First, I'd like to say I'm just a lowly nursing student. I'm not a CRNA so I am, by and large, ignorant on this subject. I've tried to do some board searches but couldn't find much except some general discussion on this issue.
However, a good friend of mine is a Washington D.C. attorney who is representing CRNA's before the local city council. Apparently they are fighting some action from the Board of Medicine which recognized AA's, and the CRNA's are requesting that the AA's also become licensed PA's before they are allowed to practice in D.C. Apparently the CRNA's are arguing that the patient outcomes with these AA's aren't as good as CRNA's, but I don't have any specifics or data on this claim.
My attorney friend says the Health Department is supporting the CRNA's, and that hearings were held on this issue just today, but the outcome is uncertain. I've also heard of CRNA's fighting similar actions by the Veterans Adminstration to allow AA's in their hospitals.
My question is: Are these political battles growing in number, and what do you think the outcome/trend will be, let's say, in ten years? I know that there are only two AA schools in the country, but the physicians definitely seem to be pushing for this. (My attorney friend says this comes at a time where two D.C. area colleges are planning to launch new CRNA programs and he thinks this has something to do with the D.C. action.)
Unfortunately, I don't have much more information than this. (I'm trying to bug my attorney friend to send me more data, but he's very busy.)
So what do you guys think about all of this? Will the AA's win on this eventually and, if so, what does this mean for CRNAs?
I am so tired of hearing the argument that this is about patient safety. The argument is about protectionism. And I feel that it is the CRNA;s best interest to pursue the elimination of any new competition that comes up, and to try and reduce the existing competitors. But let's call a spade a spade and not pretend we are being holistic and striving for order in the universe.
I have read all of the posts that say a safety study can not be done to compare CRNAs to AAs. But I do not believe it is imposable. With 30 yeas of data some sort of comparison can be made. The fact that there is no study speaks to the fact that there probably are not trails of bodies behind the AAs that are practicing.
A. The Physician's Anesthesia Assistant (PAA) may administer anesthesia under the direct supervision
of an Anesthesiologist.
B. A Physician's Anesthesia Assistant performs acute cardio-pulmonary resuscitation in life-threatening
situations as directed by a physician.
C. Establishes multi-parameter monitoring of patients prior to, during and after anesthesia or in other cute
care situations. This includes ECG, direct arterial pressure, central venous pressure, arterial blood gas
determinations, and hematocrit, in addition to the routine measurement of temperature, respiration, blood
pressure and heart rate. Also, other monitoring, as may be developed for anesthesia and intensive care
will be incorporated.
D. Manages "pre" and "post" anesthetic care, including ventilatory support of patients as assigned by
anesthesiologist.
E. Manages ventilators and other respiratory care parameters as directed by the physician.
F. Assist in research projects as carried out by an anesthesiologist.
G. Instructs others in the principles and practices of anesthesia, respiratory care parameters, as directed
by the physician.
H. Assist the anesthesiologist in gathering routine pre-operative data.
I. The choice of anesthesia and drugs to be employed are prescribed by an anesthesiologist of each patient
except:
(i) Where standard orders for the conduct of a specified anesthetic are prescribed; and,
(ii) Where life-threatening emergencies arise necessitating the utilization of standard therapeutic
or resuscitation procedures; and anesthesiologist will be immediately available personally or via
telephone and/or beeper if needed for consultation regarding changes from standard procedur
.
