Not trying to stir up bad ideas, but......

MikeyJ, RN · Nov 6, 2006

Trying to stay away from the SDN is like the forbidden fruit. And I know i am stupid for even caring....but i do. My program starts is 2 months...I have worked for years to get to this point and for some reason it is getting under my nerves. I know that this battle has been going on for years, and that it will continue, but the arrogance of many of the MDA (attendings mind you) is scary. I almost laugh at some of the crap they say. But I guess I just needed reassurance (I know it sounds stupid), but I have sacrificed and taken out loans for the program...I have always, and will always continue to love this profession, as I grow with it. But I am really curious where everyone (Practicing CRNA's specifically) see this going as it relates to CRNA's ability to freely practice.
Brian

I am not a CRNA, nor am I a pre-CRNA; however, I really do not forsee CRNA's gaining the ability to independently practice. CRNA's are mid-level practitioners, and like NP/PA/CNM/etc., they will probably always have to work under the supervision or with the collaboration of an MD/DO. I think CRNA's will always have some hostility directed toward them from MDA's, just as many IM and FP doc's have hostility toward NP's. Many doctors don't necessarily agree with mid-level practitioners doing the same work as them without the extensive training as they went through. With that said, if you want the ability to practice anethesia independently, then I suggest you pursue the MD/DO route.

Also, just my 2 cents, I really don't know if it would be of the wise for mid-level practitioners to have the ability to practice independently and freely. I don't doubt that the majority of NP/PA/CRNA's have the knowledge and skills to practice independently; however, there are many that aren't necessarily expertly skilled at their profession of choice. MD/DO's work very hard to get where they are, and I don't think it would be of wise to allow all mid-level practitioners to openly and freely open their own independent practices. I would see it as an invasion on the health care system we have today. I think the hierarchy works well the way it is, and I wouldn't want to see mid-level practitioners be on the same hierarchal level as an MD/DO. Just my 2 cents.

skipaway · Nov 6, 2006

I am not a CRNA, nor am I a pre-CRNA; however, I really do not forsee CRNA's gaining the ability to independently practice. CRNA's are mid-level practitioners, and like NP/PA/CNM/etc., they will probably always have to work under the supervision or with the collaboration of an MD/DO.

CRNAs already practice independently in many instances ie... (plastic surgery clinics, dental offices, oral surgeons' offices, Day surgery centers and yes, even some hospital ORs hire ALL CRNA groups to provide anesthesia services). We work with and without supervision of MDs and DOs depending on state law . We always work in collaboration with MD/DOs b/c they do the surgical/dental/podiatry procedure but they (the doctors) do not tell us what to give, how much to give or how to do the anesthestic. There is no reason for me to give an anesthetic to a patient without a MD/DO doing the procedure, so of course they are always there. What the ASA (American Association of Anesthesiologists) are trying to do is to make it a requirement for CRNAs to be supervised by an anesthesiologist wherever procedures are done. This is not necessary as CRNAs are quite capable and knowledgeable enough to practice without an MDA. I don't consider my profession to be "mid-level" I consider my practice to be on level with an MDA. Just a difference of opinion.

MikeyJ, RN · Nov 6, 2006

CRNAs already practice independently in many instances (plastic surgery clinics, dental offices, oral surgeons' offices, Day surgery centers and yes, even some hospital ORs hire ALL CRNA groups to provide anesthesia services). We work with and without supervision of MDs and DOs depending on state law. We always work in collaboration with MD/DOs b/c they do the surgical/dental/podiatry procedure. There is no reason for me to give an anesthetic to a patient without a MD/DO doing the procedure, so of course they are always there. What the ASA (American Association of Anesthesiologists) are trying to do is to make it a requirement for CRNAs to be supervised by an anesthesiologist wherever procedures are done. This is not necessary as CRNAs are quite capable and knowledgeable enough to practice without an MDA. I don't consider my profession to be "mid-level" I consider my practice to be on level with an MDA. Just a difference of opinion.

I must clarify what I meant. I meant that CRNA's work under collaboration with an MD/DO. I understand that the majority of mid-level providers do work "independently" persay. I was trying to say that mid-level providers will probably never (or if so, very far down into the future) work completely indepdently without any sort of collaboration with an MD/DO. And I don't disagree with that because mid-level providers should always have that support system with the MD/DO. If that support system was taken away, I think there would be an abundance of problems regarding mid-level providers opening up their own practices without any collaboration of a physician.

Trauma Columnist · Nov 6, 2006

I do respectfully disagree with the idea that the CRNA education is on-par with the MDA.

CRNA - certified registered nurse anesthetist

Remember from whence you came...as a nurse. There is nothing disgraceful about being a nurse. Plenty of us are nurses. Some of us are lucky enough (through much sweat equity I might add), to practice as advanced practice nurses.

If you want to be on par with an MD - you must have that level of education. No mid-level practitioner meets that requirement.

deepz · Nov 6, 2006

I do respectfully disagree with the idea that the CRNA education is on-par with the MDA. ........

Perhaps you misunderstand what skipaway was saying?

My interpretation: In the OR, CRNAs and MDAs are functional equivalents.

Equals? No. CRNAs are not MDs, but anesthesia IS anesthesia. One standard of care, two independent classes of providers.

Colleagues? Sometimes; often depends on the MDA's level of maturity.

Functional equivalents in the OR? You bet.

