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.
... i went into medicine to help people... if that meant changing their sheets because they were sitting in poop... then so be it...

OMG ... tenesma and I agree on something. Unprecedented. It must signify the end of this thread. Where's my merlot?

deepz

Historical point, the A$A was not incorporated until 1937, even though they like to claim 1905, when the Long Island Journal Club, or some such local entity was founded. Typical exaggeration from the OneUpManship mentality of the A$A leadership.

deepz

Let me divert the thread.. AMA is considering FMG (Foreign Medical Graduates) (IMG to be politically correct), that do not meet standards for an internsahip in the US to get licensure, for rolls in medicine. Possibly working as NURSES. in the US and Canada, due to the Nursing shortage. Lab techs, etc. Not sure what mechanism would be used to verify their skill levels, or even aptitude.

But it is being talked about. These are DOCTORS in their own countries that will be stepped down in STATUS to the roll of nurse. Talk about attitide problems? skill deficits?

Just something to think about and Look out for.

http://www.asianlabour.org/archives/000813.html

http://www.inq7.net/globalnation/sec_new/2004/feb/09-01.htm

http://www.malaya.com.ph/mar05/edtorde.htm

http://www.parl.gc.ca/committees/simc/evidence/06_95-05-10/simc06_blk101.html

Let me divert the thread..

Careful Swumpgas! People here are not quite as responsive to the "stream of consciousness" method of discussion, as you and I are used to in other areas of cyberspace ;-). Hehehe. Here, when things get "off track" (that is what they call it), somebody will start shouting to start another thread.

loisane crna

we're on a road to nowhere... :chuckle:

where are we going? :coollook:

as far as ER/pulmonology/Interventional cardiology... they are far from being as good at managing a crumping patient than an anesthesia person... without a doubt... I freakin' have to fix their messes and save their asses on a daily basis... sigh

deepz.... Coppola makes a great merlot for under $20

london.... ACLS training dictates that you initiate your protocols and call for help... if they are asystolic then you pace, if they are asystolic because of pericardial tamponade, i will place the drainage catheter --- teamwork!

Careful Swumpgas! People here are not quite as responsive to the "stream of consciousness" method of discussion, as you and I are used to in other areas of cyberspace ;-). Hehehe. Here, when things get "off track" (that is what they call it), somebody will start shouting to start another thread.

LOL - that's what you get when you put 20 type A's in the same cyberroom...LOL (me included...)

deepz.... Coppola makes a great merlot for under $20

agreed...

Let me divert the thread.. AMA is considering FMG (Foreign Medical Graduates) (IMG to be politically correct), that do not meet standards for an internsahip in the US to get licensure, for rolls in medicine. Possibly working as NURSES. in the US and Canada, due to the Nursing shortage. Lab techs, etc. Not sure what mechanism would be used to verify their skill levels, or even aptitude.

But it is being talked about. These are DOCTORS in their own countries that will be stepped down in STATUS to the roll of nurse. Talk about attitide problems? skill deficits?

Just something to think about and Look out for.

http://www.asianlabour.org/archives/000813.html

http://www.inq7.net/globalnation/sec_new/2004/feb/09-01.htm

http://www.malaya.com.ph/mar05/edtorde.htm

http://www.parl.gc.ca/committees/simc/evidence/06_95-05-10/simc06_blk101.html

FMGs have to attend college for two years and have to sit for the same NCLEX exam. This doesn't get waived for them. Florida actually has several programs. The Philippines also offer an MD-RN program............The AMA doesn't control the ANA.

Being a doctor in many other countries is equivalent to being a nurse in the US. In many other countries the nurses are not supposed to use their brains.

Here in Thailand, the doctor is responsible for doing the assessment on the patient, not the nurse. The doctors on the medical units place the folet catheters, not the nurses. The doctors draw all of the blood cultures. Over here, schooling for a doctor is 6 years in a combination program after high school. A nurse with a MSN is also the same time. So they really aren't very different. The nurses here are all licensed midwives. They actually do almost all of the deliveries at the government hospitals, the doctors only do the problem patients or per request at the private hospitals. Government hospitals account for about 90% of the hospital beds.

