Jane Fitch MD, prior CRNA, now Anesthesiologist elected president ASA

allnurses Guide · Apr 17, 2014

Got any research to show that all the non clinical BS in your online DNAP is worth a penny as far as improving patient care?

So, I guess the answer to my original question was no..?

You can downplay online training all you want, but since physicians don't even have a mandatory classroom attendance requirement and many medical students don't go to class on regular basis your point is mute as usual.

When is the last time you even attended a formal degree program JWK?

The DNP/DNAP is designed to make nurses better at utilizing research/EBP in clinical areas. This type of education is missing in almost all degrees right now including physician training. Here is how utilizing EBP that is learned through advanced education can and is helping nursing.

The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas

jwk · Apr 17, 2014

I see - so you get a doctorate degree based on courses that tell you to read studies so you'll be a better CRNA? Is that pretty much the gist of it?

"I've read about Swans - I'm sure I could put one in".

"Yes Mr. Smith - Those blocks looked really easy on the youtube video in my DNAP class - I've never done one, but I DO have my doctorate where I read about evidenced based practice, so I'm sure I get do it without too much trouble".

Home Health Columnist / Guide · Apr 17, 2014

Educational goals of a DNP Nurse Anesthesia Program:

Duke: Comparison of DNP and PhD Programs

The DNP degree is a practice doctorate. The PhD is a research doctorate. Graduates of PhD programs are prepared to conduct independent research and disseminate their findings. The DNP will provide graduates with the skills and tools necessary to assess the evidence gained through nursing research, evaluate the impact of that research on their practice, and as necessary, make changes to enhance quality of care. Scholarship is an integral part of both doctoral degrees.

University of Texas School of Nursing at Houston

The curriculum of the BSN-DNP Nurse Anesthesia Program is designed to provide the student with knowledge, skills and abilities relating to the provision of professional nurse anesthesia care while incorporating the COA doctoral competencies and AACN DNP Essentials.
Upon completion of the BSN-DNP Nurse Anesthesia program of study, the student will be able to:
Evaluate the scientific, theoretical, technical and homeostatic underpinnings associated with the provision of nurse anesthesia care.
Formulate a patient-centered, physiologically sound and evidence-based plan of anesthesia care for patients from diverse populations across the lifespan, while taking into account the surgical procedures and comorbid conditions.
Implement the formulated anesthesia plan in a safe, efficient and cost-effective manner to ensure the best possible patient outcome.
Analyze physiologic responses to anesthesia and the surgical procedure and implement scientifically sound interventions in response to these changes.
Evaluate nurse anesthesia care to promote improved outcomes, reduction in complications, improved safety and quality of anesthesia care delivery.
Collaborate effectively with interprofessional teams by fostering open, respectful communication and shared decision-making.
Investigate the strength and applicability of scientific evidence in anesthesia and health care. Integrate best evidence into clinical practice for the delivery of optimal health care.
Demonstrate the highest legal, moral and ethical standards of nurse anesthesia while accepting responsibility for one's own actions as a health care professional.
Generate practice improvement initiatives that impact patient/population outcomes, safety, quality or innovation in anesthesia care delivery or healthcare.
Demonstrate personal and professional excellence while advancing the field of nurse anesthesia while recognizing the importance of life-long learning.
Utilize information technology to promote patient outcome improvement and optimal clinical decision-making.
Analyze and promote policy initiatives that improve healthcare delivery while serving as an effective advocate for patients, vulnerable populations and the nursing profession.
Exhibit leadership skills appropriate for an entry-level professional practitioner at the micro-, meso- and macrosystem levels to facilitate improved patient, population and healthcare outcomes.

LSU Outcomes:

In addition, the graduate of the BSN to DNP program shall have acquired foundational competence deemed essential for graduates of a DNP program, as evidenced by the ability to:
Initiate, facilitate and participate in professional, collegial and collaborative efforts.
Identify healthcare needs and interventions for individuals, families and populations.
Design, implement, manage and evaluate organizational systems to address complex healthcare delivery needs and problems.
Provide educational, clinical, and administrative leadership at the local/state/national levels.
Meet the challenges and needs of an increasingly complex health care delivery system as it relates to healthcare policy, standards of care and practice guidelines for advanced nursing practice.
Integrate high ethical, legal and professional standards into: a) decision making in clinical practice; b) application of research; and c) use of technology and information systems.
Design, monitor and evaluate clinical systems, processes, policies and procedures.
Generate a caring, collegial, collaborative nursing practice environment.
Analyze social, economic, political and policy components affecting healthcare planning and delivery.
Synthesize and integrate divergent viewpoints for the purpose of providing culturally competent healthcare.
Translate, evaluate and apply research for evidence-based practice.
Integrate knowledge from theories of nursing as well as natural and social sciences into clinical practice.