CRNAs independent providers of anesthesia? Absolutely. Anesthesia is unique:

http://www.gaspasser.com/unique.html

.

skipaway · Nov 6, 2006

I do respectfully disagree with the idea that the CRNA education is on-par with the MDA.
CRNA - certified registered nurse anesthetist
Remember from whence you came...as a nurse. There is nothing disgraceful about being a nurse. Plenty of us are nurses. Some of us are lucky enough (through much sweat equity I might add), to practice as advanced practice nurses.
If you want to be on par with an MD - you must have that level of education. No mid-level practitioner meets that requirement.

Yes, but I didn't claim my education was the equal to that of an MD. I realize that they are 2 different entities. However, I do claim that my "practice" that is... that actual giving the anesthetic is equal to that of a physician MD. And I am very proud to be a nurse and a CRNA and nowhere did I claim that I wasn't. I think my nursing background makes me a better practitioner.

with respect

skipaway · Nov 6, 2006

Perhaps you misunderstand what skipaway was saying?
My interpretation: In the OR, CRNAs and MDAs are functional equivalents.
Equals? No. CRNAs are not MDs, but anesthesia IS anesthesia. One standard of care, two independent classes of providers.
Colleagues? Sometimes; often depends on the MDA's level of maturity.
Functional equivalents in the OR? You bet.
CRNAs independent providers of anesthesia? Absolutely. Anesthesia is unique:
http://www.gaspasser.com/unique.html
.

Thanks.

Trauma Columnist · Nov 6, 2006

No problem - thanks for the clarification. Personally, I've had experience with several CRNA's because they are so widely used in the military. My experiences have always been extremely positive and I would trust a CRNA with any of my family members.

Best wishes.

yoga crna · Nov 6, 2006

I am not a CRNA, nor am I a pre-CRNA; however, I really do not forsee CRNA's gaining the ability to independently practice. CRNA's are mid-level practitioners, and like NP/PA/CNM/etc., they will probably always have to work under the supervision or with the collaboration of an MD/DO

I notice from your profile that you are a student nurse, so I can't help but wonder why you think you are such an expert on CRNA independent practice? You are simply mistaken and I want to take this opportunity to enlighten you.

CRNAs practice independently now, have done so in the past and will continue to in the future. If you have contrary information, please post it here with references. I am an independent CRNA and the last time I saw an anesthesiologist in my operating room, he was on the table and I was giving him an anesthetic. In my state, there is no such thing as "supervision" per the nurse practice act regarding nurse anesthetists. Of course, we practice in collaboration with physicians, dentists, podiatrists, but that is because anesthesia is usually performed in conjunction with a surgical, diagnostic or therapeutic procedure. Except for pain blocks, which are done via an order, such as any procedure is, like an x-ray.

I have extensive experience and education in the profession of nurse anesthesiology, the law and the business of anesthesia. We are one of the most elite professions in the country and are proud of our role in making surgery painless and safe. The AANA, our professional organization has the reputation for being the strongist in nursing and over 95% of all CRNAs are members.

I apologize if you think I was too hard on you, but I am proud of my profession, love every minute of doing anesthesia and have distain for deliberate misinformation. Please prove your point or reconsider posting incorrect information.

yoga crna (independent practitioner of anesthesia)

North Cacalacky · Nov 6, 2006

Not sure I would clasify CRNA's as mid-level practitioners. CRNA's are the only advanced practice nursing profession that can do the exact same job as the Doctor in many/most states. We don't have prescriptive authority, but we don't need it to deliver anesthesia. There are many hospitals/clinics etc that use CRNA's only. No MDA's in any fashion at some of these places. Some may point to the need for CRNA's by law to be supervised. This supervisory role is filled by the Dentist/Surgeon etc doing the procedure for which the anesthesia is being provided. These physicians have no role in the anesthesia delivery.

zrmorgan · Nov 9, 2006

I notice from your profile that you are a student nurse, so I can't help but wonder why you think you are such an expert on CRNA independent practice? You are simply mistaken and I want to take this opportunity to enlighten you.
CRNAs practice independently now, have done so in the past and will continue to in the future. If you have contrary information, please post it here with references. I am an independent CRNA and the last time I saw an anesthesiologist in my operating room, he was on the table and I was giving him an anesthetic. In my state, there is no such thing as "supervision" per the nurse practice act regarding nurse anesthetists. Of course, we practice in collaboration with physicians, dentists, podiatrists, but that is because anesthesia is usually performed in conjunction with a surgical, diagnostic or therapeutic procedure. Except for pain blocks, which are done via an order, such as any procedure is, like an x-ray.
I have extensive experience and education in the profession of nurse anesthesiology, the law and the business of anesthesia. We are one of the most elite professions in the country and are proud of our role in making surgery painless and safe. The AANA, our professional organization has the reputation for being the strongist in nursing and over 95% of all CRNAs are members.
I apologize if you think I was too hard on you, but I am proud of my profession, love every minute of doing anesthesia and have distain for deliberate misinformation. Please prove your point or reconsider posting incorrect information.
yoga crna (independent practitioner of anesthesia)

very well put yoga and I would like to highlight the fact to the students that being an independent practioner of anesthesia will emphasize the importance of collaboration with other professionals (if they are available). by no means do we become lone mavericks when we are given independent privileges. one thing I would like to emphasize to the pre-crna / srnas out there is to keep in mind you may have higher expectations placed on your abilities than you ever imagined...especially if you have the same attitude as the original poster.

zrmorgan crna (another crna in opt out practice)