Practice Issues

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Since the moderators closed the thread about CRNA attitudes before I had a chance to respond, I thought I would offer my perspective on practice situations.

One of the best parts of CRNA practice is that we have so many options. In my 45 year career, I have been employed by hospitals, anesthesiologists and self-employed. There are positive and negative aspects to all and certain practice settings tend to be more appropriate at different times in our career. For example, I don't have the stamina or interest to take night call at a busy OB center.

I will fight to the end to defend our right to practice independent of "supervision" by anesthesiologists and to receive fair compensation relative to the difficulty and importance of administering anesthesia. While I won't make personal attacks, I would love to have a one on one debate on any CRNA, RN, anesthesia assistant or MD who wants to take me on with this topic. I know who I am and what I can do in the operating room, as do most CRNAs. If an dynamic scope of practice and independent practice offends anyone who is in this profession, please reconsider anesthesia as a career and save your slot for someone who exhibits the professionalism consistent with quality patient care.

If you believe you must be supervised as a CRNA, you still belong in school. If I have a difficult case, I spend the time to read the literature to determine the best way to handle it. If I believe I will have a difficult intubation or a situation where I need assistance, I pay another CRNA to help. There are many options for good care, so we must keep an open mind.

In my very humble opinion, we can't have it both ways. One of the reasons I wanted to go into advanced practice was to have more practice rights and options, including adequate compensation.

Yoga CRNA

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Specializes in Anesthesia.
Since the moderators closed the thread about CRNA attitudes ..............

Cogent points, all, my dear yoda.

The 'Attitude' OP was IMHO not a CRNA at all, simply a poser and a provocateur. Witness the cross-posting to SDN, hoping to stir up a flame fest. Who do we know who so zealously carries the A$A banner? Some jerk?

Nothing more than my humble opinion, dear moderators.

??

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I agree with you deep. It is too bad the original poster did not have the courage to own up to his identity. I have quite had it with others trying to define our practice and don't have any respect for our own, including non-CRNA nurses who buy into the negative sterotypes. I have always wondered why RNs can not stick together like the MDs do. If we would learn how to do that, a lot of our respect issues would be gone.

Yoga

Cogent points, all, my dear yoda.

The 'Attitude' OP was IMHO not a CRNA at all, simply a poser and a provocateur. Witness the cross-posting to SDN, hoping to stir up a flame fest. Who do we know who so zealously carries the A$A banner? Some jerk?

Nothing more than my humble opinion, dear moderators.

??

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Cogent points, all, my dear yoda.

The 'Attitude' OP was IMHO not a CRNA at all, simply a poser and a provocateur. Witness the cross-posting to SDN, hoping to stir up a flame fest. Who do we know who so zealously carries the A$A banner? Some jerk?

Nothing more than my humble opinion, dear moderators.

??

I am kind of confused about a CRNA's level of independance in non-opt out states. Can someone explain what the op-out is exactly?

Thanks

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I agree Deepz, it probably was a troll. Unfortunately I let it get away from me. Thank you Yoga for your well stated views. I agree with you whole heartedly.

Craig

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Opt-out is a Medicare reimbursement issue and NOTHING ELSE. It is not a practice issue or an independence isssue. State law dictates nurse anesthetist practice. Opt-out is related to how a hospital is going to get reimbursed for CRNA administered anesthesia, under Part A. By the way, CRNAs receive full reimbursement for administering anesthesia under Part B--professional services. I practice in a state that has NOT opted out and receive direct payment for administering anesthesia for Medicare patients. The checks come to me, not a facility or an anesthesiologist.

Medicare reimbursement is complicated and I have personal experience with negotiating for CRNA reimbursement with them. There is excellent information on the AANA website. Take advantage of the work our Washington DC office is doing for us. They have the information and are happy to share it.

An interesting aside, I read on the AANA website that Medicare is considering a 4% reduction in payment. Seeing that my business expenses are increasing, that is could be a significant issue. AANA is working on it.

Yoga

I am kind of confused about a CRNA's level of independance in non-opt out states. Can someone explain what the op-out is exactly?

Thanks

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i missed the parts that were personal attacks requiring moderator intervention. and yes i agree as i stated in my post, not a very pro crna anything to actually be a crna.

as for clarification, i am a srna, 11 days to graduation and i have rotated through 8-10 different hospitals in the last 2, and worked in 5 more as an icu nurse over the last 8 years years and have met many a different crnas, mdas, srnas, although i am NOT a crna the ability to observe the practice settings, discuss with preceptors and other srnas it is not hard to derive a personal opinion of anesthesia practice that one is exposed to and to come to an educated conclusion about the practice.

i edited this to add also that i have researched and been exposed through lectures and being national student representative to the aana crna pac committee and having been an attendee to the aana midyear assembly in wash dc and attended meetings on capital hill, i feel that i am fairly educated about the issues that crnas face today.

d

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