How do CRNAs/SRNAs benefit anesthesiology residents?

Specialties CRNA

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I was searching for information on the Wake Forest CRNA program and happened upon this information on the Wake Forest anesthesiology program. Dr. Royster has an interesting view on how CRNA's/SRNAs affect and benefit the anesthesiology residency program at Wake Forest.... " Another benefit of nurse anesthesia in a residency training program is the availability of nurses to relieve residents at the end of the day, so that residents can do their preoperative assignments and get home at a reasonable hour, have dinner with their family....." http://www1.wfubmc.edu/anesthesiology/Education/Residency/FAQ.htm

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If you say "anesthetist" to a patient without "nurse" in front of it to exploit their ignorance, shame on you.

I disagree. Anesthetist carries the context of practitioner. Conversely, if I earned my doctorate (PhD) after becoming a CRNA (and could officially be called Dr. Kaufman), it would probably imply to the pt that I was an M.D.

In that case, it may be innappropriate. Is "CRNA DNSc" out there to answer this one? :coollook:

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Then last year a funny thing happened. The new leadership of the ASA opened the possibility that the two groups could dialog with *no* preconditions. That overture had to be approved by the ASA Delegates, I believe. And the two groups have now had a number of meetings. More info available at aana.com

deepz

Yeah, I've seen some of the information about these meetings, I just get my info from a different website.

:chuckle

Thanks for the heads up.

I really do wonder what interest physicians and AAs have in this board

I think the subject matter is interesting, people get pretty heated in their discussions, especially with anesthesiologists involved, I like to argue, great instant feedback about my opinion. I'd rather not have these discussions with people I work with. There's my interest. And honestly, I originally posted here because I thought the comment about the CRNA's at Wake Forest needed some clarification.

Eg. Dr John [did 300,000 cases by myself] Neeld

I tried to hunt this little piece of information down, where did this come from? I'm dying here Deepz, my need for references is just killin' me.

... it would probably imply to the pt that I was an M.D. ...

I agree Ether, I think it would imply to the patient that you were an anesthesiologist. This happens all the time in medical school, lots of students get their Ph.D. before completing their M.D., I think it's suspect for them to call themselves 'doctor' in the hospital setting.

I may not sway your opinion. But I challenge you to at least look at your choices critically.

You may be surprised, my opinion can still be swayed. It's too early for me to have developed all my opinions just yet. And another problem with my view of the anesthesia care team is that i've only ever seen it done one way, anesthesiologist supervising CRNAs. I'm positive there are other ways out there to make it all work.

TD

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I disagree. Anesthetist carries the context of practitioner. Conversely, if I earned my doctorate (PhD) after becoming a CRNA (and could officially be called Dr. Kaufman), it would probably imply to the pt that I was an M.D.

In that case, it may be innappropriate. Is "CRNA DNSc" out there to answer this one? :coollook:

Yes I am out here. As one of the few (

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IMHO, the "donut breath" type comments are aimed at anesthesiologists who do not direct, and yet charge for it. CRNAs who work in these environments are capable of non-directed care. That is obvious, because that is how the care is being delivered. And yet, they are not respected for the level of that care.

I am still confused on why a CRNA would work for any MDA, much less one that does not have proper respect for a fellow professional. I understand that an AA has to be supervised, so it makes since on why they work for a MDA. But from my understanding is that a CRNA can work and bill independently in all 50 states without any involvement of a MDA. There must be some reason that I am missing on why a CRNA is willing to work for a smaller piece of the pie.

Can someone break this down for me please.

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I am still confused on why a CRNA would work for any MDA, much less one that does not have proper respect for a fellow professional. I understand that an AA has to be supervised, so it makes since on why they work for a MDA. But from my understanding is that a CRNA can work and bill independently in all 50 states without any involvement of a MDA. There must be some reason that I am missing on why a CRNA is willing to work for a smaller piece of the pie.

Can someone break this down for me please.

Many CRNAs in these type of positions do "voice their opinion with their feet" and leave such situations. They find a more agreeable ACT, or a CRNA only work situation. And sometimes they participate in cyber discussions, and are very vocal about their experiences.

But not everyone can leave. My first job was in the only medical center in the area. CRNAs were hospital employed. The anesthesiology group was very anti-CRNA in philosophy, but apparantly had no problem with CRNAs creating revenue. CRNAs left regularly, which of course meant relocating your family to another community. But there were some who stayed, for whatever personal reasons. Perhaps spouse, or children who are unwilling to leave the area. Life is about compromises, sometimes you grin and bear it, to make your family happy.

It takes guts to walk away from your home and start over. Most everyone says the good far out weighs the bad. But not everyone can do it. And I am of the mind to not judge anyone for their willingness or unwillingness to take the big leap.

This is just my perspective. Maybe there are other explanations as well, because it does seem to be an all too common occurence.

loisane crna

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Specializes in Anesthesia.
(Eg. Dr John [did 300,000 cases by myself] Neeld)

I tried to hunt this little piece of information down, where did this come from? I'm dying here Deepz, my need for references is just killin' me.

Congressional committee testimony (under oath??) during his presidency of the ASA ... what? ... 4-5 years ago?

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Many CRNAs in these type of positions do "voice their opinion with their feet" and leave such situations. They find a more agreeable ACT, or a CRNA only work situation. And sometimes they participate in cyber discussions, and are very vocal about their experiences.

