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Brenna's Dad

Brenna's Dad

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CRNA prospect

Brenna's Dad's Latest Activity

  1. Brenna's Dad

    Need help with a research project!!

    Since no one took me up on it last year, I will offer it here.... I want to know whether keeping the endotracheal cuff pressure less than 30 cm H2O during surgery results in a decreased incidence of sore throat. Of course, you will have to control for ease of intubation, # of attempts, etc. It appears that most Anesthesia practitioners inflate the balloon of the endotracheal tube by feel. Very few use a manometer, although this has long been the standard of care in ICU settings to prevent tracheal necrosis.
  2. Brenna's Dad

    Ultrasound for art lines

    In training we were frequently called up to the ICU to place A lines in edematous impossible pts. Excellent experience!! Although we sometimes tried the Doppler to locate the pulse, I never really felt this was helpful. US probably would have been. I thought I was somewhat proficient with the Sonosite when finding veins in the ICU before anesthesia school. But part of me must agree with underdog. Using "the force" often seems to be the best method.
  3. Brenna's Dad

    What Do You Miss About Bedside Nursing?

    I also am afraid to admit that I do not miss much of anything about bedside nursing. I use my nurisng experience to quickly establish trust and rapport with the patient and all those long hard years in ICU have paid off as I lateralize all those skills to my anesthesia career. But missing bedside nursing is not an emotion I have ever felt, since entering anesthesia.
  4. Brenna's Dad

    Are you happy with your job?

    It's a different kind of stress. Less physical labour to be sure... but more stressful in the reality that the patient's life is truly in your hands. Anesthesia is the big time. There's no one else to pass the buck to, no one else that is going to be held responsible. If you have the personality to handle these types of stressors, anesthesia can be the most rewarding career choice.
  5. Brenna's Dad

    Using phenylephrine in spinals

    Nice!! I have never used phentlephrine in my spinals, but had thought the dose was 50 mcg. 5 mg...now that seems like a hefty dose. Very interesting and thank you for bring it to my attention.
  6. Brenna's Dad

    Labor epidural lawsuit

    Interesting stuff. I've been lucky obviously and have had no fathers suffer injury from watching the epidural placement. I has never thought of it as a potential legal entanglement.
  7. Brenna's Dad

    CRNAs we are losing the battle.

    The entire thing smells fishy to me...or perhaps a win based on a technicality or unclear language. So basically what we are saying is that NJ CRNAs can function independently in the hospital caring for the sickest patients but not in the office caring for plastic surgery patients. Not to say that plastic surgery patients cannot have significant comorbidities, but the decision just does not make sense.
  8. Brenna's Dad

    Difference between medically directed and supervision

    This also is a very good overview. http://www.aana.com/crna/prof/legal.asp
  9. Brenna's Dad

    Difference between medically directed and supervision

    Actually, this link http://www.aana.com/crna/prof/reimbursement.asp explains it much better than I can.
  10. Brenna's Dad

    Difference between medically directed and supervision

    First of all, it is the nurse practice act of each state that determines the elements of CRNA practice. It is my understanding, and several people more qualified than me have agreed, that no states require CRNA supervision by an anesthesiologist, only the request for services by a physician, dentist, podiatrist. Thus, supervision and direction are only insurance billing terms, specifically Medicare billing terms. Although Medicare could care less whether the anesthetic is performed by a CRNA, an MDA, or both....to qualify for medical direction and thus secure 50% of the medicare billing, the anesthesiologist must meet the 7 TEFRA rules, ie. prescibe the anesthetic plan, be present for induction and emergence and immediately available, direct PACU care, direct no more than 4 rooms, etc. If the TEFRA rules are not met, then the MDA is "supervising" and will NOT receive 50% payment....what they do receive is not known to me. Obviously, this arrangement is strange. Why would the CRNA give up 50% of their billing rights to an anesthesiologist, when they are doing most of the work? It is my feeling that the ASA has perverted these Medicare billing rules to imply that CRNAs must always be directed/ supervised and in my opinion have done a very good job at perpetuating this misconception. My apologies to my anesthesiologist colleges if this is mere conspiracy theory on my part...
  11. Brenna's Dad

    CRNAs in Florida to require anesthesiologist supervision

    I'm astounded by the continuance of bills such as these. You would have thought that the past lack of success by various boards of medicine would serve as a wake-up call to stop these attacks. From a quick read of the website, the attorney speaking for the BME, states, that the bill is needed, "To make sure that the Board of Medicine can discipline a physician who allows a nurse to perform functions that are beyond the nurse's qualifications." What does this have to do with CRNA practice rights?
  12. Brenna's Dad

    Anesthetic for Bone Marrow Harvest

    Hey heartICU, I've only ever seen one bone marrow aspiration, and it was during my initial nursing training. There were two of us in the room watching and my partner passed out and hit the wall, putting a hole in it. Needless to say, I pursued a career in critical care, and she went into community health. I digress.... Anyway, back then I'm pretty sure the patients were sedated (probably with Valium). Did you think about whether the cases could be done on MAC?
  13. Brenna's Dad