Listed above are the duties approved by the Composite State Board of Medical Examiners
as a basic job description for Physician's Anesthesia Assistants. Any additional duties must
be requested on an "Additional Duties Form" supplied by the Medical Board. Any
additional duties must be individually approved by the Medical Board BEFORE those
duties may be performed by the Physician's Anesthesia Assistant.
as stated earlier by georgia aa and others about floating their own swanz and putting in epidurals and spinals, i do NOT see this in the basic job description. there was not a detailed one on the georgia medical examiners website, however the aa was listed under pa's.
cvp was the most invasive action they could take. and the word establish is sort of grey in regards to hooking up monitors etc or actually cannulated the internal jugular.
when the aa's state they do this or that at their facility because their mda's trust them. does that mean they are practicing LEGALLY?
legality is important. safety is the most important. there are reasons aa's cannot LEGALLY do things. often this is in line with direct patient safety.
d
btw i no longer am assuming. if the georgia aas are doing spinals epidurals swanz, it appears they are practicing outside of their scope.
a. the physician's anesthesia assistant (paa) may administer anesthesia under the direct supervision
of an anesthesiologist.
b. a physician's anesthesia assistant performs acute cardio-pulmonary resuscitation in life-threatening
situations as directed by a physician.
c. establishes multi-parameter monitoring of patients prior to, during and after anesthesia or in other cute
care situations. this includes ecg, direct arterial pressure, central venous pressure, arterial blood gas
determinations, and hematocrit, in addition to the routine measurement of temperature, respiration, blood
pressure and heart rate. also, other monitoring, as may be developed for anesthesia and intensive care
will be incorporated.
d. manages "pre" and "post" anesthetic care, including ventilatory support of patients as assigned by
anesthesiologist.
e. manages ventilators and other respiratory care parameters as directed by the physician.
f. assist in research projects as carried out by an anesthesiologist.
g. instructs others in the principles and practices of anesthesia, respiratory care parameters, as directed
by the physician.
h. assist the anesthesiologist in gathering routine pre-operative data.
i. the choice of anesthesia and drugs to be employed are prescribed by an anesthesiologist of each patient
except:
(i) where standard orders for the conduct of a specified anesthetic are prescribed; and,
(ii) where life-threatening emergencies arise necessitating the utilization of standard therapeutic
or resuscitation procedures; and anesthesiologist will be immediately available personally or via
telephone and/or beeper if needed for consultation regarding changes from standard procedur
.
listed above are the duties approved by the composite state board of medical examiners
as a basic job description for physician's anesthesia assistants. any additional duties must
be requested on an "additional duties form" supplied by the medical board. any
additional duties must be individually approved by the medical board before those
duties may be performed by the physician's anesthesia assistant.
as stated earlier by georgia aa and others about floating their own swanz and putting in epidurals and spinals, i do not see this in the basic job description. there was not a detailed one on the georgia medical examiners website, however the aa was listed under pa's.
cvp was the most invasive action they could take. and the word establish is sort of grey in regards to hooking up monitors etc or actually cannulated the internal jugular.
when the aa's state they do this or that at their facility because their mda's trust them. does that mean they are practicing legally?
legality is important. safety is the most important. there are reasons aa's cannot legally do things. often this is in line with direct patient safety.
d
btw i no longer am assuming. if the georgia aas are doing spinals epidurals swanz, it appears they are practicing outside of their scope.
d
i am not a lawyer or practicing crna for help me out here. where does it say that an aa is not legally allowed to spinals epidurals or swanz? again i am not a crna so do not fully understand the scope of the procedures but i would thing that it falls under section a
a. the physician's anesthesia assistant (paa) may administer anesthesia under the direct supervision of an anesthesiologist.
as part of the anesthesia. or are those not considered anesthesia? not trying to pick a nit here, just want to fully understand.
A. The Physician's Anesthesia Assistant (PAA) may administer anesthesia under the direct supervision
of an Anesthesiologist.
B. A Physician's Anesthesia Assistant performs acute cardio-pulmonary resuscitation in life-threatening
situations as directed by a physician.
C. Establishes multi-parameter monitoring of patients prior to, during and after anesthesia or in other cute
care situations. This includes ECG, direct arterial pressure, central venous pressure, arterial blood gas
determinations, and hematocrit, in addition to the routine measurement of temperature, respiration, blood
pressure and heart rate. Also, other monitoring, as may be developed for anesthesia and intensive care
will be incorporated.
