Here's what AAs really think of CRNAs

[Athlein1]

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 malpractice insurance 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: [phone].

[ken-pin]

What a refreshing post....a joy to read!

As a future CRNA, hopefully anyways, thanks so much for your keen and sometimes funny insight. It has that beautiful ring of truth to it.

-ken

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

This is bound to make a lot of eyeballs roll back in a lot of heads, but ya gota understand the history of Nurses in anesthesia and MD's in anesthesia.

I'm sure anyone knows that early anesthesia was traditionally done by Nurses.. They were more "Vigilant" (attentive) than the residents and interns , then came the surplus MD situation.

It's a matter of control. CRNA's on a day to day basis "witness" the clinical skills of Anesthesiologists, (from now on MD-A for short)

These are the guys that are supposed to be our superiors.. and in many cases, they are good.. not superior, but at least equal.. Then there historically has been the Foreign Trained MD that chose Anesthesia, because they could not speak enough English to enter private practice. Their skill level might have been good, but their other skills lacked.

For years MD-A's were looked down upon by their surgeon colleagues for some of those reasons.

And at the other extreme is the MD that is not trained in anesthesia at all, possibly taking a rotation in anesthesia for a few months, then calling themselves an Anesthesiologist. They are still out there, maybe as a GP doing anesthesia ,to a lesser degree, but still mucking about. Then there are the ones that cannot pass their boards in anesthesia, but call themselves "board Eligible" and work as MD-A's.

Now this fussin has been going on for at least 40 years that I have been passing gas and longer between CRNA's , that usually come from the tops of their classes, are somewhat over achievers, and clinically excellent, in comparison with some of the older so called MD-A's that just squeezed through med school.

The issue now is about control of anesthesia provision and competition, by the MD-A's, that by law, and standard practice have no real control over CRNA practice. CRNA's are technically supervised by a surgeon, as part of a team effort in most states, but Surgeons do not know a lot about modern anesthesia . It's about all they can do to stay on top of their own Board requirements.

So the CRNA-AA fuss stems from the CRNA / MD-A control issue. They have been unsuccessful in legislating control over CRNA's, so they have created their own Newtech Anesthesia provider.. The Anesthesia Assistant. And these folks have put down their sliderules from engineering, Botany, Chemistry , etc degrees, and come into a patient care field without any background in human science (eg Nursing background-- remember all the hoops you all had to go through, taking care of patients? Enemas till clear. talking to the family of a child that just died, Psych and OB training, etc,wrestling with the drunk in ER, and worse as part of your nursing backgrounds? )

This is not a put down of Anesthesia assistants, they have just been sucked into the CRNA MD-A turf Battle... All proposed legislation to permit Anesthesia Assistants to work has required that they be SUPERVISED by an MD-A--- talk about built in control..

there is NO requirement in ANY state that a CRNA must be supervised by an MD-A , but MD-A's would love this requirement, and control.

There is an old saying among CRNA's , that we all get smarter at 3:30, when the MD-A's go home, and we are left there by ourselves, finishing the schedule, or being on call the rest of the night, with no supervision..

The Anesthesia Programs at Emory and other places, were started as a direct attempt by MD-As to gain control over anesthesia. Note, it was not mentioned that the MD-A's actually do the cases, Lord no.. that would make it difficult to sit in the lounge and watch the stock ticker and eat donuts..

I do not really have a problem with AA's, but again I do not personally know any. They may be the greatest people in the world, I don't know. I do know, that by law, their wings are Clipped,, they may not make independent decisions , insert invasive cardiovascular lines, do regional anesthesia in most situations (another facet of "Control")

God forbid the MD-A should be stuck in the bathroom or have an MI and they had to make a clinical judgments, that is not in their armamentarium.

When I have my next surgery, I want my anesthesia done by someone that can give me an emergency enema if needed, without calling an MD-A for advice.

