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].

[jwk]

I have been listening. But, quite frankly, there doesn't seem to be compelling arguments coming from the CRNA side. They say AA's don't have enough training, but there's no evidence that patient outcomes are adversely affected. They say MDA's are greedy, but the same argument can be made against CRNA's. They say clinicals may be adversely affected but, once again, no one seems to know for sure.

I agree with GeorgiaAA that the Florida decision is probably significant and, IMHO, it's a sign that CRNA's aren't doing a great job of selling this to the public. Perhaps we don't fully understand all of the details and history on this issue, but then, the Florida legislators apparently didn't either.

And, in the end, that's what really matters since the bottom line is: CRNA's have just lost another state on this issue. Not exactly a ringing endorsement that the CRNA arguments are working, is it?

I'm sorry - what did the CRNA's lose in Florida, or anywhere else? None of you have lost or been denied a job in favor of an AA.

[gaspassah]

None of you have lost or been denied a job in favor of an AA.

not today, but what about those out there trying to get into crna school, or 10 years from now or 5 years. dont look just at today, look to the long term ramifications to the profession. it should become quite clear.

d

[dneill01]

All of this talk about AA versus CRNA is making my head hurt! I am a critical Care nurse of 12 years, I have been using sedation, inotropes, vasopressors, ventilators, IABPs, PA catheters, A-lines etc.........for many years. Those of us who have worked in the ICU know that autonomy that is afforded us especially at night. Nursing school provided us the basis for our practice but experience is what makes us what we are. Not all ICU nurses are created equal and I dont favor being clumped with all because so many are lazy slugs that come in get a pay check and go home, never expending their education, and never making a contribution to their profession. I cannot concur that an AA has "paid their dues" if their BS is in philosophy. Most CRNAs have a minimum of 5 years experience in critical care. Someone had stated that MDAs dont have this experience. This is crap of course, look at the length of residency and fellowship before they can function independently. The simple fact is: the ASA has never liked the CRNA and feels threatened by the practice. The ASA has gone as far as manipulating their date of origin (of anesthesiologist speciality) to look older than it is. Nurses are the forefathers of anesthesia care. The AMA and ASA feel threatened thus the reason for creating the AA. They now still have control over the provider, and can profit from their labor. If the ASA and the AMA where truely trying to meet a need of shortage, they would be courting more anesthesiology residencies (maybe they are). Hey what a scam, I can supervise 4 rooms (all at once WOW what a feat, kinda makes you wonder how well they are supervising) and bill for all of them! I can sit in the lounge and get paid, what a great gig! The ASA belittles the practice of anesthesia when they insinuate that they can supervise 4 at a time (makes anesthesia seem like a pretty simple practice). AS far as the titles: Many CRNAs are ashamed of their roots as a nurse, in my opinion this is pathetic. Nursing background is what makes such good anesthesia providers. Years of patient care (besides the technical aspects as I had mentioned previously) are what make us able to make a patient and family comfortable prior to surgery and give us the ability to interprete into laymans terms what they are about to experience in the few minutes that anesthesia providers are alloted.

The AA will survive. Flourish? is yet to be seen. See, the shortage of anesthesia providers is more of a rural problem and it is here that CRNAs can indeed function independently.

The AA who had the problem with the Stars and Stripes article depicting the AA as an assistance needs to look inward and at their profession and see it for what it is. A profession that is prostituted by the ultimate of pimps "ASA"!!! An AA is an assistant plain and simple, this is why they where created. To be under the thumb of the AMA and the ASA.

I do not question the ability of AAs to provide anesthesia care as there are good and bad in all anesthesia professions. I do however take a stand that if the AA is to be an assistant and trained to do so, then they should not be providing independent care. If they do, they are only letting the MDA off even easier and practicing beyond their scope (unsafe situation).

Professionalism: good and bad in all but the most unprofessional is the MDA as those of us with long term experience in healthcare know. HOwever,I work with some great MDAs, To many MDAs have been groomed to be the "all knowing better than everyone else physician".

If a AA is a PA then that makes everything very clear, they work under the Physicians license and liability and their scope of practice is limited to whatever that physician allows them to do.

I hope that the family of anesthesia can know their practice, abilities and limitations and continue to work together to provide the best anesthesia care possible. Everyone be proud of what you are but always remember what you are: CRNAs, are not physicians you are highly educated nurses, AAs, are not independent anesthesia providers you are trained assistants, and MDAs, you are not GOD you are doctors!

