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 Step-down ICU.

There seems to be a great debate here about AA's vs. CRNA's. I am wondering, what is the REAL difference?? When I say REAL difference I am only meaning in terms of job outlook. Are there more jobs for AA's than CRNA's? Here in NC I see a lot of job listings for CRNA's, and I haven't seen many for AA's. So are AA's more popular in other parts of the country?? I thought AA's were more like PA's ( Physician's Assistant)? CRNA's are more like nurses, correct? I am considering CRNA school in the future, so I am hoping someone can help me. I don't want to cause another debate about which one is better. Obviously they both are similar in nature. So please someone respond with the pros and cons of each. Thanks. :)

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."

"Jailhouse RN" That is like saying...I want only a nurse with a BSN, CCRN to take care of me. Please, that's ridiculous. Why dont you just ask, is my provider competent and compassionate?

Specializes in Anesthesia.
..... AA's vs. CRNA's. I am wondering, what is the REAL difference?? When I say REAL difference I am only meaning in terms of job outlook......

Hot, there are no more than a few hundred AAs in practice after 30 years. And 31,000 CRNAs with a history stretching back to the 1880s. CRNAs working solo, independent of any anesthesiologist, serve half the hospitals in our nation; CRNAs deliver two-thirds of the 20-plus million anesthetics given each year. AAs are assistants to doctors only. See AANA.com for further comparisons and contrasts.

Atlanta is an anomolous situation, almost unique, wherein Emory University and only one other program actually train AAs, and it's reasonable to expect AAs to be clustered nearby, since they cannot practice solo in rural areas, as CRNAs can.

The A$A line is that anesthesia is strictly, solely, and no less than The Practice of Medicine. AAs accept that line and they assist the doctors. They also (see above) use the term 'anesthesia nurse' to confuse the public into thinking that CRNAs are not full-fledged ANESTHETISTS in their own right but merely assistants to the doctors, as they are.

CRNAs OTOH (and American courts, in legal precedents dating back to the early 20th century) view anesthesia as the practice of medicine when delivered by MDs, and yet also the practice of nursing when delivered by CRNAs. It is both, and not strictly the purview of either MDs or CRNAs.

Refusing to be subjugated is where CRNAs rub the A$A wrong, and the main reason the A$A would wish to replace CRNAs with AAs. Wishful thinking.

There are few job for AAs because the A$A wishful thinking hasn't borne much fruit after 30 years. Many AAs move on to med school, or to other pursuits, greener pastures.

If you want to stand on your own two feet, I wouldn't think twice about AA school. I'd sooner pick cotton.

Just MHO

deepz

You don't see job advertisements for AA's in NC because they still do not have the legal right to practice here.

I am with you. I ve read your past posts and I ver read your personal web site so I know you are knowlegable about this stuff.

I like the way write.

p.s. just so you know you have some support.

Specializes in Step-down ICU.

Thanks for all they replies, keep 'em coming!

they also (see above) use the term 'anesthesia nurse' to confuse the public into thinking that crnas are not full-fledged anesthetists in their own right but merely assistants to the doctors, as they are.

deepz, are you dealing with some kind of complex about the title? are you not an 'anesthesia nurse'? what part of the title do you not fit into? the nurse part or the anesthesia part? i think that is a silly point to get so angered over.

i hope that georgia aa does come back and respond to the questions and that have been posted. this thread has grown so quickly that we need to remember that just because it is on the third page; it has only been 1 day since his first post and the comment

how convenient.

all hat, no cattle.

referring to the fact that he did not jump up and reschedule his life to reply to our questions is not very inviting to opening a dialog.

i'm not familiar with these articles or editorials that call you a "bunch of incompetents". in fact, the aana is often silent in response to rhetoric from the aaaa or the asa. i am not an idiot. i understand that there is a great deal of intra-profession grousing from both sides. to take that grousing to a public level in the media is something else entirely. i would be very interested in seeing these articles and editorials. can you please provide more information? .

i have not seen the article with the term "bunch of incompetents" either, but i do remember the add that was taken out in the "stars and stripes" that said that aas were under qualified to administer anesthesia. see attached link

https://allnurses.com/forums/attachment.php?attachmentid=2132

i am curious what crnas make in atlanta if an aa is pulling 160k/yr. if my salary is brought down to this level once i get my crna cart i am not sure how many tears i will be shedding

and for the record. i would never want a mda to give me an iv or prep me for surgery. but once i was ready to go under anyone with the proper training and a couple of years of experience will be fine for me. aa, crna, or mda, as long as they are not students.

what is going on here

OK, most of you seem genuinely interested (DEEPZ notwithstanding) so I will attempt to address as many of the issues you have raised as I can.

There were several questions relating to my scope of practice vs that of a CRNA. Keep in mind that I can only speak of those practices where there are MDA's supervising a group of anesthetists consisting of both CRNAs and AA's. In this type of practice, AA's and CRNAs are 100% equivalent. I can do anything that the CRNAs are permitted to do and vice versa.