Barry University's DNP curriculum for practicing CRNA's includes

ANE 706 Leadership, Policy & Interdisciplinary Collaboration (3)
ANE 712 Finance and Business Management in Anesthesia Practice (3)
ANE 716 Advances in Anesthesia Practice (2)
ANE 724 Perioperative Safety, Risk Reduction, & Outcomes Assessment (3)
ANE 750 Capstone Seminar III (1-2)
Completion and formal presentation of the scholarly project begun in Capstone Seminars I and II that demonstrates synthesis of the student’s work. The project will require students to engage in scholarly inquiry to analyze, evaluate, and/or transform a relevant aspect of nurse anesthesia clinical practice.
HSA 530 Healthcare Law & Ethics (3)
HSA 535 Applied Biostatistics (3)
NURA 678 Advanced Health Assessment & Differential Diagnosis (3)
NUR 721 Scientific Foundations of Doctoral Nursing Practice (3)
NUR 727 Healthcare Informatics for Doctoral Nursing Practice (3)
NUR 733 Translational Research for Doctoral Nursing Practice (4)
NUR 711 Role of the DNP (2)
Emphasis is on the identification of the essentials of the Doctor of Nursing Practice role in preparation for the highest level of nursing leadership and application of evidence-based practice. The eight essentials that will be introduced are: scientific underpinnings for practice, organizational and systems leadership for quality improvement and systems thinking, clinical scholarship and analytical methods for evidence-based practice, information systems/technology and patient care technology for the improvement and transformation of health care, health care policy for advocacy in health care, inter-professional collaboration for improving patient and population health outcomes, clinical prevention and population health for improving the nation’s health, and advanced nursing practice.

This education is what NURSES deem important for improving the patient anesthesia experience and improving health outcomes via evidenced based practice.

allnurses Guide · Apr 17, 2014

I see - so you get a doctorate degree based on courses that tell you to read studies so you'll be a better CRNA? Is that pretty much the gist of it?
"I've read about Swans - I'm sure I could put one in".
"Yes Mr. Smith - Those blocks looked really easy on the youtube video in my DNAP class - I've never done one, but I DO have my doctorate where I read about evidenced based practice, so I'm sure I get do it without too much trouble".

Ha Ha....unlike AAs I was already trained to be a fully independent anesthesia provider when I did my CRNA training. The additional training with the DNAP that I trained for will help develop my practice in the future through better use of research while continuing to develop my clinical skills through day to day with independent practice while utilizing the most up to date EBPs. This gives me the ability not to rely on MDAs to tell me what the most up to date EBPs are or how to utilize them, but I guess if you are an AA it doesn't matter what your knowledge base is or how you might chose to advance your education because you are still stuck everyday doing whatever the MDA tells you to do.

https://txwes.edu/academics/graduate-programs-of-nurse-anesthesia/doctorate-of-nurse-anesthesia-practice/#coursedescriptions The Texas Wesleyan program is designed for post-Masters prepared CRNAs. It is not designed to teach clinical skills that CRNAs already possess.

JimBeam · May 13, 2014

They will win the PR war. The general public has not been keen on critical thinking skills. The ASA now has a president who has been a CRNA. As for politicians... they are not the " Best and Brightest" of our society... ( Think MOST POLITICIANS)...Dr Fitch can now use the ASA's "They do not know what they do not know" argument with impunity.

Fixed That For You

AnesRN · May 16, 2014

Got any research to show all those clinical rotations make MDAs safer and/or better anesthesia than CRNAs?