[jwk]

All of this talk about AA versus CRNA is making my head hurt! I am a critical Care nurse of 12 years, I have been using sedation, inotropes, vasopressors, ventilators, IABPs, PA catheters, A-lines etc.........for many years. Those of us who have worked in the ICU know that autonomy that is afforded us especially at night. Nursing school provided us the basis for our practice but experience is what makes us what we are. Not all ICU nurses are created equal and I dont favor being clumped with all because so many are lazy slugs that come in get a pay check and go home, never expending their education, and never making a contribution to their profession. I cannot concur that an AA has "paid their dues" if their BS is in philosophy. Most CRNAs have a minimum of 5 years experience in critical care. Someone had stated that MDAs dont have this experience. This is crap of course, look at the length of residency and fellowship before they can function independently. The simple fact is: the ASA has never liked the CRNA and feels threatened by the practice. The ASA has gone as far as manipulating their date of origin (of anesthesiologist speciality) to look older than it is. Nurses are the forefathers of anesthesia care. The AMA and ASA feel threatened thus the reason for creating the AA. They now still have control over the provider, and can profit from their labor. If the ASA and the AMA where truely trying to meet a need of shortage, they would be courting more anesthesiology residencies (maybe they are). Hey what a scam, I can supervise 4 rooms (all at once WOW what a feat, kinda makes you wonder how well they are supervising) and bill for all of them! I can sit in the lounge and get paid, what a great gig! The ASA belittles the practice of anesthesia when they insinuate that they can supervise 4 at a time (makes anesthesia seem like a pretty simple practice). AS far as the titles: Many CRNAs are ashamed of their roots as a nurse, in my opinion this is pathetic. Nursing background is what makes such good anesthesia providers. Years of patient care (besides the technical aspects as I had mentioned previously) are what make us able to make a patient and family comfortable prior to surgery and give us the ability to interprete into laymans terms what they are about to experience in the few minutes that anesthesia providers are alloted.

The AA will survive. Flourish? is yet to be seen. See, the shortage of anesthesia providers is more of a rural problem and it is here that CRNAs can indeed function independently.

The AA who had the problem with the Stars and Stripes article depicting the AA as an assistance needs to look inward and at their profession and see it for what it is. A profession that is prostituted by the ultimate of pimps "ASA"!!! An AA is an assistant plain and simple, this is why they where created. To be under the thumb of the AMA and the ASA.

I do not question the ability of AAs to provide anesthesia care as there are good and bad in all anesthesia professions. I do however take a stand that if the AA is to be an assistant and trained to do so, then they should not be providing independent care. If they do, they are only letting the MDA off even easier and practicing beyond their scope (unsafe situation).

Professionalism: good and bad in all but the most unprofessional is the MDA as those of us with long term experience in healthcare know. HOwever,I work with some great MDAs, To many MDAs have been groomed to be the "all knowing better than everyone else physician".

If a AA is a PA then that makes everything very clear, they work under the Physicians license and liability and their scope of practice is limited to whatever that physician allows them to do.

I hope that the family of anesthesia can know their practice, abilities and limitations and continue to work together to provide the best anesthesia care possible. Everyone be proud of what you are but always remember what you are: CRNAs, are not physicians you are highly educated nurses, AAs, are not independent anesthesia providers you are trained assistants, and MDAs, you are not GOD you are doctors!

Feel better? And all this from a non-CRNA - I'm impressed.

Last I looked, there is a shortage of anesthesia providers everywhere, urban, as well as rural. There are THOUSANDS of anesthesia vacancies nationwide.

Yes, AA's work WITH the anesthesiologist. That is not some earth-shattering discovery. We've done it for more than 30 years.

No, we were NOT created by the ASA and the AMA (where did THAT come from?). Check my upcoming AA history post for the facts.

Oh, and just in case you didn't know, we're legally licensed in Missouri.

[Trauma Tom]

Many CRNAs are ashamed of their roots as a nurse, in my opinion this is pathetic.

I am afraid I am going to challenge you on this line. Where did you come up with this information? I have not had extensive exposure to CRNA's, however I have never met any CRNA's who were ashamed that they are nurses. In fact, all I have met have been proud of their training as nurses because they feel that being a nurse is what seperates them for other anesthesia providers. It is their background as nurses that gives them their unique perspective in dealing with the holistic care of the patient. I just completed my first day of orientation as a SRNA. The director commented during class that anyone can be taught to push medication to relieve a patient's anxiety. However, a skilled anesthesia provider can often talk to their patient to reduce their anxiety as opposed to always using medication. That is the difference between that art and science of anesthesia. I feel that as a nurse my training will help me to be that skilled anesthesia provider. Remember, CRNA stands for Certified "REGISTERED NURSE" Anesthetist.

