georgia_aa

This is complete and total BS. I can categorically state with 100% certainty that no graduate of an accredited AA program has EVER gone back to be trained as a CRNA.

Greg - I have no doubt that you are a good guy and mean what you say. However, you ARE against AAs if you are a dues paying member of the AANA. A percentage of every dollar that you pay to them goes directly towards efforts severely curtail or eliminate AA practice rights. You can't have it both ways. If you disagree with what your national organization is doing then I hope that you are voicing your opposition in some way other than posting it on a nursing forum. Otherwise, you are paying to put your friends out of work.

Well... I read THAT and absolutely laughed MY you know what off. Smearing a profession with no outcome studies to back it up?? Why the audacity of it!!! You guys kill me. How is that any different from what you CRNAs and your beloved AANA are doing to AAs in their smear campaign across the country. Same exact thing.. no studies showing any difference at all, just as you said "slant and spin" highlighting training and experience differences. You guys are such hypocrites.

Actually this document better outlines the recertification process for anesthesiologists. http://www.csahq.org/pdf/bulletin/issue_7/strum044.pdf

AA ongoing certification: http://aa-nccaa.org/certification.htm#Certification Anesthesiologists ongoing certification: http://www.abpsga.org/certification/anesthesiology/recertification.html Now please cite YOUR references to back up your incredibly innaccurate and misleading statement. As JWK stated, CRNAs are the ONLY anesthesia providers not required to take a periodic recertification exam - FACT!

Very simple. We take the jobs in the cities working with the anesthesiologists, thereby freeing you guys up to take the jobs in the underserved rural areas. You don't want to work under MDA supervision anyway ... no problem - we'll do it.

Where did you get the statistic that complications are occuring in 1% of AA cases???? That is an outrageous fabrication. Where is your data to support the notion that the public is at risk?? It is a fact that AAs are as safe as CRNAs. If you read the rest of my post, I said that the brand new AA is a little more closely supervised by the MDA and is doing the more basic cases right at first - no one is at risk and to allege that they are is pure unsubstantiated crapola. They ramp up quickly to being more independant and doing more difficult cases over the first year as they grow more comfortable and experienced. Also, we don't feel like we lack credibility at all. Amongst those that matter, our patients, the ASA, and the CRNAs that we work with our credibility is fine. It's only the CRNAs that don't know us, or don't want to know us that we lack credibility and to be honest with you - that's more your problem than ours.

1. Emory 2. Case Western 3. South University 4. Nova - Ft. Lauderdale 5. Univ of Missouri School of Medicine

Guys.... guys.... please! Don't fight with each other. That's what JWK and I are here for.

Umm.... Okay...not exactly a scathing indictment of the AA profession, but if it really happened I see that as nothing more than you coming across a slack AA student. Maybe she did not know you were discussing Succinylcholine. If she came from the Emory system, she really might not know that drug by it's brand name. Maybe she's one of these people who just blanks out when put on the spot in front of an audience. I have a hard time believing that a soon to graduate student can't recite chapter and verse about Succinylcholine but that is definitely the exception and not the rule. No matter how hard we try, weak under-performers slide into every program under the radar from time to time - CRNA programs included. I mean, do you really want to get me started on all of the SRNAs (or CRNAs for that matter) that I've encountered over the years that didn't know basic stuff? How about elaborating on your perception of how the real staff AAs seemed to perform clinically instead of recounting some lame story about a student who flamed out during a Q&A. C'mon and enlighten all of your CRNA brethren on how the AAs were led around by ropes by their supervising physicians and did little more than put on the tegaderm after the MDA started the IV. You have so much first hand knowledge... let's hear it.

Hey, it looks like he's getting ready to say something. Shhhhh everybody, let's hear what he has to say........ Ahh forget it. Same crap he said in the other thread. Again, Deepz , you add nothing of substance to the discussion. You really are quite talented at putting people to sleep as you have always said you are. By the way, I do lines everyday. I don't do blocks but many, many AAs do everyday. You know nothing about me, but profess to know everything. And no, quoting an Aesop fable does not make you seem more intelligent. Go back to sleep Deepz and bury your head in the sand and go on believing that AAs will never be what you are (thank God!!!).

Forgive me , but when did I ever say or even imply that I was the superior provider????

Cool Mike. New AA grads are brought along slowly in the ACT environment. Easy cases to start, lots of direct supervision. Over time, they become more independant and gravitate to the bigger more complex cases. Just like the mentoring that you got as a greenhorn.

No, I am an AA who can do everything that a CRNA does (except bill for my services) and I was trained in 2 years. And I, unlike you have more insight into your profession than you have in mine since I have always, my whole carreer worked with CRNAs and I'm willing to bet that you have never even met an AA much less seen one working in the OR.

You get no argument from me on this. I have stated numerous times that the CRNA right out of school probably has an advantage over the new AA grad. But after 5 years you would not be able to tell them apart. I'll take it one step further and say that if that new CRNA grad goes to a small outpatient center and does knee scopes all day and the AA grad goes to a major center and does cardiac and major vascular cases all day, that the AA will be superior in terms of skills, knowledge, and ability after those same 5 years. Please understand that I am not making these statements out of sheer supposition like many of you on this board. I have worked with CRNAs for years and years. When we hire a CRNA who has worked in surgi-centers or other low-acuity settings, they are quite overwhelmed when they get here believe me. Some of them will gravitate to the outpatient surgery center and stay there while others will eventually get to where they are comfortable doing the bigger cases. We currently have 8 CRNAs in our group right now and not a single one of them does cardiac. Not because we won't let them - they simply don't want to do it.