But not everyone can leave. My first job was in the only medical center in the area. CRNAs were hospital employed. The anesthesiology group was very anti-CRNA in philosophy, but apparantly had no problem with CRNAs creating revenue. CRNAs left regularly, which of course meant relocating your family to another community. But there were some who stayed, for whatever personal reasons. Perhaps spouse, or children who are unwilling to leave the area. Life is about compromises, sometimes you grin and bear it, to make your family happy.

It takes guts to walk away from your home and start over. Most everyone says the good far out weighs the bad. But not everyone can do it. And I am of the mind to not judge anyone for their willingness or unwillingness to take the big leap.

This is just my perspective. Maybe there are other explanations as well, because it does seem to be an all too common occurence.

loisane crna

My practice in the Atlanta area employs approximately 10 CRNAs and 20 AAs. We have VERY little turnover. Most of the CRNAs in this group have been with us for 10 years or more. We have an incredibly cohesive group and we are all great friends. We have a great group of MDAs who truely treat us as colleagues and not underlings. We work hard together and party together frequently. We do extremely difficult cases on very sick patients. We are all gratified professionally. If a CRNA is seeking professional challenge such as the opportunity to do hearts or big vascular cases then they will likely work in a physician supervised setting. If you want to do more bread and butter type cases then you might gravitate to a dual (MD/CRNA) or CRNA only setting. If the really big bucks is what motivates you then MD supervision is not going to be your choice. We make pretty good money as it is and we enjoy our work. No one complains about who bills for what.
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To add to the debate in a (I hope) civil manner:

I think there is a subtle but very significant difference between referring to us as "anesthesia nurses" versus "nurse anesthetists," a difference that on some level is not lost on the general public. "Anesthesia nurse" implies a nurse who assists the anesthesia doctor, and nothing more. He or she works in the anesthesia department, following the orders of the anesthesiologist. "Nurse anesthetist" recognizes the education and abilities of a person who has sought to be a nurse of higher degree and skill. In short, whether you intend it or not, by referring to us as "anesthesia nurses" you slight us by ignoring the experience and education we have.

Considering the subtle difference in meaning, were I simply an "anesthesia nurse" I could not work at my present job. We have no MDA's, so there is no one who could direct me in the conduct of my anesthetic. In my small, rural hospital, and most other small rural hospitals, all surgery would have to cease. But, since I am a "nurse anesthetist," I safely and efficiently provide anesthesia care to all my patients. It may seem like a silly point, but I think if the radical members of the ASA had their way, all surgery would cease at places without anesthesiologists.

If it is a silly point, and "nurse anesthetist" is just a title, then fine. Let's stop using "nurse anesthetist." Let's also stop using "anesthesiologist." From now on, we are all just "anesthesia providers." After all, "anesthesiologist" is just a title, and by ignoring the fact that you are an MD we mean no slight. And the term "anesthesia provider" is much more easily understood by the public. "I'm the person who is going to administer your anesthesia." It certainly removes the confusion. I suspect the ASA would raise the roof were we to actually start a movement to change the titles. How dare we presume to take the title "anesthesiologist," and all that implies, from MD's? By the same token, then, how dare the ASA take away the title nurse anesthetist, and all it implies, from us?

Does that make it a bit clearer why CRNA's object to being called "anesthesia nurses?" It isn't that we are not nurses anymore, nor are we ashamed of being nurses. However, the title "nurse anesthetist" gives us credit for the education and experience we have, while the title "anesthesia nurse" tries to marginalize us.

I said in my earlier post that anesthesia as a discipline faces a number of severe problems, which are not helped by this AANA vs ASA debate. To me, referring to CRNA's as "anesthesia nurses" is just another attempt by the ASA to continue this debate, to the detriment of solving the real problems that face all of us.

Kevin McHugh

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To me, referring to CRNA's as "anesthesia nurses" is just another attempt by the ASA to continue this debate, to the detriment of solving the real problems that face all of us.

Kevin McHugh

Does anybody know of a link where the ASA actually said this? I could not find anything on their website or with a google search where they referred to CRNA's as "anesthesia nurses," but perhaps I missed something.

However, the ASA website does have tons of references where they do refer to CRNA's as "nurse anesthetists."

:confused:

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Quick question for the CRNAs that are practicing now.

Does a MDA take offince to the term "Anesthesia Doctor"?

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"I suspect the ASA would raise the roof were we to actually start a movement to change the titles. How dare we presume to take the title "anesthesiologist," and all that implies, from MD's? "--by Kevin M.

I once shadowed a CRNA who was written up because she allowed her patient to call her an anesthesiologist. Actually the CRNA corrected the patient and explained her title to the patient, but the pt. continued to call her an anesthesiologist(while winking at the CRNA at the same time).

Well, the situation was misinterpreted by an MDA resident who reported the incident to his superiors...who in turn hit the roof. Soon after, a memo was circulated to remind all providers that the title of "anesthesiologist" was the exclusive domain of MDAs, etc, etc....

Apparently, this issue of titles is not new, nor do I believe that MDAs would give up their title of anesthesiologist for "anesthesia provider." Nice concept, though Kevin!

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Understand that my point was not that we should stop using the honorific "anesthesiologist." Nor would I suggest that CRNA's be allowed to identify themselves in that manner. My point was that MDA's would bristle at the suggestion that we stop using the honorific in favor of a more general, less specifically identifying term. Why then is it so difficult to understand why many CRNA's might object to being referred to by the less specific term "anesthesia nurse" as opposed to the honorific "nurse anesthetist?"

KM

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