I am licensed as a PA in the state of Georgia. I hold the same physical license as a surgical PA, cardiac PA and so forth. The difference is that I am delineated as a subclass of PA with a job description on file with the state licensing board. In that description are most of the duties commonly performed by anesthetists. Anything not covered in that description can be delegated to me by my sponsoring physician. In my practice, I do not perform regional blocks, but neither do our CRNAs. I do, however, know many AA's that routinely perform spinals and epidurals everyday. I am primarily a cardiac anesthetist. I place all of my own lines including PA catheters. I can perform femoral cannulation and IJ cannulation but am not permitted to perform a subclavian stick (neither are the CRNAs). Again we are totally interchangable.

As a senior anesthetist I am given free reign to manage my cases as I see fit. Very rarely does my attending dictate what the anesthetic should be. They may make a suggestion here or there like "work in a little Morphine towards the end" but I am not required to check with them about most decisions that come up during a case. New grads on the other hand (AA and CRNA) really are expected to communicate with their attendings a little more often. I commonly do extremely complicated cases from beginning to end with little to no involvement from my supervising MD.

There was a question asking me how long it took to get comfortable with critically ill patients. This is a great question as it cuts straight to the heart of the whole "not a nurse first" issue. I will not say that I was as comfortable right out of school as a nurse with 10 years of ICU experience probably would be, but I did feel prepared to handle most situations. Nobody would be ready to do a thoracoabdominal aneurysm their first week out, I don't care how much nursing experience you had. I do feel that my training was first rate. Emory's department of Anesthesiology is one of the best in the country and I had access to Grady Memorial which is one of the nations busiest trauma centers. Egleston Children's hospital performs cutting edge procedures every day and is a major referral center in the southeast.

As far as the whole salary issue is concerned let me dispel a CRNA myth right now. AA's do NOT work for less than CRNAs. Salary is determined solely based on experience and what you bring to the table as well as supply and demand. I am at the very top of the salary scale in my department. There are many AAs and CRNAs that do not earn what I earn in my group. This is true in all mixed practices - end of story.

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.

Mull this over for a while and let me know your thoughts. I will end by saying that it is not the AAs that made this an adversarial relationship. Every single AA practicing in America today works side by side with CRNAs. We are advocates for the team approach to anesthesia care and I truely believe that it is what is safest for our patients. If you want to practice solo in rural USA - go for it. I will NEVER compete with you for those jobs.

Thank You for the information nec

Okay, maybe I also have a complex, but I dislike the term "anesthesia nurse" same as deepz. I think it misleads the public into thinking I'm just a regular RN (which could just be a 2 year degree), who helps the doc out. If the public was educated as to what I truly do, maybe that term wouldn't be so touche. "Anesthetist" I think moreso speaks to what I do on a daily basis (or will do when I graduate). JMHO......

While I can understand the need to look at issues from a personal level, using specific/individual examples, I would like to ask that we step back and take a more global look at the CRNA vs. AA comparison.

Medicine is a profession. Physicians were the first to establish themselves as professionals in health care, and standardize their education and licensing.

Nursing is also a profession. We are younger, but we have a well established system of educational and licensing standards.

The practice of nurse anesthesia by CRNAs is accountable to the standards of the nursing and the governmental institutions that regulate nursing.

Who are AAs accountable to? My understanding is that they are not professionally accountable (GeorgiaAA of course, is welcome to comment on this). Since AAs are by definition assisting the physician, it is the physician who is professionally accountable for the AAs actions. (The AA may be personally accountable, but that is a different standard from professional accountability). They are truly physicain extenders. This is congruent with organized anesthesiology's position that all anesthesia is the practice of medicine. They believe the only role for non-physician anesthesia providers is to perform delegated medicine. The physician is always accountable, at the top of the pyramid.

So, the central issue as I see it (stay with me now)- is this a correct position? Is society best served by the physician always in charge model? Are other licensed health care providers incapable of safe, effective care without the direct supervision of a physician?

Our culture has a strong pro-physician bias. This often leads to the (erroneous in my opinion) view that CRNAs are a "second best". Everybody wants the best of care for themselves and their families, and we have been conditioned to believe that the only way to receive that is from a physician. Everyone else is second best. There was a time, when physicians were first establishing professional standards, that this was actually true. But I believe health care has evolved past that.

Nursing is a profession. Nurses have a legitimate role in patient care, separate from physicians. We are not physician extenders. Medicine does not control us. We have our own license, our own professional regulatory Board and our own professional standards.

Nursing stands on its own. I don't agree with the model that requires CRNAs to always be subordinate to the anesthesiolgist. But I am not looking to replace all of them with CRNAs. What is so wrong with wanting to work side by side as equals? Those in medicine who would like to see us subserviant need to know that we aren't their hand maidens, and we aren't going back to that. Nurse anesthesia is leading the way, and the rest of nursing will follow.

loisane crna

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