I've been lurking here for a fairly long time and just though I'd throw my two cents in. It is this type of arguing that let's the ASA and MDAs win the PR war. You're kidding yourself if you don't think those rotations don't allow them to have better clinical acumen, otherwise they would do away with them. They expose them to a broader breadth of clinical situations which in turn strengthens their clinical skills and diagnostic abilities, which is important because, as we know, anesthesia has global effects on the human body. Thus, the more pathophysiology you're exposed to the better you become as a provider, CRNA/MDA/whatever. I'm proud to be a CRNA, a NURSE, I didn't want to be a doctor, so I didn't go to medical school, but I'm not naive enough to believe that just because 'research' doesn't exist to show they are superior providers means that we are somehow equal. Grow up. The research was put out by a nursing organization, and a hospital organization, what conclusion did you honestly think they would come to? This argument is a fallacy and it gives good CRNAs like me a bad name. BTW, there isn't any research to suggest that we nurses are superior to med techs at patient care either, does that mean med techs are equal/superior to us in this manner? You get my point.

allnurses Guide · May 16, 2014

I've been lurking here for a fairly long time and just though I'd throw my two cents in. It is this type of arguing that let's the ASA and MDAs win the PR war. You're kidding yourself if you don't think those rotations don't allow them to have better clinical acumen, otherwise they would do away with them. They expose them to a broader breadth of clinical situations which in turn strengthens their clinical skills and diagnostic abilities, which is important because, as we know, anesthesia has global effects on the human body. Thus, the more pathophysiology you're exposed to the better you become as a provider, CRNA/MDA/whatever. I'm proud to be a CRNA, a NURSE, I didn't want to be a doctor, so I didn't go to medical school, but I'm not naive enough to believe that just because 'research' doesn't exist to show they are superior providers means that we are somehow equal. Grow up. The research was put out by a nursing organization, and a hospital organization, what conclusion did you honestly think they would come to? This argument is a fallacy and it gives good CRNAs like me a bad name. BTW, there isn't any research to suggest that we nurses are superior to med techs at patient care either, does that mean med techs are equal/superior to us in this manner? You get my point.

I get your point that you don't know what you are talking about.

Nurse anesthetists have been giving independent anesthesia care for 150 years in the U.S. with exceptional outcomes, and there has yet to be any research to show that MDAs provide superior care to CRNAs. When CRNAs ask for restrictive misguided laws on anesthesia care to be replaced it is this research that is used to show that we provide just as safe and effective anesthesia care as MDAs.

My kinda of thinking of "show me the research" must be why CRNAs and APNs are gaining more independence all the time.

It is awful to use research to prove a point versus making innuendos based on anecdotes.

AnesRN · May 16, 2014

I get your point that you don't know what you are talking about.
Nurse anesthetists have been giving independent anesthesia care for 150 years in the U.S. with exceptional outcomes, and there has yet to be any research to show that MDAs provide superior care to CRNAs. When CRNAs ask for restrictive misguided laws on anesthesia care to be replaced it is this research that is used to show that we provide just as safe and effective anesthesia care as MDAs.
My kinda of thinking of "show me the research" must be why CRNAs and APNs are gaining more independence all the time.
It is awful to use research to prove a point versus making innuendos based on anecdotes.

You addressed literally none of my points. Do you have any research/proof to back up your statement that "your kind of thinking" has been getting us more independence? I have been practicing for several decades and have witnessed the ebb and flow of the healthcare market in various political climates and one thing holds true, militancy gets us nowhere. We are looked upon with disdain because of it, it doesn't gain us any respect (from the public or other providers), and it makes us look childish. I am not petty nor a child, and have been routinely lumped in with this mentality, which is why it bothers me. Collaborative efforts would be so much more effective, especially with winning the PR war. This is, however, only my opinion.

allnurses Guide · May 16, 2014

You addressed literally none of my points. Do you have any research/proof to back up your statement that "your kind of thinking" has been getting us more independence? I have been practicing for several decades and have witnessed the ebb and flow of the healthcare market in various political climates and one thing holds true, militancy gets us nowhere. We are looked upon with disdain because of it, it doesn't gain us any respect (from the public or other providers), and it makes us look childish. I am not petty nor a child, and have been routinely lumped in with this mentality, which is why it bothers me. Collaborative efforts would be so much more effective, especially with winning the PR war. This is, however, only my opinion.

Playing nice with the ASA has got us where? The ASA only wants to control the entire anesthesia market and CRNA practice. How has this changed over the years?

If you are happy working in an anesthesia environment where MDAs control your practice that is fine. I for one enjoy being an independent CRNA provider and couldn't see myself working anyway else, if the ASA had their way CRNAs wouldn't be able to work in any non-supervised environment.

As far as your comments about MDAs clinical experience makes them "better providers" the research absolutely disagrees with you, and that research has not all been funded or conducted by nurses/CRNAs.