All of this talk about AA versus CRNA is making my head hurt! I am a critical Care nurse of 12 years, I have been using sedation, inotropes, vasopressors, ventilators, IABPs, PA catheters, A-lines etc.........for many years. Those of us who have worked in the ICU know that autonomy that is afforded us especially at night. Nursing school provided us the basis for our practice but experience is what makes us what we are. Not all ICU nurses are created equal and I dont favor being clumped with all because so many are lazy slugs that come in get a pay check and go home, never expending their education, and never making a contribution to their profession. I cannot concur that an AA has "paid their dues" if their BS is in philosophy. Most CRNAs have a minimum of 5 years experience in critical care. Someone had stated that MDAs dont have this experience. This is crap of course, look at the length of residency and fellowship before they can function independently. The simple fact is: the ASA has never liked the CRNA and feels threatened by the practice. The ASA has gone as far as manipulating their date of origin (of anesthesiologist speciality) to look older than it is. Nurses are the forefathers of anesthesia care. The AMA and ASA feel threatened thus the reason for creating the AA. They now still have control over the provider, and can profit from their labor. If the ASA and the AMA where truely trying to meet a need of shortage, they would be courting more anesthesiology residencies (maybe they are). Hey what a scam, I can supervise 4 rooms (all at once WOW what a feat, kinda makes you wonder how well they are supervising) and bill for all of them! I can sit in the lounge and get paid, what a great gig! The ASA belittles the practice of anesthesia when they insinuate that they can supervise 4 at a time (makes anesthesia seem like a pretty simple practice). AS far as the titles: Many CRNAs are ashamed of their roots as a nurse, in my opinion this is pathetic. Nursing background is what makes such good anesthesia providers. Years of patient care (besides the technical aspects as I had mentioned previously) are what make us able to make a patient and family comfortable prior to surgery and give us the ability to interprete into laymans terms what they are about to experience in the few minutes that anesthesia providers are alloted.

The AA will survive. Flourish? is yet to be seen. See, the shortage of anesthesia providers is more of a rural problem and it is here that CRNAs can indeed function independently.

The AA who had the problem with the Stars and Stripes article depicting the AA as an assistance needs to look inward and at their profession and see it for what it is. A profession that is prostituted by the ultimate of pimps "ASA"!!! An AA is an assistant plain and simple, this is why they where created. To be under the thumb of the AMA and the ASA.

I do not question the ability of AAs to provide anesthesia care as there are good and bad in all anesthesia professions. I do however take a stand that if the AA is to be an assistant and trained to do so, then they should not be providing independent care. If they do, they are only letting the MDA off even easier and practicing beyond their scope (unsafe situation).

Professionalism: good and bad in all but the most unprofessional is the MDA as those of us with long term experience in healthcare know. HOwever,I work with some great MDAs, To many MDAs have been groomed to be the "all knowing better than everyone else physician".

If a AA is a PA then that makes everything very clear, they work under the Physicians license and liability and their scope of practice is limited to whatever that physician allows them to do.

I hope that the family of anesthesia can know their practice, abilities and limitations and continue to work together to provide the best anesthesia care possible. Everyone be proud of what you are but always remember what you are: CRNAs, are not physicians you are highly educated nurses, AAs, are not independent anesthesia providers you are trained assistants, and MDAs, you are not GOD you are doctors!

[dneill01]

Feel better? And all this from a non-CRNA - I'm impressed.

Last I looked, there is a shortage of anesthesia providers everywhere, urban, as well as rural. There are THOUSANDS of anesthesia vacancies nationwide.

Yes, AA's work WITH the anesthesiologist. That is not some earth-shattering discovery. We've done it for more than 30 years.

No, we were NOT created by the ASA and the AMA (where did THAT come from?). Check my upcoming AA history post for the facts.

Oh, and just in case you didn't know, we're legally licensed in Missouri.

JWK

I am all about good safe anesthesia care, that is why I am pursueing the profession. As long as it provided, I dont really care who gives it. The routes are different but the end result is hopefully the same "good practice".

I stand corrected the AA where not created by the AMA or the ASA but where created at medical schools and are more and more starting to be pushed by the ASA. They dont want to lose their hold on the money or power, you know that is true. Regardless of AAs or CRNAs, there are more than enough jobs for each. I havent run into any AAs in Missouri but I am sure I will and I am sure that we will work side by side. I only hope that the AA programs and the CRNA programs continue to be selective and keep the standards high as to not flood the market with anesthesia providers and kill what is now becoming a good paying job. MDAs have been making >350k a year for too long as the CRNA have carried the load and now the AAs too.

Note that the ASA is trying to rope AAs and CRNAs into their organization to provide better care according to them. This would be a grave mistake for AAs and CRNAs as it would suggest that AAs and CRNAs provide care substandard to that of an MDA.