Oh yea, someone made the comment about the US being the only place that uses CRNA's... Untrue, and it is being experimented with in England, Australia, Canada, and many other places that have traditionally had only MD-s Doing anesthesia.. they are beginning to see the light..

Many Anesthesia Assistants are trying to pass themselves off as Physician's Assistants. The Nation Physician Assistant Assn, states in no uncertain terms, that Anesthesia Assistants are NOT the equivalent of Physicians Assistants.

http://www.aapa.org/gandp/aas2.html

You can see Emory's evaluation of the 2 on their own web site

http://anesthesiology.emory.edu/PA_Program/whatis.html

As nurses you have seen the good and bad Physicians. And the control issues. This is what I all comes down to. Control and MONEY..

I'm done ....you can wake up now..

[Athlein1]

AA2B,

Your arguments are too weak to merit much of a response. It's interesting that the only part of my viewpoint you care to address is the number of postings on gaswork.com.

Seems no one from the AA camp wishes to dispute the facts that have already been presented in this discussion. I will give a quick re-cap for the sake of clarity:

1. AAs and CRNAs are not interchangeable, as CRNAs are able to practice independently by virtue of their training.

2. CRNAs have the distinct advantage of prior training in nursing and patient care, at least initially, and arguably for the remainder of their careers.

3. CRNA and AA salaries are comparable in some markets with the anesthesia care team model, but this is an absolutely untrue generalization. I know many CRNAs whose salaries are double, even triple, that of an AA or CRNA in a team setting. AAs will not be able to raise their salaries to that level because AAs cannot bill, nor can they work independently.

4. AAs are not the solution to this country's "anesthesia provider shortage", as your national organizations assert, because AAs must have a physician supervisor. Physicians do not want to work in the settings with the greatest need for anesthesia providers, such as rural areas, communities with poverty, and disadvantaged minorities. Therefore, AAs cannot be the solution to this situation.

5. AA practice has recently been significantly restricted in one of the states with an AA program. CRNAs practicing in that state were not similarly restricted.

And, as a side note:

AA's are a young virgining organization with vigor and full of promise

"Virgining"? What the heck is that? I don't mean to be a snot, but if you're going to practice those GRE words, try to use them correctly. Might you mean burgeoning?

[nurseunderwater]

AA2B,

And, as a side note:

"Virgining"? What the heck is that? I don't mean to be a snot, but if you're going to practice those GRE words, try to use them correctly. Might you mean burgeoning? :rotfl:

:rotfl:

omg.... :chuckle

[AA2B]

and, as a side note:

"virgining"? what the heck is that? i don't mean to be a snot, but if you're going to practice those gre words, try to use them correctly. might you mean burgeoning?

athlein1 it is your argument that is weak. i addressed your point of view regarding gasworks.com only because your other points had already been expressed by your fellow crna's, which i responded to. you and your fellow crna's ask redundant questions. the anti-aa questions and statements are addressed by others and myself with relevant and valid information but the anti-aa continue just as if they hear nothing; thus the redundant questions. you can expect more redundant questions in future posts. i suppose purposeful ignorance will provide temporary comfort and security but sooner or later you will have to face reality. so consider my other points, they will apply to you as well. moreover, your reasoning consists of nothing more than finding excuses or exceptions to go on believing as you already do (the lot of you anti-aa's). your itemized statements (1-5) are mere assertions not accepted practices. regardless, i did say in my last post that there were exceptions to my statements but for the most part there is little if any difference in the daily routine of a crna and an aa. i think you would serve yourself well if you studied my post. if you would like to discuss any point with substance my offer stands, contact me via private email. we can arrange for an amicable discussion. but if you want to squabble over trivial differences in point of view, don't waste your time. like i've said, this is petty and i don't have the time or the inclination to address everybody's unique "experience". and for your information i did mean virgining! it was a metaphor but you need it spelled out, don't you? well, at the risk of sounding sexist here goes. the metaphor was between the crna profession and the aa profession in that although age can have significant benefits, so can youth. a prime example would be a spouse or significant other. would you prefer your spouse to be 143 years old or would you prefer your spouse to be in her/his prime 30's? now, i know my point of view is not popular here or will even fall into favor but i won't respond to anymore discord. best regards and enjoy!

