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.

I understand "John Wayne" type behavior, but how do you get fired due to greed? If your employer declines to meet your salary demands you can stay on at your current rate or you can leave, you don't get fired for asking (at least I hope not!). Unless there was bribery or some such dirtiness going on.

Well, I don't know all the details but basically, two CRNAs were really pushing the system and getting raises about every quarter. Yet, they still complained about how poor their job satisfaction was...over $150,000 a year for about four hours of work a day must be real hard work...

Anyway, that kind of thing doesn't work well in a small hospital with a four bed OR....they were released from their duties.

To me...that is greed

Thanks. Great conclusions!

...and have no interests in redefining my "philosophy"

Thanks for clarifying, and I understand that "choice of words" are just that, and may not have any "hidden meanings". But words are powerful, and we all can gain personal insight into ourselves through them. We all hold assumptions that may or may not be validated when brought to the light of day. My attempt is not to be confrontational, this is a process I reccommend for all of us, including myself.

...My statement was in fact meant for the nurse anesthesia providers that continuously degrade AAs and ultimately feel flying "solo" is the only way to go and fear that AAs will strip them of their $$.

Of course there is much truth to the saying "follow the money", it is at the root of everything. So I believe we agree that money is a significant factor in this debate. We also agree that there is no need to "AA bash", and I have not participated in that myself (at least I certainly hope nothing I have said here would sound like that to anyone).

But I believe it is counter productive to our profession to downgrade the contributions of the independents. Many CRNAs have expressed this attitude. They question our association's priorities, why do we even care about them when the numbers of ACT CRNAs are greater? And I thought I picked up a little of that in your post. It is an attitude I always try to address, especially in students who are just forming their professional attitudes.

The independents are very important to our profession, no matter their numbers. I have never worked outside the ACT, but I understand that my work environment and future choices are better because the opportunity for independent practice exits. And that right is under constant attack, from many fronts. Many people even think that independent CRNA practice is something new, that we are trying to extend our scope of practice. Nothing could be farther from the truth.

So the independents are often thick skinned, and abrasive. That is understandable when you realize they are on the front lines, fighting to protect all of our practice rights. I applaud them, and support them, as should all nurse anesthetists.

Obviously, everyone is accountable for their actions, and nothing excuses illegal or unethical behavior. Sounds like your greed example might fit that category. In which case, I think we should make the distinction between providers who cross the line, and those who are standing their ground to practice in a way to which they are legally entitled, despite the fact that it ruffles the feathers of many powerful people.

loisane crna

Thanks for clarifying, and I understand that "choice of words" are just that, and may not have any "hidden meanings". But words are powerful, and we all can gain personal insight into ourselves through them. We all hold assumptions that may or may not be validated when brought to the light of day. My attempt is not to be confrontational, this is a process I reccommend for all of us, including myself.

Of course there is much truth to the saying "follow the money", it is at the root of everything. So I believe we agree that money is a significant factor in this debate. We also agree that there is no need to "AA bash", and I have not participated in that myself (at least I certainly hope nothing I have said here would sound like that to anyone).

But I believe it is counter productive to our profession to downgrade the contributions of the independents. Many CRNAs have expressed this attitude. They question our association's priorities, why do we even care about them when the numbers of ACT CRNAs are greater? And I thought I picked up a little of that in your post. It is an attitude I always try to address, especially in students who are just forming their professional attitudes.

The independents are very important to our profession, no matter their numbers. I have never worked outside the ACT, but I understand that my work environment and future choices are better because the opportunity for independent practice exits. And that right is under constant attack, from many fronts. Many people even think that independent CRNA practice is something new, that we are trying to extend our scope of practice. Nothing could be farther from the truth.

So the independents are often thick skinned, and abrasive. That is understandable when you realize they are on the front lines, fighting to protect all of our practice rights. I applaud them, and support them, as should all nurse anesthetists.