D. Manages "pre" and "post" anesthetic care, including ventilatory support of patients as assigned by
anesthesiologist.
E. Manages ventilators and other respiratory care parameters as directed by the physician.
F. Assist in research projects as carried out by an anesthesiologist.
G. Instructs others in the principles and practices of anesthesia, respiratory care parameters, as directed
by the physician.
H. Assist the anesthesiologist in gathering routine pre-operative data.
I. The choice of anesthesia and drugs to be employed are prescribed by an anesthesiologist of each patient
except:
(i) Where standard orders for the conduct of a specified anesthetic are prescribed; and,
(ii) Where life-threatening emergencies arise necessitating the utilization of standard therapeutic
or resuscitation procedures; and anesthesiologist will be immediately available personally or via
telephone and/or beeper if needed for consultation regarding changes from standard procedur
.
Listed above are the duties approved by the Composite State Board of Medical Examiners
as a basic job description for Physician's Anesthesia Assistants. Any additional duties must
be requested on an "Additional Duties Form" supplied by the Medical Board. Any
additional duties must be individually approved by the Medical Board BEFORE those
duties may be performed by the Physician's Anesthesia Assistant.
as stated earlier by georgia aa and others about floating their own swanz and putting in epidurals and spinals, i do NOT see this in the basic job description. there was not a detailed one on the georgia medical examiners website, however the aa was listed under pa's.
cvp was the most invasive action they could take. and the word establish is sort of grey in regards to hooking up monitors etc or actually cannulated the internal jugular.
when the aa's state they do this or that at their facility because their mda's trust them. does that mean they are practicing LEGALLY?
legality is important. safety is the most important. there are reasons aa's cannot LEGALLY do things. often this is in line with direct patient safety.
d
btw i no longer am assuming. if the georgia aas are doing spinals epidurals swanz, it appears they are practicing outside of their scope.
d
I'm impressed that a STUDENT nurse anesthetist feels so qualified to ASSUME the intent of the Georgia Legislature when it passed AA legislation 30 years ago.
Stop assuming and get the facts:
FACT - In Georgia, AA's may legally place invasive lines (art lines, swans, CVP's) and perform regional anesthesia (SAB's, epidurals, blocks). Whether they actually do or not is controlled by their employer's policies, whether that is a hospital or a group practice. In a group practice, the same rules apply equally to both CRNA's and AA's i.e. if an AA is not allowed to place a swan, then the CRNA isn't either.
FACT - In an Anesthesia Care Team practice, HCFA, most payors, and most malpractice carriers REQUIRE the active participation of the anesthesiologist during the case, including induction, emergence, and being available should problems arise. These rules are very specific, leaving little room for interpretation.
FACT - The Anesthesia Care Team is not a new concept. I have practiced under this care model for 23 years, although it never had a formal name until fairly recently. In my first practice, I placed invasive lines and regionals. Now I don't do either. I don't measure my professional existence by where I stick a needle in someone.
FACT - The Basic Job Description in Georgia is an outline of the basic responsibilities and privileges of an AA in Georgia. These duties can be expanded by making application to the Composite State Board of Medical Examiners.
The previous posts by GeorgiaAA do a great job of outlining what we do. We operate fully within the letter and intent of Georgia law. In the practices that he and I are employed by, the ANESTHETISTS do the same thing, are subject to the same policies, and are paid the same for comparable experience. Such is the case with ALL of the care team practices throughout Georgia, as well as the other states that AA's are in practice.