Tenesema,

I believe we are in agreement!

Let me divert the thread.. AMA is considering FMG (Foreign Medical Graduates) (IMG to be politically correct), that do not meet standards for an internsahip in the US to get licensure, for rolls in medicine. Possibly working as NURSES. in the US and Canada, due to the Nursing shortage. Lab techs, etc. Not sure what mechanism would be used to verify their skill levels, or even aptitude.

But it is being talked about. These are DOCTORS in their own countries that will be stepped down in STATUS to the roll of nurse. Talk about attitide problems? skill deficits?

Just something to think about and Look out for.

http://www.asianlabour.org/archives/000813.html

http://www.inq7.net/globalnation/sec_new/2004/feb/09-01.htm

http://www.malaya.com.ph/mar05/edtorde.htm

http://www.parl.gc.ca/committees/simc/evidence/06_95-05-10/simc06_blk101.html

Foreign docs will never be allowed to work as nurses in Canada without going through a nursing program. Foreign nurses have a hard enough time getting lisenced, so it isn't something I'll worry about any time soon.

Specializes in Anesthesia.
Tenesema,

I believe we are in agreement!

Good Lord, this phenomenon is rampant!

deepz

from "athomas91": "(didn't know that - thanks for the education)"

from "nilepoc": "how long did it take for you to feel comfortable caring for patients with multi system disease? i know that the time i spent in the icu prior to entering crna school really helped me attain this comfort level." perhaps this individual (like many others i will presume) is resentful because aa's do not require a year or more of icu experience or time expended really. moreover, not everybody will need 1 or 2 or 3 or etc., ect., ect years of experience to achieve this comfort level. for an example consider "athomas91" whom states; "the thing that bothers me is that i have to have a bsn in nursing, years of critical care experience, and another nearly 3 years of intense training". also consider "ether": "by way of the four-year bsn i am working towards and after some time in the icu, i feel i will be prepared to learn the scope of anesthesia.....however, i will be doing my time as an rn until i'm accepted - this goes for many other nursing students." i haven't seen anybody make the same argument towards physicians. they too do not have years of icu experience when they become residents and eventually anesthesiologists. or are most people here suggesting that the crna tract is the only way to train for proper administration of anesthesia? moreover nilepoc, athomas91 and ether how do you feel about np whom can enter directly into an anp program without years of training?

from "deepz": "civil? when georgiaaa posts a veiled threat to invade my state? don't make me laugh. folks, there are merely a few hundred aas ... and 31,000 crnas. bring it on." yes, a few hundred aa's and 31,000 crna's but lets keep it in prospective won't we. crna's have been around since 1861 and aa's only from the early 1970's. naturally i would expect more members in an organization that is over a century old. aa's are a young virgining organization with vigor and full of promise. i love a challenge. check yourself again against in a few years.

from "angel337": "crna's have to be competent or else they wouldn't be in the or." if we may, lets extend your logic to aa's. since aa's are in the or aswell then by your rules of logic aa's have to be competent.

from "athomas91": "i am sorry to hear the practice of the crna's in georgia are so restricted...no subclavians etc...." when the crna profession was young they too had many restrictions. our profession is a young one and making progress by leaps and bounds, state by state. watch us grow.

from "athlein1": "lbhot, i hope you clearly see that there is more difference than job outlook. but since you asked, the last time i checked www.gaswork.com, there were 1138 jobs posted for crnas (obviously, some may be repeats, agency, etc). there were 3 aa postings. aas are not pas. they can practice in a limited role in a minority of states in this country." keep in mind what your crna peers keep repeating--we've been around for over 100 years. i think this fact has more to do with it than with the number if job posting on gasworks.com. a more realistic appraisal of job outlook would include job offers of recent aa graduates. i'd guess 100% placement most with job offers before graduation. keep watching gasworks.com and watch the aa job posting grow exponentially.