[todabnrn]

AA2B

Just one quick question. If AA's are such a great idea.........and correct me if I'm wrong.....have been in existance for 30+ years..........why is there only two schools? How long does it take for the the school to "come into favor"

just a thought

[Sheri257]

If AA's are such a great idea.........and correct me if I'm wrong.....have been in existance for 30+ years..........why is there only two schools? How long does it take for the the school to "come into favor"

just a thought

It probably wouldn't make sense to have many schools since AA's are only licensed in a few states. Afterall, why would anyone want to set up a school in states where AA's can't practice? And, of course, CRNA's have fought the licensing efforts so, with few states on board, there probably hasn't been much incentive for new schools.

If AA's are more successful with the licensing effort, that may change. Since Florida now allows AA's, there are plans for two new schools there, and the Louisiana AA bill also includes support for a new school, if it becomes law.

[todabnrn]

"It probably wouldn't make sense to have many schools since AA's are only licensed in a few states".

Why is this? Again, if they are such a good idea why are there not more schools?

[jewelcutt]

How could I not reply to this thread since every one involved in this forum would have to in order to create 22 pages :chuckle. I am so tired that I couldn't get through all of them. I have really enjoyed loisane's posts because they are right on the dot. It should be in our nature as nurses to fight for our professionalism because we distinguish our practice separate from that of medicine.

It is insulting to us to be compared to AA's as equals because of our experience. Bsn's are required in addition to gen chem, micro, biochem, math, nutrition, etc to take pathophys, pharmacology and numerous nursing classes that teach systems and disease processes throughout four years of schooling. We learn every in and out of the human body and mind, that's why we are proud to be nurses. Then we are required to spend years in critical care where we are, in actuality, independent providers, ie, the sh#@ goes down and we are the first ones there. We understand PA cath monitoring, how and when to give all meds, when and why a patient is crumping. We join professional committees, organizations, and participate in numerous continuing education activities. Working in critical care is like going to school, you are always learning (certifications, classes)! Because of this training taking care of patients is ingrained in our souls, we instinctly act.

And we do all of this before even applying to CRNA school.

Next we take additional classes before applying to CRNA school (here's your oh-so-precious "premed" classes that obviously deem you superior to all others not having had 3 credits of undergrad physics). Most schools require physics, organic, statistics. Then we take additional graduate courses to make us look better candidates. We then pursue and intense 2 1/2 year program in anesthesia. So up to this point we have fours years (at least) of BSN learing about health, humans, pathophys/ 2-3 years of critical care nursing experience (not including those who worked elsewhere first) of learning how to become a professional practitioner/ extra time on classes to be admitted/ 2 1/2 years of crna school. This equates to approximately 9 1/2 years of hard work for us to become a CRNA. granted some may do it a year or so less but that's not the majority.

AA's can have a bachelors in anything, as long as they have core courses, with two years of AA school with no previous training in the medical field. They could literally walk into school without never having touched or seen a patient before, and everything they learn about a patient is during two years. I'm not putting AA's down, but I simply don't want my education compared to that of theirs. I have worked soooooooo hard to get into school, I cannot even begin to explain how much I've grown just becoming a nurse. And I know every nurse out there feels the same way and will defend our professional standards.

As Lizz states previously, she's only concerned about outcomes. Well licensure and training should be your first priority. Hell, why don't we cut med school down to 2 years and residency programs to 1 year as long as we have the same outcomes. Experience accounts for a lot.

