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.

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......

ncgirl,

i think that the term "anesthetist" is probably the best for letting the patient know what the professional does. i do not think that the term "anesthesia nurse" is particularly flattering. i guess i was just in shock by the amount of anger that a silly title (that is technically correct) generated.

Iam glad I have metors like you.

GeorgiaAA - i don't think anyone here is against you personally ...but....

1. I (upon graduation) will NOT be an anesthsia nurse - that is like being an ER nurse (which i once was)...i will be a NURSE ANESTHETIST....

who...can function independently anywhere....period.

2. AA's on the other hand...can only function in 2? states...and ONLY under the supervision of an MDA...whether you all follow those rules or not..they are in place....

i am sorry to hear the practice of the CRNA's in Georgia are so restricted...no subclavians etc.... i for one would move and work elsewhere.

loisane....great post.

deepz....i kinda dig the hostility...keep it coming baby...

and one last comment....(and again not a personal attack) - GeorgiaAA - AA's have a long way to go (if they can even get that far) before tackling the rest of the states.

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.

Well, I believe that some of you are indeed against me personally, but that's beside the point.

When you make statements as if they are fact it feeds the problem. AA's currently practice in 19 states. We just passed legislation in the biggest of them all - Florida. Florida was seen as the lynchpin in the national arena since it is historically the most difficult state to pass credentialling legislation. Other states will now follow in short order. A third program is set to open this summer.

Trust me - we are here to stay.

By the way, it's the hostility that hurts you guys and makes you seem unprofessional.

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...

I am not against you personally, but I am agianst any possible threat to my livelyhood which is what you represent. If MDA's get there way I will iether have a low paying job or no job. and how will I pay my student loans.

yes, what I am saying is that I belive you and your cohorts would like to put my family on the street. and noone will swallow that easily.

GeorgiaAA - i truly have nothing against you personally or professionally - i am sure that after 14 years you are an excellent practitioner in all ways. 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 that allows me to call myself a Nurse Anesthetist...and i hold a deep respect for that ... I feel very slighted when we are called anesthesia nurses - it implies that we are "handmaidens" of an MDA which we are most definately not. AA's can practice in 17 states (didn't know that - thanks for the education) - but under the supervision of an MDA - whether they are "in the room" or not - they are professionally ultimately responsible for the patient...this to me shows a distinct difference in roles - which IF complied to i have no issue with - i do take issue when the "rules" are not complied to - because then the lines of distinction are blurred...

like i said - your experience i am sure has made you a wonderful provider - but there is no way that a new AA has anywhere near the experience a new CRNA does - the years of critical care experience alone places a Nurse Anesthetist heads and tales above..it has to - because experience is 90% of the game. I just feel that comparing AA's to CRNA's is like apples and oranges and shouldn't be done.

I'm not so sure about that Tenesma. In Canada at least, which is of course based on the British medical system, an Anesthetist is a physician who practices anesthesia. (Not that I want to project myself as a physician).

Athomas is of course correct, anesthesia nurse does not give the correct impression of what CRNAs do. Anesthesia doctor on the otherhand, probably does give the correct impression.

Actually I prefer the term Anesthesia Specialist. lol ... since we are having a battle of names.

or "lord Anesthesia".. top that... wait here comes one.

"anesthesia mac-daddy"

" distiguished Anesthesia crem-dela-crem"

woo, I am almost dessert now. :)

just trying to add some lightheartedness.

I do like the anesthesia specialist one though.

how about "royal anesthetist"...

i am partial to "queen anesthetist..." yes- i think i shall adopt that one...LOL

great job on the laughs ....

Loisane, your post was excellent. Thank you for your insight. The distinction you make is clear - and also an angle that I hadn't considered.

And DeepZ, you always inject a bit of fire into the discussion! Thanks for the explanation of reimbursement.

Pnurse, the issue is far more complex than who is supervised and who works independently. Do a search on this board for the several recent threads.

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.

Alansmith, I think we need to get you and DeepZ together for a beer at the National convention. Now THAT conversation would be a hoot!

User69, did you really mean to say "as long as they are not students"? Are you not just starting nursing school, not even an RN yet? Who are you going to practice on? Because let me tell you, starting an IV in an orange is not the same as a screaming, kicking meth-user who just arrived in your ICU pooping blood. And "anesthesia nurse" is meant to be condescending. There are nurses in endoscopy and special procedures that call themselves "anesthesia nurses". They are not CRNAs, and "anesthesia nurse" is a non-technical, made-up name. Few people in the public can even pronounce anesthetist, let alone grasp the scope of the job description.

Tenesma, the term anesthetist (pronounced ah-neeth-ta-test or ah-neese-tha-tist with some regional variation) is a common term for physician anesthesiologists across the British isles.

Athomas, how about "Anesthesia Diva?"

And seriously, Georgia_AA, I appreciate your thorough post. Your explanations were helpful and your description of the salary issue is true in the Atlanta metro area and surrounding towns, as I understand it.

By your own admission, though, you

commonly do extremely complicated cases from beginning to end with little to no involvement from my supervising MD
I should point out that if you are running your cases with no involvement from your supervising MD, s/he is committing billing fraud and you are practicing beyond the scope of your license. This illustrates beautifully one of the main issues regarding AA practice. You simply cannot argue that what is designed to be a supervisory role often lapses into one of independent practice with the "supervision" being applied only to allow four rooms staffed by CRNAs or AAs to be run by one MDA, and billed accordingly. Please do not take this as a personal attack. I understand well that this is a common phenomenon that is not at all unique to your department.

The other key issue at stake here is that the acceptance of this "anesthesia care team" model in which AAs and CRNAs function interchangeably serves as a springboard for the future restriction of CRNA scope of practice. AAs cannot rise to the current level of practice of CRNAs by virtue of their training and licensure, so the CRNA scope of practice is restricted to allow for equitable working conditions. This is not acceptable.

And let's be honest. Physician anesthesiologists are extremely concentrated in metro/suburban areas or those with a higher quality of life. The real shortage lies in the underserved, rural areas and those with less desirable working conditions. AAs cannot practice independently, AAs must have a supervising anesthesiologist, and anesthesiologists typically do not choose to work in areas with the greatest need, therefore AAs cannot be the solution to this country's anesthesia provider shortage, contrary to the attestation of your national organizations.

Many thanks to all for this dialogue...

+ Add a Comment