from "gregsto": ""an aa will do nothing unless he is directed to and a crna will do everything unless he is directed not to." (use she if you like) truely this can describe the practice situation i found myself in. this is not to slight aa's, this is simply the way their training is designed......extreme restriction of practice" also "deepz": says "so, as the saying goes: you want to be my equal?" this is the major point pro-crna's have been harping on. but by an large the arguments are mere semantics. for all practical purposes aa are supervised little more than crna's and the daily routine for both professions for all intents and purposes are alike.

from "swumpgas": "surgeons have said for years tha monkeys can be trained to do anesthesia, maybe a bit of exaggeration, but just as the mda's tout a background in medicine is needed for anesthesia, it also applies to aa's with no background in medicine, or medical science. you are and will always be technicians, or "bag squeezers". serving at the whim of your overseer. doing their bidding. asking permission" this statement is wrong at so many levels but it reflects this persons "dumbness" for lack of a better word. this is what aa training is for, to gain experience not unlike medical students whom have to start somewhere. perhaps swumpgas is resentful (the common denominator amongst crna) because we can't, well to put it in his words "can you give an enema and not have the sheets all discolored?" lol. you know, it just occurred to me. i don't believe that one of the prerequisites for crna is to "give an enema and not have the sheets all discolored" or is it? i believe this hostile resentment is rooted in the fact that although aa's perform the same duties and get paid as well as crna's, aa's did necessary attend nursing school or are rn's . don't forget that a bachelors degree is required for admission to an aa program. correct me if i'm wrong but it wasn't too long ago when crna's only required certification beyond rn training. aa's school will also come into favor and will continue to evolve.

from "athomos91": "and i bring that to the table prior to any anesthesia training...but some try to tell you that their english major plus their anesthesia training makes them my equal...wrong answer." do you think a nursing degree makes you better qualified to administer anesthesia? i don't think that all of your crna colleagues would agree because many have achieved an associate degree and rn certification only. in fact, most crna schools will accept merely rn certification and an english bachelors degree will do just as well as a bsn.

from "smiling ru": "a nurse anesthesia student starts the program with a great deal of education and experience in the medical field. they all understand medical terminology, how to chart appropriately. various disease processes, their effects, and treatment. pharmacology, lab interpretation, ekg interpretaion, ventilator strategies, acls, pals, cpr, sterile technique, this list could go on and on." this point is shared by deepz and others i'm sure. in case all of you have forgotten, you are no longer is in the er, medsurg floor, icu, ccu, etc., ect., etc. by and large your daily routine consists of bread and butter cases, ortho, cardiac, well name your specialty. in any case, 98% of the surgeries are scheduled, sometimes weeks in advance. your job is to anesthetize a patient and keep him/her stable. you are no longer dressing wounds, administering meds., etc., etc., etc.. it is a very constrained and controlled situation. yes nursing will teach you a lot but how relevant is the proper turning of a patient to prevent bed sores, etc.. or consider this: when was the last time any crna or aa had to insert a catheter while the patient was undergoing surgery and under anesthesia? or when was the last time a crna or aa had to dress a wound while a patient is under anesthesia undergoing surgery? i could go on and on with examples. name your floor and i will give you scenario ofter scenario were procedures are not utilized in the or. although these are important skills they have little practical use in the or. as a crna, you have chosen to specialize. with that comes many new skills learned and many old skills less utilized or obsolete altogether. keep in mind that my assersions are generally true. there are exceptions i know this. i don't care to nor will respond to "your experience or training". i am not implying that crna's don't utilize their training as a nurse. far from that. i know that nursing skills are utilized. i do believe though, that to be profecient as an aa i don't need a lot of the nursing skills learned in nursing school. i will learn to be profecient in the or through the aa training curriculum.

