer of anesthesiologists? No way. I may be a colleague of sorts, providing the same services in the OR with the same high quality (or better), but being a colleague in anesthesia in no way makes me the equal or the peer of an MD. Just as AAs are not the equal of CRNAs.

I'm a simple CRNA, that's all. No more than that. AND NO LESS. 'Anesthesia nurse' I am not, thank you very much. Does the phrase 'where the sun don't shine' ring a bell? Having seen so much of the hypocrisy and the fraud prevalent in the closed environment of the OR, I have no need to be anything more than a simple anesthetist ... off on my own. Occasionally I work alongside anesthesiologists, but not under them, and we get along great. No supervision for me, thank you; I've had all the hypocrisy I can take. (Burp)

JMHO

deepz

When the gullible are watching, the MDAs're all "We're so indispensable, keeping a close eye on these 'nurses.' Take our word for it -- we're doctors!" When the public's back is turned, however, they're off 'supervising' from the golf course.

Of course MDAs'll always be around. Joe Sixpack's unfounded presuppositions of physician superiority over nurse practitioners will guarantee that. And truthfully we do need them, in certain places on occasion, for their input in that one in a thousand or ten thousand cases complicated patient, to oversee management of perioperative problems. Do I think I'm a peer of anesthesiologists? No way. I may be a colleague of sorts, providing the same services in the OR with the same high quality (or better), but being a colleague in anesthesia in no way makes me the equal or the peer of an MD. Just as AAs are not the equal of CRNAs.

deepz

THis paragraph clarified some issues for me. I think that you made a good point with the fact that MDA's will be needed for the paitient that has multiple perioperative issues that are complicated and rare. in this arena the CRNA is not the "equal" of a doctor, just as the AA is not going to be the equal of a CRNA in most perioperative issues because of their lack of training and experience outside of the actual anesthesia administration. I know i never thought of it this way before, so thanks! Also i really appreciate losianes posts for their clear establishment of the issues.

Yes Alansmith, I agree with you. It is getting overrun by the "global allnurses.com network." Some posters are making remarks that make no sense. While I am a nursing student just finishing my ADN, I went into nursing for the sole purpose of pursuing a career as a CRNA. This forum and its continuous availability has been of great value to me. I appreciate Georgia bringing "the other side" to the table. It's been very enlightening. Thank you Georgia. To be honest though, I do view your job as a threat to my future career. As many have stated, I am sure you are quite competent in what you do. I harbor no ill will towards you as a person. I do believe I would be naive in saying that we can all work side by side down the road- no troubles. However, I will be hard pressed to work in a hospital that employs AA's because I do want to protect my job. Once I'm in the door and they bring them on later, well we'll cross that bridge when I come to it. But for me personally, it's job security - nothing more, nothing less. And I hope nobody in their right mind misconstrues that statement. Of course, patient safety is always number one. But we as professional nurses (or soon-to-be thereof) know that's a given. It really shouldn't even have to be brought up.

One last thing - there are so many of you in this forum that are personal mentors to me and you don't even know it - alansmith, loisane, athomas91, that's just to mention a few on this particular thread. I enjoy reading and learning from your comments here. No need to thank me - just keep posting.

Theresa

they know that we crnas see through their bs. we all know who does the real work. it's our shared 'secret' -- something akin to the way pedophiles have 'secrets' with their victims. don't tell, or else. they have the power to fire us on a whim. and they do. they also pocket the major share of the cash. yes, it's fraudulent. all of which drives them to resent us at the same time that they exploit us. it's truly sick.

did you really just compare mdas to pedophiles? i can see you read the book how to win friends and influence people.

have to applied for a position on the aana lobbing team?

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