    *******SUPERVISION REQUIRED or NO for CRNAs?*******

    I also thought it would be interesting to compare Illinois law with the laws in Washington, where I am completeing my training. WAC 246-840-300 Advanced registered nurse practitioner.An advanced registered nurse practitioner is a registered nurse prepared in a formal educational program to assume primary responsibility for continuous and comprehensive management of a broad range of patient care, concerns and problems. Advanced registered nurse practitioners function within the specialty scopes of practice and/or description of practice and/or standards of care developed by national professional organizations and reviewed and approved by the commission. These statements form the basis for selection of test items or competency based evaluation processes and are derived from standard educational curricula for certain practice areas. ARNP members of the commission will review these statements on a biennial basis and will present substantive changes to the full commission for approval or disapproval. Advanced registered nurse practitioners are prepared and qualified to assume primary responsibility and accountability for the care of their patients. This practice is grounded in nursing and incorporates the use of independent judgment as well as collaborative interaction with other health care professionals when indicated in the assessment and management of wellness and conditions as appropriate to the ARNP's area of specialization. Within the scope of the advanced registered nurse practitioner's knowledge, experience and specialty scope of practice statement(s), licensed advanced registered nurse practitioners may perform the following functions: * Examine patients and establish medical diagnoses by client history, physical examination and other assessment criteria; * Admit patients to health care facilities; * Order, collect, perform and interpret laboratory tests; * Initiate requests for radiographic and other testing measures; * Identify, develop, implement and evaluate a plan of care and treatment for patients to promote, maintain and restore health; * Prescribe medications when granted authority under this chapter; * Refer clients to other health care practitioners or facilities. An advanced registered nurse practitioner: (1) Shall hold a current license to practice as a registered nurse in Washington; (2) Shall have completed a formal advanced nursing education meeting the requirements of WAC 246-840-305; (3) Shall present documentation of initial certification credential granted by a national certifying body recognized by the commission, approved ARNP specialty whose certification program is approved by the commission and subsequently maintain currency and competency as defined by the certifying body; (4) Copies of statements of scope of practice or practice descriptions are maintained in the nursing commission's office. Specialty designations recognized by the commission and the date of the commission approved statement of scope of practice or practice description are: (a) Family Nurse Practitioner (FNP) (American Nurses Association, 1998; American Academy of Nurse Practitioners, 1992). (b) Women's Health Nurse Practitioner (WHNP) (American Association of Women's Health, Obstetric, and Neonatal Nurses, 1997). © Pediatric Nurse Practitioner (PNP) (National Association of Pediatric Nurse Associates and Practitioners, 2000; American Nurses Association, 1998). (d) Adult Nurse Practitioner (ANP) (American Nurses Association, 1998; American Academy of Nurse Practitioners, 1992). (e) Geriatric Gerontological Nurse Practitioner (GNP) (American Nurses Association, 1998). (f) Certified Nurse Midwife (CNM) (American College of Nurse Midwives, 1997). (g) Certified Registered Nurse Anesthetist (CRNA) (American Association of Nurse Anesthetists, 1996). (h) School Nurse Practitioner (American Nurses Association, 1998). (i) Neonatal Nurse Practitioner (NNP) (American Association of Women's Health, Obstetric, and Neonatal Nurses, 1997). (j) Psychiatric Nurse Practitioner or Clinical Specialist in Psychiatric-Mental Health Nursing (American Nurses Association, 1998). (k) Acute Care Nurse Practitioner (American Nurses Association, 1998). (5) Shall be held individually accountable for practice based on and limited to the scope of his/her education, demonstrated competence, and advanced nursing experience; (6) Shall obtain instruction, supervision, and consultation as necessary before implementing new or unfamiliar techniques or practices; (7) Shall be responsible for maintaining current knowledge in his/her field of practice; (8) Must be prepared to show documentation of any additional formal education, skills training, or supervised clinical practice beyond the basic ARNP preparation; and (9) May choose to limit his or her area of practice within the recognized specialty or specialties. (10) If recognized in more than one specialty area, must obtain and maintain certification in all areas and must obtain formal education and training for each area of specialization. [statutory Authority: RCW 18.79.110 and 18.79.050. 00-21-119, 246-840-300, filed 10/18/00, effective 11/18/00. Statutory Authority: Chapter 18.79 RCW. 97-13-100, 246-840-300, filed 6/18/97, effective 7/19/97.] Much more CRNA friendly...
  14. Brenna's Dad

    *******SUPERVISION REQUIRED or NO for CRNAs?*******

    Interesting stuff. Section 10.7 (3)(B) states: For anesthesia services, an anesthesiologist shall participate through discussion of and agreement with the anesthesia plan and shall remain physically present and be available on the premises during the delivery of anesthesia services for diagnosis, consultation, and treatment of emergency medical conditions. In the absence of 24‑hour availability of anesthesiologists with medical staff privileges, an alternate policy (requiring participation, presence, and availability of a physician licensed to practice medicine in all its branches) shall be developed by the medical staff and licensed hospital in consultation with the anesthesia service. It appears that if anesthesiologist coverage is not available, a hospital must simply have a policy in place that requires the presence of another physician (eg. surgeon) during the anesthetic. Like many other indiividuals have stated, this requirement does not mean that the physician dictate the anesthesia, but rather be available for emergencies and agree with the anesthesia plan.
  15. Brenna's Dad

    How many sick days do you guys have?

    35 total vacation and sick days for the 28 month program. Also, we get the odd bonus day.
  16. Brenna's Dad

    *******SUPERVISION REQUIRED or NO for CRNAs?*******

    I'm really not sure why this checkbox you mention is required. The only requirement by the surgeon is to request anesthesia services. Since the surgeon knows next to nothing about anesthesia, I'm not sure how they can provide "medical direction." In fact, it is in the surgeon's best interest to minimize their liablity by staying out of the anesthetic all together. CRNAs continue to be independent practitioners. Yoga, please correct me if I am wrong.

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