If it was sarcasm "Feel better? And all this from a non-CRNA - I'm impressed"

That really isnt necessary, this is a forum of opinions and we know that everyone has one.

Trauma Tom, speaking of Nurses ashamed of their nursing background, I feel being called an Anesthesia Nurse upsets some (not all) because it insinuates that they are nurses first, but then again we are. I may feel differently when I finish this program, I am of course speaking from ignorance rather then stupidity.

[forane2001]

:rotfl: That is laughable. She is a nurse that is resentful of CRNA's or probably wanted to do anesthesia and was too lazy to go to school or could not get in!!! .....(edited TOS. Karen) You deserve an AA.

By the way , if you have been a staff nurse for 30+ years take a hint- retire. You dont know what you are talking about. I image you suck up to doctors too. I know your type all too well. That is what is wrong with nursing and why it will never progress the way medicine has.

Im a nurse with 3 decades in service

If Im having surgery I want an AA, not an CRNA.

and also for my family

[ZAHMAN]

It's still moving. Kick it again.

[zrmorgan]

The times that I have surgery, I said "I do not want a CRNA or other anesthesia assistant. You will provide an MD or you will have a problem."

fine...who is on call for derm tonight?

[hotomalis]

I would like to take you up on your offer.....

I ask that this remain civil, and I would like to thank you for this opportunity.

Craig

I am looking in to going to graduate CRNA school. I'm still an undergraduate student and I had no idea there was such a thing as a "AA vs CRNA" thing going on.

I tried following the string of postings and I think the bottom line is not how much each profession contributes to healthcare (because we both know we both do!). I think the problem is how CRNA's are portrayed in the speech by the MD: "Nurses....don't think much of them, in fact, don't put your life in their hands, but AA, YES! put your life in their hands. I would". That is the message I'm getting from that speech.

A healthy education on each point is important to learn from. But consider this: it is a doctor making the point, and not an AA or a CRNA. The MD knows about medicine but does not have the bedside manner AA AND CRNA's have and the continuity of patience that it requires. This MD thinks that being a nurse is not as important as he portrays in this speech, yet, there is an emergency on understaffing of nurses and people are panicking.

AA and CRNA are both important and don't let ANYONE tell you the contrary. We can both benefit from each other's practice and we should treat each other with the respect all the years of school and experience have given us the right to have.

If an AA wants the recognition, consult with the CRNA as to how to become an independent practitioner like the CRNA's have accomplish. If you don't feel comfortable with that, it is ok too. We (and this is news to me because I took the same courses as a PA) could learn about the courses an AA takes and that the dear MD was talking about so that not only we can have the CRNA knowledge but we can also have the AA's.

Let's face it guys, there is too much hate out there and too many people dying. We have to learn to re-direct our outrage into curiosity and learn from it so that we can become better people.

Did I mention I'm a nursing student? Oh, yes, I'm also 42 with 21 years of experience as an electrical engineer, a mom, a wife and a homemaker. But I never doubted, my career was in nursing because I LEARNED that to be a nurse, it takes a special "something" to be a good one.

Cheers!

[jjjez]

i don't see what is wrong with anesthesia nurse... i am an anesthesia doctor... who cares?

by the way, don't be so hell bent on having anesthetist as part of your title, because in Great Britain, the term anesthetist (until the last few years) was primarily used for the anesthesia assistant who sets up the room and equipment, and draws up drugs...

WRONG!!!

In the UK the term anaesthetist (how it's spelt here) is the equivalent to the US anesthesiologist.

As we say in the UK

'Get it right!'

[tridil2000, MSN, RN]

Why does the ASA support us. Very simple - we are not their competitors. We exist solely for one purpose and that is to allow the MDA to supervise and bill for up to 4 anesthetizing locations at once. I have heard the term physician externder used when discussing AAs and CRNAs in this type of practice. It is entirely accurate. You as CRNAs are going up against the ASA at the national level on a regular basis. You see yourselves as their equivalent and that is why they are less than friendly when it comes to the politics of anesthesia.

~~ my friend is in crna school. i do er and icu, and have NO interest in who is better. i just wanted to say that it sounds like the mds are 'using' you. sooner or later insurances (medicare included) will catch on to that, and put a stop to it. in the end, it will be cheaper for them to pay 1 crna for 1 procedure, than 1 md for 4. they won't care about the 'wait.'

you might not care about that point bc you're making good money now, but some in your field may get disgusted with being the 'tool' through which the md gets paid. hey, take it from us nurses... there was a time when we didn't do foleys or hang blood or put in simple ivs! YOU should always be paid for the service you provide directly by the payor/insurance. otherwise, your future is as secure as a dixie cup at a picnic.