i believe it boils down to two things: competition for jobs (which effects salaries) and the sore subject that nursing school and "having paid my dues" isn't a requirement to do the same job (forgetting that aa school requires a 4 year degree to apply). we've paid our dues too and no you won't have the job vacancies to yourselves. face it, an aa is trained to be competent and proficient in or environment. anti-aa can talk all you want but you can't turn the tide. the aa profession will flourish. it is inevitable, in fact it is imminent. the confirmation is in the state statues that continue to come to fruition. this "i don't require supervision" stance is so elementary, ineffective and unappealing. i completed 6 years as a combat medic in the navy attached to a special forced unit. i'm not impressed with taking or giving orders. i want to do a job and do it well. there is a slight difference in the two titles (spelling) but the daily routine is the same. i don't feel inferior in any way because i will be "supervised" by an anesthesiologist. i hardly think "supervision" a burden. the job is challenging, the environment is stimulating and the pay is good. earlier on these posts i noticed some crna/srna individuals who suggested a get together of the pro crna and pro aa people get for a "discussion". i welcome that invitation. considering geography would prohibit a face to face discussion (at least for the time being), a chat over the telephone would be just as stimulating. if there are any takers, contact me via private email. i'm sure we can arrange, in a discrete method a time to talk and discuss these matters further so as to not disclose telephone numbers to the general public.

they too do not have years of icu experience when they become residents and eventually anesthesiologists. or are most people here suggesting that the crna tract is the only way to train for proper administration of anesthesia? moreover nilepoc, athomas91 and ether how do you feel about np whom can enter directly into an anp program without years of training?

noone is suggesting that crna training is the only route - just that it has better prepared practioners at the starting line - i don't agree w/ any advanced practice nurse that has obtained a degree w/o prior patient experience. if you are reasonable and logical in your thought process - it would occur that prior experience w/ patients, disease processes, medications, invasive lines and monitoring, reading and evaluating ekg's and lab work can only make you better. noone said (and if you would have posted my entire posts) that aa's aren't capable - but that they are limited as compared to a crna.

when the crna profession was young they too had many restrictions. our profession is a young one and making progress by leaps and bounds, state by state. watch us grow.

when the crna profession was young - what - 100 years ago?!?!?! you are remiss in your history of anesthesia if you fail to mention that nurses began the art of anesthesia and trained physicians....

do you think a nursing degree makes you better qualified to administer anesthesia? i don't think that all of your crna colleagues would agree because many have achieved an associate degree and rn certification only. in fact, most crna schools will accept merely rn certification and an english bachelors degree will do just as well as a bsn.

of course having nursing experience gives one an advantage - for 7 years i have been doing iv's - dealing w/ cardiac meds - treating patients.....all of which adds to ones knowledge base and prepares one to deal w/ emergencies when they arise. your statement makes no sense...an rn w/ an associates degree can have the same work experience a bsn prepared rn can have...that was not the point of the statement - if you bother to read it thouroughly you will see that the point was someone working as a nurse rather than an english teacher will have a better clinical grasp of anesthesia.

unfortunately you have failed to read the good comments in many of our posts - but that is your issue - not ours...do not expect to come to a nursing discussion and for us not to be very pro-nursing....it only takes a small use of the noodle to figure that one out. it doesn't boil down to job security - because i can practice in places where you cannot (like in the military overseas as a single practitioner)...it boils down to the asa wanting to keep control of the money flow ... i have no problem w/ aa's who function w/in the guidelines set...but frequently those guidelines are too loosely followed - but you won't have to worry - you won't be held legally responsible - the mda will. if you want to talk money - lets....why pay for 8 aa's and at least 2 mda's...when you could hire 4mda's and 4crna's - monetarily speaking that would be the most fiscally responsible hiring ratio...or even 2 mda's and 6 crna's ....still 2 less employees...if you think all we do are bread and butter jobs..you should rethink ...i am sure that most aa's are very competent and skilled practitioners...but there is no way a provider w/ patient experience cannot be superior at the get go - f you argue that (which even georgia aa conceded to) then you are just being dull. and if you were in the military...and had all this training - they of course encourage the nurse and crna route...couldn't you get in??

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