FACT - In Georgia, AA's may legally place invasive lines (art lines, swans, CVP's) and perform regional anesthesia (SAB's, epidurals, blocks). Whether they actually do or not is controlled by their employer's policies, whether that is a hospital or a group practice. In a group practice, the same rules apply equally to both CRNA's and AA's i.e. if an AA is not allowed to place a swan, then the CRNA isn't either.
ok - IF this is the case.....then WHY SHOULD WE BE SUPPORTIVE when working beside AA's OUR PRACTICE IS THEN LIMITED? Our practices are NOT equal - although we do many of the same tasks - an AA MUST be supervised (whether it is really being done or not is another arguement) - a CRNA doesn't require this supervision - yet all of a sudden the same restrictions are being placed on us?? and you ask why we fight this??
ok - IF this is the case.....then WHY SHOULD WE BE SUPPORTIVE when working beside AA's OUR PRACTICE IS THEN LIMITED? Our practices are NOT equal - although we do many of the same tasks - an AA MUST be supervised (whether it is really being done or not is another arguement) - a CRNA doesn't require this supervision - yet all of a sudden the same restrictions are being placed on us?? and you ask why we fight this??
Again, in a care team practice, supervision is present for all anesthetists. This didn't happen BECAUSE of AA's in being in practice. We have done nothing to limit the practice of CRNA's. It happens now in states that don't use AA's. If you are in a care team practice, with MD's and CRNA's, there is going to be supervision. This does not necessarily mean the "standing over your shoulder and push all your drugs" kind of supervision. But in a care team practice, the anesthesiologist will have the ultimate responsibility in the end.
We could go on for years about the differences, and there truly aren't as many as you think when you get right down to it, but the single biggest difference between us is that the CRNA is legally able to practice independently in many situations and AA's are not. AA's are not seeking to change that. You have never seen a move by an individual AA or our professional association to impose any limitation on right to practice or scope of practice upon any CRNA or CRNA's in any state.
we all work in "team care settings" - but that doesn't - for CRNA's - mean supervision...it does for AA's - and if they practice that way where you are - i can only surmise it is in an attempt to equalize practices.....for example in the northeast (not D.C.) AA's are not used- and although CRNA's and MDA's work as a team - it is not them supervising us....they aren't legally responsible for our patients - we carry that responsibility ourselves.
i agree w/ you - the arguments will and can go on forever - but you will find it impossible to succeed w/ your arguments on a nursing board. it is not personal - i hope you haven't found it such.
we all work in "team care settings" - but that doesn't - for CRNA's - mean supervision...it does for AA's - and if they practice that way where you are - i can only surmise it is in an attempt to equalize practices.....for example in the northeast (not D.C.) AA's are not used- and although CRNA's and MDA's work as a team - it is not them supervising us....they aren't legally responsible for our patients - we carry that responsibility ourselves.
i agree w/ you - the arguments will and can go on forever - but you will find it impossible to succeed w/ your arguments on a nursing board. it is not personal - i hope you haven't found it such.
If the restrictions are so undesirable, then why do CRNAs work in "team care settings"? It has been established many times over that they can work independantly and that there is huge demand for their services.
we all work in "team care settings" - but that doesn't - for CRNA's - mean supervision...it does for AA's - and if they practice that way where you are - i can only surmise it is in an attempt to equalize practices.....for example in the northeast (not D.C.) AA's are not used- and although CRNA's and MDA's work as a team - it is not them supervising us....they aren't legally responsible for our patients - we carry that responsibility ourselves.
i agree w/ you - the arguments will and can go on forever - but you will find it impossible to succeed w/ your arguments on a nursing board. it is not personal - i hope you haven't found it such.
Correct me if I'm wrong - in an Anesthesia Care Team practice, with MD's and CRNA's (and/or AA's) - don't the 7 TEFRA requirements have to be met, at least with Medicare cases? That implies supervision/medical direction.
user69
80 Posts
I am so tired of hearing the argument that this is about patient safety. The argument is about protectionism. And I feel that it is the CRNA;s best interest to pursue the elimination of any new competition that comes up, and to try and reduce the existing competitors. But let's call a spade a spade and not pretend we are being holistic and striving for order in the universe.
I have read all of the posts that say a safety study can not be done to compare CRNAs to AAs. But I do not believe it is imposable. With 30 yeas of data some sort of comparison can be made. The fact that there is no study speaks to the fact that there probably are not trails of bodies behind the AAs that are practicing.