Mike - thank you for the kind words in your earlier post. That being said, I take issue with your statement that ""AAs will never have this experience.." I, too, have coded many,many patients. I practice in a large academic city hospital where the acuity level is very high. I do primarily cardiac anesthesia and work with one of the pre-eminent off-pump heart surgeons in the world. Let me tell you, when you ligate the left main and try to sew a graft to it, very scary things can happen - ischemia, ectopy, full arrest. We commonly have to code our open heart patients right in the middle of their distals. Why is your experience more valuable than mine. Could I do it right out of school?? No, probably not. But now, with 16 years under my belt there isn't anything that you have seen that I haven't dealt with either - I promise you.

Absolutely I do. I know it for a fact because I did it.

By whom - nurses??

And many AAs aren't nurses before beginning their anesthesia training and it doesn't seem to be affecting the level of care that THEY provide. So why are you right and I'm so wrong. OF COURSE, it's not the degree that makes the provider a great clinician. I actually agree with you on that point. Masters prepared or certificate, it's the persons intellect and work ethic that ultimately determines how they'll function in the stress filled and often fast paced environment of the OR. Let me ask you this - where did you get your experience before you started taking care of patients in the ICU? I mean, surely you weren't pushing all of those dangerous drugs and titrating drips and taking care of those incredibly sick patients with no prior clinical experience were you? Maybe all ICU nurses should be nursing assistants first so that they will have clinical experience before entering the acute care environment of the ICU. Oh wait - you went to NURSING SCHOOL with didactic and clinical rotations BEFORE you entered the ICU as a bonafide licensed practitioner. AAs get 2 solid years of hands-on direct patient care proctored by practicing AAs and MDAs before they are ever left alone in the OR. We've already proven that you don't have to have a nursing background to be an anesthetist. I think that it just galls you guys that there is a shorter path to the same goal. Just because you have to jump through all of those hoops that your nursing profession places in front of you, doesn't mean that I have to. I maintain that each and every one of you great CRNAs would have been just fine had you entered CRNA school right out of nursing school. Maybe not right away, but ultimately - yes. I know it, and I think you know it too - you just can't say it.

Who are you and what have you done with Deepz and Swumpgas?

Ahhh... Deepz. Missed you buddy, how've you been??

We are not trying to close the gap. We don't want to take over the world. How many times and how many different ways do you need me to say it. While the AANA has as a major agenda the abolition of AAs nationwide, the AAAA is not interested in putting a single CRNA out of work. There in a nutshell is the difference. You want me out of the OR and unable to provide for my family. I simply want the right to work in my chosen profession anywhere I want. I don't want to put a single CRNA out of work, but I should be able to compete with you for ACT practice positions. Yes, you can fill a need in the rural areas. I will NEVER compete with you for those jobs. ACT practices, on the other hand can and should hire either practitioner interchangably with supply and demand being the major driving force in the decision. A couple of facts meant to enlighten not inflame. Four years ago there were two AA programs - the same two that had been in existence for 30 years. Now there are five programs, each of which will graduate approx 30 AAs per year. There are several others in the works at major institutions that will train similar numbers.

JWK - Okay - why you guys resurrected this old thread is beyond me but I'll play. Here's how my day went today: Met my patient in preop. He's posted for an off-pump CABG X 4 with bilat. mammaries. He's got a normal EF but has unstable angina and is on heparin and NTG. He had a right Carotid endarterectomy last Wednesday. I put in a 16g IV and art-line. PA catheter has to go on the left side. I have a little trouble locating the IJ and finally get it using a Sono-site Ultrasound machine. I then float the PA catheter without problem. BTW - all of this took place without an attending in sight. Attending present for induction and TEE exam. After that, I'm on my own for the take down of the mammaries and the first graft to the LAD. The patient got a little ischemic during the LAD anastamosis but it was never a real concern. During the distal to the RCA, the patient's lateral leads began to display some rather ominous ST changes. I call my attending because the patient was starting to develop ectopy and looked like he was getting ready to arrest. I didn't call him because I was unsure of what to do, I called him because if an arrest was imminent, it was going to take both of us to get him through it safely. The surgeon ended up shunting the vessel, and the ST's came back down. With that potential problem averted, my attending left the room and that was the last I saw of him the rest of the case. The anesthesia care team approach worked exactly as intended during this case. My attending knew that I would recognize when the patient was getting into trouble and that I would not try to handle a potentially disastrous situation myself. With that trust, he knew that he could leave me to manage the entire case without him. I can assure you of two things: 1) I am not a robot (whatever that means). 2) That patient today got excellent care. BTW - since this thread's inception, two more AA programs have started up bringing the total to 5. The latest is at Univ of Missouri School of Medicine in KC. This one is significant because it is the first program in a public university and it's also the first AA program west of the Mississippi. There are 3 others in the works, two of which are at major university departments and will be huge for the advancement of AA practice when they are announced.

When placing an IV, you have to think not only about how that IV will function intra-op but post-op as well. If I'm cannulating the AC or an EJ I'll always use the longer catheter because I worry that the shorter catheter might lever out of the vein with normal patient movement. If you place a 1.25" catheter in the AC, the catheter could easily migrate out of the vein just by the patient bending their elbow. This is especially true if you don't get much of the catheter into the vein to start with. Ditto for EJ's - a simple turning of the head and that catheter is out of that extremely mobile vein. Everywhere else, the shorter catheter is more desirable due to it's more favorable flow characteristics.