Is there anything besides your opinion that you give that shows that CRNAs are inferior anesthesia providers compared to MDAs?

loveanesthesia · May 16, 2014

The clinical rotations for MDs are necessary because they begin the anesthesia residency with no patient care experience. I had 5 years of caring for patients prior to beginning anesthesia. I came with a significant knowledge base to anesthesia. I've worked with 1st year anesthesia residents-they don't know the basics of patient care. So no, I don't buy that the clinical rotations gives the anesthesiologists a better clinical background that me.

jwk · May 16, 2014

You addressed literally none of my points. Do you have any research/proof to back up your statement that "your kind of thinking" has been getting us more independence? I have been practicing for several decades and have witnessed the ebb and flow of the healthcare market in various political climates and one thing holds true, militancy gets us nowhere. We are looked upon with disdain because of it, it doesn't gain us any respect (from the public or other providers), and it makes us look childish. I am not petty nor a child, and have been routinely lumped in with this mentality, which is why it bothers me. Collaborative efforts would be so much more effective, especially with winning the PR war. This is, however, only my opinion.

Ah, a voice of reason AND experience from the silent majority.

This fully independent, better than an anesthesiologist, we care more, we do more, yada yada yada type CRNA is a relatively new phenomenon. Oh sure, there have always been some beating that drum in decades past, but they were fairly small in number. And they still are - they're just very vocal about wanting their "rights" to practice independently. Big city, big hospital, big cases, where the majority of cases are done in the US? All those hospitals have anesthesiologists - the hospital wants them, the surgeons want them, the patients want them. It's really that simple. There are tens of thousands of CRNA's working every day in ACT practices BY CHOICE that have ZERO desire to work independently, have extremely satisfying and rewarding careers and are valued and respected members of their group and hospital staffs, yet their efforts and careers are largely derided and even ridiculed by nurse anesthesia associations. I suspect AnesRN would be in that silent majority (please let me know if I'm off base on that assumption).

AnesRN · May 17, 2014

Playing nice with the ASA has got us where? The ASA only wants to control the entire anesthesia market and CRNA practice. How has this changed over the years?
If you are happy working in an anesthesia environment where MDAs control your practice that is fine. I for one enjoy being an independent CRNA provider and couldn't see myself working anyway else, if the ASA had their way CRNAs wouldn't be able to work in any non-supervised environment.
As far as your comments about MDAs clinical experience makes them "better providers" the research absolutely disagrees with you, and that research has not all been funded or conducted by nurses/CRNAs.
Is there anything besides your opinion that you give that shows that CRNAs are inferior anesthesia providers compared to MDAs?

“Experience seems to be a prerequisite for expertise”

“Incremental development is dependent on a combination of depth and range of clinical experience, which is positively correlated with the time spend in nursing”

This was taken from “Relationships among professional nursing autonomy, perceived organizational support, and clinical nursing expertise” by Margaret Kamalini Kumar

Published in 2008 EDIT: I took that from a nursing publication so you would see that this is not a biased discussion.

If this is true for nursing it is true for all aspects/fields of medicine. Also, I would venture to say that it applies to most fields of study, regardless of discipline. It is axiomatic. You get better with experience, not worse, not the same and the MDAs just have experience with more pathologies than we do, its not bad that we don’t, its just the nature of the game. And the more pathologies you see the better you understand the physiology/pathophysiology behind the medicine, which after all is essentially what the practice of anesthesia is, managing patients’ physiology during surgery! I know the limitations of my knowledge and training. I’m not being flippant, I am just pointing out the craziness of this argument.

Again, just playing devil’s advocate here, I don’t think you can compare our experience nursing on the wards to medical training, as they are trained to diagnose and we aren’t really trained for that. Which is what you really learn in DNP/Masters training. I think the first year residents are obviously not great right off the bat, but to say they graduate medical school and “they don’t know the basics of patient care” is a little ridiculous. Which is my problem with this whole argument. The LOGIC is seriously flawed and just downright ridiculous, and that’s my problem, it makes us as professionals, as CRNAs, look bad.

I think you nearly hit the nail on the head jwk, the ones who speak out against the flawed logic and fallacious arguments do tend to be ridiculed. I don’t understand why our value is somehow completely reliant on our ability to practice 100% independently. I am EXTREMELY appreciated by my MDAs and I love what I do.