[SnowymtnRN]

WOW, this article was pretty strong in its message to nurses. That is...you are no longer welcome in the "realm" of anesthesia delivery. Truth is no AA or MDA can produce any reliable, verifiable study that clearly demonstrates an increased hazard to pts. having surgery under the care of a CRNA. The cold fact is that MDA' not CRNA's are terrified of losing their grip of anesthesia profits and could care less about pt care. This reality is borne out of the hundreds of thousands of dollars spent by MDA organizations to buy off senators and congressman to support legislation to keep CRNA's from directly billing Medicare and MDA's supporting other efforts at the federal and state levels to maintain a physician supervision requirement for CRNA's delivering anesthesia care. The policy of requiring physician monitoring of anesthesia delivery by CRNA's only increases the amount paid by insurance companies and Medicare because these physicians are billing for services they are NOT providing. Since when have you ever heard of a MDA making 500k to 1m dollars a year ever care one bit about the patient on the table. This can plainly be seen by the MDA' support of AA education. The AA works for the PHYSICIAN. This person's role is to collect data about the pt, maybe even start an IV. Are we really going to hand over care of our loved one to a person who's primary undergraduate education may have been music, art or phys Ed??? A person with no REAL experience in health care? Truth is, nurses are highly educated individuals who must fiercely COMPETE for entry into any CRNA program. Their primary undergraduate education is in health care, pharmacology, and nursing process. Nurses spend a lot of time, money and FREE work (nurses don't get paid for clinical like residents) getting there education in a field that they were drawn to, not out of a love for money, like MDA's, but rather a commitment to there fellow man and a sense of advocacy for what amounts to helpless humans laying on an operating table. The article states that CRNA's are getting paid too much for their care in the OR. Reality, $150000 is CHICKEN FEED compared to the amount of money any hospitals or MDA for that matter is making on a case by case basis. Don't take my word for it!! Ask you local hospital how much money they make in a year for anesthesia delivery, then ask them how much they pay their CRNA's. Don't have the exact figures, but I suspect that their labor costs in this are run roughly 15-19%. Let's not forget nurses have been SAFELY delivering anesthesia care for over 90 years. The only reason physician began this practice was to generate another line of profit for themselves, NOT to create more access or safer care. Finally, if one wants a real eye opening experience as far as anesthesia care goes, spend some time in an ICU. No really. Spend some time there. I think you'll find, as I have, that many times, cases are brought back to ICU not PACU because its getting late and some MDA has a golf or softball game to get to. Pt's are not stable, can't get any orders for fluids or drugs to keep em going, or my favorite activity, the old perioperative "lets guess how much fluid the pt lost" game. Sound like patient advocacy to you??

[Sheri257]

As Lizz states previously, she's only concerned about outcomes. Well licensure and training should be your first priority. Hell, why don't we cut med school down to 2 years and residency programs to 1 year as long as we have the same outcomes. Experience accounts for a lot.

Actually, as far as patient outcomes, I was referring to how legislators and other outsiders might view the issue. However, since you mention experience and training, I think the D.C. CRNA's have developed a better approach. Instead of trying to eliminate AA's, they want to require that AA's become PA's first, i.e. more education and training, which is what CRNA's have been complaining about all long.

I don't know if it will work, but I personally think it's a brilliant argument and political move. For one thing, it thwarts the perception that CRNA's are trying eliminate the competition, since AA's will still be allowed. But it still benefits CRNAs since the additional requirements will limit competition from AA's, at least to some extent.

And, not only does it address the CRNA criticisms about the lack of training, but it's also good public policy since, theoretically at least, you get more qualified anesthesia providers. I think it's possible that everybody could with win with this type of proposal.

[jwk]

I also have to agree "anesthesia nurse" is not the appropriate term and does not denote respect. I have too long and hard for my education to not be respected.[/quote']

We AA's have also worked hard for our education.

Using the term "anesthesia nurse" is offensive to some of you, and I see that point. However, it is offensive to AA's to see full page ads in Stars and Stripes asking "DO YOU WANT AN ASSISTANT DOING YOUR ANESTHESIA"

[athomas91]

well AA stands for anesthesia ASSISTANT.......... :uhoh21:

no where in CRNA (Certified Registered Nurse Anesthetist) is there an anesthesia nurse....