Obviously, everyone is accountable for their actions, and nothing excuses illegal or unethical behavior. Sounds like your greed example might fit that category. In which case, I think we should make the distinction between providers who cross the line, and those who are standing their ground to practice in a way to which they are legally entitled, despite the fact that it ruffles the feathers of many powerful people.

loisane crna

Well said. It is obvious there are things I will develop as I grow professionally in this awesome arena of medicine. I know I will mature and nuture my skills and most likely, might be a private practice provider at some point. The majority of my comments only arrive from a handful of postings on the site and as mentioned, a few personal contacts that has left a bad taste in everyone's mouth. It is not a global attitude I have developed. I support the front line as you mentioned....might not agree with them always, but support them. I believe it is always a true display of character when those can interact on such a diverse topic yet stay professional....no feelings of confrontation felt. Again, thanks.

Swumpgas, not only was I not yawning I was interested in every word of your cogent post.This has been an utterly fascinating thread and I have learned much by reading your post as well as many of the others. As I was reading I was thinking that the crux of the issue between AA's and CRNA's seems to be the old "medicine vs nursing" conflict. Medicine seeks to retain control and nursing wants to achieve it's own place in history. You have done a wonderful job of explaining what was an emerging kernel of thought for me. I have thought much about this in terms of PA's as compared with APRN's and now I realize that nursing is being threatened on another front, one I was not aware of until today. That AMA is a powerful force to be reckoned with isn't it?!

Personally, I have worked in L&D and in the OR with both CRNA's and MD-A's (never heard of AA's until today) and although there are some wonderful MD-A's I would personally prefer the care of a CRNA under most if not all circumstances.

Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

I am an NP and had never heard of AA's either.

My personal experiences with CRNA's have been good. I have been slept by one and didn't even have a scratchy throat later. Even the ones I've known that were not pleasant to work with from the nurses' point of view were very good with their patients and good at their jobs. I now live in the Panhandle/South Plains area of West Texas and know that a lot of smaller rural hospitals would not be able to do even the limited surgeries they do if not for the CRNA's.

Do AA's compare with PA's? Most physician's assistants have bachelor's degrees, are trained in schools of medicine, and work under the physician's license.

When I started graduate school, I took core curriculum classes with CRNA students. I remember that they had at least 6 months longer in school than the NP's and CNS's did, and had an ungodly number of clinical hours to complete before they could graduate. They graduated with Masters' degrees. I would hardly call them inexperienced! (All had a number of years' nursing experience, as well, in areas like OR, ICU, ER, etc).

Also, just for my information, what kind of certification exam do CRNA's take? Who are they certified by? I have actually never thought to wonder before!

Specializes in Anesthesia.
....Also, just for my information, what kind of certification exam do CRNA's take? Who are they certified by? I have actually never thought to wonder before!

http://www.aana.com

http://www.aana.com/council/default1.asp

Wonder no more.

deepz

Isn't this thread like 4-5 months old. Please quit bumping this thread back up. The debate between the 4-5 original peeps is over, quit trying to start a fire on the forum with ancient threads. Visit the forum more often if you want in on these types of threads.

http://www.aana.com

http://www.aana.com/council/default1.asp

Wonder no more.

deepz

Isn't this thread like 4-5 months old. Please quit bumping this thread back up. The debate between the 4-5 original peeps is over, quit trying to start a fire on the forum with ancient threads. Visit the forum more often if you want in on these types of threads.

The debate appears to be alive and well. Relax.

Isn't this thread like 4-5 months old. Please quit bumping this thread back up. The debate between the 4-5 original peeps is over, quit trying to start a fire on the forum with ancient threads. Visit the forum more often if you want in on these types of threads.

sheesh. :rolleyes: don't read it if it bugs you.

:rotfl: :rotfl: :rotfl: Right On! lol

I

Now the REAL TRUTH...it's not that AAs drive the market down in Atlanta...it's that the combination of the enormous amount of AAs there and also the CRNAs somewhat saturate the market in the metro area.

There is NO saturation of the market in Atlanta. In fact, there is a SHORTAGE of CRNA's/AA's. Job placement is 100%. Many facilities are struggling to fill their schedules. The simple fact is, in the eyes of the MDA's, AA's are there to assist their practice. The see CRNA's no differently and they certainly aren't going to pay their "assistant" the wages of the CRNA. Having worked in Atlanta, I can see no other explanation. Job saturation simply does not exist.

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